Internet and Medicine: 10 years after

1
Internet and Medicine 10 years after

• From the network's perspective
• Marc Nyssen
• Medical Informatics dept.
• Vrije Universiteit Brussel
• Belgium

2
Internet and Medicine 10 years after

• From the network's perspective
• Technology
• Institutes
• Medical profession
• Schools/universities
• Where do we come from? - trends
• Patients
• Conclusions

3
Internet and Medicine 10 years after

• From the network's perspective
• What is the network 's perspective?
• health sector consist of computers connected to
  me
• hospital computers activate medical staff to
  produce data
• general practitioners are prompted to produce
  messages with patient data
• Pharmacists spend their spare time discussing
  with representatives
• I produce a lot of administrative messages to
  keep Ministries and medical insurance
  institutions busy
• distance education, Ehealth research and
  E-med-commerce

4
Technology

• 10 years ago first web browsers (mosaic, ...)
• Internet bad reputation
• Ad-hoc dial-up network services
• E-mail most widely spread and used service
• Little or no encryption

5
Technology

• Now large connectivity fraction
• Internet
• Permanent connectivity not far away
• Wireless wap, bluetooth, IEEE802.11 a/b,
  gprsUMTS
• E-mail most widely spread and used service
• Little or no encryption

6
Technology

• 10 years ago first web
• browsers (mosaic, ...)
• No tables
• No frames
• No javascript
• No Java ...

7
Technology

• From static to dynamic web pages
• Database driven web servers
• Java
• Public key encryption
• XML
• ssh/sftp replacing telnet/ftp
• E-mail sender authentification required! (smtp)

8
Institutes

• Authoritative centers
• Karolinska Institute
• NIH
• DG Information Society Unit C4 eHealth
• Medline (pubmed, medlineplus)
• Several others

9
Institutes

• Karolinska Institute
• Institut Pasteur

10
Institutes

• DG Information Society Unit C4 eHealth

11
Institutes

• Medlineplus

12
Institutes

• Pubmed

13
Portal sites

• Medical portals
• After the Internet bubble ... just a few
  examples
• Medscape
• Medwebplus
• Medical Martix
• Promedmail

14
Portal sites

• Medscape

15
Portal sites

• Medwebplus

16
Portal sites

• Medical matrix

17
Portal sites

• Promedmail (Jack Goodall)

18
Portal sites

• EHTO

19
Societies

• Societies

20
Societies

• Conferences

21
Publications

• Journals
• IEEE TITB (2003-)
• Electronic Healthcare (2001-)

22
Publications

• Journals

23
Publications

• On-line

24
Publications

• pubmed searches on Internet AND medicine

25
Ethics

• HON (Healtcare On the Net)
• http//www.hon.ch
• Internet Healtcare Coalition
• http//www.ihealthcoalition.org

26
Ethics

• HON code of ethics
• Authority, complementarity, confidentiality,
  attribution, justifiability, transparancy of
  authorship, transparancy of sponsorship, honesty
  inadvertising
• Ehealth Code of Ethics
• Candor, honesty, quality, informed consent,
  privacy, professionalism, responsible partnering,
  accountability

27
Medical profession

• General Practitionner
• Hospitals
• Specialists
• Para-medics
• From cards to servers
• Large nationwide projects

28
Medical profession

• General Practitionner
• Electronic health record
• Medication databases
• Communication of lab results
• Communication with GP's (group practice/guard)
• Communication with hospitals
• Communication with specialists

29
Medical profession

• Hospitals
• patient administration
• communication with health insurance bodies
• technology oriented departments
• local network(s)
• communication with referring GP's
• communication with patients???
• teamwork who can access what?

30
Medical profession

• Specialists
• Very different needs
• Common patient administration
• Financial administration reporting
• Mini-clinics and group practices

31
Medical profession

• Para-medics, health workers at large
• Tele-follow-up of patients
• Access to at least part of medical record
• Nursing record
• Physical therapist's record

32
Medical profession

• From cards to servers?
• Social security card (national, European)
• Diabetes card
• Minimal health record -gt summary health record
• Big brother example in Spain
• Centralized vs. distributed health records

33
Medical profession

• Nationwide projects (amongst many others)
• Denmark electronic prescription
• Belgium
• kruispuntbank sociale zekerheid
• Electronic passport
• Telematics commission labeling of her
• UK masterplan for NHS

34
Medical profession

• Nationwide projects (amongst many others)
• Hygeia
• Crete

35
Medical profession

• Nationwide projects (amongst many others)
• Keneya Blown (vestibule de la sante)
• Mali

36
Schools/universities

• E-learning
• Computer literacy
• E-health programs
• Master after master management of health data
• Need for an European master program in eHealth?

37
Standards bodies

• Internet Society (IETF)
• WWW Consortium
• CEN
• HL7
• IEEE

38
Where do we come from?Where do we go to?
Trends...

• Basic connectivity
• New protocols?
• New models?
• Client-server
• Peer-to-peer
• Distributed systems
• Huge parallelism (grid?)

39
Patients/public

• Finally widely available to the public at large
• Remote diagnosis
• New medication announcements
• Distance pharmacy
• Distance education/certification
• Accurate medical information and councelling

40
Patients/public

• Useful health tricks

41
Patients/public

• Distance pharmacy

42
Patients/public

• New medication

43
Patients/public

• Distance education/certification effortless
  diploma

44
Patients/public

• Finally widely available to the public at large
• missing
• super portal combining all of these!

45
Patients/public

• Informative sites patients are most concerned!

46
Conclusions

• Medical Internet applications become
  established
• Most required technologies are available
• Diversity of medical systems
• Quality labels and interoperability
• Privacy
• Few completely new ideas
• Complex application standards
• Missing level between research and deployment
• Political drive exists but for the right motives?

47
References

• Resource Book of IST Projects relating to Health
  (September 2002 Edition), Directorate B, Unit B1,
  European Commission , Information Society
  Directorate General
• E-Health in Belgium and in the Netherlands,
  Proceedings of MIC2002, Roger France, Hasman, De
  Clercq, De Moor eds., IOS Press, ISBN 1 58603 313
  1
• Information and Communication Technologies and
  Poverty Reduction in Sub Saharan Africa, Richard
  Gerster, Sonja Zimmermann, Gerster Consulting,
  October 2003
• Yearbook of Medical Informatics 2003, IMIA
  Schattauer GmbH, ISBN 3-7945-2263-X
• Health related virtual communities and electronic
  support groups systematic review of the effects
  of online peer to peer interactions, Eysenbach G,
  Powell J, Englesakis M, Rizo C, Stern A. BMJ.
  2004 May 15328
• Ethical challenges of medicine and health on the
  Internet a review, Dyer KA., J Med Internet
  Res. 2001 Apr-Jun3(2)