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Internet and Medicine: 10 years after

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

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Internet and Medicine: 10 years after

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  1. Internet and Medicine: 10 years after From the network's perspective Marc Nyssen Medical Informatics dept. Vrije Universiteit Brussel Belgium

  2. 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

  3. 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

  4. 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

  5. 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

  6. Technology 10 years ago: first web browsers (mosaic, ...) • No tables • No frames • No javascript • No Java ...

  7. 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)

  8. Institutes • Authoritative centers • Karolinska Institute • NIH • DG Information Society Unit C4: eHealth • Medline (pubmed, medlineplus) • Several others

  9. Institutes • Karolinska Institute • Institut Pasteur

  10. Institutes • DG Information Society Unit C4: eHealth

  11. Institutes • Medlineplus

  12. Institutes Pubmed

  13. Portal sites • Medical portals After the Internet bubble ... just a few examples • Medscape • Medwebplus • Medical Martix • Promedmail

  14. Portal sites Medscape

  15. Portal sites Medwebplus

  16. Portal sites Medical matrix

  17. Portal sites Promedmail (Jack Goodall)

  18. Portal sites EHTO

  19. Societies Societies

  20. Societies Conferences

  21. Publications Journals • IEEE TITB (2003-) • Electronic Healthcare (2001-)

  22. Publications Journals

  23. Publications • On-line

  24. Publications pubmed searches on “Internet AND medicine”

  25. Ethics • HON (Healtcare On the Net) http://www.hon.ch • Internet Healtcare Coalition http://www.ihealthcoalition.org

  26. 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

  27. Medical profession • General Practitionner • Hospitals • Specialists • Para-medics • From “cards” to servers • Large nationwide projects

  28. 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

  29. 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?

  30. Medical profession Specialists • Very different needs • Common: “patient administration” • Financial administration + reporting • Mini-clinics and group practices

  31. 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

  32. 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

  33. 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

  34. Medical profession Nationwide projects (amongst many others) • Hygeia Crete

  35. Medical profession Nationwide projects (amongst many others) • Keneya Blown (vestibule de la santė) Mali

  36. Schools/universities • E-learning • Computer literacy • E-health programs • Master after master “management of health data” • Need for an European master program in eHealth?

  37. Standards bodies • Internet Society (IETF) • WWW Consortium • CEN • HL7 • IEEE

  38. 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?)

  39. 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

  40. Patients/public Useful health tricks

  41. Patients/public Distance pharmacy

  42. Patients/public New medication:

  43. Patients/public Distance education/certification: effortless diploma

  44. Patients/public Finally widely available to the public at large missing: “super portal” combining all of these!

  45. Patients/public Informative sites: patients are most concerned!

  46. 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?

  47. 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)

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