E-Health

E-Health?

Let us cur a long story short and define what E-Health means:
The health sector is changing due to digitalization as well. And because things need cool sounding names it is called electronic HealtheHealth, or E-Health. Never electronic health industry – sounds too harsh. Or too much like last century.

Starting your research in this “young” industry without nomenclature, one finds even more synonyms: Online HealthCybermedizinCyberdoctorConsumer Health Informatics, or – attention – Health 2.0.

Actually nobody really knows how things will turn out in the end. Some believe that solutions will replace (some) professionals. Others see chances for rural flight fall outs, underserved regions and overaging (keyword: Assisted Living) by using electronic doctor’s offices, video chats and voice messages. It does give much more access to information for patients already through google or even better through special, medical platforms.

Yet others proclaim that software will be as potent as a drug or medical device. Yes, of course those ideas have their own names in  Software as a medical Device (SaMD) and Software as a drug (SaaD) as well.

And then there are those who focus on applications to be run on mobile devices (mobile Health or mHealth). Makes sense as by the end of 2015 Google had more search requests from mobile devices (smartphone, tablet, etc.) than desktop PCs.

And if one says mobile device, you must think app as well. The modern pocket knife with all possible extra tools in those many app and Play Stores from various providers. Consequently these are called mobile Health Apps, or mHapp (*sigh).

In recent years, you have also had the trends of Self-Tracking and Self-Monitoring. It is now fashionable to count your steps, calories, heartbeat and posture, to save it and to share it. Quantified Self is what they call this movement. Are your bathroom scales connected to the internet yet? In the Internet of Things (IoT) this will be common place. They say.

Where there is a lot of data, there should be chance to derive new insights from it. They suspect. Big Data is the keyword. Or we could pull together all existing data for starter to gain a holistic picture. Clinic Decision Support Systems will support interdisciplinary teams to do just that. Unified electronic patient files are and will be a milestone on the way to the definition of further standards and applications.

To be honest none of all that is really new, apart from all those fancy names. Since the 1980s, there has been research called tele medicine or telehealth. Today you find it as internet medicine or health IT. What has remained is the question of whether a system can and should replace a human professional. Especially when it comes to addiction discorders it is the complexity of the patients state (comorbidity) that prohibits such endeavors.

In all E-Health mess, the treatment of mental illnesses is called E-Mental-Health. Cognitive behavioral therapy is referred to online CBT or computerized CBT (cCBT). For depression stress, panic, sleeping disorders, trauma and eating disorders there are quite many applications existing already. A nice overview of available apps can be found in the  active minds Blog.

E-Health research is ongoing, but one thing is already for certain: to the client it seems to make no difference whether he meets the counselor virtually or in real life. It is also documented that tools with human assistance are more effective than those without. Such powerful guided self-help tools may be applied at various stages of the treatment.

In psychosocial care it may help to prevent the later need for professional care as an early intervention. Alcohol addicts, for instance, are usually addicted for 10 or more years before they seek help and treatment. The resulting patient detoxication is hard to assist by digital means. In withdrawal as an in or out patient digital assistance is very possible and appreciated. The larger the spacial and timely gap between client and counselor, the better the assistance by digital tools to foster long lasting behavioral change. Only very few tools focus on the aftercare to prevent relapses.

For alcohol use disorders there are these tool categories that can be found as of now(1):

  • text-messaging monitoring and reminder systems that primarily use the cell phones’ text-essaying capabilities to monitor alcohol use or remind the user to report their alcohol consumption
  • text-messaging intervention systems that, in addition to monitoring alcohol use, deliver text messages intended to promote abstinence and recovery
  • Comprehensive recovery management systems that use the internal sensors (e.g. monitoring of GPS coordinates) and other computer-like capabilities of modern smartphones to deliver multifaceted messages and interventions
  • Game-bases systems that attempt to engage the user through game playing

RADIUS is the online tool especially for the treatment of out patients with the Community Reinforcement Approach during withdrawal and aftercare. It belongs to the group of Comprehensive Recovery Management Systems. Other and older project in this group have already shown great results. High-Risk drinking days were reduced by 60% in 6 weeks and drinks per day were reduced from 5.6 down to 2.9. The numbers come from the LBMI-A system (University of Alaska) and the Addiction CHESS (A-CHESS) system (University of Wisconsin-Madison). A-CHESS shows and explains the E-Health tools’ goals and functions in this short video representatively for this tool category:

Reference:

1) Quanbeck, A., Chih, M.-Y., Isham, A., Johnson, R. and Gustafson, D. (2015). Mobile Delivery of Treatment for Alcohol Use Disorders: A Review of the Literature Alcohol Research 36/1