In the sections to follow I'll describe how technology, the Internet and other communication media, do now and will continue to play a major role in the improvement of our health as individuals, and as a nation. Funding for such innovations will be briefly discussed because it is an important reality, and a current barrier in many situations, but does not have a major focus.
We’ll begin at a very high level view to get a picture of our current state as a nation, and then we’ll look at some examples of how specific health challenges can be effectively managed by physicians and other health care providers with the aid of current and very soon to come technologies.
We’ll also take an exciting look at how some technologies currently in development may be implemented to help an example patient reach measurable goals and maintain healthy lifestyle changes.
Health Status of Americans
In a 2008 study the United Health Foundation looked at twenty two measures to quantify America’s health rankings. (United Health Foundation, 2008) I am going to use this study to quantify the health status of Americans to frame our health problems that reform and technology can help individuals and providers to mitigate.
This ongoing study uses determinants and health outcomes to rank each of the fifty states, and broader measures to compare us to other countries. The determinants were weighted either positively or negatively, and being causal in nature they represent factors that impact health, such as personal behaviors (e.g. smoking and prevalence of obesity), community and environmental factors, public and health etc. Outcomes represent the effects, and were measured by either death or missed work days.
In the last nineteen years, many improvements in several measured decreases in infectious disease, prevalence of smoking and immunization coverage. Many measures which had improved since 1990 are once again listed as challenges including children in poverty and immunization coverage. The prevalence of obesity has increased 127% since 1990. (Table 7, “National Changes since 1990”).
According to the study by the United Health Foundation Japan has the highest Healthy Life Expectancy at seventy five years, we rank twenty-seventh along with Portugal and Slovenia. (Table 6, “International Comparisons”, section on “Comparison to Other Nations”). We can use our epidemic of obesity, and the associated increased risk of chronic diseases such as type-two diabetes, high blood pressure, cardiovascular disease; stroke; as well as colon, kidney and breast cancers to focus on how technology can help Americans improve their health. As a country we are finally beginning to see that preventative health care may save more money than our historical model of ‘sick care’. Health care reform will push individuals to select healthier behaviors to maintain wellness and manage chronic illness. Technology is and will continue to play a major role.
The Current Role of Technology and the Internet to Manage Health
The citizens of the world have already embraced the Internet as a major source of health information. It can be a very reliable and beneficial resource to patients. According to our text, Dr. Peter Yellowlees (2008), notes that over sixty percent of Internet users, more than 140 million people, had used the Internet for researching a health topic. There are 231.5 million web sites on the Internet (WolframAlpha Computational Knowledge Engine. 2009), but it is very difficult to find a reliable number of them that pertain to health. The World Health Organization (WHO) (2009) has 747 links to national health related websites in about 192 countries world-wide. Even the WHO makes notation as to the difficulty of keeping track of the actual number of sites and valid links. Dr Yellowlees estimated that there were 100 times more health words on the Internet in 2008 than in 2000 (2008). (The sum of the 2008 estimate is about 3,047 million, or over 3 billion health words!). While it may be difficult to quantify the number of Internet health resources, there are many, many sites.
Patients and providers alike are using the Internet for a vast number of reasons. Important to this paper is the use of the Internet to help patients and providers manage health. Patients can look up symptoms, medications, health & wellness topics, treatments and procedures from reliable sources. Patients can also find physicians for a traditional appointment or even get a consultation online. The National Institute of Health (NIH) provides information for consumers to help them find reliable sources: “MedlinePlus Guide to Healthy Web Surfing” (NIH , 2009). Printed resources such as Dr. Yellowlees’ book provide a safe guide as a bridge for newcomers from the world of printed media to the Internet and related technologies.
Physicians are already using the Internet as a connection to the patient’s Electronic Health Record (EHR), perform research or access clinical trials data, or even to remotely visit a patient or other provider on behalf of a patient for consultations and more advanced activities using Telemedicine. These are only a few of the many current uses of the Internet by physicians for health care.
The American Telemedicine Association (ATA) website lists many services such as referrals and consultations, remote patient monitoring, medical/health professional education and includes Internet use for consumer health education. (2009) Other health care venues such as home care use Telemedicine to provide services to patients in remote locations from larger metropolitan areas where specialty health care resources are more plentiful. Telemedicine saves money in both patient travel and provider travel.
Telemedicine can enhance available services to a remote location with sophisticated devices and technologies. For example a specialty surgeon hundreds of miles away can be present and even assist in procedures or surgeries using robotics or other advanced peripheral devices. This has been especially beneficial in war zones where general surgeons must perform highly specialized and intricate surgeries to save lives and minimize long term disabilities in wounded soldiers. (Poropatich, 2009).
Telemedicine also can network hospitals, clinics and other care sites using private networks, dedicated telemedicine networks or the Internet. Provider physicians or other care agencies such as home health can connect to patients in clinics or their own homes using a varied number of technologies from telephone to video. Providers can visit face to face with patients, or indirectly using automation to monitor patient status indicators such as blood pressure, blood sugar or a number of other metrics using devices. Perhaps the most known and used telemedicine service “Web-based e-health patient service sites” expand services described above (consumer outreach for example) by providing some direct care services over the Internet. (ATA, 2009). I have not discussed email, scheduling and other common Internet enabled communications methods, but they are widely used today.
Other Internet services currently available offer individuals the ability to keep their health records online, and some providers (Health Systems, hospitals or Physician practices for example) can link their EHRs to the patient’s online health record to provide continuity of information across time and the continuum of care. Microsoft Health Vault is an example of such a service. (2009).
Funding for Telemedicine services remains limited, and privacy concerns continue to hamper acceptance of some Internet technology usage for health care purposes.
The current administration’s Health Care Reform initiatives are impaired in part because of worry about the privacy of health information on the Internet. Despite 1996 HIPAA legislation, breaches in privacy continue to occur in hospitals, with insurance companies and government agencies (Pear, 2009) eroding the confidence of legislators and the general public when these breaches reach us in the news.
Other creative uses of technology entail use of virtual worlds such as Second Life. These are in use now. There are many locations in Second Life that provide either marketing information for new, futuristic health facilities, or provide a virtual health education experience for both the lay public and students in a health care profession. Some impressive uses of Second Life for such purposes can be previewed on YouTube:
1. Virtual Hallucinations – a Second Life virtual experience that demonstrates in a very experiential way the hallucinations of patients with Schizophrenia: http://www.youtube.com/watch?v=s33Y5nI5Wbc
2. Cisco Hospital of the Future – Palomar West a Second Life virtual walk through of a Cisco connected hospital campus under construction in Southern California: http://www.youtube.com/watch?v=KMtMWdlX9Z8
3. MD Kiosk, virtual health island on Second Life, provides a large number of interactive educational experiences to watch and explore: http://www.youtube.com/watch?v=U3Szet7MJEM
4. UC Davis Mass Prophylaxis Research & Virtual Hallucinations in Second Life, part of this video shows a little bit of a mass prophylaxis clinic training site in Second Life for a bioterrorist event: http://www.youtube.com/watch?v=8fggzZSFKcU
I am optimistic that Health Care Reform legislation will pass this year, and hopefully will significantly help both the funding and privacy problems; this will be a big step to move us forward to what is to come.
Exciting Internet and Related Technologies are Around the Corner
Already we are seeing glimpses of how physicians and individuals alike will use technology connected by the Internet to communicate and continue to improve the health of our nation, and more safely treat illness with better outcomes.
A simple patient scenario can demonstrate some exciting possibilities. Since obesity is a major health problem in the U.S. along with the associated health problems, such a patient with hypertension and pre-diabetes is a great candidate for technology based health management.
Perhaps our patient, knowing he’s overweight has been ignoring some shortness of breath and fatigue for some time, but recently has had more symptoms, such as excessive thirst. Our patient has already been on the Internet to review symptoms and has found a physician, an internal medicine / endocrinologist thinking perhaps he might have diabetes or some heart problems or both. He used “Health Grades” (an independent healthcare ratings organization) to find a highly recommended physician, but only has office visits periodically near him because he lives in a remote area and has transportation problems.
Our patient uses the Internet for a lot of research on the tests, medications and some health behavior changes such as diet and exercise prescribed after the follow-up visit to the physician. But our patient has difficulty getting out, and for him, compliance to a diet and exercise program is difficult.
Since the physician is used to caring for patients with limited access to services, he sets the patient up with some innovative services (such as the XBOX 360 game console with some extra equipment). And since the patient is already computer literate, the patient is an excellent candidate for a virtual rehabilitation program.
The program includes attending nutrition classes with a number of his other patients in a virtual world. So, if our patient is a little shy or self conscious, her virtual self can be created to be whatever she wants to look like. These nutrition classes are interactive, but use an avatar instead of a video camera image of her real self. Instead of using a keyboard or joystick, our patient is interacting with the computer system itself, no hands. (Hands Free PC, 2009). The game console provides a hands free, virtual experience with other participants linked through the Internet to the nutrition class.
The program also requires the patient to get at least 175 minutes per week of exercise, monitored to make sure that she doesn’t have any untoward symptoms that require intervention. Or that if she does, EMS can be summoned immediately. This system has EMS connectivity for just that purpose; it was set up much like ‘Life Line’ when the console was set up. Our patient gets on the treadmill with the electrodes placed appropriately and begins to walk at the pace prescribed. The virtual therapist is monitoring our patient, and the patient can chat with other patients, like in a gym if she likes. She can see the instructor on her wide screen TV, and interact with any of the participants. The console monitors her physiological parameters, but also her facial expressions and body language and the therapist inquires appropriately. The virtual therapist can even suggest the appropriate technique or posture, or to speed up or slow down.
If our patient would prefer to continue without other participants, and choose virtual participants instead, he can choose that option, perhaps because of his schedule.
Using the same technology the patient can visit with the physician’s nurse practitioner every week to monitor progress. (The patient is already docking his blood glucose meter after each test so that the physician office has the results almost immediately)
After only a few months of this rehab program our patient is now diet controlled for blood sugars, and has lost 25 pounds. Our patient will continue on the program until the goals are met and maintained for a prescribed period of time.
All of this will soon be a reality; such technology is already in development. The creators of Second Life are working on similar technology as the XBOX Company. (Kapor, 2009)
With funding, research and creativity; with EHRs and RHIOs sharing and storing discrete data for analysis, and patients actively involved in their health management, the future of health management can and will be greatly enhanced, and the United States will have population health status measures more in keeping with our health care expenditures.
References
American Telemedicine Association. (2009) Telemedicine Services and Delivery Mechanisms. Retrieved September 30, 2009 from http://www.americantelemed.org/i4a/pages/index.cfm?pageid=3333
Hands Free PC. (2009). XBOX 360 Project Natal. Retrieved September 29, 2009 from: http://www.xbox.com/en-US/live/projectnatal/
Health Grades. (2009). Find a Doctor. Retrieved September 30, 2009 from: http://www.healthgrades.com/find-a-doctor
Kapor, M. (2009). Hands Free 3D: Second Life Navigation Demo. Retrieved September 24, 2009 from: http://www.youtube.com/watch?v=2t52gkAwJq8&feature=channel_page
Microsoft Health Vault. Welcome to Microsoft Health Vault, Be Well. Connected. Retrieved September 26, 2009, from: http://www.healthvault.com/Industry/index.html
National Institute of Health. (2009) MedlinePlus Guide to Healthy Web Surfing. Retrieved September 30, 2009 from http://www.nlm.nih.gov/medlineplus/healthywebsurfing.html
Pear, R. (2009). Privacy Issue Complicates Push to Link Medical Data. The New York Times. Retrieved September 30, 2009 from: http://www.nytimes.com/2009/01/18/us/politics/18health.html?_r=1
Poropatich, R. (2009). Innovations in Health Informatics for the Armed Forces. Retrieved September 15, 2009, from UC Davis Health Informatics Extension Web Site: http://hera-ucdavis.tegrity.com/tegrityUtils/InstructorViewer.aspx?directLink=1&startTime=0&currSessionGUID=25d75fe4-0caf-4dc9-a766-f89335fede84&httpSessionKey=82b45cf0-a473-4843-b44b-69a7041e5cb7
United Health Foundation. (2008). America’s Health Rankings. Retrieved September 26, 2009, from http://www.americashealthrankings.org/2008/index.html
US Department of Health and Human Services (HHS). (September 29, 2009). Secretary Sebelius Releases $27.8 Million in Recovery Act Funds to Expand the Use of Health Information Technology. Retrieved September 29, 2009, from http://www.hhs.gov/news/press/2009pres/09/20090929a.html
WolframAlpha Computational Knowledge Engine. (2009). Retrieved September 30, 2009, from http://www.wolframalpha.com/input/?i=number+of+web+sites
World Health Organization. (2009). Links to National Health-Related websites. Retrieved September 30, 2009 from http://apps.who.int/whosis/database/national_sites/index.cfm
Yellowlees, P. (2008). Your Health in the Information Age – How you and your doctor can use the Internet to work together. Bloomington: iUniverse.
