Assessing Health Consumerism on the Web: A Demographic Profile of Information-Seeking Behaviors

The growing diversity of the online health information community is increasingly cited as a limiting factor related to the potential of the Internet as an effective health communication channel and information resource. Public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a “Digital Divide,” presents a like problem specific to health care consumers. Access to information, however, is an essential part of the consumer-centric framework outlined in the recently proposed U.S. National Health Information Infrastructure (NHII) and Health Architecture initiatives. To date little research has been done to differentiate the types of health information sought on the Web by different subgroups, linking user characteristics and health-seeking behaviors. Data from a study of consumer Web search activity in a post-intervention era serves as a natural experiment, and can identify whether a “digitally underserved group” persists in the United States. Such an environment would serve to exclude traditionally underserved groups from the benefits of the planned national heath information infrastructure. This exploratory technology assessment study seeks to differentiate and delineate specific behaviors, or lack of desired behaviors, across targeted health care subgroups. Doing so allows the design of more effective strategies to promote the use of the Web as a health education and health promotion tool, under the envisioned shared decision-making, consumer-centric health information model.     

Racial disparities in health information access: resilience of the digital divide

Policy initiatives of the late 1990s were believed to have largely eliminated the information “Digital Divide.” For healthcare consumers, access to information is an essential part of the consumer-centric framework outlined in the recently proposed national health information initiative. This study sought to examine how racial/ethnic characteristics are associated with Internet use and online health information. Using a cross-sectional nationwide study of reported Internet use and information search in 2000 and 2002, we studied a stratified sample of computer users from the Pew Internet & American Life Project surveys. Adjusted estimates of race/ethnicity and income effects on Internet use and search behaviors were derived from generalized estimating equations. Results show wide gaps in the use of computers between Hispanics and Whites (OR = 0.593 [0.440, 0.798]) and between African-Americans and Whites (OR = 0.554 [0.427, 0.720]) in 2000 significantly narrowed in 2002 (OR of Hispanic to white = 1.250 [0.874, 1.789]; OR of African-American to Whites = (0.793 [0.551, 1.141]). Gaps in access to the Internet, however, remained consistent between 2000–2002. Differences in health information seeking between Hispanics and Whites existed in both 2000 and 2002. 56% of White Internet users at some time searched for online health information, whereas 42% of Hispanic Internet users did so in 2000. By 2002, these percentages had increased to 13.4 and 15.8%, respectively. Data highlight the persistence of “Digitally Underserved Groups,” despite recent Divide reduction strategies.     

The Adoption of Mobile Health Management Services: An Empirical Study

As their populations age, many countries are facing the increasing economic pressure of providing healthcare to their people. In Taiwan, this problem is exacerbated by an increasing rate of obesity and obesity-related conditions. Encouraging the adoption of personal health management services is one way to maintain current levels of personal health and to efficiently manage the distribution of healthcare resources. This study introduces Mobile Health Management Services (MHMS) and employs the Technology Acceptance Model (TAM) to explore the intention of students in Executive Master of Business Management programs to adopt mobile health management technology. Partial least squares (PLS) was used to analyze the collected data, and the results revealed that “perceived usefulness” and “attitude” significantly affected the behavioral intention of adopting MHMS. Both “perceived ease of use” and “perceived usefulness,” significantly affected “attitude,” and “perceived ease of use” significantly affected “perceived usefulness” as well. The results also show that the determinants of intention toward MHMS differed with age; young adults had higher intention to adopt MHMS to manage their personal health. Therefore, relevant governmental agencies may profitably promote the management of personal health among this population. Successful promotion of personal health management will contribute to increases in both the level of general health and the efficient management of healthcare resources.     

Short-term impact of cognition-motivation-emotional intelligence-resistance skills program on drug use prevention for school students in Wuhan,China

Drug abuse continues to be a serious public health threat worldwide.Most drug abuse prevention research has been conducted with predominantly American or European adolescent populations.Little is known about approaches that work best to prevent the initiation of Chinese adolescent drug use.For targeting risk factors of drug initiation in Chinese adolescents,a school-based health intervention program named "Cognition-Motivation-Emotional IntelligenceResistance Skills" (CMER) was developed to enhance cognition upon drug use,to decrease motivation of drug use and to improve emotional adjusting and drug resistance skills in this study.A total of 798 students from 3 senior high schools in Wuhan,a city in central China,were assigned randomly to intervention and control groups.The intervention group received the CMER program in which knowledge,development of positive attitude and motivation towards drugs and training of peer resistance skills were basic elements.The immediate impact was compared by measuring the above mentioned elements prior to and three-month after the training session.Students from both groups were asked to complete a self-administered questionnaire.The questionnaire included demographic items,self-reported drug use behavior,cognition,attitude,and motivation associated with the initiation of drug use and resistance skills.Three months after the intervention,significant effects were found on "illegal substance use at least once" (P<0.05) between the intervention and control groups.Immediate effects of the intervention were also found on knowledge,motivation and peer resistance skills (P<0.05),but there was no clear evidence for any effects on attitude towards substance use (P>0.05).It was concluded that the CMER program,which significantly increased the knowledge of drugs and peer resistance skills,was effective in the drug abuse prevention in a sample of school students in Wuhan,China.     

e-Consent: The Design and Implementation of Consumer Consent Mechanisms in an Electronic Environment

The effective coordination of health care relies on communication of confidential information about consumers between different health and community care services. However, consumers must be able to give or withhold “e-Consent” to those who wish to access their electronic health information. There are several possible forms for e-Consent. In the general consent model, a patient provides blanket consent for access to his or her information by an organization for all future information requests. Conversely, general denial explicitly denies consent for information to be used in future circumstances, and in each new episode of care, a new consent would be needed to obtain information. In the general consent with specific denial model, a patient attaches specific exclusion conditions to his or her general approval to future accesses. In contrast, in the general denial with explicit consent model, a patient issues a blanket block on all future accesses but allows the inclusion of future use under specified conditions. There also are several alternative functions for an e-Consent system. Consent could be captured as a matter of legal record. E-Consent systems could be more active by prompting clinicians to indicate that they have noted consent conditions before they access a record. Finally, the record of patient consent could be fully active and used as a gatekeeper in a distributed information environment. There probably will need to be some form of data object that is associated with patient information. This e-Consent object (or e-Co) will contain the specific conditions under which the data to which it is attached can be retrieved. Given the complexity of clinical work and the substantial variation we can expect in an individual''s desire to make his or her personal medical details available, it is unlikely a “one size fits all” approach to e-Consent will work. Consequently, with a well-chosen consent design, it should be possible to balance the specific need for privacy of some of the population against the desire by others to err on the side of clinical safety, and clinicians desire to minimize the burden that an electronic consent mechanism would impose.The effective coordination of health care relies on the communication of confidential information about consumers between different health and community care services. Electronic data exchange and Internet technologies increasingly play important roles in such communications. Consumers must, however, be able to give or withhold consent to those who wish to access their electronic health information.For example, electronic patient records are seen by many as an essential prerequisite for health care,¹ opening up patient data to the whole clinical team involved in patient care. So, by definition, the presence of an electronic environment means that more clinical workers will be able to access patient information more often and in a greater diversity of locations. With the broadening of access to patient information comes the risks that such information is used for purposes not originally consented to by the patient.While much is known about the ways in which security technology can protect information transactions from unwanted interception,² very little work exists to determine how a consumer''s consent to view their private information is safeguarded in a networked and online environment. This report will outline a framework for obtaining and determining electronic consent (e-Consent) within health care. It will examine a range of models for e-Consent and examine some of the technical issues associated with transforming those models into working systems. It is not the intention of this report to make a specific judgment about which consent models are more acceptable or to make specific recommendations about the detailed implementation of an e-Consent system. Such decisions would need to reflect the legal framework within which any e-Consent system operates, and the expressed wishes of consumers regarding the strength of protection they desire.Specifically, the report proposes a set of basic design principles that any consent framework might need to adhere to and focuses on some of the trade-offs in system performance that these principles imply. It then examines various possible forms of consent, explores the ways that these can be implemented in an online environment, and examines how well these models reflect the design principles. Next, the report explores the nature of information exchanges in health care and uses this to reflect on the acceptability of the different consent mechanisms in the clinical workplace, as well as to consumers. Finally, the report develops a health transaction model and uses this to sketch the set of behaviors or services an e-Consent system will need to perform its key functions. Appendices contain detailed examples of information transactions in health and an example set of computational rules for determining consent.     

Characterizing Cancer Information Systems

The objective is to determine the extent to which information systems (IS) for cancer are unique and necessary. Via an analysis of Medical Subject Headings used to index relevant literature and other bibliometric techniques, cancer IS are compared and contrasted with IS of other specialties. Cancer IS are relatively little discussed and primarily connect radiation equipment with the radiation oncology staff. By contrast, clinical laboratory and radiology IS are frequently discussed and connect specialized equipment to the hospital. A “Specialty Need” model accounts for these patterns and says that the “need for a specialty IS” is proportional to the “uniqueness of the specialty tools” plus the “degree to which the information from those tools is needed throughout the particular health care entity.”     

The Evaluation of Psychopharmacological Enhancers Beyond a Normative “Natural”–“Artificial” Dichotomy

The extra-therapeutic use of psychotropic drugs to improve cognition and to enhance mood has been the subject of controversial discussion in bioethics, in medicine but also in public for many years. Concerns over a liberal dealing with pharmacological enhancers are raised not only from a biomedical–pharmacological perspective, but particularly from an ethical one. Within these ethical concerns, there is one objection about the normative differentiation between “natural” and “artificial” enhancers, which is theoretically indeed widely discredited in bioethics, which has, however, entrenched itself in such a persistent way in everyday moral consciousness that it keeps a crucial influence on the assessment of pharmacological enhancers made by the public and medical professionals. This paper tries to first show why a normative differentiation between “natural” and “artificial” enhancers is highly problematic. In a second step, the resulting implications for our current dealing with pharmacological enhancers shall be examined. In a specific comparison of synthetic pharmaceuticals (modafinil, SSRIs) with phytopharmaceuticals (ginkgo biloba, St. John’s wort) and other already established enhancers (alcohol, caffeine), argumentative inconsistencies are pointed out which, at least partly, result from a rationally untenable preference for the “natural” over the “artificial”. Therefore, it is conclusively argued the case for an unprejudiced assessment of pharmacological enhancers beyond a “natural”–“artificial” dichotomy, which equally takes into account biomedical and ethical aspects. The goal is to reach a coherent dealing with pharmacological enhancement in the long run.     

Organization’s Quality Maturity as a Vehicle for EHR Success

In health care industry, EHR has been advocated to improve care quality. The journey toward the development and adaptation of EHR should be holistic and integrate all the EHR’s building blocks-health record management, business process improvement (BPI), collaboration and innovation, change management, user governance, etc.—that are intertwined together as like the links of a chain to improve quality of health care services. These cornerstones that shares common features with quality principles will pave the way for implementing EHR. To go along with quality features and take advantage of quality principles namely “quality maturity” builds a solid foundation for adaptation of EHR. Therefore, the recent theories of EHR success go far beyond technical rationales and focus on organizational and managerial factors in quality improvement. The milestone of quality concept in information system success is revealed in Delone and Mclean’s model which launches system quality, information quality, service quality, as distinct elements of the IS success. EHR is a means to an end -to improve quality within enterprises- based on quality approaches. In this regards, more research should be conducted to investigate the relationship between of organization’s quality maturity and EHR development success.     

Developing Informatics Tools and Strategies for Consumer-centered Health Communication

As the emphasis on individuals'' active partnership in health care grows, so does the public''s need for effective, comprehensible consumer health resources. Consumer health informatics has the potential to provide frameworks and strategies for designing effective health communication tools that empower users and improve their health decisions. This article presents an overview of the consumer health informatics field, discusses promising approaches to supporting health communication, and identifies challenges plus direction for future research and development. The authors'' recommendations emphasize the need for drawing upon communication and social science theories of information behavior, reaching out to consumers via a range of traditional and novel formats, gaining better understanding of the public''s health information needs, and developing informatics solutions for tailoring resources to users'' needs and competencies. This article was written as a scholarly outreach and leadership project by members of the American Medical Informatics Association''s Consumer Health Informatics Working Group.     

DigiSwitch: A Device to Allow Older Adults to Monitor and Direct the Collection and Transmission of Health Information Collected at Home

Home monitoring represents an appealing alternative for older adults considering out-of-home long term care and an avenue for informal caregivers and health care providers to gain decision-critical information about an older adults’ health and well-being. However, privacy concerns about having 24/7 monitoring, especially video monitoring, in the home environment have been cited as a major barrier in the design of home monitoring systems. In this paper we describe the design and evaluation of “DigiSwitch”, a medical system designed to allow older adults to view information as it is collected about them and temporarily cease transmission of data for privacy reasons. Results from a series of iterative user studies suggest that control over the transmission of monitoring data from the home is helpful for maintaining user privacy. The studies demonstrate that older adults are able to use the DigiSwitch system to monitor and direct the collection and transmission of health information in their homes, providing these participants with a way to simultaneously maintain privacy and benefit from home monitoring technology.     

医院门诊药房与医院分离的理性探讨

介绍了医药分业的定义、国外医药分业的目的和少数医院无门诊药房的原因。指出门诊药房从医院分离出去弊大于利,认为门诊药房从医院分离,难以达到预期目的,反而有损于医疗卫生事业的公益性;医药分离削弱、甚至取消了医院对医师不当处方和合理药物治疗等医疗行为的行政和技术监管与干预;医药分离不适合我国的国情,不符合我国卫生体制改革的精神,不利于医疗质量的提高,不利于病人安全、有效、经济用药,不利于调动医院广大药学技术人员的积极性,不利于医院药物治疗管理自动化的实现与信息的传递。建议医药结合的模式必须加强;保留门诊药房,加大监督力度;建立药品配送中心,完善社会化物流机制;加速非处方药药品的发展;在条件成熟后实施处方调剂费;高薪养廉,较大幅度提高医师职业的收入;解决当前医疗体系中分配不合理问题,适当提高挂号、手术、诊疗等收费标准,降低药品收入在医院总收入中所占的比例。     

智能视频分析系统在防范药品差错中的初步构建

目的:药品差错存在于临床用药的各个环节,直接关系到患者的生命健康。利用人工智能技术,构建药品差错智能视频分析系统,保障临床用药安全。方法:根据视频监控,采用人工智能中的深度神经网络技术,实时分析识别监控视频中药品的名称、规格、剂型、厂家和数量,与HIS中处方/医嘱的药品信息进行对比,若有药品差错,实时报警提醒。结果:药品差错智能视频分析系统与医院HIS的处方/医嘱对接,适用于分析防范开具处方/医嘱后调剂、发药、配置和给药环节的药品差错。结论:基于人工智能的视频分析系统可防范临床药品差错,保障临床安全用药。