assignment

Chapter 13
The Evolving ePatient
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Historical Background and Drivers of the ePatient Evolution
ePatient as a pioneering concept
Technology, policy, and legislative influences
Characteristics of early and contemporary online healthcare consumers

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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The term epatient has its origins long before the advent of the Internet. It was coined in 1975 by a physician to describe a patient who is Equipped, Enabled, Empowered, and Engaged.
A number of factors converged to propel the epatient movement including access to the Internet and simplified search capability; policy initiatives focused on safety and quality in healthcare; passage of legislation to encourage widespread adoption of electronic medical records and health care reform legislation calling for patient-centered care and comparative effectiveness research.
People seeking health information online were categorized by their health status. The Well, the Newly Diagnosed, and the Chronically Ill and their caregivers often exhibit information-seeking behaviors based on these health states.
Studies show that 71% of adults seek information, care, and support from healthcare professionals, reinforcing the importance of collaboration.
Contemporary epatients continue to be characterized by their health status as identified in early online healthcare consumers. However, the contemporary epatient has access to a more interactive Internet environment known as Health 2.0.
Activist epatients are increasingly invited to participate in conferences targeting health professionals.
New tools for tracking and monitoring personal health metrics have given rise to the quantified self-movement.
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ePatient as a Pioneering Concept
1960s: Computer-based, patient-driven medical interviews were conducted.
1975: Term epatient was coined.
1999: eHealth becomes a common term.
Today, eHealth remains a broad concept used to describe Internet or web-based activities that relate to healthcare, yet no consensus about the definition exists among researchers, policymakers, clinicians, or patients.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Technology, Policy, and Legislative Influences
Use of the Internet has had an unprecedented impact on access to information, sharing, and connectedness.
As of the first quarter of 2012, approximately 2.3 billion people worldwide were on the Internet, with nearly 8 new users being added every second.
Safety and quality flaws in the American healthcare system has led many to become vigilant advocates.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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World Internet Usage
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Figure 13-1 from text.
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Technology, Policy, and Legislative Influences (Cont.)
Patients should expect the following from their healthcare:
Beyond patient visits
Individualization
Control
Information
Science
Safety
Transparency
Anticipation
Value
Cooperation

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Characteristics of Early and Contemporary Online Healthcare Consumers
Well: Online needs are episodic and occasionally driven by the need to seek out specific information related to prevention and wellness.
Newly Diagnosed: Is driven by a sense of urgency to understand, manage, and mitigate a recent change in health status.
Chronically Ill: Aligns loyalty to sites with resources, services, and support for their specific condition.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Convergence of ePatient, Patient-Centered Models of Care, and Informatics
Patient-centered care model
Participatory healthcare characterized by patient-clinician collaboration
Evolution of healthcare informatics
Electronic health records (EHRs)
Personal health records
Transparency and access to data

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Participatory healthcare is characterized by meaningful patient-clinician collaboration
Health professionals involved in informatics should seek input from epatients in developing information technology innovations.
Clinicians may need new skills to integrate epatients and participatory medicine into their practice.
Adoption of Electronic Health Records and Personal Health Records.
Epatients will lead the way in demanding a healthcare system that includes patients as integral members of the healthcare team.
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Participatory Patient-Centered Healthcare
Berwick’s three maxims:
The needs of the patient come first.
Every patient is the only patient.
Nothing about me, without me.
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Discuss pros and cons of patients vs. providers direction healthcare.
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New Role of Clinicians and Informaticists in ePatient Care
New culture of partnership and “guided discovery” is emerging.
Clinicians may need to learn new skills.
ePatients look for willingness by understanding the value of online resources to epatients.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Health Informatics and ePatient
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Is the first national, standardized, public report of patients’ perspectives of their experiences with healthcare organizations and healthcare providers.
Patients Like Me: Is a research-based, online platform created for patients to share and learn from real-world experiences and to produce outcome-based health data for advancing the current pace of research.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Personal Health Records, Transparency, and Access to Data
Some physicians believe in the tangible benefits of sharing notes with patients.
Concerns of others include:
Increased demands on time
Lengthier office visits
Inability to be candid in office notes
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Who owns a patient’s data?
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Evolution of Health 2.0
and Beyond
eHealth matures in the Health 2.0 environment
Health 2.0 and virtual patient communities

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Ehealth remains a broad concept used to describe Internet or web-based activities that relate to health care.
The seven themes of Health 2.0 include: Web 2.0/technology, patients, professionals, social networking, health information/content, collaboration, and change of health care.
Digital divide exists in Internet accessibility despite the proliferation of technology across all aspects of society.
Patient-focused virtual communities are environments where patients interact, freely share health-related data and learn from each other’s experiences while unbounded by geographic limitations, social stigmas or other limiting characteristics.
Patients should consider both the benefits and risks of virtual online communities
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Health 2.0 Environment
Dynamic and interactive environment of Web 2.0 within which collective intelligence is harnessed
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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How does Health 2.0 differ from Health 1.0?
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Health 2.0 and the Creation
of Virtual Patient Communities
Patients interact, freely share health-related data, and learn from each other’s experiences while being unbounded by geographic limitations, social stigmas, or other limiting characteristics.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Health 2.0 and the Creation of Virtual Patient Communities (Cont.)
PatientsLikeMe
iVillage
CafeMom
Baby Center
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Patient and Caregiver Journey
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Figure 13-2

Chaordic
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Figure 13-3 from text.
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Future Directions: Moving toward Health 3.0
Web 1.0 was similar to a library where loads of information could be accessed but where nothing could be contributed.
Web 2.0 has more of a community feel where groups can gather and exchange information.
What might Web 3.0 bring about?
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