Consumer health informatics
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Consumer Health Informatics. Deborah Lewis, Ed.D, RN, MPH Associate Professor of Nursing University of Pittsburgh. Definitions….

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Consumer health informatics

Consumer Health Informatics

Deborah Lewis, Ed.D, RN, MPH

Associate Professor of Nursing

University of Pittsburgh


Consumer health informatics

Definitions….

Consumer health informatics is the branch of medical informatics that analyses consumers’ needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers’ preferences into medical information systems.

Eysenbach, 2000


Consumer health informatics

Consumer health information (CHI) is information

on health and medical topics provided in response

to requests from the general public, including patients

and their families.

In addition to information on the symptoms, diagnosis

and treatment of disease, CHI encompasses information

on health promotion, preventive medicine, the

determinants of health and accessing the health

care system.

Medical Library Association, 2000


Consumer health informatics

Consumer Health Informatics is defined as the integration of consumer health information and information technology in an environment of shared healthcare decision-making that supports effective self-health action.

Lewis and Friedman, 2000


Consumer health informatics

Integrating Process

Communication Strategies that include:

Information

Technology…

In concert with

Human Interventions

Consumer

Outputs

Informed Consumer

Achievement of Personal Health Goals

Improved Health Outcomes

Peaceful End-of-Life Decisions

Inputs

Family, Friends and Healthcare Providers

Accurate

Health

Information

Current Health Status

Personal Beliefs and Values

Personal Health Goals

Prior Understanding

Model for Consumer Health Informatics


What has caused recognition of the importance of consumer health informatics

What has caused recognition of the importance of Consumer Health Informatics

  • Changing values toward patient autonomy and self-care

  • Changing cost models

  • Withdrawal or change in previously-delivered service

  • New opportunities for access and connectivity

Adapted from P. Brennan


The possibilities

The Possibilities

  • For the consumer: distributed systems make it possible for information delivery to transcend the hospital/clinic environment when the “teachable moment” most often occurs. New media will make access more affordable.

  • For the educator/clinician: The use of web-based technologies provide for easy upgrades of content and access to multiple information sources.


Consumer health informatics

  • Technology can provide a vehicle for basic information and supportive interaction (Internet).

  • Technology-based Media can model non-linear processes.

  • Computers are available whenever the patient is available.(if the patient has access)


Characteristics of today s healthcare consumer

Characteristics of Today’s Healthcare Consumer


Today s health consumer

Today’sHealth Consumer

  • Busy with little free time

  • Well educated

  • Less intimidated by physicians

  • Want choices

  • Eager to take control or play a major role in their own health

Adapted from Hospitals & Health Networks


Where do people get health information

Where Do People get Health Information?

Family

Physician


They want

They want…

  • Comprehensible, relevant knowledge

  • Communication with peers and professionals

  • Personal health information management tools


Applications for consumers

Applications for Consumers

  • Medical Information

  • Drug Information

  • Storage of Personal Medical Records

  • E-Mail to Physicians

  • Body Mass Index Calculators

  • Health Risk Assessment


Consumer health informatics

A 32-year old mother of two living in Wausau, recently

diagnosed with Ovarian Cancer, locates and enrolls in a

clinical trial lead by a University-affiliated oncologist in

her community.

A married couple, their three children, and the wife’s mother live on a 200 acre farm and get weekly updates on ground water quality and contamination from their state’s

Health Alert Network.

The Health Planning Council of a medium size town conducts a resource assessment and concludes that their community lacks services for disenfranchised people (unemployed, uninsured, transients, migrant workers, racial and ethnic minorities

A single father

of a 7 year old child learns

from her pediatrician that the

child has Crohn’s disease. The

father reviewed his child’s

records, including laboratory

tests and physician notes over

the web from his home

computer, and was also able

to look at health information

from major research

universities.

A 72-year old woman works out a planwith her physician to modify her medication schedule so that on the days she plays bridge she takes her diuretic AFTER the game is over


The contexts of care

The Contexts of Care

  • Living Environment

    • Homes

    • Communities

  • Social Environments

    • Families

    • Cultural Groups

  • Psychological Environments

    • Illness representations

    • Human Information Processing

  • Technological Environments


Where do people keep health information

Where do people keep health information?


Consumer health informatics

Computer-based Approaches

to Patient Education


Consumer health informatics

Knowledge Transfer

improved knowledge in Children with Asthma

improved knowledge in Elderly with Arthritis

improved knowledge in Adults with Diabetes

improved medication knowledge in Adult psychiatric patients

Health Behaviors

improved self-care behaviors in Adults with Arthritis

improved adherence to medication therapy in Elderly

Clinical Outcomes

reduced fat intake and decreased HgbA1c in Adults with Diabetes

decreased HgbA1c in Adults with Diabetes

decreased hospital admissions in Adults with Asthma

decreased plasma cholesterol in Adults with Hyperlipidemia


Relationships with care providers

Relationships with Care Providers

  • Patients prefer live interaction for some types of communication

Skill Development and Decision Support

  • Computer-based technologies are used effectively to transfer self-care management skills in diabetes.


S ocial f actors

Social Factors

  • Rural patients and patients from low socio-economic backgrounds respond well

  • Gender does not make a difference

Personswith Disabilities

  • Virtual learning environments enhance interaction, diminish feelings of isolation and improve self-esteem


L iteracy c onsiderations

Literacy Considerations

  • Use of multimedia make programs more understandable by persons with limited reading ability.

  • One study found that patients who were less well-educated benefited most from an interactive video program.


D evelopmental c onsiderations

Developmental Considerations

  • School age children responded positively and had improved health outcomes (n=6)

  • Elderly clients with little prior computer experience have improved knowledge scores and reported satisfaction with CBPE (n=4)


The internet

The Internet


Growth of the internet

Growth of the Internet

  • 17 million Americans use the Web to search for Health Information

    • Average age 41

    • 53% are female

    • Average annual income 61K

    • 81% have a college degree

http://www.cyberdialogue.com/pdfs/articles/intel.pdf


Consumer health informatics

What has the Internet brought us?

Convenience

Increased Access to Resources

New Media Possibilities

Concerns about Information Quality

“Information Overwhelmus”


Issues of information overload and information quality

Issues of Information Overload and Information Quality

  • Amount of Information is Overwhelming

  • Increased Quantity of Information may not be an increase in Quality

  • There is an ongoing need for new approaches to assist Consumers in locating Information that is Accurate, Understandable and Personally Meaningful


Consumer health informatics

How will we reach those who need

health information most?

Aging population

18-25% who are poor and uninsured

9 million Americans who are functionally illiterate.

(National Adult Literacy Survey, 1993)

Those without access: The digital divide


Caring place

Communication and Information resource for Family Caregivers (Parents) of Children with Cancer

Caring Place


Consumer health informatics

“Caring Place”, will provide individualized clinical information, patient-centered information resources, and access to online family-provider and family-to-family communication for family members of children with cancer


Health almanac

Health Almanac

The Health Almanac module includes a framework for summarizing the child’s clinical record. Specific information for the “Caring Place” will include the chemotherapeutic protocol, lab values and radiology reports. Information resources (found in the Information Library) will assist the parents in understanding what their child’s health information means. A calendar function will also be available to allow parents to track appointments.


Gathering place

Gathering Place

Online access to discussion groups within self-designated communication groups. They will be able to decide how they wish to participate. Each family communication group will have the opportunity to access their child’s participating healthcare providers or other family caregivers who are participating in the study.

The discussion group participants will be able to post text-based messages and upload external files (for example, images, video, sound files, word processing documents, or spreadsheets)


Information library

Information Library

The Information Library module is under development. It will contain specific information for pediatric oncology patients. These information resources will be patient-centered and will include traditional patient education materials currently being use in the oncology clinic at Children’s Hospital, Pittsburgh.

The traditional information resources are primarily paper-based and have been developed by oncology clinic staff at Children’s Hospital of Pittsburgh. We will include those resources that apply directly to treatment, side-effects, clinical tests, and social support.

Links will be provided to selected

external web-based resources.

Additional paper-based resources

will remain available from the

information shelves in the patient

waiting areas of the Oncology Clinic.


Review of the prototypes

Review of the Prototypes


Family caregivers internet use n 40

Family Caregivers Internet Use n=40

  • 83% access Internet from Home

  • 14% access Internet from Work

  • 72% find the information they are looking for “most of the time” or always

  • 97% have searched for information related to their child’s diagnosis

  • 64% searched for information regarding new medications

  • 64% searched for answers to unanswered questions after MD visits


Consumer health informatics

  • 78% use search engines

  • 39% use e-mail to communicate with care providers

  • 72% have not participated in online support groups

  • 61% are concerned about the security of electronic health information

  • 63% question the quality of the information they find


Comments from parents

Comments from Parents

  • The website should contain

    • Current valid and reliable information resources

    • Easy to search

    • Information regarding clinical trials

    • Access to e-mail with healthcare providers

  • “The Internet is my only way of fighting this disease”


Usability testing

Usability Testing

  • 17 parents

  • Average age 42

  • Time since diagnosis 1 wk – 4.5 yrs average 1.25 years

  • 16 have computers

  • 15 have Internet access

  • Use ranged from never (n=2) to daily (n=8)

    The one person who had no computer used the Internet often at the public library and carried all the information with her.


User testing comments

User testing comments

  • Need a disclaimer about outside sites

  • Need a place to ask questions

  • Need drug information

  • Information needs to be tailored to your child

  • Need to be able to organize all the information they give you

  • Need chat rooms for kids and teens“Not everyone is rationale at first, the Internet may not be the best choice for information seeking”


Personal experience first questions

Personal Experience: First Questions

  • What does this diagnosis mean?

  • How will this change her life?

  • Will her normal development change?

  • Will she still be able to go to school?

  • More information about the drug?

  • What was the name of that drug?

  • How will I get help when I go home?


First internet encounter

First Internet Encounter

http://www.epilepsyfoundation.org/answerplace/Life/children/


What i ve learned

What I’ve learned

  • The Internet can cause great stress

  • It is not always easy to find the Information you are seeking

  • The .gov sites don’t often appear in searches

  • The Healthcare team is the best resource for individualized information but they are not always available

  • Rationale thought leaves you when your child is diagnosed with a serious illness

  • There is much work to do in the area of Consumer Health Informatics

  • We need to leverage these new technologies in ways that will meet consumer and healthcare providers needs


Top consumer health information web sites

Top Consumer Health Information Web Sites

  • AMA Health Insight: On-Line Health Information for Everyone http://www.ama.org

  • Centers for Disease Control and Prevention (CDC) http://www.cdc.gov

  • Healthfinder TMhttp://www.healthfinder.gov

  • National Cancer Institutehttp://www.cancer.gov/cancerinfo


Top consumer health information web sites1

Top Consumer Health Information Web Sites

  • HealthWeb http://www.healthweb.org

  • HIV InSite http://hivinsite.ucsf.edu

  • Mayo Clinic Health Oasis http://www.mayohealth.org

  • MEDLINEplus http://medlineplus.nlm.nih.gov/medlineplus


Top consumer health information web sites2

Top Consumer Health Information Web Sites

  • National Women's Health Information Center http://www.4women.gov

  • NOAH: New York Online Access to Health http://www.noah-health.org

  • Oncolink:University of Pennsylvania http://www.oncolink.upenn.edu

  • American Cancer Societyhttp://www.cancer.org


Top consumer health information web sites3

Top Consumer Health Information Web Sites

  • Clinical Trials http://www.clinicaltrials.gov/

  • Oncology Nurses Societyhttp://www.ons.org

  • Leukemia Society http://www.leukemia.org


Consumer health informatics

'Understand me and my tumor.

Neither one of us reads your textbooks.'

http://www.mskcc.org/mskcc/html/3149.cfm


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