AUTHOR
Manuel Sanromà and Joan M. Adserà
ABSTRACT
E-Health, this is healthcare practice supported by electronic processes and communication, has become a commonplace, particularly since the popularization of the Internet. In as much as healthcare is, in many countries, one of the most important public services, it can be considered a part of E-Governance. In any case, healthcare is an information intense activity and therefore Information Technologies should have much impact on its practice. Yet E-Health lags far behind, as far as its common use by citizens is concerned, compared to other activities like banking, shopping or even administration. Of course citizens are able to find much health information on the Internet and use this information as an instrument to socialize and share their concerns related to their health, but the vast majority of health organizations and/or health professionals in most countries are still reluctant, or simply failing, to offer online services to their patients.
We maintain that this is so because unlike in those other activities, where much of the information belonging to citizens is available in digital form, Medical Records are not yet so. Indeed Medical Records are at the base of Health Information Systems: they not only contain all the relevant information for the relationship between health professionals and patients as far as healthcare provision is concerned, but also of the healthcare activity from the economical, entrepreneurial and social point of view. Until recently, and even today in many organizations and countries around the world, this information is fragmented in a jumble of paper files and archives, even among the same organization. During the last few years we have witnessed a move towards computerization of this information in what is commonly known as Electronic Health Records opening the possibility of transforming Medical Records in powerful databases useful not only for the healthcare provision but also for research. This move towards computerization has opened new possibilities. On the side of health organizations it has allowed the implementation of quite a number of (not yet fully operational) projects of Shared Health Records at the regional, national and even international levels, where several organizations, with different information systems are able to share the basic information of patients which was fragmented and spread among the organizations. On the side of the patients it also allows a real control of their information by patients themselves, in what is commonly known as Personal Health Records; last year some well known companies of the Net, Google and Microsoft among them, launched websites where patients take full control of their health information.
We review all these developments and introduce an evolutionary model in five steps that allows us to integrate and understand all of them. Following this model we claim that a new a natural step of this evolution is ready to appear: what we call the Personal Health Space. This is a virtual 3-dimensional space where all the recent and new developments of ITs applied to healthcare provision will become integrated and that will substitute (or better include) the previous real space of healthcare centres where health professionals and patient used to (and still do) interact. One dimension of this space is shaped by the Personal Health Records, a patient-oriented (and not organization-oriented as Medical Records are) information system. Another dimension is the extension of the current model of face to face interaction: it is the world of multichannel interaction (which includes real face to face interaction plus all the possibilities of Telemedicine). We have finally as a third and last dimension all the possibilities opened by the Web 2.0, the social web: social interaction among patient and professionals has always been in place as far as healthcare is concerned, but when it is combined with the possibilities opened by Personal Health Records and Telemedicine it empowers patients and healthcare in general in ways not know before.
We discuss the direction towards which Information Technologies, combined with the cultural assimilation of these technologies, will be leading healthcare in the next years/decades. The Personal Health Space will change not only the way professionals and patients interact but their very same roles in this interaction along with that of health organizations. It will also alter the role o public and private spheres in healthcare provision. We also take into account the new issues raised by these developments which are of particular concern for such a sensitive and vital subject as healthcare is: digital divide, access, privacy and security are but some of the topics that will become even more important when patients’ health related information be concerned. In any case with the new tools available in the Personal Health Space, patients will have complete access and control of their own medical records as well as those of their close relatives, they will use knowledge coupling tools in conjunction with providers to support medical decision making, and they will be taught from childhood on how to interact with the system, just as they now learn how to interact with transport systems. As patients assume such decision making power they will reshape the whole and socially strategic healthcare marketplace.