1. e-health Present and future
Ramona Mayer
EBG MedAustron GmbH, Wiener Neustadt, Austria

2. eHealth . . .
"eHealth is the single-most important revolution in healthcare since the advent of modern medicine, vaccines, or even public health measures like sanitation and clean water”
Silber D. The case for eHealth. (Presented at the European Commission's
first high-level conference on eHealth May 22/ )
European Institute of Public Administration 2003.

3. From medical informatics to eHealth
Classical Medical Informatics – stand alone era (1970+)
Health Telematics – early telecom days (1985+)
eHealth – Web era (1995+)
Pervasive and ubiquitous eHealth - ambient intelligence era (2005+)

4. From medical informatics to eHealth
Classical Medical Informatics – stand alone era (1970+)
Systems for the storage, retrieval, sharing and optimal use of biomedical data, information and knowledge
Health Telematics – early telecom days
(1985+)
Regional health care networks
Remote diagnosis and telemedicine applications
Decision Support Systems

5. From medical informatics to eHealth
eHealth – Web era (1995+)
Internet based applications and services
Medical content for prevision
Intranets for health service management
Pervasive and ubiquitous eHealth - ambient intelligence era (2005+)
Health knowledge infrastructure
Wearable and implantable systems
Biomedical informatics for personalized health
Health GRIDs

6. eHealth mHealth Electronic Medical Records Telemedicine
eCardiology
Telemedicine
eRadiology
Consumer Health Informatics
Virtual healthcare teams
Health knowledge management

7. „eHealth“…
eHealth encompasses a range of services that are at the edge of medicine/healthcare and information technology
e-health encompasses much of medical informatics, but has to prioritise the delivery of clinical information, care and services rather than the functions of technologies
No development of basic technology, but development of beneficial applications
for
patients
physicians
care facilities
health care insurance companies
etc

8. EC definition of eHealth
“….the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers"

9. WHO definition of eHealth
"eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields,
including health-care services
health surveillance
health literature
health education, knowledge and research"
(World Health Organization , Ninth plenary meeting, 25 May Committee A, seventh report)

10. 5 Steps of eHealth
Electronic diabetes diary

11. Steps of eHealth… Step 1 - Information Step 2 - Communication (action)
Providing information for patients or doctors e.g. via the web (information in one direction), Medical databases like PUB MED
Step 2 - Communication (action)
The exchange of information between two people involved (patient - doctor, doctor - doctor...) without direct and current reaction of the communication partner (e.g. on-line diabetes diary)
Step 3 - Interaction (action + reaction)
Exchange of information or dates between people involved with immediate reaction of the communication partner (e.g. telemonitoring, telesurgery…)

12. Steps of eHealth… Step 4 - Transaction
Electronic handling of a complete (treatment)process (“All or nothing”)
Step 5 - Integration (e.g. Electronic health record - EHR)
Electronic health biography – central documentation for all health relevant data from birth to death

13. Step 1 – Information Providing information for patients or doctors
e.g. via the web
(information in one direction)
DIAB-MEMORY

14. Step 1 – Information Provider of the information Information medium
Publishing companies, authors
Provider of medico technical equipment
Pharmaceutical companies
Health insurance companies
Physicians and health care professionals …
Information medium
Print media
CD, DVD, …
Computer network / Internet
Recipients
Physicians
Patients
Family members

15. Step 1 – Information Physicians Patients http://www.medterms.com/
Medical literature
PubMed
Medical database (z.B. Drug informaton systems) /…
Patients
Health advisor
Dictionary of medical terms …

16. Step 1 – Information Health on the Web
Estimated ~ 20,000 health websites
Used by 98 million adults
75% of people who have web access
Average of 3.3 times per month
More than consult doctors each day

17. Step 1 – Information Health on the Web Pro Con Correct information
can lead to more knowledgeable and less anxious patients
more participatory health decisions
Con
Misinformation
can lead to confused patients
Bad decisions, false hope, harm

18. Step 2 – Communication Communication = Action
The exchange of information between two people involved
(patient - doctor, doctor - doctor...)
without direct reaction of the communication partner
(e.g. online diabetes diary)
Electronic diabetes diary

19. Step 2 – Communication Online diabetes diary
Diabetes-diary allows
to document the blood glucose values
enables the physician to access the data
adjust the insulin dosage accordingly The patient can
communicate with the physician online
save time and unnecessary office visits.
from:

20. Step 2 – Communication Online diabetes diary

21. Step 2 – Communication Online diabetes diary
From:

22. Step 3 - Interaction Interaction = action + reaction
Exchange of information or data with immediate reaction of the communication partner (e.g. telemonitoring,…)
Electronic diabetes diary

23. Step 3 - Interaction Telemedicine
Most useful when
Specialist services are in very high demand
or patients are extremely isolated ( Antarctica or remote communities in Australia, Africa and Alaska)
Telemedicine encompasses any medical activity
involving an element of distance (R. Wootton)

24. Step 3 - Interaction Telemedicine
Online versus store-and-forward
Functional
Telecardiologye
Teleradiology
Telesurgery
Teledermatology
Telecare (homecare)
Action
Telemonitoring
Second opinion
Telediagnosis
etc…
Multimedia (Text, Audio, Image, Video, Augmented Reality)

25. Step 3 - Interaction Telemedicine
1. Live telemedicine via videoconference
2. Store-and-forward telemedicine – transmit for assessment offline
Typical telemedicine interaction: store and forward followed by live interaction
Data types
Text ( e.g. patient's notes)
Images (e.g. x-ray, CT, etc) ( Telemedicine often relies on images)

26. Step 3 - Interaction Telemonitoring
Schaubildtitel
Schaubildtitel
2. CardioMessenger sends a SMS daily and additionally in the case of an event
1. Patient with an implant with home monitoring function
4. Physician with secure internet access
3. Automatic data processing at the service centre

27. Step 3 - Interaction Teleradiology
Quelle:

28. of a complete (treatment)process
Step 4 - Transaction
Transaction
Electronic handling
of a complete (treatment)process
(“All or nothing”)
Electronic diabetes diary

29. Step 4 – Interaction Electronic health card
For example : Austria
Rollout until end of 2005
Electronic handling of a complete (treatment)process
Includes:
On the reverse side = EHIC - European Health Insurance Card
Digital signature
At present the ecard cannot be used at:
Private medical practice
Other contractual partners (e.g. optician, midwife, …)

30. Step 4 – Interaction Electronic health card}
Patient record
Physician letter
Health care provider index
Work in progress
e-medication √
Administrative data
EHIC - European Health Insurance Card

31. Step 5 - Integration Electronic health biography
= central documentation for all health
relevant data from birth to death
Electronic diabetes diary

32. Step 5 - Integration Central data repository
Local data repositories + central index
Case record (e.g. under discussion in Germany)
Live long electronic health record
Any combination is under discussion
in countries across Europe!!

33. E-health in different environments for example:
General Hospital Ion beam facility
eHealth on the EU-level

34. eHealth in a general hospital
Administration
Billing
Hospital information system (HIS)
Procurement
Logistic
Medical data
Radiological images and findings
Lab- Information System
Discharge letter
Teleconference
etc…
Step 1 - 3

35. Clinicians are very busy and under constant pressure to perform !
They will NOT change their behaviour, unless the new workflow is clearly more efficient on a personal and individual level !
Sulivan2002; Holzinger & Errath 2004

36. Usability ….. For an interface to be a success it must provide
the right functionality
at the right place
at the right time
and in the right form
from the user's point of view!
Holzinger 2000

38. E-health in different environments for example:
General Hospital Ion beam facility
eHealth on the EU-level

39. and Hungarian hospitals
Concrete project:
Platform for the planned co-operation between the Ion beam Research and Treatment centre MedAustron in Wiener Neustadt, Austria
and Hungarian hospitals

41. MedAustron eHealth services
Provided services
Accept patient information
Accept medical findings
Accept radiological images and findings
Provide RT planning information
Dose information
Plan details
Provide medical reports

42. Scenario I Patient base data Medical relevant data CT/MRI/PET-CT/US
Patient referral without pre-irradiation
Possible data input from referring hospital
Patient base data
Medical relevant data
Histological data
Surgical report
Other findings
CT/MRI/PET-CT/US
RT planning documents
Applied dose
Medical report
Available data output from MedAustron

43. Teleconference

44. Scenario II Patient base data Medical relevant data CT/MRI/PET-CT/US
Patient referral with pre-irradiation
Possible data input from referring hospital
Patient base data
Medical relevant data
Histological data
Surgical report
Other findings
CT/MRI/PET-CT/US
RT plan + applied dose
RT planning documents
Applied dose
Sum dose
Medical report
Available data output from MedAustron

45. Scenario III Patient referral with pre-irradiation Step 5 1 2
Possible data input from referring hospital
Electronic Health Record
Patient base data
Medical relevant data
Histological data
Surgical report
Other findings
CT/MRI/PET-CT/US
RT plan + applied dose
RT planning documents
Applied dose
Sum dose
Medical report 4 3
Available data output from MedAustron

46. E-health in different environments for example:
General Hospital Ion beam facility
eHealth on the EU-level

47. eHealth for Regions A network for transnational co-operation
Aim
Support of an innovative process by building a platform for the exchange and generation of ideas for co-operation
Provision of experiences and knowledge about the specific challenges of transnational collaboration in the field of eHealth among the network partners
Finally the co-operation should be run by the partner themselves!

48. eHealth for Regions Co-operation fields and pilots (examples)
Personal information medical sticks
Developed for patients with chronic diseases, who are often travelling in European neighbouring countries on business or vacancies
Objectives
To improve the cross-border medical service, esp. for travelling pts. with chronic diseases
To support physicians with information treating foreign patients
To omit unnecessary examinations of patients
USB sticks are prepared with structured medical information based on the
European emergency health card
Partners: Denmark, Finland, Germany, Lithuania, Norway, Poland, Sweden
Step 1

49. eHealth for Regions Co-operation fields and pilots (examples)
Ferries with Tele ECG at the Baltic Sea
Objectives
A better health care support for travelling citizen
to reduce time from symptoms to treatment
TT Line transports 2000 to 4000 passengers every day between
Trelleborg (Sweden) and Travemünde or Rostock (Germany)
First aids room equipped with a transtelephonic ECG recorder
ECG transmitted to multilingual server of telemedicine centre in Bad Segenberg (Germany) routed from there to co-operating cardiac centres in a readable format
Step 2

50. Summary : eHealth =
„ … in a broader sense, characterizes not only a technical development,
but also a new way of working,
an attitude,
and a commitment for networked, global thinking,
to improve health care locally, regionally, and
worldwide by using information and communication
technology.”
Eysenbach G. What is e-health? J Med Internet Res 2001;3(2):e20,
adapted by Pagliari et al. 2005

51. Challenges… National legal regulations and obligations
AND: Legal and ethical implications of using health information technologies which may result in harmful effects in certain cases are not yet clear...
Safety (data integrity and completeness)
Data security and protection
System developers need to employ quality and safety assurance methods to avoid clinical risks and legal liability
Interoperability
Implementation and integration of eHealth systems into care processes are constrained by insufficient levels of systems interoperability (though moves to ensure standardisation in many current e-Health implementation programmes will reduce this)
Acceptance (availability and usability)

52. 5 Steps of eHealth Accelerated progress Used in daily practice
Moderate progress
Electronic diabetes diary
Accelerated progress
Used in daily practice

53. Summary
eHealth is not able to solve the problems of the health and social systems BUT the problems of the health and social systems cannot be solved WITHOUT eHealth

54. ...working together towards an ehealthy future