Tomorrow's leaders in health promotion are being educated at American University today.

  Corporate Health Informatics

Some thoughts

Health and medical practitioners are using a variety of techniques to help clients, patients, and the general public improve their health and quality of life. An array of approaches including health education, personal and group counseling and training sessions, motivational techniques, skill development courses, individual and mass communication campaigns, and creating multiple levels of support structures are among the traditional approaches that are being used to help individuals and groups adopt healthier life habits and behaviors, reduce risk, and increase compliance to treatment regimes. Recently, health promotion and healthcare providers have become increasingly aware of the power and potential of trechnology as a delivery and enabling mechanism to increase the effectiveness of their programs.

Some of these programs are being integrated into tradional health promotion programming. Several providers and vendors are offering new services that take advantage of some of the latest technological advances. A variety of options for web-based and on-line systems for health education, awareness, and access to information have been created. Some use tracking systems or questionnaires to evaluate the success of the programs on health-related outcomes measures.

A few innovative companies and providers are exploring the use of some of the more advanced computing techniques such as expert systems, artificial intelligence, data mining, and profiling. For example, tailoring uses profiling tools and techniques to match the intervention to the unique characteristics of each individual or target group. The results of tailored applications have been much more effective than the traditional "shotgun" approaches. However, "tailoring" requires a shift to a "customer-centric" approach. Data about the needs, preferences, and environment of the user must be collected. Finally, the process must be iterative and dynamic.

The revolutions in computing and telecommunications sectors have made it possible to use the enabling power and flexibility of the technology to allow health practitioners to tailor programs and interventions to users "one-to-one, a million at a time. The new health technologies such as on-line programs are being used facilitate the wellness movement. However, unfortunately few programs are collecting outcomes measures to verify the efficacy of the models or compliance with health enhancing programs.

A list of theorists and visionaries who have pioneered in the application of health promotion to informatic systems provided below. Much of the work cited below is based on the work of several prominent theorist including Albert Bandura, Martin Fishbein, Icek Azjen, James Prochaska, Carlos DiClemte and Victor Strecher.

This list will be updated from time to time. If you have other sources, please send them to me.

References:

Books and references

Brown, M. S. (1997, March 4). Consumer Health & Medical Information on the Internet: Supply and Demand. Internet: http://etrg.findsvp.com/health/mkginfo.html: Find/SVP.

Find/SVP is one of the best consulting companies who do in-depth analysis of trends and publish reports for businesses in the industry. This report looks that the convergence of two industry revolutions; technology and health care. The focus is on the supply side of the market. The report has a variety of Internet statistics and trends, consumer interests, and demographics and user profile information. The report concludes that there is a large and expanding market for health information among consumers. Consumer concerns include privacy, security, and confidentiality.

Chamberlain, M. (1994, November). New Technologies in Health Communication: Progress or Panacea? American Behavioral Scientist, 38(2), 271-284.

Chamberlain discusses the impact of the emerging technologies on how health communications is designed and delivered. He provides a good review of many of the latest technologies that can be used in health communications campaigns. He includes his interpretation of technologies in the context of the Diffusion of Innovations theories Toffler's Third Wave, and McLuhan (the medium is the message) where mechanomorphism or the mixing in of the computer into the message.

Collins, M. A. (1995). A History of Medical Informatics in the United States. Bethseda, Maryland: American Medical Informatics Association.

The author gives a comprehensive overview of the evolution of medical informatics. In the 1950's it was referred to as bioengineering. In the 1970's it came to represent the broad field of computers, communications, information science, engineering, and technology as applied to medical practice, research, and education. In 1976 the Oxford English dictionary defined informatics as the discpline of science information, as well as the regularities of science information activitiy, its theory, history, methodology and organization. Random House in 1987 defines it as "the study of information processing:.

Ernst & Young LLP et al. (1996, March). The Role of The Internet in Health Care: Framework. Internet: http://www.hccybervision.com/monographs.html.

This thorough report is part of the Health Care Cybervision series. The authors discuss the potential, implications, and impact of technology on health care. Technology should be part of the "health value-chain". They list 11 factors that influence the trends in health care technology. They also discuss some of the barriers identified through their surveying process. Health promotion concepts and managed care is the basis of the paradigm shift. Parity is one of the advantages of smaller companies using the Internet (no one knows you're a dog). "The consensus of the industry is that, as of 1995, the Internet has reached a critical mass in both content and number of users." A website is almost as common as a fax number. Customers are much more self-directed now.

Harris, L. M., Henderson, J., Gorry, T., Silverman, B. et al. (1995). Health and the New Media : technologies transforming personal and public health. Mahwah, N.J: Lawrence Erlbaum Associates.

A superb collection of articles by the top authorities in the field relating to the issues and applications of the new media. Chapters by Chris Dede, J. Michael McGinnis, Kevin Patrick, Mary Jo Deering, and other luminaries are included. The forward is by C. Everett Koop and Mike McDonald. This book sprang from a Forum on Interactive Multimedia and Health Care, held November 1992 in Washington, D.C.

Jimison, H. B., Sher, P. P. et al. (1995, December). Consumer Health Informatics: Health Information Technology for Consumers. Journal of the American Society of Information Science, 46(10), 783-790.

This article provides much of the basic information about the various types of technology available for consumers in health. The authors present several of the programs, applications, and some systems that are available. They identify behavior change, literacy, empowerment and self-efficacy, usefulness, and decision support for patients as the most important research-related issues.

Kemper, D. W., Loring, K., Mettler, M. et al. (1993). The Effectiveness of Medical Self-Care Interventions: A Focus on Self-Initiated Responses to Symptoms. Patient Education and Counseling, 21, 29-39.

The authors summarize the literature on studies that deal with self-care for medical conditions. They assert, "approximately 80 percent of all health care involves problems treated at home." Four types of self-care activities are identified: regulatory, preventative, reactive, and restorative. They cite six studies from several countries and provide evidence for efficacy of self-care approaches to health care. They also summarize the shortcomings of the studies.

Kieschnick, T., Adler, L., Jimison, H. et al. (1996). 1996 Health Informatics Directory : A Resource Guide for the Use of

Computers in Patient Education, Health Promotion, and Informed Patient Decision Making. Baltimore, MD: Williams & Wilkins.

A compendium of 400 interactive health technology software titles. The authors have provided a matrix for comparison of the various types of software programs available. The first three chapters include a review of the literature and include an excellent discussion of some of the critical issues for developers and consumers.

Sosa-Iudicissa, M. C., Oliveri, N. et al. (1997). Internet, Telematics, and Health. Amsterdam, Holland: IOS Press.

This book is an excellent collection of articles, primarily with a global and medical perspective. Part of a series in conjunction with the International Medical Informatics Association and the Pan American Health Organization. George Alleyne, sees the work being done currently as a resource which will allow underdeveloped countries to bypass some of the difficult stages of technological evolution. He differentiates between the major divisions of telehealth. In three articles, Francis DeDumbal covers many of the limitations of computers as well as their prospects for the future. He also explains why physicians are reluctant to use computer technology. Sauer discusses the importance of context and information. Reinhoff covers the issues of importance of evaluation, user orientation, and the lack of realization of potential. Sandor, defines the interface and how it impacts on the users. Valles, discusses usability.

Street, Richard Gold, William, Manning, Timothy (Editors) (1997). Health Promotion and Interactive Technology : Theoretical Applications and Future Directions. Mawah, New Jersey: Lawrence Erlbaum Associates.

An excellent overview of the current state of health information technology. Many of the theoretical models provide an excellent framework from which to consider the efficacy and development of health technologies.

United States General Accounting Office. (1996). Consumer Health Informatics: Emerging Issues. Washington, D. C.: United States General Accounting Office.

An excellent summary of the issues for consumers and technology. Included in the report are summaries for the testimony of the 78 experts in the field who were interviewed.

Websites

This is not meant to be a comprehensive listing of all of the available programs or vendors. It is a representive collection of the ones that I know. Many of the offerings change frequently. More sites, vendors, and information will be added periodically.

Health Information/Education

Best of Health - on-line health education (Lifeline) http://www.lifelines.com/lifeline.html - Access for members only http://www.bestofhealth.com/

CHESS - University of Winconsin - information, education, and support - stand-alone and web modules (under development) http://chess.chsra.wisc.edu/Chess/

Health Enhancement Systems - information and materials plus HRA - WellStage - http://www.hesonline.com/survey.html

Health Partners - information and materials aiming at the HMO market http://www.healthpartners.com/

HealthWise - information and education - Community-wide intervention in Idaho http://www.healthwise.org/

Mayo HealthQuest information and education through the Mayo Clinic - http://mayohealthquest.org

Inelihealth - John Hopkins - information and education (members only)- http://www.intelihealth.com/IH/ihtIH

Kaiser Permente - KaiserPermente On-line - information and education http://www.kponline.org/

Prevent It - Mitretek (Under Development) - information and education http://hitiweb.mitretek.org/preventit/

Planet Health - Windom Health - health information and HRA Under Development)http://www.planet-health.com

Advanced Health Informatics - Tailoring/Expert Systems

American Heart Association - tailored messaging for heart-related conditions (Under Development) http://www.americanheart.org/

Global Medic - health and wellness with expert system linked through HRA http://www.globalmedic.com

Health"O"Vision - University of Michigan Cancer Prevention - interactive kiosks and website (under development) for tailored messaging based on the Stages of Change Model http://hov.arborlink.com/

InfoTech - information and education with some expert systems capabilities http://www.infotech-wellness.com/

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Last Updated: December 10, 2001