CHAPTER 22 INFORMATICS AND

THE HEALTHCARE INDUSTRY

Informatics and the Healthcare Industry

Amy J. Barton, PhD, RN, FAAN
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A. Historical Context of eHealth

1. Telemedicine
a. The rudimentary roots of telemedicine extend back to
ancient times
b. Long-distance communication evolved
2. Telehealth
a. In the past, trends in telehealth applications were grouped
according to the various media
b. With the convergence of these technologies, newer
technologies merge across these media
c. Despite these newer technologies, voice applications remain
a mainstay of telehealth applications
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B. The Concept of eHealth

1. eHealth
a. eHealth is an emerging field of medical informatics
b. In a broader sense, the term characterizes a number of
things
c. eHealth represents optimism
d. eHealth technologies
e. Patients can also post their comments and advice to virtual
communities
f. The World Health Organization identified that that the health
sector must now integrate technology into its way of doing
business
g. eHealth opens doors for new types of relationships
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2. The Concept of Telehealth

a. The American Telemedicine Association (ATA) uses the
terms telemedicine and telehealth interchangeably
b. “Telemedicine is the use of information exchanged from one
site to another via electronic communications to improve
patients’ health status.”
c. Telehealth is often used to encompass a broader definition
of remote healthcare that does not always involve clinical
services
d. Telehealth can be considered another component of the
eHealth concept
e. Teleconferencing and digital networking systems are now
merging
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f. Variations in the definitions of telemedicine and telehealth

exist
g. There is agreement that telemedicine is “the delivery of
personal and non-personal health services and education as
well as a means for safeguarding the living environment via
information and communication technology”
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3. The Concept of mHealth

a. Another component of eHealth is mobile-health
b. mHealth typically refers to the use of a wireless
communication device
c. mHealth is viewed as the new generation of telemedicine
d. The healthcare model itself is including all stakeholders
e. It is crucial to note that these changes will be global in
distribution
f. As mHealth continues to progress, nursing care will need to
evolve
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C. eHealth Applications
1. Overview
a. Telehealth has both clinical and nonclinical uses
b. Nonclinical applications include professional education
c. Clinical uses include diagnostics
d. These two categories are somewhat blurred as patients and
providers exchange e-mail
e. Clinical applications for telemedicine can be provided at another
location
f. Telehealth applications can be specialized
g. Telehealth is moving care out the physician-centric perspective
into the 21st century model of healthcare that will see more
consumer empowerment
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2. Impact of the Web

a. Today, 85% of American adults (ages 18 and older) are using the
Web
b. A 2010 Pew Internet and American Life Project study indicates
only 72% of adults living with chronic disease are likely to access
the Web
c. These findings are in line with trends in public health and
technology adoption
d. Chronic disease is typically associated with living in a lower-
income household
e. While Internet use is associated with living in a higher-income
household
f. People living with chronic disease are disproportionately offline
g. Those who are online have additional support
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h. Two online activities that are common among people living

with chronic diseases are blogging and online health
discussions
i. Having a chronic disease significantly increases the likelihood
that the user will use the Web to read and share information
j. “Nuggets” of information are discovered via these online
discussion groups; individuals in the groups connect and
they “just keep going”
3. Consumer Engagement
a. The National eHealth Collaborative developed the Patient
Engagement Framework to assist healthcare organizations
b. The framework includes five phases
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4. Personal health records

a. Personal health records (PHR) are maintained by the patient
b. The PHR facilitates patient access to information about his/her
health and healthcare experiences
c. Use of a PHR encourages patients to track care encounters and
collect relevant health information to share in care
management
d. Google Health is a Web-based personal health record
5. Managing health conditions and accessing resources
a. Electronic resources are being used increasingly to learn about
and manage health conditions
b. Health seeking behaviors of adults with chronic conditions are
notably different from those of adults in general
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c. Internet users living with one or more conditions are more

likely than other online adults to gather information online
about medical problems, treatments, and drugs
d. Those with chronic conditions are more likely to fact check
information found on the internet with their clinicians
D. Transforming the Practice of Healthcare
1. Wearable and Portable Monitoring Systems
a. Remote patient monitoring is maturing, with a number of
applications available
b. The VitalJacket utilizes microelectronics in a wearable T-
shirt that continuously monitors electrocardiogram waves
c. BodyMedia is a wearable monitoring system that focuses on
weight loss, health, and fitness
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d. The Health Buddy System is a remote monitoring platform

that provides a daily interface between care coordinators
and patients with chronic illnesses
2. Telenursing and Decision Support Tools
a. Telenursing is broadening the role of nurses in the chain of
healthcare delivery to consumers in remote regions or to
homebound patients
b. Home health nursing via visual communication is a
technique that provides accessible care
c. Teletriage is a component of telenursing
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3. Possibility of Virtual Worlds

a. Web-based 3D virtual worlds are currently being investigated
as a potential tool
b. These tools are also being used as a new educational method
for the healthcare professions
c. The 3D worlds are created online using a virtual persona, or
avatar, which interacts with other avatars in the online world
4. Health Portals and Web 2.0
a. Web 2.0 social networking sites such as Facebook, Twitter,
YouTube, and MySpace are proliferating
b. Hospital portals are being developed where patients can
make appointments, renew prescriptions, and review test
results and their medical records online
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c. WebMD is a consumer portal that is a leader in providing

online health information
d. PatientsLikeMe is a popular social networking site
5. mHealth Applications
a. The rapid and pervasive worldwide adoption of mobile
cell phones is going to drive tremendous growth in
handheld healthcare over the next decade
b. Applications areas for mHealth include consumer
education and others
c. mhealth growth has been around the world
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E. Impact of eHealth Applications

1. Transforming the Way We Learn
a. Web-based educational programs are changing the way
consumers and healthcare providers learn
b. The role of the nurse as a patient and consumer educator in
the digital age is evolving as well
2. Transforming Health Care Delivery
a. Electronic data exchange
1) Advances in eHealth and the growing use of electronic
health records have contributed to the realities of health
data exchange
b. Payment reform through meaningful use
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F. Research Opportunities
1. Overview
a. Much is written on how eHealth applications may help
b. There is a need to study symptom management and
effectiveness of “distant” clinical assessments to identify
standardized best practices
c. Unique methodologic research issues and challenges for
nursing around the use of information and communication
technologies (ICT) have been identified
d. Another gap in current research is on the use of telehealth
applications for emergency and disaster preparedness and
response
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2. Transforming Emergency Preparedness and Response

a. During a disaster situation, the use of telehealth technology
would allow clinicians to provide healthcare services remotely
b. Advanced wireless electronic technologies are the quickest
vehicles to communicate needs during emergency situations
G. eHealth Challenges and Issues
1. Overview
a. Innovations in eHealth do not come without challenges and
issues that healthcare professions must address
b. As the transformation of healthcare moves toward patient-
centric models, the healthcare professionals must resolve some
key challenges and issues
c. These issues concern on legal, ethical, and public policy arenas
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2. Licensure
a. The lack of infrastructure for interstate licensure was a key
impediment to the growth of telehealth
3. Ethical Issues
a. The predominant ethical issues concerning telehealth are
privacy, confidentiality, and security
b. Definitions have been set forth by the American Society for
Testing and Materials Committee E31 on Healthcare
Informatics, Subcommittee E31.17
c. It is imperative that providers and healthcare systems
establish policies concerning privacy, confidentiality, and
security as they create systems to facilitate patient-centered
care through the provision of eHealth
Phase Description

Inform me The focus is on providing information to assist patients in

obtaining relevant materials. Examples include use of

mobile devices for directory services, access to basic health

information for wellness and prevention, electronic access to

standard forms (HIPAA, insurance forms, etc.), and specific

information about tests, medications and procedures.

Engage me The focus is on providing patients with specific

information concerning their care needs. Examples

Table 22-1. The Patient
include electronic tools to facilitate tracking of health
Engagement Framework
and fitness behaviors, online tools to schedule

appointments, and access to the electronic health record.

(National e-Health
Collaborative, 2012).
Empower me The focus is on enhancing patient involvement in the

care process. Examples include secure messaging and

virtual coaching. In addition, patients could have the

capability of generating their own data for the health

record.

Partner with The focus is on tools for shared decision-making and

me coordination of care across sites. Examples include

home monitoring devices and specific directives for

patient preferences and intolerances.

Support my e- The focus is on enhanced information exchange.

community Examples include online e-community support forums

and e-visits with providers.

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H. Emerging Issues and Challenges

1. Overview
a. For all the possibilities it presents, eHealth does come with
challenges, including privacy concerns, equity across
populations, and the need to define a new type of
relationship between the patient and healthcare provider
b. Disparities in healthcare and access to care still persist and a
true solution eludes us
2. Regulation of mHealth Applications
a. A recent development regarding mHealth is rules by the
United States Food and Drug Administration to regulate a
small segment of these applications
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3. Public Policy
a. The American Telemedicine Association outlined guidelines
to “advance the science, to assure uniform quality of service
to patients, and to promote reasonable and informed
patient and provider expectations.”
b. These guidelines include administrative, clinical, and
technical recommendations designed to provide a safe,
quality, telehealth experience