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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
Portal sites
Medical portals
After the Internet bubble ... just a few examples
Medscape
Medwebplus
Medical Martix
Promedmail
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)
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?
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
Finally widely available to the public at large
missing:
“super portal” combining all of these!
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)