PerspectivesAre you interested in submitting a Perspective Article? Be sure to read The Science Advisory Board's Editorial Guides for Perspective Articles. Click here. The Age of e-Health by Vincenzo Della Mea, Ph.D. From e-Commerce, to e-Learning, to e-Health, adding a "e-" means adding information and communication technologies (ICT) to some traditional fields of activity. So, "e-Health" is, using the Ahmad' Risk' definition, "...the application of Internet technologies to create, deliver or receive health information, products or services." All of us working in the biomedical field, whether in Medical Informatics, BioInformatics, Electronic Patient Records, Medical Engineering or Telemedicine, have already encountered the interface between ICT and Medicine, so…what's new? The following four factors might have influenced the evolution of e-Health in novel ways:
The Gunther Eysenbach' definition attempts to cover such kinds of issues: "e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology." Let's consider some specific issues: Healthcare sites devoted to consumers are now commonplace on the Web. Their quality is variable depending on the content provider's expertise and reputation, the timeliness of updates, and the clear distinction between information and advertisement. Methods are currently under study for helping users comprehend the quality and features of a medical site (e.g., labeling systems, quality codes, etc), as well as helping the Web manager of a medical site guarantee a minimum quality standard (codes of conduct, guidelines, etc). Apart from such active research, a posteriori evaluations of quality and usage patterns are needed (and are being carried out) for understanding actual web sites and usage patterns. Such problems are fairly typical of healthcare web sites, as the information provided by them is crucial for the patient. Another important issue might be viewed in light of some recent developments of ICT technologies and in particular, of the World Wide Web. In fact, the current cultural status regarding communication technologies is moving towards integration at various levels. As a first practical example, the development of the XML (Extended Markup Language) language for the World Wide Web is clearly meant as a method for exchanging structured information, such that they can be not only displayed for the user's sake, but also directly exploited by software programs able to "understand" the content and choose the most adequate action to be carried out. As a complement to XML, RDF (Resource Description Format) is a way for giving meaning to data exchanged on the Web. This way of thinking on the Web is strictly part of the "Semantic Web" concept, launched by Tim Berners-Lee; following that, the future of the Web will be the integration among applications able to give personalized and active services to users, basing on the reciprocal understanding. In fact, at present there is plenty of data that may mainly be displayed on the user screen and not used directly by software. Another scientific area dealing with integration and communication inside communities is that of the so-called software agents paradigm. Software programs are seen as autonomous, social, reactive and proactive components able to interact and intercommunicate in a possibly complex environment. Beyond the client-server paradigm, agents communicate as peers, trying to fulfill their specific design aims. The agent's approach is aimed at modeling interaction and its problems as they occur in usual, complex "human" communities, including concepts like beliefs, trust, contracts, etc., and the properties that could emerge from a community of such kind of software components. Although new, this could be an approach towards integration and intercommunication in e-Health, where agents might represent software systems, as digital extensions of individuals (physicians, nurses, patients, etc) and institutions (hospitals, administrations, medical practices, etc). Some applications already exist in the field of shared care, where a patient is no more followed by a single doctor, but instead by a team of specialists, who need to exchange data and discuss (e.g., the GUARDIAN system, by B.Hayes-Roth, devoted to the patient monitoring in an intensive care center and the G.Lanzola' system for diabetes management). Of particular interest is also the knowledge management area, where a novel approach to organizations is being considered. This approach is concentrated on the knowledge held inside an organization, which is continuously improving and changing. Schreiber et al. defined knowledge management as a framework and a tool set for improving an organization's knowledge infrastructure, aiming at getting the right knowledge to the right people in the right form at the right time at the right cost. M.Stefanelli applies the concepts proper of knowledge management to healthcare organizations, specifically referring to the evidence-based medicine (EBM) approach. In fact, in order to guarantee quality of care and efficiency, a health care organization should necessarily be able to timely adopt the most recent knowledge coming from research findings, diffusing them at the right places inside the organization itself. In order to do that, ICT support is needed, but also organizations need to reconsider their structure and roles in order to exploit best the capabilities of new technologies. Finally, a note about the problems created by the large amount of data available on the Internet, and the use of this data. Information retrieval and data mining are helpful tools for extracting the needed information from networks and databases. On the Internet, the availability of meta-data formats (such as XML and RDF) might simplify such tasks, although the internationality of sites makes it difficult to access data expressed in foreign languages. An excellent example of e-Health application related to the extraction of relevant data (through data mining) from heterogeneous sources is GPHIN (Global Public Health Intelligence Network), aimed at monitoring outbreaks starting from raw data coming from laboratories, news services, etc. The topics just surveyed are exciting and still in their preliminary stage of application in certain areas, particularly related to consumers and/or patients. However, integration and easy retrieval of data is interesting as well for researchers and professionals in the biomedical field. At present, e-Health support to research is expressed by online libraries, virtual congresses, electronic support to clinical trials and to teamwork. As for future possibilities - just think about a uniform way of retrieving products, drugs, genes, with e-procurement possibilities that might help to overcome current limitations in online products acquisition, and information retrieval techniques able to make this easier. These concepts and applications have been discussed at the 6th World Congress on the Internet in Medicine (MEDNET2001), with the keynotes of Ahmad Risk (author of a WHO's report on the quality of information on the Internet), Mario Stefanelli (regarding the socio-organizational age of e-health) and Denise Werker (regarding the GPHIN approach). Further examples might be found browsing the Proceedings on the Congress web site. ### [ Discuss this topic in the Forum ] FURTHER READINGS
Vincenzo Della Mea, Ph.D. Steering Committee Member, The Science Advisory Board SAB Member Since January 1998 [ Discuss this topic in the Forum ] ### << Previous Next >> [ View All Perspectives ] |
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