1. 1 Course Medical Statistics with Informatics

2. eHealth - Transforming health systems through eTechnologies Source: Professor Helen Christensen Transforming health systems through e-technologies (http://www.google.rs/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0C DcQFjAA&url=http%3A%2F%2Fcmhr.anu.edu.au%2Ffiles%2Fe- health_christensen.ppt&ei=XYqHUZO- NIartAaG9IG4CA&usg=AFQjCNHNgGG_jBcNr13bXoCbyYJzdjGmnw&sig2=mf93- 0bcV8Su6Naza_WfRA&bvm=bv.45960087,d.Yms&cad=rja)

3. Let’s use technology for better health “wield technology's wonders to raise health care's quality and lower its cost”. Barack Obama: Inaugural speech. 21 st January 2009

4. eHealth is here

5. Why e health? E health applications do work – the real questions are: – What benefits do they have over other traditional forms of health? – Given they work, how can they realistically be implemented? – Why do they get a negative press?

6. What are e-health services? A range of services that use technologies such as the internet, SMS, telephones, email – usually with little or less face to face contact with health professionals than traditional services Present focus is on sites which provide mental health services But they do vary…..

7. A framework The sphere of e-health

8. Lifeline

9. The sphere of e-health Lifeline

10. The sphere of e-health General practice

11. Problems faced by traditional forms of health provision Problems that plague traditional mental health services ACCESS: Many people with mental health problems (65%) do not seek assistance for them through current health models: Reasons: stigma, lack of advice, poor knowledge, no services DELAY: People with conditions often wait to get services by which time disorders are more advanced and more difficult to treat. CONTINUITY, CONNECTION AND SAFETY: People get lost in the system: Less than 20% of those undertaking CBT programs with general practice return of follow-up with doctor. VOLUME: There are simply not enough health professionals or health workers even if people sought services. One solution is to put more effort into self help. COST: Face to face psychological services are costly especially given the potential volume of recipients.

12. eHealth may assist by providing..……. …..access to services and information – 80% of Americans search the internet for health information (Fox, 2006). The most common search is for information on depression, stress or mental health. The web forms an important portal to access health services The web can provide higher quality information than other sources. Internet allows development of large libraries of information, that can be compiled, shared or discussed. Think Wikipedia and NHS web portals.

13. eHealth may assist by providing..……. …prevention and early intervention – eHealth technologies provide a platform for one to one intervention via a browser- cheaply and efficiently – before intensive medical assistance is needed. – Programs can be personalized – These brief eHealth interventions are effective.

14. eHealth may assist by providing..……. … services that are safe and promote connections E-systems can be developed to provide tracking systems for safety and record keeping E systems promote connections with others through email, telephone, bulletin boards and through self help Online websites such as American Self Help Clearinghouse http://www.selfhelpgroups.org/ or The website Daily Strength http://dailystrength.org/ hosts over 900 online communities for physical and mental health conditions, life challenges such as divorce and bereavement. http://www.selfhelpgroups.org/http://dailystrength.org/

15. eHealth may assist by providing..…….… … simultaneous access that promotes high volume use – The web allows interventions to be accessed simultaneously. – This means a large number of individuals can be provided with health info and services at the same time, particularly if the service provided is automated or directs for self help. – 50 million people accessed the Internet following September 11 to seek information p.513. Ruggiero et al., 2006, noted that “early interventions that reduce the societal burden of mental health problems in the aftermath of disasters and mass violence have the potential to be enormously valuable. Internet-based interventions can be delivered widely, efficiently, and at low cost”. P. 190.

16. eHealth may assist by providing..……. … services that promote self help and self care – E-health services often put the consumer in the driving seat and thus promote a patient centered approach. – Technological advances are seen to assist patients by providing greater access to more medical information, more treatment options, fewer doctors, choice in the spending of their own health funds (Herrick, 2005).

17. … eHealth may assist by providing..……. … services that are cheap and useful in developing countries… Most of the worlds 400 million people with a mental illness live in poor countries…Many people with mental illness can be helped with simple and cheap treatments….

18. eHealth may assist by providing..……. … means to overcome individuals’ barriers to care – Notably, 33% of Soldiers who were not willing to talk to a counselor in person were willing to utilize at least one of the technologies for mental health care. These results support the feasibility of using technology- based approaches as a means to overcome barriers to care.

19. MoodGYM - an innovative, interactive web program designed to prevent depression Countries from which MoodGYM has been accessed (dark shading). The white regions depict countries from which there is no record of access (Jan 2008).

20. Given they work, how can they realistically be implemented? Model 1:Standalone fully automated systems that offer prevention, self help and self care Model 2: Consumer assisted care Model 3: Virtual clinics Model 4: General practice models Model 5: Stepped care models

21. Model 1:Standalone fully automated systems that offer prevention, self help and self care The sphere of e-health ANU’s MoodGYM e couch and blueboard systems

22. Model 1: How it works? Person comes to the website/s Chooses among a number of programs (fully automated) MoodGYM, e_couch for anxiety and depression. The site provides feedback about symptoms. The person may email and will receive referral and support by health professional. May join a moderated bulletin board for support

23. Model 1 implementation: A number of these sites worldwide MoodGYM Living Life to the Full (http://www.livinglifetothefull.com/)http://www.livinglifetothefull.com/ Feel Better (http://www.kpchr.org/feelbetter)http://www.kpchr.org/feelbetter Mina Drinka Colour Your Life

24. Model 1: Living Life to the Full site

25. Model 2: Consumer assisted care The sphere of e-health Consumer assisted care

26. Model 2: How it works? Person comes to the website/s or to directly to the service. A consumer volunteer with or without professional qualifications assists the person to find and use evidence based websites and programs, such as Living Life to the Full, or Beating the Blues. Support is provided through the implementation of these programs by those with direct experience of the disorder.

27. Model 2: Self Hep Services site

28. Model 3: Virtual clinics The sphere of e-health Lifeline

29. Model 3: How it works? Patients come directly to the service or are referred by public medicine. Clinics offer a range of treatments, use CBT, and provides online therapy from a central location using prepared web materials, treatment manuals and telephone contact. Individuals are screened using a 10 minute assessment, and intake is examined by senior psychologists. Individuals pay privately, or are supported by health insurance companies or the National health system. Outcomes are monitored and evaluated

30. Model 3: http://www.interapy.nl/ site

31. Model 3: E therapy clinic in Australia Similar models in Australia

32. Model 3: http://www.crufad.com/ Shyness tv through CRUFAD

33. Model 4: General practice models The sphere of e-health

34. Model 4: How it works? Patients go to their GP who provides computerised CBT through validated systems such as Fearfighter and Beating the Blues. Patients receive assistance from GP and other health professionals at the same time. The GP uses the web tools in their face to face sessions.

35. Model 4: Australian implementations MoodGYM in general practice: Spontaneous use of web products by doctors Climate TV where person does a web program in parallel with referring (partner) doctor New programs to offer telephone based CBT through ATAPs.

36. Stepped care and integrated models

37. Model 5: Stepped care models The sphere of e-health Automated self hep Consumer assisted Virtual clinics General practice models

38. These models combine e-health tools and websites with face to face care. The web forms the portal to health services Individuals are screened, and individuals with low levels of symptoms and risk are offered self help or self care. Individuals with high symptoms are offered treatment, or transferred to specialists if needed.

39. To our knowledge these systems have not been developed but development is underway – particularly in the Netherlands. Technology will be needed for tracking recording and providing the platform for continuity of care.

41. So why do they get such bad press? They don’t work They are dangerous and risky Nobody wants them They are second best They are not as good as face to face People drop out and don’t use them

42. So why do they get such bad press? They don’t work They are dangerous and risky Nobody wants them They are second best They are not as good as face to face People drop out and don’t use them

43. Conclusion Australia can learn from the innovations in the developments of these systems overseas. E health applications do work. They have benefits over other traditional forms of health especially in self help and self care areas. They can be implemented and this is being done- ---people vote with their feet – and the e health train has left the station- other countries are racing ahead with their provision of information and development of tools for self help Why do they get a negative press?

44. Prediction There are drivers in place for these developments Consumer driven Financial drivers from industry, health insurers, and governments Australia?

45. A place for Lifeline? The sphere of e-health Automated Consumer assisted Virtual clinics General practice models Volunteer assisted