Thursday, December 28, 2006


Gunther Eysenbach, M.D., Head of the Unit for Cybermedicine, Institute for Clinical Social Medicine and Public Health, University of Heidelberg, Germany

compass-shot.jpg (5249 Byte)

uk.gif (216 Byte) Summary of:
Eysenbach G, Sa ER, Diepgen TL. Shopping the Internet today and tomorrow - Towards the Millennium of Cybermedicine. BMJ 1999;319:1294 [full] (13 November)

See also:
Eysenbach G. Introduction: Towards the Millennium of Cybermedicine. In: Arvanitis T, Eysenbach G, Woodall J (eds.).Towards the Millennium of Cybermedicine. Educational Technology Research Papers of the University of Birmingham, No. 10. Birmingham/Heidelberg, 1999, p.2-3 (also published in linkout.gif (901 Byte)J Med Internet Res 1999;1(suppl 1):e2)

d-flag.gif (98 Byte) For Germans: A FAQ Cybermedizin in German is available here (Fragen und Antworten zu Medizin im Internet finden sich hier).

Introduction - Medicine and the Internet

The evolution of the "information age" in medicine is mirrored in the exponential growth of medical webpages, increasing numbers of online accessible databases, and expanding services and publications available on the Internet. The handful of computers linked by the predecessor of the Internet in 1969 has grown to more than 5 million websites today. In spring 1998, the World-Wide-Web had at least 320 million web pages of general content. In addition, there are countless conversational areas on the Internet, like chat rooms and newsgroups, where people exchange messages on tens of thousands of subjects. Somewhere more than 150 million people currently communicate over the Internet.

Medical information is often said to be one of the most retrieved information on the web. In fact, according to a survey of October 1998, 27% of female and 15% of male Internet users say that they access medical information weekly or daily. An interesting observation from this and other surveys is that health and medical content appears to be one of only a few online content categories that women are more likely to use than men.

No-one knows the exact number of medical (including health and "wellness") websites, but the frequently cited figure of 15,000 health sites is probably an underestimation, given that Yahoo USA alone lists more than 19,000 websites under the topic "health", and other international Yahoo catalogs together add roughly another 15,000 sites. Assuming conservatively that a maximum of 30% of all sites are registered in Yahoo, we can estimate that there are a minimum of 100,000 health-related websites available. Health information providers on the web include mostly private companies offering medical products or medical information (news services, electronic journals, databases), individual patients and health professionals, patient self support groups and professional associations, non-governmental organisations, universities, research institutes and governmental agencies.

Cybermedicine - a definition

The developments outlined above likely have a significant impact on efficiency and quality of future health care, consumer empowerment, public health, medical education and a number of other areas.

At the crossroads of medical informatics and public health a new academic field of "cybermedicine" is emerging (fig. 1).

An arbitrary definition of the discipline "cybermedicine" could be

"the science of applying Internet and global networking technologies to the area of medicine and public health, of studying the impact and implications of the Internet and of evaluating opportunities and the challenges for health care"

[Source: Gunther Eysenbach, in:
Eysenbach G, Sa ER, Diepgen TL. Shopping the Internet today and tomorrow - Towards the Millennium of Cybermedicine. BMJ 1999;319:1294 [full] (13 November)]

Of particular interest in our "Unit for Cybermedicine" at the Department of Clinical Social Medicine in the University of Heidelberg is

  • the exploration and exploitation of the Internet for
    • consumer health education,
    • patient self-support,
    • professional medical education
    • and research,
  • the evaluation of
    • the quality of medical information on the Internet,
    • the impact of the Internet on the patient-physician relationship and quality of health care
  • and the use of global networking for evidence-based medicine.

Fig. 1

fig-cybermed-corr.jpg (76057 Byte)

Cybermedicine is distinctive from telemedicine (although there are overlapping areas, especially as the Internet can also be used as a medium for telemedical applications): While telemedicine focuses primarily on a restricted exchange of clinical, confidential data, with a limited number of participants, for the most part from patient-to-physician and from physician-to-physician, in "cybermedicine" there is an global exchange of open, non-clinical information, mostly between patient-to-patient, sometimes between patient-to-physician and from physician-to-physician. Telemedicine for the most part is applied to diagnostic and curative medicine, while cybermedicine is applied to preventive medicine and public health.

Telemedicine Cybermedicine
Geographic coverage Local or regional Global
Application area Primarily curative medicine Primarily preventive medicine
Security High security possible Security limited
Data exchanged Clinical data Information for patient education and self-support, anonymised clinical data for medical education, anonymised epidemiological and public health data
Exchange between Patient-to-physician, physician-to-physician Patient-to-patient,
Aims monitor individual patients, diagnose and treat Prevention, monitor populations, gather epidemiological and other data from patients, use patient feedback and consumer involvement for evidence based medicine
Driven by Sometimes technological push Mostly consumer pull
Setting Controlled setting, limited number of well-defined users Uncontrolled conditions
Evaluation Possible Impact on population very difficult to measure
Reach Reaching tens or hundreds Reaching millions


E-Health and E-Patients

by John M. Grohol, Psy.D.
November 9, 2006

You’re going to hear a lot more about these two things in 2007, as companies, doctors and organizations look to help better equip people to have a two-way conversation with their health or mental health professional that treats each person as a relative equal in the relationship.

We’ve all seen the power and reach of Wikipedia, and its success in showing that providing a platform to allow the world to collaborate can be a healthy, positive thing. And while it has had its bumps in its development, they shouldn’t detract people from understanding that the underlying message — empowering people to create and share — is very attractive and viral. Wikipedia has become, for instance, the first place many college students go to start research on a topic.

But along with e-health and giving people more information about their health and health care, there has to be some back and forth with professionals. After spending the past few days with a group of thought leaders in this area, I’d have to say that more and more professionals and doctors are willing to open their minds to a different way of interacting with their patients. And more and more patients are demanding such openness from their doctors.

The doctor-patient relationship is moving from doctor-as-expert to doctor-as-helpful-guide for those who would rather that kind of relationship. Not everyone will. But for those willing to take on a more active role in their health and healthcare, there is a growing rank of doctors willing to change their role. Willing to listen. Willing to help inform and guide where needed, but allowing the patient to really remain in control of their own future and health.

In the next few months, you’re going to see some amazing things online to help people take better control of their health, and to start to engage with their doctors in this new way. To open up the dialogue, and move the conversation from 20th Century medicine into 21st Century medicine. I’ll be writing more about this in the weeks and months to come, but I just wanted to give you a heads-up to be prepared. Because healthcare as you know it is going to change, and it’s going to start now.

Source: Psych Central

U.K.: Sharing e-health info requires patient consent

BY Bob Brewin
Published on Dec. 20, 2006

Sharing medical information in electronic health records in England will require explicit patient consent, the United Kingdom Department of Health (DOH) said earlier this week.

The decision followed the release of a task force report on the National Health Service Summary Care Record. The record includes individual patient EHRs that sit at the core of a 10-year, $10 billion NHS project to serve 50 million patients in Britain with a system that connects 30,000 health care professionals.

The DOH said it plans to have general practitioners upload patient information contained in the Summary Care Record to the NHS HealthSpace portal. Patients will then be able to correct or amend their records and offer explicit consent for their records to be shared or opt out of sharing.

“After a realistic period, it would be assumed that those patients who have chosen not to view their summary care record are giving implied consent for it to be shared in appropriate settings,” according to DOH.

The Guardian reported that Lord Warner, the U.K.’s health minister, provided an ironclad guarantee at a press briefing this Monday that patient information would not be uploaded or shared without specific consent. If patients “don’t want their information uploaded, they can stop it before it is uploaded,” he said.

The Summary Care Record Task Force, which included representatives from DOH, the British Medical Association (BMA), emergency medical services, and hospitals and universities, said it considered patient consent on the use of electronic records the key issue of its work.

Dossia, the electronic health record project launched early this month by major American employers Applied Materials, BP America Intel Corporation, Pitney Bowes and Wal-Mart, will allow patients to opt in to the system and then decide what information to share and with whom.

James Johnson, chairman of the BMA, said the task force’s report was the first of its kind to look at the ethical and practical implications of sharing electronic summary care records and should help address patients’ anxieties about the use of their records.

While patients can bar sharing of their medical information, Sigurd Reinton, chairman of the London Ambulance Service NHS Trust, urged them to consider the consequences of their actions.

“In thinking about their options, I hope people, especially the elderly and vulnerable, will bear in mind that if we have your information, then paramedics, for example, will be able to offer the best possible treatment,” Reinton said. “It is the elderly and the vulnerable who may miss out if they have to formally opt in.”

Members of the Summary Care Record Task Force consulted with officials of the Veterans Health Administration in the U.S. to learn how the agency handles patient consent in its Veterans Health Information Systems and Technology Architecture (VistA) system. The task force said it decided not even to consider the compulsory model of VistA electronic records in the U.K.

DOH said with its acceptance of the recommendations of task force, it now plans to move forward with the rollout of Summary Care Records next February to early-adopter general practitioners.

Source: GovHealthIT

Friday, December 22, 2006

European health informatics

The European Union's Member States are committed to sharing their best practices and experiences to create a European eHealth Area, thereby improving access to and quality of healthcare at the same time as stimulating growth in a promising new industrial sector. The European eHealth Action Plan plays a fundamental role in the European Union's i2010 strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services.

In the United Kingdom, moves towards registration and regulation of those involved in Health Informatics have begun with the formation of the UK Council for Health Informatics Professions (UKCHIP)

The NHS in England has also contracted out to several vendors for a National Medical Informatics system that divides the country into five regions and is to be united by a central electronic medical record system nicknamed "the spine". National Programme for IT in the NHS. The project, in 2006, is well behind schedule and its scope and design are being revised in real time.

In 2006, 60% of residents in England and Wales have more or less extensive clinical records and their prescriptions generated on 4000 installations of one system (EMIS) written in 'M' (MUMPS as was). The other 40% predominantly have records stored on assorted SQL or file-based systems.

Scotland has a similar approach to central connection under way which is more advanced than the English one in some ways.

Scotland has the GPASS system whose source code is owned by the State, and controlled and developed by NHS Scotland. It has been provided free to all GPs in Scotland but has developed poorly[1]. Discussion of open sourcing it as a remedy is occurring.

The European Commission's preference, as exemplified in the 5th Framework, is for Free/Libre and Open Source Software (FLOSS) for healthcare.

Source: Wikipedia

Thursday, December 21, 2006

e-health information in WHO official websites

You can get information related to e-health at the WHO official website (including region websites). Just enter "eHealth" into Google, Live search, Yahoo search etc. , then you will get it!

Wednesday, December 20, 2006

Radio Frequency Identification (RFID)

(Radio Frequency IDentification) A data collection technology that uses electronic tags for storing data. The tag, also known as an "electronic label," "transponder" or "code plate," is made up of an RFID chip attached to an antenna. Transmitting in the kilohertz, megahertz and gigahertz ranges, tags may be battery-powered or derive their power from the RF waves coming from the reader.

Like bar codes, RFID tags identify items. However, unlike bar codes, which must be in close proximity and line of sight to the scanner for reading, RFID tags do not require line of sight and can be embedded within packages. Depending on the type of tag and application, they can be read at a varying range of distances. In addition, RFID-tagged cartons rolling on a conveyer belt can be read many times faster than bar-coded boxes.

Serialization - A Major Factor

RFID tags hold more data than bar codes, but a major differentiator is the unique serial number in the RFID's Electronic Product Code (EPC) because it allows tracking of individual items. While a UPC bar code might identify a 16 oz. bottle of mayonnaise, an EPC RFID tag could identify that single bottle. In this case, item level tracking could determine if the food had passed its expiration date. See bar code, UPC and EPC.

Tracking livestock was one of the first uses of RFID, as well as vehicle and container tracking. RFID is also used to track people. In 2004, an amusement park in Denmark put RFID wrist bands on children, which could be quickly located by readers in the park if they were lost. RFID chips are even implanted into humans (see VeriChip).

Libraries use RFID tags to quickly check out books and videos, and employees merely wave their RFID badges by a reader rather than insert them into a slot. For entrance ways manned with security guards, RFID tags can trigger calls to a database that puts pictures of the badge holders on screen by the time they approach the gate. To prevent theft, retail stores tag their merchandise with a tag similar to RFID, but without the chip (see EAS).

Passive, Active and Semi Tags

"Passive" tags have no power source but use the electromagnetic waves from the reader to energize the chip and transmit back (backscatter) their data. Passive tags can cost less than a quarter and be read up to approximately 10 feet from the reader's antenna.

"Active" tags have a battery that can transmit up to 300 feet indoors and more than a thousand feet outdoors. Used for tracking trailers in yards and containers on the loading dock, active tags cost several dollars and may periodically transmit a signal for readers to pick up or may lie dormant until they sense the reader's signal.

"Semi-passive" tags, also called "semi-active" tags, combine passive backscattering with a battery that allows the device to beep, blink or perform some operation. For example, a semi-passive tag on refrigerated cartons can include a sensor that, when interrogated, reports the temperature range during shipment.

The Squiggle Tag
Alien Technology was one of the first companies to make RFID tags, and its various Squiggle designs became widely used (see RFID tags). (Image courtesy of Printronix, Inc.,

Reusable Vs. One-Time

RFID tags for applications such as highway toll collection and container tracking are in continuous use for several years. Like regular electronic components, the tags are adhered to rigid substrates and packaged in plastic enclosures. In contrast, tags on shipping cartons are used for a much shorter time and are then destroyed. Disposable tags are adhered to printed, flexible labels pasted onto the carton, and these "smart labels" contain an RFID chip and antenna on the back. A thermal printer/encoder prints alphanumeric and bar code data on the labels while encoding the chip at the same time. See RFID tag.

RFID Goes Way Back

Although first used in World War II to identify friendly aircraft, RFID technology really materialized in the 1980s and began to reach the masses in the 1990s. In 1993, the E-ZPass highway toll system was launched in the Northeast. In 1996, General Motors introduced OnStar, which is satellite-based RFID. A year later, Mobil's Speedpass let people wave a keychain tag at the gas pump to pay by credit card. After the turn of the century, RFID began to proliferate.

When Tags Cost a Few Cents

When the price of tags becomes economical enough, it is expected that RFID will take off in a myriad of areas. Pundits have suggested applications such as reading a full supermarket cart as it passes by the reader, a washer/dryer that determines its settings from clothing tags and a refrigerator that automatically creates a shopping list. See RFID tag, RFID reader, RFID printer, EPC, Gen 2 and tag singulation.

Keeping Pallets Intact
The unique serial number in the electronic product code (EPC) lets RFID readers scan all the cases in a pallet without having to break it down. This provides a huge cost savings in warehouse management and is the reason why Wal-Mart required its suppliers to begin using RFID in 2005. (Image courtesy of Intermec Technologies,


Related links:

Tuesday, December 19, 2006

Riding the Waves of “Web 2.0”

---More than a buzzword, but still not easily defined

By Mary Madden and Susannah Fox
Pew Internet Project
October 5, 2006

“Web 2.0” has become a catch-all buzzword that people use to describe a wide range of online activities and applications, some of which the Pew Internet & American Life Project has been tracking for years. As researchers, we instinctively reach for our spreadsheets to see if there is evidence to inform the hype about any online trend. What follows is a short history of the phrase, along with some data to help frame the discussion.

Let’s get a few things clear right off the bat: 1) Web 2.0 does not have anything to do with
Internet2: 2) Web 2.0 is not a new and improved internet network operating on a separate
backbone: and 3) It is OK if you’ve heard the term and nodded in recognition, without having the faintest idea of what it really means.

When the term emerged in 2004 (coined by Dale Dougherty and popularized by O’Reilly Media and MediaLive International),1 it provided a useful, if imperfect, conceptual umbrella under which analysts, marketers and other stakeholders in the tech field could huddle the new generation of internet applications and businesses that were emerging to form the “participatory Web” as we know it today: Think blogs, wikis, social networking, etc..

And while O’Reilly and others have smartly outlined some of the defining characteristics of Web 2.0 applications —utilizing collective intelligence, providing network-enabled interactive services, giving users control over their own data—these traits do not always map neatly on to the technologies held up as examples. Google, which demonstrates many Web 2.0 sensibilities, doesn’t exactly give users governing power over their own data--one couldn’t, for instance, erase search queries from Google’s servers. Users contribute content to many of Google’s applications, but they don’t fully control it.

Instead, the Web 2.0 concept was intended to function as a core “set of principles and practices” that applied to common threads and tendencies observed across many different technologies.2 However, after almost three years of increasingly heavy usage by techies and the press, and, as the writer Paul Boutin notes, after “Newsweek released the word, Kong-like, from its restraining quotes,” critics argue that the term is in danger of being rendered useless unless some boundaries are placed on it.3

Technology writers and analysts have, in fact, devoted countless hours to the meta-work of using Web 2.0 applications (blogs, wikis, podcasts, etc.) to debate and refine the definition of the term. Still, there has been little consensus about where 1.0 ends and 2.0 begins. For example, would usenet groups, which rely entirely on user-generated content, but are not necessarily accessed through a Web client, be considered 1.0 or 2.0?



Tuesday, December 12, 2006