Internet and Medicine: 10 years after

From the network's perspective

Marc Nyssen

Medical Informatics dept.

Vrije Universiteit Brussel

Belgium

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

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

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

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

Technology

10 years ago: first web

browsers (mosaic, ...) No tables

No frames

No javascript

No Java ...

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)

Institutes

Authoritative centers

Karolinska Institute

NIH

DG Information Society Unit C4: eHealth

Medline (pubmed, medlineplus)

Several others

Institutes

Karolinska Institute

Institut Pasteur

Institutes

DG Information Society Unit C4: eHealth

Institutes

Medlineplus

Institutes

Pubmed

Portal sites

Medical portals

After the Internet bubble ... just a few examples

Medscape

Medwebplus

Medical Martix

Promedmail

Portal sites

Medscape

Portal sites

Medwebplus

Portal sites

Medical matrix

Portal sites

Promedmail (Jack Goodall)

Portal sites

EHTO

Societies

Societies

Societies

Conferences

Publications

Journals

IEEE TITB (2003-)

Electronic Healthcare (2001-)

Publications

Journals

Publications On-line

Publications

pubmed searches on “Internet AND medicine”

Ethics

HON (Healtcare On the Net)

http://www.hon.ch

Internet Healtcare Coalition

http://www.ihealthcoalition.org

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

Medical profession

General Practitionner

Hospitals

Specialists

Para-medics

From “cards” to servers

Large nationwide projects

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

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?

Medical profession

Specialists Very different needs

Common: “patient administration”

Financial administration + reporting

Mini-clinics and group practices

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

Medical profession

From “cards” to servers?

Social security card (national, European)

Diabetes card

Minimal health record -> summary health record

Big brother : example in Spain

Centralized vs. distributed health records

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

Medical profession

Nationwide projects (amongst many others)

Hygeia

Crete

Medical profession

Nationwide projects (amongst many others)

Keneya Blown (vestibule de la santė)

Mali

Schools/universities

E-learning

Computer literacy

E-health programs

Master after master “management of health data”

Need for an European master program in eHealth?

Standards bodies

Internet Society (IETF)

WWW Consortium

CEN

HL7

IEEE

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?)

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

Patients/public

Useful health tricks

Patients/public

Distance pharmacy

Patients/public

New medication:

Patients/public

Distance education/certification: effortless diploma

Patients/public

Finally widely available to the public at large

missing:

“super portal” combining all of these!

Patients/public

Informative sites: patients are most concerned!

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?

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 15;328 Ethical challenges of medicine and health on the Internet: a review, Dyer

KA., J Med Internet Res. 2001 Apr-Jun;3(2)