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Cybermedizin Gesundheitsförderung via Internet Ethische Fragen an Kommunikationtechnologien Veränderung der Arzt-Patienten-Beziehung in der Informationsgesellschaft. G. Eysenbach ([email protected]). Universität Heidelberg, Abteilung für Klinische Sozialmedizin, Forschungsgruppe Cybermedizin.

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G eysenbach ey@yi com l.jpg

CybermedizinGesundheitsförderung via Internet

Ethische Fragen an Kommunikationtechnologien

Veränderung der Arzt-Patienten-Beziehung in der Informationsgesellschaft

G. Eysenbach ([email protected])

Universität Heidelberg, Abteilung für Klinische Sozialmedizin, Forschungsgruppe Cybermedizin


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Vortrag

  • Cybermedizin

  • Patienteninformationssystem dermis.net

  • Änderung der Arzt-Patienten-Beziehung im Internet-Zeitalter

  • Email-Kontakt zwischen Arzt und Patient

  • Qualität von Internet-Information

  • med-CERTAIN EU Projekt


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Eysenbach G et al.

BMJ 319: 1294

(13 Nov 1999)


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Medical Informatics

Internet

Telemedicine

Cybermedicine

Epidemiology

Clinical Medicine

Public Health

Evidence-BasedMedicine

Preventive

Medicine

SocialMedicine

Therapy

Diagnosis

Medical / Health

Education

Cybermedicine is the science of applying Internet and global networking technologies to the area of medicine and public health, of studying the impact and implications of the Internet and of evaluating opportunities and the challenges for health care.”

Eysenbach G et al. BMJ 319: 1294 (13 Nov 1999)


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Telemedicine vs. Cybermedicine

Eysenbach G et al.

Towards the millennium of cybermedicine

BMJ 319: 1294 (13 Nov 1999)


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”Unit for Cybermedicine” at the Department of Clinical Social Medicine University of Heidelberg

  • exploration and exploitation of the Internet for consumer health education, patient self-support, medical education and research

  • the evaluation of the quality of medical information on the Internet

  • studying the impact of the Internet on the patient-physician relationship and quality of health care

  • studying the use of global networking for evidence-based medicine.


Unit for cybermedicine at the department of clinical social medicine university of heidelberg7 l.jpg
”Unit for Cybermedicine” at the Department of Clinical Social Medicine University of Heidelberg

  • exploration and exploitation of the Internet for consumer health education, patient self-support, medical education and research

  • the evaluation of the quality of medical information on the Internet

  • studying the impact of the Internet on the patient-physician relationship and quality of health care

  • studying the use of global networking for evidence-based medicine.


Dermis net vertical health portal l.jpg
Dermis.net - vertical health portal Social Medicine University of Heidelberg

G. Eysenbach, J. Bauer, A. Sager, A. Bittorf, T.L. Diepgen

An international dermatological image atlas on the WWW: Practical use for undergraduate and continuing medical education, patient education and epidemiological research.

In: Cesnik B, McCray AT, Scherrer JR. Medinfo98, Proceedings of the Ninth World Congress on Medical Informatics.

Amsterdam: IOS Press, 1998; pp. 788-792

Diepgen TL, Eysenbach G.

Digital Images in Dermatology and the Dermatology Online Atlas on the World Wide Web.

J Dermatol 1998;25(12):782-7


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Benutzersurvey Social Medicine University of Heidelberg

  • HTML-Fragebogen auf der Website

  • Basis: ca. 1000 Benutzer

  • Cave: Self-Selection Bias


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Nutzerdaten dermis.net (Dermatologie Online Atlas) Social Medicine University of Heidelberg


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What are consumers looking for on the web? Social Medicine University of Heidelberg


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Analyse der Patientenemails Social Medicine University of Heidelberg

Eysenbach G, Diepgen TL: Patients Looking for Information on the Internet and Seeking Teleadvice: Motivation, Expectations, and Misconceptions as Expressed in E-mails Sent to Physicians.

Arch Dermatol 1999;135:151-156


Analyse der patientenanfragen l.jpg
Analyse der Patientenanfragen Social Medicine University of Heidelberg


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Meist Patienten mit chronischen Erkrankungen Social Medicine University of Heidelberg


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Frustrated patients Social Medicine University of Heidelberg

  • I have gone to the dermatologist for more than 3 years to 3 different doctors and they have not a clue, one has said that I have follicultis and another prurigo....

  • I have been to 4 doctors in the past 4 years (...) My last doctor gave me the worst advice. He wanted to give me a prescription that would eventually make me blind.


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“Frustrierte” Patienten Social Medicine University of Heidelberg


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Cases of self-diagnosis 1+2 Social Medicine University of Heidelberg

  • I recently discovered that from some of the descriptions I’ve read that I may have symptoms of scabies. I was wondering if there is any known treatment for this disorder. If so, can you please forward any helpful information (...)

  • I would like what kind of things can I do to fight against “psoriasis on fingers” - because I saw the photo in your atlas and it seems to be the same. Thank you very much.


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Cases of self-treatment Social Medicine University of Heidelberg

  • [from a 24 years old female under treatment for onycholysis, with a disease history of 18 years]:I took Sporonox for about 4 months. I was told that this had to cure my nails, but it did not work. At this time I have resigned from making any medication and I have turned to the Internet for some further investigation of my problem.


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Positive examples (1) Social Medicine University of Heidelberg

  • [A female suspecting pityriasis rosea:]Have had this for approximately three years, and had not until this past year considered it to be a skin disorder. [After visiting the dermatological Internet atlas] I have made an appointment with a dermatologist (...) - is there anything I can do about this in the meantime?


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Positive examples (2) Social Medicine University of Heidelberg

  • [a patient with dyshidrosis lamellosa:] ...my doctor told me that I have it and is trying to treat it, but I would like to help him by finding out more about it for myself.


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Warum nutzen Patienten das Internet? (1) Social Medicine University of Heidelberg

  • Oft chronisch kranke Patienten..

  • ... oder „unheilbar“ oder schwer erkrankte Patienten (oder deren Angehörige)

  • Frustration und Unzufriedenheit über ausbleibende Behandlungserfolge

  • Das Gefühl zu haben, „alles getan zu haben“

  • Vertrauensverlust durch Rationierung im Gesundheitswesen


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Warum nutzen Patienten das Internet? (2) Social Medicine University of Heidelberg

  • Mangelnde Aufklärung durch den Arzt (Zeitdruck)

  • Gestiegene Allgemeinbildung


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„High-Tech“ medicine Social Medicine University of Heidelberg

Consumerprotection

Preventive

Medicine

Patient

Education

Programs

Reliance on physician

General

education

level

High

consumerexpectations

Relative riseof chronic diseases

Increased

ethical

and legal

standards

Explodingcosts

Market-

oriented

health system

Information

Overload

Increased

access to

information

sources

Consumer

knowledge

Consumer

power

Consumer

dissatisfaction

Less time

Poor IT skills

Self-supportgroups

-

+

increase

Information demand

mass media

Physicians

Internet

Self-reliance


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Patientinformationssystem Social Medicine University of Heidelberg


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Teleprävention Social Medicine University of Heidelberg

G. Eysenbach, T.L. Diepgen. Teleprevention and Teleepidemiology with the patient information system NeurodermIS on the World-Wide-Web.

In: Greiser E, Wischnewsky M (Hrsg.). Methoden der Medizinischen Informatik, Biometrie und Epidemiologie in der modernen Informationsgesellschaft. S. 251-253. München: MMW Medizin-Verlag, 1998


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Patienteninformationssystem NeurodermIS Social Medicine University of Heidelberg

  • patientengerechte Aufklärungstexte zum Thema Neurodermitis

  • ca. 50 HTML-Seiten mit 200 Abbildungen, teilweise aus dem Bildatlas

  • interaktiver Neurodermitis-Quiz und Atopie-Fragebogen

  • Datenspeicherung für spätere Analysen, z.B. für präventivmedizinische und epidemiologische Fragestellungen


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Patient Information on WWW Social Medicine University of Heidelberg

e.g. about Atopic Eczema

(Teleprevention)

Refinement of Patient Information

  • Electronic questionnaire:

  • disease diagnosed ?

  • risk factors/signs ?

  • calculates a-priori risk score

  • (e.g Atopy Score A [3,4])

Database

Data analysis:

Odds Ratios,

New Scoring System (Atopy Score C)

(Teleepidemiology)


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Chancen der Patientenaufklärung via WWW Social Medicine University of Heidelberg

  • Kombination massenmediale + individuumsorientierte Prävention

  • Interaktivität, Intelligenz, Flexibilität

  • Multimediaeinbindung

  • Bidirektionale Kommunikation: Möglichkeit zum direkten Feedback, Prototyping, iterative Entwicklung, Evaluation von Schulungsprogrammen, Tele-Epidemiologie


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Sehr viele Social Medicine University of Heidelberg

  • Fernsehen

Anzahl der erreichten Benutzer

  • WWW (dynamisch)

  • Radio

  • WWW (statisch)

  • Buch

  • Computerprogramme

  • Seminar

Sehr wenig

  • Einzelgespräch

niedrig

hoch

Involvierung des Benutzers /

Feedback-Level


Unit for cybermedicine at the department of clinical social medicine university of heidelberg33 l.jpg
”Unit for Cybermedicine” at the Department of Clinical Social Medicine University of Heidelberg

  • exploration and exploitation of the Internet for consumer health education, patient self-support, medical education and research

  • the evaluation of the quality of medical information on the Internet

  • studying the impact of the Internet on the patient-physician relationship and quality of health care

  • studying the use of global networking for evidence-based medicine.


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Pioneering studies assessing the quality of... Social Medicine University of Heidelberg

  • websites

    • Impicciatore P et al. Reliability of health information for the public on the world wide web: systematic survey of advice on managing fever in children at home. BMJ 1997; 314: 1875-81

  • newsgroups

    • Culver JD, Gerr F, Frumkin H. Medical Information on the Internet: a study of an electronic bulletin board. J Gen Intern Med. 1997; 12:466-70


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Pioneering studies assessing the quality of... Social Medicine University of Heidelberg

  • interactive venues (email-advice)

    • Eysenbach G, Diepgen TL Responses to Unsolicited Patient E-mail Requests for Medical Advice on the World Wide Web. JAMA 1998; 280:1333-1335

    • Eysenbach G, Diepgen TL. Evaluation of Cyberdocs. Lancet 1998; 352 (9139): 1526


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Wie reagieren Ärzte auf Patientenanfragen? Social Medicine University of Heidelberg

Eysenbach G, Diepgen TL: Responses to unsolicited patient e-mail requests for medical advice on the World Wide Web.

JAMA 1998;280:1333-1335


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Our experiments and studies Social Medicine University of Heidelberg

  • Analysis of responses to a pretended unsolicited “patient” email sent to 58 information providers

  • Questionnaire survey among 58 information providers on the WWW


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Methods (1) Social Medicine University of Heidelberg

  • Finding email suitable email addresses

    • Alta-Vista search for “+blisters +skin +pain +dermatology”, viewed 100 documents, found 12 information providers

    • list of WWW-addresses of academic dermatology departments worldwide, found 45 departments (http://tray.dermatology.uiowa.edu/AcadDept.html).


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Methods (2) Social Medicine University of Heidelberg

  • 58 email addresses

    • 4 dermatology organizations, 2 commercial sites, 2 universities, 1 dermatologist in free practice, 1 clinical psychologist specilized in skin diseases, 1 publisher, 1 hospital

    • dept’s from USA(22), Japan (8), Germany (7), Canada (2), UK (2), Spain (2), Austria, Brazil, Chile, Egypt, Finland, Hungary, Israel, Italy, Korea, New Zealand, Sweden, Switzerland, Singapore, Taiwan and Turkey (1 each).


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Methods (3): “Patient” email Social Medicine University of Heidelberg

Hello,

I am a 55 years old male and have a sudden skin problem.

During the last 4 days I had a little fever and headache. There was also a burning pain and tingling and extreme sensitivity in one area of the skin of the chest. Since yesterday suddenly multiple fluid filled painful red blisters appeared on the same skin area on the chest, on a broad streak of reddened skin. The skin eruptions are very painful and my wife says the groups of blisters look a lot like chickenpox, though they are only on that girdle-like skin area.

I am on Sandimmune since I had a kidney-transplant some time ago.

What is this? Is it dangerous? What is the therapy? Do I have to see a doctor?

Please reply!

Thank you very much,


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Responses (1) Social Medicine University of Heidelberg

n=58


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Responses (2): Contents Social Medicine University of Heidelberg


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Responses (3): Treatment advice Social Medicine University of Heidelberg

  • "Acyclovir or Famcyclovir"

  • "Valaciclovir"

  • "Aciclovir (per os or i.v.)"

  • "oral or I.V acyclovir for a couple days (...) In case acyclovir is obtainable as OTC drugs, you must consult your physician because acyclovir often affects the kidney.",

  • "within 5 days of disease, you may use Acyclovir 800 mg 5 times a day or Valtrex 500 mg 3 times a day for 5-7 days".


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Results summary Social Medicine University of Heidelberg

  • 29 (50%) responded to the pretended patient request

  • 9 of the responders (31%) refused to answer without having seen the lesion

  • 17 of the responders (59%) explicitly mentioned the "correct" diagnosis shingles in their reply

  • 27 of the responders (93%) urged the imaginary patient to visit a doctor.


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Schlußfolgerung Social Medicine University of Heidelberg

  • Keine einheitlichen ethischen und juristischen Leitlinien zur Problematik, wie Ärzte mit „Patientenanfragen per email“ umgehen sollen


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Evaluation von Cyberdocs Social Medicine University of Heidelberg

Eysenbach G, Diepgen TL. Evaluation of Cyberdocs.

Lancet1998; 352 (9139): 1526


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Evaluation of Cyberdocs Social Medicine University of Heidelberg

  • 10 free and 7 charging "cyberdocs" were identified

  • 10 cyberdocs responded

    • 3 refused to give advice because dermatology was not their area of expertise

    • 7 cyberdocs provided advice (2 for free, 5 for a charge)

      • Advice given by 5 "cyberdocs" was accurate and the "correct" diagnosis Herpes Zoster was mentioned

      • 2 questionable replies


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Misinformation 1 Social Medicine University of Heidelberg

  • A self-described "well-known naturopathic doctor, lecturer, author and a general family practitioner" wrote in his email that "the fluid filled cysts are probably nothing to worry about" and recommended "the homeopathic medicine Apis 30D" and "vitamin C".


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Misinformation 2 Social Medicine University of Heidelberg

  • "your eliminative organs may be congested (liver, spleen, gall bladder, kidneys, intestines, and skin). Make sure you get at least two good bowel movements a day. If you don't, have two apples and a warm glass of water immediately." His therapy advice was to "breath deeply (fresh air), drink plenty of rain water, or RO water, or distilled water", "getting some enzymes, which help allergies", "consider eliminating all dairy and wheat products" and to "get Red Clover and Dandelion" and "eat as many as you can".


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Qualität von Internet-Information Social Medicine University of Heidelberg


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Risiken: Qualität von Internet-Information Social Medicine University of Heidelberg

  • Keine redaktionelle/herausgeberische Kontrolle, jeder kann alles publizieren

  • Kein Kontext, Anbieter und Zielgruppe von Informationen oftmals unklar

  • Zunehmend dubiose Anbieter von Gesundheitsprodukten und Arzneimitteln aus dem Ausland

  • Verdeckte Pharmawerbung: Infomercials und Advertorials


1 keine redaktionelle kontrolle beispiel homepage von dr hamer l.jpg
1. Keine redaktionelle Kontrolle Social Medicine University of HeidelbergBeispiel: Homepage von Dr. Hamer

“Krebs ist heilbar. (...) Das ontogenetische System der Tumoren, das von Hamer im Jahr 1987 gefunden wurde, ordnet sämtliche Krebs- und krebsäquivalente Erkrankungen nach Keimblattzugehörigkeit (...). Zu jedem dieser Keimblätter gehört, entwicklungsgeschichtlich bedingt ein spezieller Gehirnteil, eine bestimmte Art von Konflikt, sowie eine bestimmte histologische Zellformation im Organbereich. Das ontogenetische System der Mikroben nun ordnet die Mikroben den drei Keimblättern zu, wobei sich folgendes ergibt:

Die ältesten Mikroben, nämlich die Pilze und Pilzbakterien (Mykobakterien) sind für das Entoderm und für durch das Althirn gesteuerte Organe zuständig.

Die alten Mikroben (Bakterien) sind für das Mesoderm zuständig und für alle Organe, die aus dem Mesoderm gebildet wurden und durch das Kleinhirn und das Großhirn-Marklager gesteuert werden.

Die jungen Mikroben (Viren) sind ausschließlich für das Ektoderm und die von der Großhirnrinde (Cortex) gesteuerten Organe zuständig.”

[http://www.geocities.com/HotSprings/3374/]


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2. Kein Kontext Social Medicine University of Heidelberg

  • Anbieter?

  • Zielgruppe?

  • British Medical Journal (Vol. 213 Heft 7022 S.3): “The Internet’s challenge to health care provision: A free market in information will conflict with a controlled market in health care”.


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3. Dubiose Anbieter Social Medicine University of Heidelberg

  • Qualität der Internet-Informationen entspricht oft nicht gültigen Richtlinien[Impicciatore et al. BMJ No 7098 Volume 314 Saturday 28 June 1997]

  • Shark-Cartilage, DHEA etc. [Bower, BMJ 17.8.96]

  • Schwere Zwischenfälle: “Poison on Line -- Acute Renal Failure Caused by Oil of Wormwood Purchased through the Internet” [Weisbord, NEJM 18.9.1997 -Vol 337, No 12]


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Weitere Risiken Social Medicine University of Heidelberg

  • “Gekauftes” Ranking bei Suchmaschinen

  • Missverständnisse auf Seiten der Benutzer

  • Selbstdiagnose

  • Überstrapazierung der Informationsanbieter durch Patientenanfragen


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EU Projekt Social Medicine University of HeidelbergmedCERTAIN(medPICS Certification and Rating of Trustful and Assessed Health Information on the Net)

Eysenbach G, Diepgen TL: Towards quality management of medical information on the internet: evaluation, labelling, and filtering of information.

BMJ 1998;317:1496-1500

Eysenbach G, Diepgen TL: Labelling and filtering of medical information on the Internet. Meth Inf Med 1999;38:80-88


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EU Projekt Social Medicine University of HeidelbergmedCERTAIN(medPICS Certification and Rating of Trustful and Assessed Health Information on the Net)

  • Förderung im Rahmen des EU „Action Plans for Safer Use of the Internet“ (IAP)

  • Projektkonsortium:

    • AKS Heidelberg (Co-ordinator)

    • ILRT Bristol

    • FinOHTA/STAKES

  • 1 Mio DEM for 18 months

  • Demonstrator for medPICS metainformation rating and filtering system


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Reviewing Social Medicine University of Heidelberg

Website A

Evaluation von Internet Information -Traditionell

(2)

Search

(3)

Search engine

User

(4)

Reviewing

Website B

(1)

URL

© Eysenbach

Medical website


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Primum nil nocere Social Medicine University of HeidelbergWhere exactly lies the “quality” problem of Internet information?

  • lack of reliability

    • complete lack of quality control at the stage of production

  • context deficit

    • no clear markers such as in traditional publishing allowing patients to recognise a document immediately as intended for professionals

    • anonymity (of authors)

    • internationality: "A free market of information will conflict with a controlled market in health care" [Coiera E, BMJ 1996; 312: 3-4].


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“Quality problem” on the Internet Social Medicine University of Heidelberg

... is a result of

  • lack of reliabilty: lack of quality control at the stage of information production

  • context deficit: the information not generally being associated with descriptive metainformation

Solution: Metainformation


Solution l.jpg
Solution Social Medicine University of Heidelberg

  • lack of reliabiltyevaluative metainformation (distributed by third parties)

    • today: badges/seals/logos distributed by the authors !

  • context deficitdescriptive metainformation (distributed by third parties and/or authors)

    • today: meta-tags can only be included by authors


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Evaluation von Internet Information Social Medicine University of Heidelberg

  • PICS=platform for internet content selection

  • ursprünglich für Jugendschutz-Zwecke gedacht

  • Struktur/Syntax für Metainformation um den Inhalt einer Website zu beschreiben

  • wert-neutral

  • Metainformation kann durch den Autor eingegeben werden (META-tags) oder durch Dritte

  • http://medpics.org


Evaluation von internet information traditionell66 l.jpg

Reviewing Social Medicine University of Heidelberg

Website A

Evaluation von Internet Information -Traditionell

(2)

Search

(3)

Search engine

User

(4)

Reviewing

Website B

(1)

URL

© Eysenbach

Medical website


Evaluation von internet information mit medpics l.jpg

(3) Social Medicine University of Heidelberg

Search

Label B

Search engine

User

(4)

Label A

Label-Bureau B

(1)

URL

Authors’

Labels

Label A

Label-Bureau A

(2)

Rating Service

Medical website

Evaluation von Internet Information - mit medPICS

© Eysenbach


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Collaborative rating approach Social Medicine University of Heidelberg

User

Label database

Medical website

Registered experts (medpics.org)


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Beyond peer-review: Social Medicine University of HeidelbergIndirect quality indicators

  • “Cybermetrics”: Web Citation Index (in analogy to the Science Citation Index) - http://webcite.net

  • Number of visitors (determined by an independent party)

  • User behavior and user demographics


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How to select (filter) “meta-tagged” information? Social Medicine University of Heidelberg

  • upstream-filtering

  • manual downstream-filtering

  • automatic downstream-filtering


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Upstream-Filtering (Review-Services, “Quality-Seals”) Social Medicine University of Heidelberg

  • centralistic approach

  • who judges the judges?

  • individual user needs?

  • enables misleading of consumers

  • dynamics of the Internet?

  • newsgroups, emails...?


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Manual Downstream-Filtering (Distribute quality criteria to consumers to enable own judgement)

  • dynamics of the Internet no problem

  • decentralized approach

  • does not really help to find high-quality information in the first place


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Automatic Downstream-Filtering (medPICS) consumers to enable own judgement)

  • user defines quality requirements, not a 3rd party

  • decentralized approach

  • meta-information can come from a 3rd party

  • meta-information automatically distributed

Filtering software


Labels l.jpg
“Labels” consumers to enable own judgement)

  • data structure containing (meta)information about a given document's contents.

  • syntax of PICS-conform labels is described in the specification document “PICS Label Distribution Label Syntax and Communication Protocols”

  • Content labels in an HTML (META-tags) or in HTTP header stream

  • Content labels available separately: client can request labels from a so-called "label bureau"


In practice 1 l.jpg
In practice (1) consumers to enable own judgement)

  • user loads the machine-readable rating system description (.rat) into his client software

  • from the electronic rating system description the client software generates a interface for the user to define certain quality requirements and/or to set their personal profile (for example stating that he is a “patient” living in the country “USA”)


In practice 2 l.jpg
In practice (2) consumers to enable own judgement)

  • the user defines several label services and label bureaus he trusts in and he wants to be checked (e.g. FDA, WHO, HON...)

  • endusers software will now automatically check at that label bureau(s) before/during accessing any webpage

  • depending on what the labels say, the filter may block access to that URL or display a disclaimer


Rating vocabulary 1 l.jpg
Rating vocabulary (1) consumers to enable own judgement)

can be divided into:

  • Descriptive labels

  • Evaluative labels


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Rating vocabulary: Descriptive consumers to enable own judgement)

  • Subject codes (UMLS CUIs)

  • Intended Audience

  • Investigational vs. Approved

  • Country

  • Educational vs. Promotional

  • Authors medical qualification

  • Internal quality control

  • Funding

  • Products needing a prescription


Rating vocabulary evaluative l.jpg
Rating vocabulary: Evaluative consumers to enable own judgement)

  • contents rating

  • source rating

  • distinction between original content and advertising

  • Authors' qualification stated

  • Funding, conflict of interest stated


Scale example l.jpg
Scale (example) consumers to enable own judgement)

  • 4: contains serious wrong or misleading information known to be false as fact or omittences, with potentially dangerous consequences

  • 3: contains some minor incorrectnesses or omittences without serious consequences

  • 2: contains no obvious errors

  • 1: excellent and up-to-date information, highly recommended


Medpics rating system description l.jpg
medPICS rating system description consumers to enable own judgement)

(category (transmit-as "med~a") (name "target-audience")

(min 0) (max 7) (label-only true) (multivalue true) (integer false)

(label

(name "kids")

(description "Easy-to-understand material appropiate and intended for kids as patients")

(value 1))


Example of medpics label l.jpg
Example of medPICS label consumers to enable own judgement)

<head>

<META http-equiv="PICS-Label" content='

(PICS-1.1 " http://medpics.org"

labels on "1997.11.05T08:15-0500"

until "1998.12.31T23:59-0000"

for "http://www.hepatitis-info.com"

by "G.E."

ratings (med~su 0019186 med~a 4:6 med~ay 2 med~t 4 med~e 3 med~q 2 med~r 2 med~f 1))

'>

</head>


Unit for cybermedicine at the department of clinical social medicine university of heidelberg83 l.jpg
”Unit for Cybermedicine” at the Department of Clinical Social Medicine University of Heidelberg

  • exploration and exploitation of the Internet for consumer health education, patient self-support, medical education and research

  • the evaluation of the quality of medical information on the Internet

  • studying the impact of the Internet on the patient-physician relationship and quality of health care

  • studying the use of global networking for evidence-based medicine.


Slide84 l.jpg

No Social Medicine University of Heidelbergtrespassing

Fig. 2a

Take two in the morning and don’t ask questions

Holy land

of the knowing

Hole of ignorance

physician

patient


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Fig. 2b Social Medicine University of Heidelberg

Let me educate* you

No trespassing

without professional

guidance

Holy land

of the knowing

*(ex ducere =to lead out)

Hole of ignorance

physician

patient


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No Social Medicine University of Heidelbergtrespassing

without professional

guidance

Fig. 2c

email

Self-support

WWW

physician

patient


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Fig. 2d Social Medicine University of Heidelberg

Welcome!

Watch your

step

Internet

patient

education

physician

patient


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Sinnvoll Social Medicine University of Heidelberg

  • Informationsrecherche für chronisch Kranke zu Alltagsfragen

  • Vernetzung mit Leidensgenossen in virtuellen Selbsthilfegruppen

  • Recherche nach neuen Forschungsergebnissen

  • Suche nach Experten (?)


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Problematisch Social Medicine University of Heidelberg

  • Arzneimittelbestellung im Internet unter Umgehung eines Arztes

  • Stellungnahme zu diagnostischen Fragestellungen, insbesondere in der Abwesenheit einer vorbestehenden Arzt-Patientenbeziehung


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Berufsordnung Social Medicine University of Heidelberg

  • § 7 Behandlungsgrundsätze und Verhaltensregeln

    • (...)

    • Der Arzt darf individuelle ärztliche Behandlung, insbesondere auch Beratung, weder ausschließlich brieflich noch in Zeitungen oder Zeitschriften noch ausschließlich über Kommunikationsmedien oder Computerkommunikationsnetze durchführen.


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Schweiz ( Social Medicine University of HeidelbergStandesordnung FMH)

  • Art. 7 ”Die regelmässige Behandlung allein aufgrund schriftlich, telefonisch oder elektronisch übermittelter Auskünfte oder Berichte von Drittpersonen ist mit einer gewissenhaften Berufsausübung unvereinbar.


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”Unit for Cybermedicine” at the Department of Clinical Social Medicine University of Heidelberg

  • exploration and exploitation of the Internet for consumer health education, patient self-support, medical education and research

  • the evaluation of the quality of medical information on the Internet

  • studying the impact of the Internet on the patient-physician relationship and quality of health care

  • studying the use of global networking for evidence-based medicine.


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Use of the Internet for EBM Social Medicine University of Heidelberg

  • Access to information for researchers (e.g. for systematic reviews)

  • Access to evidence-based information for physicians

  • Access to information for consumers


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Projekte Social Medicine University of Heidelberg

  • Consumer involvement for priority setting for systematic reviews (Cochrane Skin Group)

    • Questionnaire posted at http://dermis.net/cgi-bin/cochrane/question.htm

    • database on consumer questions (doc-quest)

  • „Narrative based medicine“ - Internet-based database on individual patient experiences (i-DIPEX)


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