Semina Report

On

(E-Health Services)

Department of Computer Science

Faculty Of Science, Mai Idris Alooma Polytechnic Geidam,

Yobe State

BABAGANA M DIYARAMA

2021/PHND/COM/002

2022

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 Abstract: nowadays, it is essential for medical professionals to organize and
keep track of their patients’ medical records.
Keeping this kind of information is absolutely not an easy task, especially with
a numerous amount of records and other documents that need to be filled,
which are usually in rows of labeled folders in file cabinets. The lack in
automated electronic medical recordkeeping is apparently more in the field of
pediatrics. The growing influence of mobile phones, computers or technology
as a whole, along with the advances in medical devices, are becoming a crucial
part in the future of healthcare. All kind of technology driven devices are
creating their way towards becoming essential tools in offices of medical
practitioners. Furthermore, with these tools and equipment, record keeping of
medical information of patients could be made more productive, convenient
and fuller in content, not only including pictures but video and audio records
as well.
E-Health is a generic term which is used to characterize various aspects of
health care at a distance. In its most expansive application, E-Health can be
defined as the use of telecommunication technologies to provide medical
information and services. The key aspect of E-Health is the use of electronic
signals to transfer information from one site to another. The term, E-Health , is
becoming most recognized as referring to remote clinical care and consultation
through the use of electronic equipment that provides with images. By using E-
Health technologies and a well-planned timeline, the SERENITY APP has
successfully drawn down its hospitals complement. E-Health services that
integrate electronic medical records can decrease the number of cases where
doctors cannot access the records of patients. According to the Institute of
Medicine, around 30% of physicians could not have accessed their patient's
files in existing non-E-Health systems and about 70% of the records were
deficient.

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INTODUCTION

E -Health , the word is composed of a word “E” which means ‘Electronic

and the word
“Health” which is well-known to us already. Commonly, it is referred to as
the use of telecommunications to maintain medical information and adaptability
in delivering health services to remote patients. It might be as simple as two
health professionals examining a case over the telephone, or going to as
sophisticated as using satellite technology to broadcast a consultation between
providers at facilities between two countries, using robotic technology or
videoconferencing equipment.
Origins and history :
One of the accounts that were first published occurred in the early 20th century
when electrocardiograph data were passed over telephone wires. In its modern
form, E-Health actually started in 1960s. Large part was driven by the space
and military technology areas. There were only a few people using readily
available commercial equipment. Starting out over forty years ago with
presentation and demonstration of hospitals reaching to take care of patients in
remote areas the use of E-Health has spread speedily and is now becoming
integrated into the ongoing day-to-day operations of hospitals, home health
agencies, specialty departments, consumer’s homes and workplaces as well as
private physician offices.
E-Health is actually not a separate medical specialty. Services and products
which are related to E-Health are often part of a bigger investment by the health
care institutions in either delivery of clinical care or information technology. In
the reimbursement fee structure, usually there is no distinction made between
services which are provided on site and those provided through E-Health and
usually no separate coding required for billing of remote services. Telehealth
and E-Health are historically considered to be interchangeable terms,

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encompassing a wide definition of distant healthcare. Giving consultations to
patients via transmission of still images, video conferencing, e-health including
patient portals, remote monitoring of vital signs, consumer focused wireless
applications and nursing call centers, continuing medical education, among
other applications, are all considered to be part of tele health and E-Health .
The advancement of mobile phones along with the immense developments in
wireless technology has become a crucial part of different domains especially in
the field of medicine. There are latest mobile technologies like 3G data services
can provide with real time voice and video conversing which provides with a
numerous benefits in the medical field. This creates a way to a new technology
called Mobile
E-Health applications and nursing call centers, continuing medical education,
among other applications, are all considered to be part of telehealth and E-
Health .
The advancement of mobile phones along with the immense developments in
wireless technology has become a crucial part of different domains especially in
the field of medicine. There are latest mobile technologies like 3G data services
can provide with real time voice and video conversing which provides with a
numerous benefits in the medical field. This creates a way to a new technology
called Mobile

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LIERATURE REVIEW
E-Health Services:
Progressing in a mobile E-Health infrastructure could help improve the
traditional record keeping system for medical professionals. The platform or
system provides efficiency and correctness in recording medical data with the
use of advanced wireless technologies and web services. Gadgets which are
portable such as laptops, PDA’s, mobile phones which are synchronized with
other peripheral attachments are also used and connect with servers to achieve
real-time communication with medical professionals. It is of critical importance
to use this feature when emergencies occur and the need for immediate care and
consultations arises.
E-Health or in more specification telepsychiatry, has been applied in the United
States of America since at least the mid1960s. After that in 1964, the Nebraska
Psychiatric Institute accepted a grant from the National Institute of Mental
Health to connect the Institute with Norfolk State Hospital, which is
approximately over 100 miles away, by Closed-Circuit Television (known as
the abbreviation “CCTV”). Afterwards, the Institute was also linked to the
Omaha Veterans Administration (VA) Hospital and other VA Hospitals.
There are also several other E-Health programs which started in the late 1960s
and during the whole of the 1970s, mostly to create services to remote or some
rural populations, or to arrange access to specialists in towns with only general
practitioners. As of 2008, it is calculated that there are about 200 established E-
Health networks affecting almost 3,500 medical institutions.
While the use of technology in medicine rapidly grows, it is necessary to
understand the meaning of the various terms, partly so that activities that are
fundamentally different do not become flawed by chunking them together under
a common term. To start, we should know and understand the difference
between the terms “E-Health ” and “telehealth.”

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A broad description is adopted by the World Health Organization and it pretty
much says everything about E-Health . It says “The delivery of health care
services, where distance is a critical factor, by all health care professionals
using information and communication technologies for the exchange of valid
information for diagnosis, treatment and prevention of disease and injuries,
research and evaluation, and for the continuing education of health care
providers, all in the interests of advancing the health of individuals and their
communities”. A lot of definitions focus on the point that E-Health is an open
and constantly developing science, as it combines new advancements in
technology and adapts and quickly responds to the fast changing health
requirements. “E-Health ” is now commonly considered as one component of
“telehealth.” However, different organizations and agencies use somewhat
different explanations; “telehealth” fundamentally covers all applications of
technology to the healthcare area. This includes but is not only limited to
providing distance medical education, health administration, certain public
health endeavors, and long-distance clinical care.
The other term which is “E-Health ” is commonly defined as being limited to
the use of technology to facilitate clinical care at a distance. For instance, the
Centers for Medicare and Medicaid Services specify E-Health as “…the use of
medical information exchanged from one site to another via electronic
communications to improve a patient's health.” Therefore, The
American E-Health Association has a considerably similar definition.
“Telepsychiatry” is then a subdivision of “E-Health ”. When there is the use of
the term “E-Health ” or
“telepsychiatry” it is referred specifically to those activities that are executed at
a distance that would constitute the practice of medicine. However, most of the
time telehealth and E-Health are substitutable.

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TELE HEALTH: Reaches all applications of technology to the healthcare
field; includes, but is not limited to:
E-HEALTH : adoption of technology to simplify clinical care remotely;
technology used could be e-mail, telephone, or real-time videoconferencing;
includes:
TELEPSYCHIATRY: manage of technology to simplify psychiatric care
remotely
 Practice websites
 Social media and blogs
 Remotely- stored electronic medical records
 Long distance medical education
 Certain public health activities
There are four elements which are connected to E-Health :
1. Clinical support is one of its main purposes.

2. Geographical barriers are something that it seeks to overcome,

connecting patients and users who are not in the same physical location.
3. It contains the usage of different types of Information Communication

Technology
4. The goal is to develop better health outcomes.

What are the services that can be provided by E-Health ?

E-Health if often understood with the services it provides and the mechanism
used to provide them. Some examples will be included here:
- Primary care and specialist referral services may include health
professional deliver consultations to specialists or patients who help the
primary care physician in coming to a diagnosis. For this process, live

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 interactive video or the forward transmission of diagnosis images are
involved and many others who support these activities.
- Remote patient monitoring this process uses different devices to collect
and sent data to a home health agency from a distance. Sending remote
diagnostic facility (with the abbreviation RTDF) for interpretation and
understanding the results. These kinds of application might provide a
specific vital sign, for example, blood glucose or a variety of indicators
for patients who need to be treated from home. Such services may drop
the use of visiting nurses at homes and it helps when there is no such
possibility.
Consumer medical and health information involves the use of wireless
devices connected to the Internet for patients to obtain specialized health
information and online discussion groups to create a peer-topeer assistance.
- Medical education delivers for health professionals with constant
medical education credits and special medical education seminars for
targeted groups who are interested remotely.

What are the advantages of using E-Health Services:

There are four essential benefits that have pushed E-Health to grow so rapidly.
- Improved access – for a period of over 40 years, E-Health has been
trying its best to provide healthcare services to patients remotely. This
allows health facilities and physicians to expand their reach which is
outside and not reachable by their own offices. Taking into consideration
providing shortages throughout the world- in both urban and rural areas-
E-Health has an exceptional capacity to enlarge the service to millions of
patients.
- Cost efficiencies – one of the most crucial reasons for funding and
implementing telehealth technologies is actually reducing and containing
the cost of healthcare. It also increase effectiveness through better

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 management of chronic diseases, reduced travel time, shorter hospital
stays and shared health professional staffing.
- Improved quality – it is proved that by studies that the quality of
healthcare provided by E-Health are as good as those provided by
traditional in-person consultations. However, in some specialties, E-
Health provides superior product, along with better outcomes and higher
customer satisfaction. For example, in mental health and ICU care.
- Patient demand – the highest impact E-Health make is on the patients,
their families, their loved ones. Thus, consumers require E-Health . Using
it patients save from travelling time and reduce stress. It has been
documented that over 15 years, patient satisfaction has increased and they
support E-Health services.

APPLICATIONS AND SERVICES FOR DIVERSE CONTEXTS

E-Health applications can be grouped into two major types, according to the
timing of the transmission of the information and the other thing is the
interaction between the individuals engaged- be it health professional to patient
or health professional to health professional. E-Health sometimes uses the pre-
recorded data between the individuals at different times; it is also called store
and-forward. In contrast, the real time, or also called synchronous, E-Health
involve the engaged individuals to be simultaneously present for the
instantaneous exchange of information, for example, the case of
videoconferencing. In both types of E-Health , synchronous and asynchronous,
appropriate information and files should be transmitted in the varieties of
media. For instance, text, audio, video or images.
Teledermatology, telepatology, teleradiology are all using the wide array of E-
Health services. In not so advanced countries which have lowincome and in
areas with limited infrastructure,

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E-Health applications are mainly used to connect health-care providers with
specialists, tertiary care centers and referral hospitals. There a barriers that do
not allow these applications to be adopted in those areas, even though it has
proven to be feasible, sustainable and clinically useful.
STANDARD OF CARE IN E-HEALTH SERVICES

Grasping the standard of care connected to E-Health is fundamental. Even

though “the standard of care” is a vague and often controversial concept, it
represents the idea that physicians should provide at least minimally acceptable
and clinically appropriate diagnosis and treatment to all patients, regardless of
circumstances. It is becoming clearer that E-Health as a delivery mechanism
does not alter the standard to which physicians will be held.
KEY POINT
Utilizing E-Health does not alter the standard of care to which the physician
will be held - it is the same standard of care that would apply if the patient was
in the physician’s office or facility.
There are many sources that may help define the standard of care, such as peer-
reviewed studies, professional association (AMA, APA, etc) treatment
guidelines, medical texts and treatises, and licensing board policies. Rarely is
any one source a definitive statement of the standard of care, but rather each
contributes to a discussion about whether a given action is acceptable medical
practice.
From a risk management perspective, licensing board statements are particularly
important. After all, if an aggrieved patient files a complaint with the board, you
will be investigated by the same entity that issued a statement potentially
relevant to your conduct. Having conformed to the board’s stated position then
makes you more likely to prevail in the investigation, whereas having ignored
the board’s position may place your license in jeopardy.
LICENSING BOARD EXAMPLES

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 New York’s Board for Professional Medical
Conduct has made it clear that there is not a different standard for E-Health .
Their Special Committee on E-Health stated “All the current standards of care
regarding the practice of medicine apply. The fact that an electronic medium is
utilized for contact between parties or as a substitute for face-to-face
consultation does not change the standards of care.” The Special Committee
also references a statement by the American College of Obstetricians and
Gynecologists, which said “The standards of care for medical practice apply
with equal force and vitality to E-Health if a physician-patient relationship is
deemed to exist.” California’s Medical Board has been equally explicit about
the standard – “The standard of care is the same whether the patient is seen in-
person, through E-Health or other methods of electronically enabled
healthcare.”
Medical board statements, by themselves, do not actually define the standard of
care. However, they demonstrate that there are certain things that a physician
should carefully consider before providing E-Health services. In particular, the
physician should consider which tasks would be expected of them should the
encounter take place with all participants in the same room, and then examine
the ways in which the circumstances surrounding the arrangement – including
the particular technology to be used – are likely to impact his/her ability to
perform those tasks. In the case of treatment, these statements mean that the
“minimally acceptable” evaluation and treatment is the same whether the
patient is in your office or on the other side of the country. Merely defining
what you would be expected to do may take some careful thought. What cues
would you be expected to pick up on if the patient was in your office? What
kinds of evaluations would you be expected to perform, and what interventions
might you be expected to do?

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Once you have defined what would be expected of you were the patient in your
office, you should evaluate what abilities you will lose by using E-Health . One
obvious loss is the ability to physically touch the patient, but other lost abilities
may not be so readily identified. The final step would be to determine whether
and to what extent you can mitigate these losses, and, after taking these
mitigating steps, whether you can meet the expected standard of care. In future
articles, we’ll look closer at lost and restored abilities in the context of
telepsychiatry.
EXAMPLES OF LOST ABILITIES IN E-HEALTH SERVICES
E-Health Technology and the Abilities Lost May Include (But are Not Limited
To):
o Telephone: Ability to see, smell, or touch the patient.

o Email: Ability to see, smell, hears, or touch the patient; Ability to

confirm the person is the patient.

o Real-time videoconferencing: Ability to smell or touch the patient.

TYPES OF E-HEALTH

E-Health can be broken into three main

categories:
1. store-and-forward,
2. remote monitoring
3. interactive services.
Store-and-forward E-Health involves acquiring medical data (like medical
images, biosignals etc) and then transmitting this data to a doctor or medical
specialist at a convenient time for assessment offline. It does not require the
presence of both parties at the same time. Dermatology (cf: teledermatology),
radiology, and pathology are common specialties that are conducive to

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asynchronous E-Health . A properly structured Medical Record preferably in
electronic form should be a component of this transfer. A key difference
between traditional in-person patient meetings and E-Health encounters is the
omission of an actual physical examination and history. The store-and-forward
process requires the clinician to rely on history report and audio/video
information in lieu of a physical examination.

Remote monitoring, also known as selfmonitoring/testing, enables medical

professionals to monitor a patient remotely using various technological devices.
This method is primarily used for managing chronic diseases or specific
conditions, such as heart disease, diabetes mellitus, or asthma. These services
can provide comparable health outcomes to traditional in-person patient
encounters, supply greater satisfaction to patients, and may be cost-effective.

Interactive E-Health services provide real-time interactions between patient

and provider, to include phone conversations, online communication and home
visits. Many activities such as history review, physical examination, psychiatric
evaluations and ophthalmology assessments can be conducted comparably to
those done in traditional face-to-face

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CONCLUSION

E-health Services is a rapidly-expanding field, and considering the recent

developments in our nation’s capital, is a field that is likely to continue
expanding at an exponential rate. This means that E-Health is very likely to
become more prevalent than it already is. However, it is important to recognize
the impact that the use of technology can have on both legal requirements for
physicians, such as licensure, and on the ability of the physician to provide
appropriate clinical evaluation and care.
Because the field is still developing, it is incumbent on physicians to carefully
analyze the implications of any E-Health they desire to engage in.
However, with proper preparation and risk management, E-Health may be a
very useful tool for providing needed specialty services to patients who would
not otherwise be able to access them.

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