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eHealth
Overview
The convergence of digital technologies in the area of healthcare is creating an age of digital health that will be highly individualized through the use of mobile communication, wireless sensors, wearable wireless devices, and super networks of big data. This convergence allows diagnostics not solely based on symptoms, but rather on up-to-the-minute individual health factors. Micro sensors built into clothing and wearable devices send health data to Internet capable devices or directly to the cloud and connect users, caregivers, and healthcare providers to vital signs that could allow for better healthcare dec is ions. Th is is “Big Health Data,” and it is bringing our health information together in ways that will improve personal health and aid in advancements in artificial intelligence and robotics which have the potential of saving lives through innovative diagnostic and treatments. No matter how you look at it, eHealth is driving healthcare transformation with technological innovations that are saving lives and reducing healthcare costs.
Introduction
When was the last time you were at the doctor, the emergency room, or any other healthcare provider’s office? When you were there, how many encounters with technology did you have? Did you fill out patient information online? Did the nurse check your blood pressure and temperature with a digital device? Did the doctor use a computer or tablet in the exam room? Did the prescription you received go directly to the pharmacy via electronic delivery? When you left the office, did you think about the diagnosis and treatment and seek further clarification or information online or on a mobile app? This is eHealth—the use of electronic information and communication technologies in the field of healthcare (Cashen, Dykes, & Gerber, 2004).
eHealth affects everyone and is one of the fastest growing areas of innovations in communication technology. Throughout this textbook you have read about the impacts of the digital revolution and how it has affected every aspect of our lives. The rapidly decreasing size of computer technology in the form of micro-computers, near ubiquitous Internet access and increasing bandwidth speeds, the connectedness of social media, and cloud computing have created the perfect storm for eHealth to burst on the scene and fundamentally change healthcare as we once knew it (Topol, 2013).
Essentially, eHealth is empowering consumers to play a bigger role in managing their own health. Patients now have access to their own electronic health records (EHR) and can access information about symptoms, diagnostics, and treatments about every common illness. This shifts the balance of healthcare and creates a way for individuals to take control of their own health by focusing on personalized health plans and prevention.
Definitions
Background
Convergence of digital technologies has given health communication increased traction over the past 30 years. However, the history of medicine is rich with information-sharing from the earliest days of recorded history. The first recorded evidence of healthcare predated the use of paper, pens, or even books. They were chronicled in cave paintings in France dating back thousands of years (Hall, 2014). The cave art depicted the use of plants to treat ailments. Early evidence of surgeries and the use of anatomy in diagnosis were found in Egypt around 2250 BC (Woods & Woods, 2000). These drawings were some of the first forms of health communication because they documented health conditions and treatments for future generations of physicians.
It wasn’t until the 19th century that the field of medicine advanced exponentially with developing sciences and growing knowledge of chemistry, anatomy, and physiology. The mass dissemination of information can be credited to innovations in mass communication. Medical information was communicated through the use of telegraphs, printed journals, books, photography, and telecommunications that delivered medical information to doctors and healthcare workers (Kreps et.al, 2003).
Computers were introduced in healthcare in the early 1970s and served as an administrative tool to store patient information and medical practitioner records. Developments in surgical and diagnostic instruments continued, but it wasn’t until 1995 that the information floodgates were opened to provide individuals access to a pool of knowledge about every aspect of their healthcare through the Internet (Kreps et al., 2003).
Innovations in communication technology also created concerns regarding the protection of patient information on the Internet. In 1996, the Health Insurance Portability & Accountability Act (HIPAA) propelled the healthcare industry to adopt new ways of safeguarding the privacy of health records. HIPAA gave more control of information to the consumer, but because of the regulated safeguards, the healthcare industry has been slow to adopt technologies that would give patients ready access to their own medical records. The days of limited access to personal health information are long gone as innovations of communication technologies that are designed to facilitate the flow of information between the healthcare provider and the healthcare consumer have been established.
Recent Developments
mHealth
93% of physicians believe that mHealth apps can improve patient’s health (Greatcall, 2017)
mHealth, or mobile health, is the use of mobile technologies such as cellphones and tablets for health communication and delivery of health information. Gone are the days when cell phones were used to simply make a call; cellphones are multifunctional tools performing as photographic and video devices, word processors, electronic organizers, and now even ECGs (electrocardiograms) or thermometers to monitor your health.
Technologies in mHealth have been featured at major technology shows worldwide for the past few years as an introduction to a rapidly growing industry. That growth can be attributed in part to ubiquitous mobile technologies which connect users to health information. More than 77% of American adults own a smartphone, and that number is expected to continue to rise (Pew, 2018). Worldwide, the number of smartphone users is expected to grow from 2.1 billion in 2016 to around 2.5 billion users by 2019 (Statista, 2017).
Apps
More than 6.1 billion users are expected to use mobile apps on their smartphones by the year 2020, and the healthcare and business sectors are quickly jumping on the opportunity to engage individuals through mHealth apps (Ericsson, 2016). There are more than 325,000 mHealth apps available for Apple and Android users with 78,000 of those apps being added in 2017 (R2G, 2018). These apps allow smartphones to carry out diverse eHealth functions from monitoring physical activity to monitoring heart rhythms with a mobile ECG (Costello, 2013).
Fitbit Health/Fitness Apps
Source: Fitbit
mHealth apps make it possible for patients to access their medical records on the go. It used to be that if patients wanted to check their medical records, they would have to logon to each medical provider’s website and search for the information needed. Apple is the first tech company to offer users the ability to sync their medical records with the Health Records section within the Health app. Johns Hopkins Medicine, Cedars-Sinai, and other participating hospitals and clinics are among the first to make this feature available to their patients (Apple, 2018).
App publishers consistently identify those with chronic illness as their major target group, with people interested in health and fitness as the secondary focus (R2G, 2016). Corporations and makers of mHealth apps have found that their success comes from consistent engagement with the use of gamification, which is the application of game playing to encourage engagement with a product or service (Weintraub, 2012). Gamification serves as a way to promote and sustain healthy behaviors by using strategies such as goal setting, feedback, reinforcement, progress updates, and social connectivity (Edwards et al., 2016). Because of past success, makers of mHealth apps continue using gamification to keep users engaged in healthy lifestyles, including diet and exercise.
Social Media
The healthcare industry has turned to social media to share information that will promote both individual and community health practices. Hospitals, physicians and healthcare providers are connecting with patients on social media providing connections with preventative healthcare, health crisis readiness, and general healthcare information on popular social media sites such as Facebook, Instagram, Twitter, YouTube, and Pinterest. With seven in ten American adults using social media, it’s not surprising that the healthcare industry would use social media to connect with patients (Pew, 2018). The majority of hospitals have a Facebook page (94.4%) and Twitter account (51%) while nearly all have a Yelp page for reviews (99%) and Foursquare page for patients to check-in online (99%). While the vast majority have adopted social media, the consistent use is more prevalent among larger hospital systems in urban areas (Griffis, et al., 2014).
Research shows that there is a high level of trust with social media. Nearly 90% of respondents between the ages of 18 to 24 said they would trust medical information shared by others on their social media networks (PWC, 2015). Another 41% have used social media to make decisions about which doctors or hospitals to use while 34% said the information they find in social networks affects their decision about what medication to take (PWC, 2015).
Big Data
The next big breakthroughs in healthcare may come from advances in technology that utilize Big Data. Every time you use your cell phone, watch a video online, use an App, interact on social media, make a purchase with a credit card, or fill out a form online, that data is collected and stored for companies and governments to use to understand customer behaviors and preferences.
Big Health Data is a subset of Big Data and is derived from electronic health records (EHR), mHealth device, health sensors, social networking data, clinical notes, medical imagery, lab results, and medical research. Big Health Data is the new normal for healthcare organizations that want to understand their customers, but there are issues. Most Big Health Data is collected and stored in massive data centers where it sits, mostly unused leaving the potential for great insight and discoveries untapped. In fact, more than 88% of Big Health Data collected is uncategorized data that is ultimately unusable because there is no way to make reliable connections that would lead to usable insights (Reddy, 2017).
Data scientists are busy extracting usable health data because it is believed that the analysis of this data has life-saving implications for patients, from managing long-term care to discovering innovative cancer treatment plans. Data scientists are making big discoveries using artificial intelligence, or AI, to process and analyze both structured and unstructured data that exists to reveal patterns, trends, and insights that could lead to innovations in healthcare. It is believed that the analysis of this data has life-saving implications for patients, from managing long-term care to discovering innovative cancer treatment plans.
Artificial Intelligence
Artificial Intelligence is one of the most promising areas of technological advancement in eHealth. AI are computer systems that are designed to mimic the human brain’s ability to learn, process information, and adapt to change. AI machines such as IBM’s Watson are being used in medical research and have been found to be accurate in diagnosing critical ailments such as cancer and have advised on innovative life-saving treatment options that medical specialists had not discovered.
Researchers in the U.K. used AI to find predictions of heart disease in patients. The AI analyzed 10 years of patient data and discovered 22 predictors of heart disease including ethnicity, arthritis, kidney disease, age, and other factors that had not been considered. Researchers compared what the AI had found to current patients and found that the AI predicted heart disease more accurately than the standard and accepted clinical guidelines. The AI also identified the strongest predictors for heart attacks that were not included in the American Heart Association guidelines (Hutson, 2017). The advances in AI in healthcare are moving at a fast pace as scientists discover new diagnostics, treatments, and pharmaceutical discoveries that could potentially save the healthcare industry in the U.S. more than $150 billion a year by 2026 (Collier et al., 2017).
eHealth Games
Video games are mostly a sedentary activity, but there is a growing trend for companies to use video games to promote health education, physical activity, physical therapies, mental health treatments, and to generally encourage a healthy lifestyle. Major video game companies such as Nintendo, Sony, and Microsoft have developed consoles, games, and accessories that not only provide entertainment enjoyment, but also improve overall quality of life (QOL) by engaging consumers with health literacy and education to help them take control of their health (Nintendo, 2015).
eHealth gaming is being used by 70% of the top companies in the world and is expected to bring in $5.5 billion in revenue in 2018 (Lewis, 2018). The Nike+ program enables users to compare exercise results and challenge friends to earn ‘fuel points.’ Nike+ is a growing community of more than 11 million subscribers (Lewis, 2018). Another example involves the monitoring of chronic illnesses such as diabetes. The Bayer Didget was the first blood glucose monitor designed specifically for children with Type 1 diabetes. The unit connects to Nintendo gaming systems and rewards children for consistent testing of their blood sugar (Bayer, 2014).
The most common use of eHealth games is in health and nutrition. Users track nutrition, calorie intake, and physical activity and earn points, badges, and virtual rewards while engaging with family, friends, and other online competitors. Companies such as Fitbit have created communities of healthy competitors that use competition to help individuals achieve their own health goals while also motivating competitors to achieve more.
Another use of eHealth games is for exergaming which combines the interactivity of a video game with physical exercise. Gaming systems such as Nintendo Switch or Xbox 360 use technology that incorporates motion detecting cameras or handheld motion sensors to measure movement and physical activity of users. Popular video games such as Just Dance or Kinect Sports involves exergaming activities such as golf or bowling and pits competitors against each other in physical competitions.
Exercise equipment such as treadmills, elliptical machines, or stationary bikes commonly use exergame integration to simulate races or challenges that encourage users to compete for points or rewards. Most recently, exergames are incorporating virtual reality (VR) or augmented reality (AR) to provide a more immersive experience for the user.
Consumers can expect to see more innovations in eHealth games in the future as different organizations tap into the success of eHealth games. Major health insurance companies such as UnitedHealthcare, CIGNA, and Kaiser Permanente use eHealth games in their wellness programs to encourage group participation in healthy activities, such as diet and exercise, while also lowering costs resulting from claims. Participants are encouraged to participate to earn points, badges, monitor their progress online, and compare their results with other users. The results have been positive. Blue Shield claimed that 80% of its employees that participated in their program had a 50% drop in smoking which ultimately results in lower healthcare costs (Lewis, 2018).
Wearables
Wearables are eHealth technologies that record and communicate biometric data regarding your heart rate, blood pressure, glucose levels, and more. Wearables include clothing, wristbands, watches, earphones, sensor rings, computerized contact lenses, and dermal patches equipped with sensors that wirelessly collect and transmit health data over extended periods of time with minimal lifestyle disruptions. This is one of the fastest growing areas of eHealth with one in six Americans owning some form of wearable technology (Piwek, et. al., 2016). The wearable market is expected to grow in sales from $10 billion in 2017 to almost $29 billion by 2022 (CCS, 2018).
Pedometers and Wristbands
The most widely used wearable device for health and fitness is the pedometer, which measures the number of steps an individual has taken. The pedometer has undergone several levels of innovation and has evolved into a more powerful digital device. Wristbands dominate the wearable fitness device market, and many companies have designed wristbands that wirelessly communicate with smartphones to measure steps, physical activity, sleep patterns, and calories burned.
The Federal Drug Administration (FDA) has issued guidelines for regulatory review of health apps intended to be used as an accessory to a regulated medical device or transform a mobile platform into a regulated medical device. The only mobile apps that are currently regulated by the FDA are those that are used as an accessory for a regulated medical device or transform the mobile platform into a regulated medical device (FDA, 2016).
Wristbands and Smartwatches
Source: Fitbit
Smartwatches
Smartwatches combine the functionality of simple timekeeping with sensor and computational power that can monitor biometrics and instantly record and report the data to your mobile device or online monitoring account. Smartwatches can perform a myriad of tasks including tracking steps taken, distance traveled, activity rates, tracking sleep patterns, and alerting the user when they have achieved health goals. Smartwatches are the fastest growing eHealth wearable product in the health and fitness technology sector. In 2017, the Apple Watch sold more than 17 million units making it one of the best-selling wearable trackers in the world (Canalys, 2018). Other health and fitness wristbands available include Fitbit Ionic, Garmin Vivosmart 3, and Samsung Gear Sport which all work similarly by recording physical data and connecting wirelessly to a smartphone loaded with the designated app.
Developers are working on advanced sensors that will take eHealth wearables to a new level in health monitoring. Smart Monitor’s Smartwatch Inspyre™ is a device with mobile connectivity that alerts the user of impending convulsions, tremors, or seizures. The watch connects with a smartphone and alerts users when repetitive motion is detected and then connects with chosen emergency contacts with alerts and GPS coordinates of where the individual SmartWatch user is located. Other data collected by the SmartWatch is then compiled for review by the user and can be shared with a healthcare provider (SmartMonitor, 2018).
Smart Clothing
Smart clothing is apparel with embedded sensors and other electronics that communicate precise health metrics to a smart device through Bluetooth or Wi-Fi connectivity. Smart clothing is not a new concept but is still in its infancy. In 1984, Adidas introduced the first smart running shoe that measured distance, speed, and calories burned from a sensor located in the tongue of the shoe (Bengston, 2015). Since that time, tech companies have innovated sensor and electronic enhanced fabrics and textiles and are incorporating them into socks, shirts, yoga pants, running or biking shorts, sports bras, and other smart clothing to measure biometrics as well as kinesthetic techniques such as cadence and movement for specific sports.
Sensor Clothing
Source: Sensoria Fitness
The adoption of smart clothing is expected to grow by more than 550% by 2022 as specialized smart clothing finds its place with the consumer (Moar, 2018). Regulations and safety concerns are the biggest hindrances for this industry. Rollouts of new products take time in the research and development stages and are sometimes held back because of government regulations that are catching up with the pace of the industry.
Dermal Devices
While wearables such as wristbands have definitely moved into the forefront of eHealth hardware technology, the next innovation in wearables is found in dermal technologies that seamlessly integrate with the body allowing freedom of movement and more precise health monitoring (Ahlberg, 2011).
Harvard University researchers have developed Dermal Abyss, a biosensitive ink that allows smart tattoos to change color as changes in the body occur. The inks measure glucose, sodium and pH concentrations in the interstitial fluid surrounding cells. Dermal Abyss has a green ink that gets darker as the patient’s sodium levels increase. The company is testing a pink ink that turns blue as the body’s pH levels rise (Nelson Jr., 2017). The Dermal Abyss tattoo inks can be incorporated into long lasting tattoos for chronic conditions or temporary designs for short-term monitoring. Researchers are still developing and testing new inks but have already made great strides. One of the major areas of use of Dermal Abyss ink is for diabetics who could check their glucose level by looking at the color of a tattoo and avoiding having to draw blood from finger pricks several times a day (Vega et al., 2017).
Telehealth
Telehealth involves the use of telecommunications and virtual technology to deliver health services outside of the traditional healthcare setting (WHO, 2017). This is an umbrella term that is used to refer to the delivery of a multitude of healthcare services such as long-distance medical care, health education for patients and professionals, public health, health administration, and prevention (La Rosa, 2016). Trends in telehealth are now moving from hospitals and satellite clinics to the home and mobile devices (Dorsey & Topol, 2016).
Telemedicine
Telemedicine is a type of telehealth and involves the use of clinical services to patients from a distance through teleconference exams, shared diagnostic data, as well as phone and computer-mediated conversations (du Pré, 2017). Telemedicine is favored by young and affluent patients who are more comfortable utilizing technology (du Pre, 2017). This type of healthcare is most often used for recurrent concerns, such as getting a prescription refilled (Uscher-Pines & Mehrotra, 2014).
Telemedicine has grown exponentially since the first remotely-performed surgery in 2001 and has affected many aspects of healthcare (Collen & Ball, 2015). Telemedicine provides a convenient and consistent way to transmit medical information, imaging, and other data a healthcare provider might need for diagnostics and prescriptive assessments (Topol, 2016).
Telemedicine is not just a healthcare option for people living in rural or remote locations. It is now being used to connect healthcare practitioners with patients as a means of healthcare cost savings by meeting patients wherever they are through a mobile device or computer connectivity. Companies such as Doctors on Demand provide access to board certified doctors or psychologists at a much lower cost than an urgent care facility.
Doctors on Demand
Source: Doctors on Demand
Telemedicine could help reduce healthcare costs by more than $6 billion a year, according to analysis by Towers Watson (2013), a global financial and technological consulting firm. Towers Watson found that more than 78% of employers offer telemedicine services as an alternative to ER or doctor’s’ office visits for non-emergency health issues. While employers see the financial benefits of telemedicine, employees are lagging behind in actual use with less than 10% of employees utilizing this relatively new technology (Watson, 2017).
Voice Activated Personal Assistants
Another technology that has great implications for telehealth is voice activated personal assistants. One in six U.S. adults owns a voice-activated smart speaker, and this technology is set to outpace the adoption of smartphones and tablets in the next few years. Voice activated personal assistants are voice command devices integrated with a virtual assistant that can help users find information, purchase products online, set timers and alarms, control smart home devices, and listen to music and books on command. Personal assistants are increasingly being used as eHealth devices, and the healthcare industry is testing the devices to assist home bound patients with medical information and reminders while also allowing for direct connectivity with the medical providers (Edison, 2017).
Robotics
It is likely that you will encounter a healthcare robot in your near future as robotics are increasingly used for day-to-day care, health monitoring, as well as more complex health procedures such as surgeries. While we will still rely on doctors, nurses, and other clinicians in the future, advances in robotics are making strides to provide more efficient and quality care while also reducing healthcare costs (Kilgannon, 2016).
Robots provide accuracy and precision that are not always attainable by humans. Hospitals are using robots for high precision surgeries resulting in high success with smaller incisions, less pain, reduced complications, and lessened healing time (Nuzzi & Brusasco, 2018). Robots are also being used in pharmacies to help reduce prescription errors. Pharmacists who fill a prescription have to read the prescription, find the medicine, count or measure the prescribed medicine, fill the prescription, and then label the prescription based on the dose and instructions.
When a pharmacist is busy, these steps may be missed and human errors may occur. It is believed that 2.8% of prescriptions have errors. Pharmaceutical robots have reduced the number of errors in prescriptions to 0%, further reducing risks and costs (Bui, 2015).
Rural areas in the U.S. continue to experience shortages in doctors. Fortunately, new technologies in robotics have allowed doctors to meet remotely with patients. Remote robotic access in eHealth is the ability for the doctor to be off-site and project themselves to another location. They have the ability to move, see, hear, and talk as though they were actually there with the patient (Huiner, 2016). These robots can maneuver throughout the hospital making a doctor who is offsite feel as if she is on-site. Ultimately, this technology reduces costs and improves efficiency and safety at hospitals and healthcare facilities (Lee, 2013).
Robots were in operating rooms as early as 1985, with the use of the PUMA 200 industrial robot used for CT-guided brain biopsy (Kwoh et al., 1988). Medical advancements have come a long way since then, with the world’s first telesurgical procedure taking place in 2001 in which a doctor located in New York used a joystick to operate a robotic arm in Strasbourg, France (Sheynin, 2016). Telesurgery is fast on its way to becoming available in “remote areas and rural communities where doctors and formal medical care are scarce and hard to come by” (Sheynin, 2016).
Healthcare facilities use robots to help prevent the spread of disease. With flu epidemics becoming more common in recent years, healthcare facilities are concerned with protecting their patients’ health and safety by maintaining germ free facilities. Hospitals across the U.S. have started using disinfecting robots that use xenon ultraviolet (UV) light to destroy bacteria, viruses and other pathogens that can cause the spread of disease.
The Xenex LightStrike Germ-Zapping robot is one of the latest robot models being adopted by hospitals in the U.S. After a normal cleaning has been conducted in a room, the LightStrike robot is brought in to kill any remaining microscopic germs or bacteria by shooting high-intensity UV rays to all surfaces (Bailey, 2018).
Xenex LightStrike Germ-Zapping Robot®
Source: Xenex
The implications for telehealth are vast and so are the issues. There is a concern that decreased human interaction could prevent a medical practitioner from identifying issues that may only be recognized in direct face-to-face interactions. The healthcare sector has shown caution in the adoption of newer telehealth technologies because of patient safety and liability concerns because medical advice given remotely without a full physical exam could lead to misdiagnosis and serious or even fatal errors for the patients. Another growing concern is in the area of patient privacy. Patient data breaches cost the U.S. healthcare industry $6.2 billion in 2016 (Ponemon Institute, 2016). The number of patient data breaches will continue to be an issue, and companies using telehealth technologies will need to invest in ways to protect the privacy of patient information.
Developing Countries
Developing countries are set to benefit the most from telehealth technologies. Millions of people die each year in developing countries due to lack of access to proper medical care. The World Health Organization reports a global shortage of 7.2 million healthcare workers in the next 20 years, but that number is expected to nearly double (GHWA & WHO, 2013). Advances in eHealth technologies have the potential of aiding in this acute shortage.
Telehealth expands healthcare access to remote areas of the globe that never dreamed of having modern medical care. Technologies such as live video conferencing, uploading of MRI or other scans to a cloud network, and remote monitoring of vital signs such as body temperature, blood pressure, and glucose levels, are all used by healthcare providers located at a distance and sometimes across the globe. All that is needed is a smartphone or computer device coupled with Internet access at both ends to connect patients with quality healthcare.
In emerging and developing nations around the globe, mHealth is being used where doctors are scarce and resources are non-existent. In developing countries, about a third of the adult population now owns a smartphone (Poushter, 2016). With a projected 5.13 billion mobile phone users worldwide by 2017, innovations in telemedicine could be a solution in these underserved areas (eMarketer, Dec 2014).
Healthcare professionals use of mobile devices around the world is also increasing. A global study of patients found that 44% have seen medical professionals using a mobile device during treatment or diagnosis. In Qatar and Saudi Arabia more than half of consumers have seen mHealth used in treatment or in diagnosis (AVG, 2015).
With a continued projected growth of smartphone users worldwide and the adoption of new applications of use, mHealth can serve as a foundation to economic growth in these developing countries by improving the health of its citizens. The major barriers to the progress of eHealth technologies in developing countries are the lack of technological resources, conflicting health system priorities, and the lack of legal frameworks.
Healthcare Worker Using a Cellphone in Ghana
Source: Nana Kofi Acquah and Novartis Foundation
Current Status
The health system in the United States is facing many challenges. The cost of healthcare in the United States is the highest in the world with the average per capita cost reaching US $10,348 (CMS, 2017, and the aggregate healthcare spending in the United States is expected to reach US $4.8 trillion by 2021 (CMS, 2011). On December 20, 2017, the Senate passed a Republican party tax bill, which in part repealed the individual mandate initiated under the Affordable Care Act (ACA), better known as “Obamacare.” The tax bill eliminates the individual mandate penalty for not purchasing health insurance beginning in 2019.
The Patient Protection and Affordable Care Act (PPACA) is fueling eHealth by restricting health spending and creating new business models for healthcare that are more value-based. Historically, the healthcare industry was not rewarded for keeping patients healthy and avoiding expensive treatments; however, PPACA is forcing change to that model by propelling healthcare organizations into the adoption of new technologies to engage and empower patients to take more control of their healthcare. As this chapter was written, the PPACA was still intact, but further legislative action could be taken to repeal the Act.
The use of new technologies and apps that engage consumers is not enough. Full adoption of these new technologies as well as new applications of use will take time and will require a change in consumer behavior. These changes will require incentives for use and compatibility with current technologies, making it easy for users to adopt. As the proliferation of new eHealth technologies continues, it may be harder for consumers to navigate the many options available to them.
Security Issues in Digital Health
Security concerns are the biggest inhibitor of adoption of new eHealth technologies. The key security issues in eHealth include security for patient confidentiality, security that enables authentication of electronic health records, and systems security that ensures secure transmission, processing, and storage of health data (PWC, 2017). Electronic Health Records (EHR) were believed to be the solution for improved management of an individual’s health, and to be the tool that would give the patient control of their own health by providing access to his or her own medical history (Waegemann, 2002). EHRs have opened the doors for patient access, but have also opened the doors to security risks. The issues of protection of EHRs against intrusion, data corruption, fraud, and theft are of highest concern for healthcare professionals and the patients they serve.
Since 2009 there have been more than 1,437 major breaches of protected health information affecting more than 154 million patient records. Of the 154 patient health records compromised, 113,208,516 occurred in 2015. In 2016, the healthcare industry saw a 320% increase in the number of providers victimized by attackers (Redspin, 2017). Over 80% of patient records breached in 2016 were a direct result of hacking attacks (Redspin, 2017). Patient information will remain a top priority for governmental agencies, healthcare, and the technology sectors.
Factors to Watch
We live in a highly personalized era where technologies have increased access to a wide range of goods and services. For example, you don’t have to get in your car and drive to the store to get everything you need to survive in this world. You have access to thousands of health products online and you can have them delivered to your door, in some cases, the same day. Mobile phones have thousands of personalized accessories, case options, and more than 325,000 mHealth apps to choose from—and you don’t even have to leave the comfort of your home to see a doctor when you’re sick (R2G, 2018). This culture of individualized access has created a generation of consumers that expect products and services that are customized to their individual needs. Watch for eHealth options that are highly individualized as these cultural influences continue to expand into the healthcare sector.
Getting a Job
There are tremendous career opportunities in eHealth. A growing field is health informatics. According to the Bureau of Labor Statistics, employment of health information specialists is expected to grow faster than any other occupation in the U.S., 22% by 2022. The University of South Florida (n.d.) defines health informatics as “the acquiring, storing, retrieving and using of healthcare information to foster better collaboration among a patient’s various healthcare providers.” Careers in health informatics include nurse informaticist, chief medical information officers, director of clinical informatics, clinical data analyst, and IT consultant. Getting a Master’s Degree in Health Informatics or Health Information Management is a good first step. There are also career opportunities in the creation, sales, and management of health-related technologies such as wearables, apps, and monitoring
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* Blossom is Associate Professor and Chair and Neal is Instructor, Dept. of Mass Communication, North Greenville University (Greenville, South Carolina).