E-Health Care Information Systems: An Introduction for Students and Professionals

by Joseph Tan (Editor)

Overview

E-Health Care Information Systems is a comprehensive collection written by leading experts from a range of disciplines including medicine, health sciences, engineering, business information systems, general science, and computing technology. This easily followed text provides a theoretical framework with sound methodological approaches and is filled with numerous case examples. Topics include e-health records, e-public information systems, e-network and surveys, general and specific applications of e-health such as e-rehabilitation, e-medicine, e-homecare, e-diagnosis support systems, and e-health intelligence. E-Health Care Information Systems also covers strategies in e-health care technology management, e-security issues, and the impacts of e-technologies. In addition, this book reviews new and emerging technologies such as mobile health, virtual reality and nanotechnology, and harnessing the power of e-technologies for real-world applications.

Product Details

ISBN-13:	9781118425770
Publisher:	Wiley
Publication date:	05/02/2005
Pages:	624
Product dimensions:	0.39(w) x 0.39(h) x 0.39(d)

About the Author

Joseph Tan, Ph.D., currently on leave from the University of British Columbia, is professor and head of the Information System and Manufacturing Department at Wayne State University. He serves as guest editor and editorial board member for various journals and sits on key organizing committees for local, national, and international meetings and conferences. Tan’s research—which has enjoyed significant support from local, national, and international funding agencies and other sources—has been widely cited and applied across a number of major disciplines, including health care informatics and clinical decision support, health technology management research, human processing of graphical representations, ergonomics, health administration education, telehealth, mobile health, and e-health promotion programming.

Read an Excerpt

E-Health Care Information Systems

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By Joseph Tan

John Wiley & Sons

ISBN: 0-7879-6618-5

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Chapter One

E-HEALTH

The Next Health Care Frontier

Joseph Tan

I. Learning Objectives II. Introduction III. Foundations and Benefits of E-Health A. Basic Components of an E-Health System B. E-Health Core Value Propositions IV. E-Health Domains and Applications A. E-Health History B. Domains of E-Health Applications V. E-Health Strategies and Impacts A. Planning E-Health Strategies B. E-Health Implementation and Evaluation Issues C. E-Health Impacts VI. Conclusion VII. Chapter Questions VIII. References IX. The Telebaby(r) Case

Learning Objectives

1. Articulate the emergence of revolutionary thinking in the e-health paradigm, business models, and practices

2. Identify basic components of an e-health care system

3. Recognize the underlying value propositions of an e-health care system

4. Understand the history of computing in health care and recognize how this process relates to the evolution of the e-health paradigm

5. Organize the range of current and emerging e-health care applications according to whether they require a high degree of internal integration or a high degree of external integration

6. Understand the scope of e-health care strategies and impacts

Introduction

The application and use of machines and computer-based technologies in health care have undergone an evolutionary process. Advances in information, telecommunication, and network technologies have led to the emergence of a revolutionary new paradigm for health care that some refer to as e-health. New experience and knowledge that crosses traditional disciplinary boundaries-particularly cross-disciplinary and multidisciplinary research in the fields of information technology and health care, along with emerging knowledge to promote evidence-based medicine (evidence-based medicine is discussed in the Case section of Chapter Thirteen), e-medicine, and remote e-health services-are causing not just episodic but systemic transformation of traditional health care systems and environments. Applications of electronic commerce (e-commerce) and electronic business (e-business) concepts to health care have resulted in efforts to use the availability of low-cost, high-speed Internet-related or wireless technology to revolutionize the health care business.

Health care administrators, clinicians, researchers, vendors, purchasers, and other health practitioners are facing increasing pressure to adapt to growing expectations for accountability from both the public and the private sector (see Chapter Sixteen). Major sources of this pressure include decreased government and third-party funding; increased patient education, participation, and expectations; and new and emerging forms of health organization reporting structures as well as breakthroughs in telecommunication and networking technologies. The simultaneous need for and technological opportunity to create more efficient, effective, secure, and economical health data sharing; large-scale health information processing; better and more effective communications; and seamlessly coordinated health knowledge management, data mining, and evidence-based health decision making demands a concerted effort to harness the power of e-technologies in the service of health care.

Those who understand electronic health (e-health) perspectives, domains, and challenges, as well as the potential benefits of e-health applications will be better prepared to work collaboratively through the use of computer-based groupware, virtual networks, and Internet appliances. E-health understanding will increase health awareness, improve decision-making effectiveness, cultivate more positive consumer-provider relationships, and enhance the partnership of e-health care product and service delivery networks. In addition, rapid shifts in the e-health market and environment also dictate a growing need for improved ergonomics and more intelligent interfaces in e-public health data systems and e-decision support applications and implementations.

E-health can be viewed as an integrated, multidisciplinary field, bridging the following key areas:

Strategic health systems planning and e-marketing concepts

Specialized e-record keeping and e-business operational analysis

All forms of e-medicine linking health professionals to individuals

Corporate and enterprisewide health technology management

E-technologies encompass the following:

Complex information technology network design and methodologies for consumer-oriented system development

E-health informatics (information sciences and methodologies)

Wireless communications and emerging technological applications

Web services implementation

Ongoing evaluation of automated security of Web-based health information exchange

Clinical monitoring and management systems

Three general topics characterize the eclectic field of e-health: (1) e-health foundations and benefits; (2) e-health domains and applications; and (3) e-health strategies and impacts.

Before discussing the e-health foundations and benefits, I will first attempt to answer a very basic question: "Can e-health help solve North America's health care crisis, particularly in terms of key challenges such as escalating health care costs, access for the underserved, and improving (or even maintaining) the quality of current health care service delivery?" Answers to parts of this question have remained unclear; e-health has sometimes been described as hype that may not make any appreciable difference in resolving current challenges. Thus, continuing investments and efforts that encourage investors, vendors, and purchasers to pursue e-health initiatives may well be limited by the lack of coordinated effort to unlock the potential benefits and powerful promise of the e-health paradigm shift (e-health paradigm shift is more fully explored in the beginning of Chapter Two). Essentially, the underlying argument is such that if we cannot diffuse medical and health care data, information, knowledge, and expertise from the e-providers and experts to the e-consumers so that we empower them to new heights of health and well-being rather than perpetuate their relentless dependence on care providers to cure their everyday problems, e-health investment will be fruitless. Until a few years ago, the thought of e-consumer empowerment from health information therapies was still a remote, far-fetched possibility. How could consumers have more current and detailed medical information on hand about their own illness or predicaments than their family physicians? Perhaps our question should be "Has the time come for us to move e-health knowledge and practice from being largely hype to being a new and respectable field?"

Understanding the values and benefits of investing in the e-health field is therefore critical to the future success of e-health initiatives. In the next section, we discuss e-health perspectives, infrastructures, components, and services and relate these concepts to core e-health value propositions by focusing on how core e-health values can benefit e-health's investors as well as its users, enhancing or supporting complex e-health technologies and applications.

Later, we survey and highlight major aspects of e-health domains and applications. Specifically, we review e-health history to show how emerging domains of e-health applications are derived from our understanding of health management information systems (HMIS), health decision support systems (HDSS), health informatics, and e-medicine (also called telemedicine). Following this, we organize e-health application clusters, dividing domains and applications that provide seamless internal system process integration from domains and applications that provide external linkages with e-stakeholders and the public. Finally, we shift the discussion to the signifi- cance of e-health strategies and impacts and conclude the chapter by examining how these various topics can be combined to achieve an effective understanding of the e-health field and provide the basis for considering how e-health practices in the coming era may be affected by changing e-consumer needs, trends, and expectations.

FOUNDATIONS AND BENEFITS OF E-HEALTH

To grasp the fundamentals of e-health technology, it is necessary to recognize its diverse perspectives, as well as its basic infrastructures and components. Part Two of this book is devoted to the details of the foundations of e-health and covers various theoretical perspectives of the e-health paradigm as well as concentrates on the different network infrastructures that make e-health care delivery systems possible. In this chapter, we emphasize basic e-health components, including the core value propositions and the basic characteristics of the e-commerce services as applied to e-health care (for example, business-to-consumer [B2C] and business-to-business [B2B] e-health models), the e-stakeholders, and future e-health impacts. Without these basic components, the e-health paradigm shift would never have been possible and patients would always have to travel to their doctors instead of having the best health care information sources transported to their fingertips.

In fact, the e-health paradigm shift did not begin with the linking of e-consumers to the e-care providers; instead, its current success has been largely the result of linking one health care business to another, increasing efficiencies and eliminating the need for manual administrative information exchange and off-line business transactions. We therefore begin by discussing electronic data interchange (EDI) methods used in typical B2B e-commerce applications in health care and then move to examine the design of Web sites using HTML versus XML standards to provide e-consumers with specific or specialized health information and dynamic electronic data interchange capabilities.

Since the advent of e-commerce, EDI has offered companies a largely automated way to conduct business transactions. Business processes that once required significant human intervention are now being done efficiently and effortlessly with little or no human interaction required. EDI, the standard method for conducting B2B e-commerce applications, is therefore considered the traditional basic infrastructure for electronic data sharing and transaction activities among e-stakeholders-for example, between a health provider and a payer. The best way to understand EDI processing is to divide the flow of data into several phases in the context of a provider-payer transaction, as depicted in Figure 1.1.

As shown, the provider sends data about services and care rendered to a selected clearinghouse by either using a value-added network (VAN) as an intermediary or using point-to-point (P2P) connectivity.

A VAN essentially functions as a post office for EDI transactions. Users are assigned "mailboxes" that store their data. Each mailbox is given a unique identity (ID) or communication code, accompanied by a qualifier. Together, the ID and qualifier serve as an address to which data can be mapped. Once the data arrive at the clearinghouse, they are translated and reformatted to the payer's specifications. Many clearinghouses make it possible to check the validity and completeness of the document. From the provider's clearinghouse, data are then sent to the national clearinghouse via VAN. In essence, a clearinghouse provides connectivity between health care providers (physicians, hospitals, pharmacies, and clinics) and payers (health maintenance organizations, insurers, and government entities such as Medicare). Clearinghouses take claims, eligibility requests, claim status checks, and other information from providers in various formats, translate and reformat them according to the prespecified or standardized formats demanded by payers, and transmit the reformatted versions to their destination. As an additional service, the clearinghouses may perform editing functions that check the claims.

At the national clearinghouse, data are further cleansed, and precautions are taken to ensure that the security, privacy, and confidentiality of the data set are kept intact. The data are then received at the payer-selected clearinghouse via a VAN or P2P connection. Then, data are again translated and reformatted before being sent to the payer via a P2P connection or VAN. With P2P connection, all of the data interchange and formatting activities discussed with the use of a VAN are preplanned and data transmission is performed through a secured channel.

If the data exchange process simply provides static health information from health information systems and legacy databases, then the information dissemination process is straightforward. In this case, the Internet and the typical HTML (Hypertext Markup Language) offer a convenient platform via which the information can be predesigned, validated, and captured or presented as a user-friendly multimedia document as with a P2P connection. To improve the data's timeliness, validity, and integrity, the preferred data collection method is automated and direct data input at the source-for example, using predesigned documents stored in organizational intranets or extranets, then warehousing the completed documents either centrally or via on-line distributed network technology. Data direct entry requires that the acquired data be converted into easily readable and appealing user-oriented information.

While most current documents on the Web are stored and transmitted in HTML because it is easy to use and generate, the need for dynamic and interactive Web interfaces as opposed to static ones resulted in the World Wide Web Consortium's introduction of a new standard known as XML (eXtensible Markup Language). With XML, data or even documents can be simultaneously transformed into useful, meaningful, and interactive information in a format that is readily retrievable, comparable and transactional, where data can be used for exchanging dialogues and executing monetary payments. The data transfer and data distribution functions (that is, data retrieval and transmission activities) become integrated with those of presentation, exchange, and use. A key problem with HTML data display is its inability to provide information by transaction and querying capability for users as well as its inability to convert e-commerce data into e-business information that can be further used in transactions. In contrast, XML technology allows the creation of multimedia and intelligent graphical Web interfaces and thus has the ability to compact large amounts of information conveniently. The information can be further packaged to support individual users by filtering out information that may not be needed for a particular application or for a particular data exchange transaction. For example, on an HTML Web site where an e-consumer may be looking for a quick answer to a question about the extent of her individual health insurance coverage, the presented information may only be tabulated. However, with an XML Web site, the e-consumer can ask the question via e-mail in an open format (that is, no special format is needed for the query to be understood and processed) and receive a direct answer within twenty-four hours through the secured Web site. On the same site, a direct transaction may be executed within a short processing time. Quality displays and functionality of Web-based e-health services are important because e-consumers are more likely to visit and use a Web site if it is dynamic rather than static.

Three common forms of data management technology can support Web-based information processing and management for data-centered and, to a lesser degree, for document-centered Web sites.

Database management technology

Model-base management technology

Knowledge-base management technology

Database management enhances data collection and data storage activities, improves data integrity, reduces data update anomalies to ensure data consistency (see Tan, 2001), and promotes preservation and structuring of data for efficient data processing and effective data retrieval activities. Model-base management constructs, stores, manages, and interrelates models that may be needed by the user to make sense of the data being linked, analyzed, or computed. In fact, not all data collected are directly useful in the e-health care delivery or e-health information dissemination process. Some e-health information (including data elements and models) is collected merely to assist in the organization and generation of comparative data and statistics or simply for research purposes such as adding to the collection of data models and extending their applications.

(Continues...)

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Table of Contents

Tables, Figures, and Exhibits xi

Preface xv

Acknowledgments xix

The Editor xxi

The Contributors xxiii

PART ONE: E-HEALTH OVERVIEW 1

1 E-Health: The Next Health Care Frontier 3
Joseph Tan

The Telebaby Case 27
Ronald Spanjers, Anne F. Rutkowski

2 E-Health Vision: Drivers of and Barriers to E-Health Care 37
Joseph Tan

Cyber-Angel: The E-Robin Hood Case 52
Joseph Tan, Joshia Tan

PART TWO: E-HEALTH FOUNDATIONS 57

3 E-Health Perspectives: General Systems Concepts, Chaos and String Theories, and Social Science Thinking 59
Joseph Tan

Multicommunity E-Health Promotion Programming Case 82
Joseph Tan

4 E-Health Records: The Lifeblood of E-Health Care 91
Joseph Tan

E-Primary Health Care and E-Health Records Cases 116
Penny Grubb

5 E-Public Health Information Systems: E-Technologies for Public Health Preparedness and Surveillance 127
Joseph Tan, Francisco G. Soto Mas, C. Ed Hsu

E-Profiling of Community Health Performance Indicators Case 155
Lee Kallenbach, Joseph Tan

6 E-Networking: The Backbone of E-Health Care 163
Joseph Tan, Winnie Cheng

Mobile Health Networks Case: Unconfined Mobile Bluetooth Technology for E-Medical Services 190
Qiang Cheng, Huyu Qu, Yingge Wang, Joseph Tan

PART THREE: E-HEALTH DOMAINS AND APPLICATIONS 201

7 E-Health Domains: Surveying the E-Health Landscape: Cases and Applications 203
Pam Forducey, Kawaljeet Kaur, Cynthia Scheideman-Miller, Joseph Tan

E-Speech Therapy for Children in a Rural Oklahoma School Case 224
Cynthia Scheideman-Miller, Pam Forducey, Sharon S. Smeltzer, Avery Clouds, Bob Hodge, David Prouvéty

8 Diffusion of E-Medicine: E-Medicine in Developed and Developing Countries 231
Joseph Tan, Mengistu Kifle, Victor Mbarika, Chitu Okoli

E-Medicine Development in Taiwan Case 260
Paul Jen-Hwa Hu, Chih-Ping Wei, Tsang-Hsiang Cheng, Joseph Tan

9 E-Home Care: Rejuvenating Home Health Care and Tele–Home Care 267
George Demiris, Joseph Tan

The OliverHome Case 290
Joseph Tan, George Demiris, Joshia Tan

10 E-Diagnosis Support Systems: An E-DSS for Lower Back Pain 295
Lin Lin, Paul Jen-Hwa Hu, Olivia R. Liu Sheng, Joseph Tan

Teleradiology Case: Present and Future 321
Yao Y. Shieh, Mason Shieh

11 E-Health Intelligence: A Multiple-Level Clustering Approach for E-Health Data Mining 330
Chih-Ping Wei, Paul Jen-Hwa Hu, Liang-Ming Kung, Joseph Tan

E-Patient Image Retrieval Case: Incremental Neural Net Learning 352
Lin Lin, Olivia R. Liu Sheng, Chih-Ping Wei, Paul Jen-Hwa Hu, Joseph Tan

PART FOUR: E-HEALTH STRATEGIES AND IMPACTS 363

12 E-Health Strategies: Reshaping the Traditional Health Care System 365
H. Joseph Wen, Joseph Tan

E-Health Technology Strategies and Impacts Case 396
Jung P. Shim, William E. Sorrells

13 E-Health Care Technology Management: A Multifactorial Model for Harnessing E-Technologies 406
George Eisler, Sam Sheps, Joseph Tan

Evidence-Based Medicine Case 439
Barry P. Markovitz

14 E-Security: Frameworks for Privacy and Security in E-Health Data Integration and Aggregation 450
Joseph Tan, Patrick Hung

Integrated Selective Encryption and Data Embedding for Medical Images Case 479
Qiang Cheng, Yingge Wang, Joseph Tan

15 E-Health Impacts on the Health Care and Health Services Industry: Surfing the Powerful Waves of E-Technologies 489
Joseph Tan, David C. Yen, Sharline Martin, Binshan Lin

E-Communities Case: Scalability Challenges in Information Management 515
Harris Wu, Joseph Tan, Weiguo Fan

PART FIVE: E-HEALTH PROSPECTS 521

16 E-Health Prospects: Mobile Health, Virtual Reality, and Consumer-Driven E-Health Systems 523
Joseph Tan

Virtual Reality Case 547
Joseph Tan, Pency Tsai

Name Index 554

Subject Index 562

What People are Saying About This

From the Publisher

"E-Health Care Information Systems is essential reading for those who are interested in learning about a vision for e-health, its foundational perspectives, applications, and strategies in this time of e-health paradigm shift."
—In Lee, editor-in-chief, International Journal of E-Business Research

"Understanding the power of the Internet is absolutely necessary for any business to operate in the world today. Joseph Tan presents a very complete and comprehensive picture of the world of e-health and its uses in the health care field. E-Health Care Information Systems is an excellent source of information that provides a platform for both the student and the health care professional in today’s environment."
—David Thompson, chief information officer, Borgess Health Alliance

"Joseph Tan’s emphasis on the significance of e-health puts health care providers on notice that technology is a force to befriend in delivering sound medical care in the 21^st century! A must-read for all of us committed to providing the best care for those we love."
—Tony Fama, president, Maria Madeline Project, Inc.

"As a result of the explosion of Internet usage by the general public over the past few years, most consumers have begun to shift their focus to self-empowerment in all aspects of their daily lives. With his new book, Dr. Tan effectively delves into this new arena of providing health care applications through the Internet."
—Greg Bowerbank, senior consultant, Information Builders Incorporated

Editorial Reviews

Reviewer: David M. Liebovitz, MD (University of Chicago Medicine)
Description: This book provides a reference for understanding the motivations, design techniques, and scientific constructs behind implementing selected modern information management approaches in healthcare. Examples of implementation and electronic dissemination in different environments are included.
Purpose: The purpose is to provide a comprehensive text on e-technologies in healthcare for students in a variety of healthcare disciplines. This book serves as an important contribution in terms of facilitating understanding of important design considerations and the varied environments of ongoing e-healthcare implementations. The objectives are met.
Audience: The book is written for students in a variety of healthcare related disciplines according to the author. This is an appropriate audience, however, emphasizing the best match between students of population health and epidemiology and health services research; areas that were included among many others in the preface. The author is a credible authority.
Features: The book covers many perspectives in e-healthcare systems and applications. Specifically, motivating factors leading to system development and examples are included such as remote interaction with specialized clinical scenarios. Use of decision support, including some rigorous design approaches, is discussed. The impact of e-health care in larger contexts is also discussed. A nice summary of all tables and figures is included at the beginning and serves as an easy tool for later referencing. A minor shortcoming is the frequent use of the "e-" prefix where this would likely be understood from the context.
Assessment: This book provides snapshots from the perspective of design and implementation for many aspects of electronic health information. As such, together with focused clinical examples, it is useful to students who have health information systems curricula.

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