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Weaving Your Way Through the Medical Information Web A Survivors AAA Roadmap to the Weaving Your Way Through the Medical Information Web A Survivors AAA Roadmap to the Medical Web Dennis Mungall , Pharm. D. Director, Virtual Education, NTPD Associate Professor , Pharmacy Practice Ohio State University/ College of Pharmacy http: //www. osuntpd. com [email protected] com

Audio PPT Version http: //www. coagexpert. net/octobertalk/octob erimpatica. html PPT Alone http: //www. coagexpert. Audio PPT Version http: //www. coagexpert. net/octobertalk/octob erimpatica. html PPT Alone http: //www. coagexpert. net/octobert alk 2/frame. html

Introduction • Overview • Content • Communication • Patient Management • Commerce • Education Introduction • Overview • Content • Communication • Patient Management • Commerce • Education on the Web

Number of Years To Reach 10 Million Users The Web is the Fastest Growing Number of Years To Reach 10 Million Users The Web is the Fastest Growing Medium. . . Ever Source: The Revere Group

Audience? cyberdialogue Audience? cyberdialogue

Content Areas Content Areas

Characteristics Characteristics

Categories of Technology Emphasis for Caregivers n n n n Medical Record Self-Care Mgmnt. Categories of Technology Emphasis for Caregivers n n n n Medical Record Self-Care Mgmnt. References Physician Order Entry Telemedicine Patient Information and Education Telecommunication n n n n Monitoring News and Issues Telephony Case Management Database Decision Suppor CME Practice Mgmnt. Scheduling

Content on the Web Where to Find Information Content on the Web Where to Find Information

General Content Resources General Content Resources

Drug Information Resources Drug Information Resources

Pediatric Information Sites • • • http: //www. npan. org/ National Pediatric AIDS Network Pediatric Information Sites • • • http: //www. npan. org/ National Pediatric AIDS Network http: //kidshealth. org/ Kids Health site for consumers http: //www. aap. org/bpi/ID. html Children’s infectious disease site

Disease and Drug Information : MD Consult: Clinical Information For Physicians Disease and Drug Information : MD Consult: Clinical Information For Physicians

Drug And Disease Sites Welcome To Merck. Medicus Drug And Disease Sites Welcome To Merck. Medicus

Drug Information Site Drug Information Resources: A Guide for Pharmacists Drug Information Site Drug Information Resources: A Guide for Pharmacists

Micromedex PHARMACY 693: NTPD Cafe - Web. CT 3. 8. 4 Micromedex PHARMACY 693: NTPD Cafe - Web. CT 3. 8. 4

Global RPH Clinicians ultimate guide to drug therapy Global RPH Clinicians ultimate guide to drug therapy

Pub. Med: Free Web Searches Entrez-Pub. Med Pub. Med: Free Web Searches Entrez-Pub. Med

Disease Specific Databases Welcome to Medscape Disease Specific Databases Welcome to Medscape

Disease Databases Diseases Database Ver 1. 55 ; Medical lists and links Diseases Database Disease Databases Diseases Database Ver 1. 55 ; Medical lists and links Diseases Database

National Guideline Clearinghouse http: //www. guideline. go v National Guideline Clearinghouse http: //www. guideline. go v

Free Medical Books and Journals http: //www. amedeo. com/ Free. Books 4 Doctors - Free Medical Books and Journals http: //www. amedeo. com/ Free. Books 4 Doctors - Free Medical Books online The Free Medical Journals Site

Evaluating the Literature Appraisal Tools e. BMJ -- How to read a paper Evaluating the Literature Appraisal Tools e. BMJ -- How to read a paper

Communication Wired and Wireless Web Communication Wired and Wireless Web

What is Mobile E-Health. Care? “The use of mobile handheld devices to communicate, interact, What is Mobile E-Health. Care? “The use of mobile handheld devices to communicate, interact, and transact via always on, high-speed connection to the Internet to manage and evaluate patient care. ”

Mobile Medical Applications: The Missing Link Paper Mobile Applications Full EMR Clinical Automation Tools Mobile Medical Applications: The Missing Link Paper Mobile Applications Full EMR Clinical Automation Tools which are delivered via Handheld (and potentially wireless) devices.

The Wireless Market Will Be Huge The Wireless Market Will Be Huge

Mobile and Internet Subscribers 1, 000 Mobility - The only thing growing faster than Mobile and Internet Subscribers 1, 000 Mobility - The only thing growing faster than the Internet Millions 800 600 Mobile Internet 400 200 0 1995 1997 1999 2001 2003 By 2003 – More that 500 Million Data Enabled Mobile Phones

Wireless Market Drivers • The ‘net’ is the virtual information megastore • People expect Wireless Market Drivers • The ‘net’ is the virtual information megastore • People expect instant access to information • Much of our work and personal lives are spent on the move • People want to be connected at anytime & from anywhere • Worldwide adoption of wireless - portable devices is steadily increasing "We believe that the mobile phone will become the e-commerce platform of the future. " Goldman Sachs, November 1999

Mobile Opportunities Personal Productivity • E-Mail • Instant Messaging • Chat • Personal Trading Mobile Opportunities Personal Productivity • E-Mail • Instant Messaging • Chat • Personal Trading • Mobile Banking • Ticketing/Entertainment • Mobile Shopping • Betting/Gambling • Games Future Services • Video Conferencing • Virtual Collaboration • Audio on Demand • Video on Demand Be close to your customer • Portfolio/Account Information • Indication of Interest • Research & Alerts • Quotes • Trading/Allocation & Confirm • Analyst Reports Mobile Field Service • Alerts & Notification • Remote Monitoring • Remote Diagnostics • Telemedicine • Telemetry • Service Reporting

Wireless Technology Overview Wireless Technology Overview

Wireless Technology Overview • Networks • 1 G… 2. 5 G. . . 3 Wireless Technology Overview • Networks • 1 G… 2. 5 G. . . 3 G • Emerging Technologies & Standards • • WAP Bluetooth • Devices • • Smart Phones Two Way Pagers PDAs / Hand Held Computers Laptop Computers

WAP: Wireless Application Protocol A communication protocol between a mobile terminal and an IT WAP: Wireless Application Protocol A communication protocol between a mobile terminal and an IT system (Internet, Intranet, corporate IT network) providing mobile access to services and content. • What’s so good about it • Network independent • If you have a WAP browser, you can get WAP content…. . usually • Worldwide support for WAP

Bluetooth: The Basics • A key enabler for the mobile handset • Uses a Bluetooth: The Basics • A key enabler for the mobile handset • Uses a 9 x 9 mm microchip, requires little power or space • Enables numerous devices to communicate wirelessly • Supported by 1, 500+ companies (e. g. IBM, Intel, Motorola) who are Bluetooth Special Interest Group (SIG) members • Intended for transmitting small amounts of data over short distances • Broadcasts in a 10 meter radius & at just 720 kbps • Designed to work in a noisy radio environment • Optimized for improved security and decreased interference www. bluetooth. com

Wireless Glossary http: //www. tatrc. org/website_wme/d ocuments/WMEglossary 1. htm Wireless Glossary http: //www. tatrc. org/website_wme/d ocuments/WMEglossary 1. htm

Wireless Devices How Can these be used in healthcare? Wireless Devices How Can these be used in healthcare?

Comparisons DEVICE STRENGTHS • Mobility, • Good Penetration • Most Mobile Large Penetration, • Comparisons DEVICE STRENGTHS • Mobility, • Good Penetration • Most Mobile Large Penetration, • • Pager 2 -Way capabilities • Mobility, • PDA Market Potential, • Better Functionality • Large Work area, • Laptop Most functionality, w/modem Market Penetration • • Phone WEAKNESSES Small work area, Difficult input, limited uses Smallest work area, Difficult input, limited uses Small work area, Difficult input, limited functionality Size and Weight = least mobile

Wireless Healthcare • Out-patient Care Centers, Home Healthcare, Off-site Medical Facilities • • Decentralization Wireless Healthcare • Out-patient Care Centers, Home Healthcare, Off-site Medical Facilities • • Decentralization of services driven by managed care Wireless is a remote lifeline keeping hospital nurses, home healthcare nurses, EMS technicians and doctors in touch • Access anytime / anywhere to: • • Medical history, patient records Medical assistance Patient care plans Test / lab results • Visiting nurses • • Burdened by paperwork on patients Need to reach doctors • Doctors • • • Need to be reached by hospital and patients Transmit prescriptions Remote monitoring of vitals • EMS • Receive real time medical support at scene of accident

Mobile E-Healthcare How it can revolutionize the Patient Experience • Email with healthcare provider Mobile E-Healthcare How it can revolutionize the Patient Experience • Email with healthcare provider • Online Medical Record: Personalized and Mobile • • Instant Online scheduling Wellness Management and Disease Management Routine and Emergency availability of data Ordering of prescriptions and other treatments, patient can check formulary at POC if doctor does not. • Administrative workflow: Billing, Referrals. . . • Analysis of Cost-Quality Issues • I can pay more for a once-a-day antibiotic, but is it worth it to me? • Should I get a PSA test, based on my personal risk-benefit analysis

Mobile E-Healthcare How it can revolutionize the Physician Experience • Mobile Email with patients Mobile E-Healthcare How it can revolutionize the Physician Experience • Mobile Email with patients and other providers • Administrative Workflow Support • schedule, to do list, billing, referrals. . . • Clinical Workflow Support • History and Physical documentation • Electronic Prescriptions and other Orders • Timely access to patient data • Support of “Information Overload” • Instant access to Medline, PDR, other texts… • Instant access to interactive tools (e. g. risk-benefit calculators • Instant access to high value local information • Regional Flu statistics, Antibiotic resistance data

Mobile E-Healthcare E-Prescriptions: A Killer App? • Criteria to succeed with Physicians • • Mobile E-Healthcare E-Prescriptions: A Killer App? • Criteria to succeed with Physicians • • Fast: sub-second speeds Easy: Intuitive and Mobile Flexible Reliable Integrated: PMS, Lab Knowledgeable: Formularies, DURs Cheap (OK- Free)

Internet Communication in the “Palm “ of your hand Internet Communication in the “Palm “ of your hand

Palm or Win. Ce based Wireless Web Phones WWW. Sprintpcs. com Palm or Win. Ce based Wireless Web Phones WWW. Sprintpcs. com

The Virtual Classroom: Voice over the internet www. elluminate. com The Virtual Classroom: Voice over the internet www. elluminate. com

Netmeeting Windows Net. Meeting Download Netmeeting Windows Net. Meeting Download

Using the Net to Phone Home www. net 2 phone. com Net 2 Phone Using the Net to Phone Home www. net 2 phone. com Net 2 Phone Comm. Center

Dialpad www. dialpad. com Dialpad www. dialpad. com

Conclusion • Wireless Technology is paving the way for the next stage of the Conclusion • Wireless Technology is paving the way for the next stage of the Internet revolution - and Healthcare needs to be ready. • Smart Organizations will not simply use the wireless Internet, they’ll help create it. • The wireless Internet is not simply a trend, it very well may be the foundation for E-Business and EHealthcare in the near future.

Digital Patient Care Tools Hardware/Software Digital Patient Care Tools Hardware/Software

Sony Vaio Sony VAIO® - Notebooks Sony Vaio Sony VAIO® - Notebooks

Comparison of Palm Products http: //www. tatrc. org/website_wme/d ocuments/PDAspreadsheet. htm Comparison of Palm Products http: //www. tatrc. org/website_wme/d ocuments/PDAspreadsheet. htm

Tablet PCs http: //www. tatrc. org/website_wme/do cuments/Tablets. htm Tablet PCs http: //www. tatrc. org/website_wme/do cuments/Tablets. htm

Internet Palm Resources Prior Health Sciences Library Personal Digital Assistant (PDAs) Resources Internet Palm Resources Prior Health Sciences Library Personal Digital Assistant (PDAs) Resources

Palm Based Medical Software http: //www. tatrc. org/website_wme/d ocuments/Software. Apps. htm Palm Based Medical Software http: //www. tatrc. org/website_wme/d ocuments/Software. Apps. htm

Palm Accessories http: //www. tatrc. org/website_wm e/documents/PDAaccessories. htm Palm Accessories http: //www. tatrc. org/website_wm e/documents/PDAaccessories. htm

Wireless in Healthcare Site Handheld Guide Wireless in Healthcare Site Handheld Guide

Mobile Health Data | The Hand-held Health Care Authority Mobile Health Data | The Hand-held Health Care Authority

Mobile Healthcare Alliance (MOHCA) Mobile Healthcare Alliance (MOHCA)

Hand Held Trade Offs Hand Held Trade Offs

Use of Mobile Devices in Healthcare Use of Mobile Devices in Healthcare

Warfarin Palm Study palmemulatorpptaudio Warfarin Palm Study palmemulatorpptaudio

Health Education Web Sites Evaluation Health Education Web Sites Evaluation

Evaluating Health Sites Evaluating Health Sites

Evaluating Health Care Sites Evaluating Health Care Sites

Evaluating Asthma Web Sites An Evaluation of the Quality and Contents of Asthma Education Evaluating Asthma Web Sites An Evaluation of the Quality and Contents of Asthma Education on the World Wide Web Donita R. Croft MD, MS 1 Michael W. Peterson MD, FCCP 1 1 Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA.

Asthma Web Site Evaluation Study objectives: To measure the accessibility and quality of currently Asthma Web Site Evaluation Study objectives: To measure the accessibility and quality of currently available asthma education World Wide Web sites using the following criteria: accessibility by readability, language, and download time; information quality based on inclusion of core educational concepts and compliance with Health On the Net (HON) principls; and utilization of innovative technology. Design: Objective evaluation of 145 Web sites.

Content Evaluation Content Evaluation

General Principles General Principles

General Principles General Principles

General Principles General Principles

General Principles General Principles

Results Measurements and results: Four search engines or directories (Yahoo, HON, Alta Vista, and Results Measurements and results: Four search engines or directories (Yahoo, HON, Alta Vista, and Healthfinder) were searched for “asthma, patient information. ”A maximum of 50 Web sites from each search engine or directory was evaluated. Only 90 of the 145 Web sites actually contained asthma educational material. The mean (± SD) time necessary to open each Web site on a 28. 800 -bits-persecond modem was 33. 6 ( ± 36. 6) s. The mean number of graphics on the Web sites was 24. 6 ( ± 30. 2) files per page. The educational material required a mean reading level beyond the 10 th grade. Only nine Web sites contained multilingual asthma education material. The mean number of HON principles with which the Web sites conformed was 6. 3 ( ± 1. 0) of 8 principles; 14 Web sites conformed to all the HON criteria. The average Web site contained 4. 9 (± 2. 5) of 8 core asthma educational concepts, and only 20 Web sites contained all 8 educational concepts. Very few Web sites utilized innovative educational technology.

Conclusions While patient asthma education Web sites are common, asthma educational material contains many Conclusions While patient asthma education Web sites are common, asthma educational material contains many accessibility barriers, is highly variable in quality and content, and takes little innovative use of technology. Patient educational material currently available on the World Wide Web fails to meet the information needs of patients.

Breast Cancer Project Beth Alison Novak, M. S. Master’s Project Peter Kwok Chan, Adviser Breast Cancer Project Beth Alison Novak, M. S. Master’s Project Peter Kwok Chan, Adviser Dr. Elizabeth Sanders Dr. Dennis Mungall

Breast Cancer Project Breast Cancer Project

Breast Cancer Project Breast Cancer Project

Breast Cancer Project Breast Cancer Project

Breast Cancer Project Breast Cancer Project

Patient Education Web Sites Examples Patient Education Web Sites Examples

Home Infusion Web Site: Sue Mashni, R. Ph. Home Infusion Therapy Home Infusion Web Site: Sue Mashni, R. Ph. Home Infusion Therapy

Mulitple Information Sites for Consumers Consumer Health Resources Mulitple Information Sites for Consumers Consumer Health Resources

Healthology : Health Topics Healthology : Health Topics

Lily Diabetes Site Lilly. Diabetes. co m Lily Diabetes Site Lilly. Diabetes. co m

Lifescan Diabetes Life. Scan Diabetes Care -- Diabetes Essentials Lifescan Diabetes Life. Scan Diabetes Care -- Diabetes Essentials

Mayo Clinic Mayo. Clinic. com - Medical and health information for a healthier life Mayo Clinic Mayo. Clinic. com - Medical and health information for a healthier life from Mayo Clinic

Personal. MD. com-Your. Lifeline Online Personal. MD. com-Your. Lifeline Online

Patient Management Via the Web Patient Management Via the Web

Virtual Anticoagulation Clinic http: //www. coagexpert. net/ clinic Virtual Anticoagulation Clinic http: //www. coagexpert. net/ clinic

Health Hero Welcome to Health Hero Network Health Hero Welcome to Health Hero Network

Health Buddy Health Buddy

Health Buddy Health Buddy

Health Buddy Health Buddy

Health Buddy Health Buddy

Medi. Monitor http: //www. informedix. com/overview. htm Medi. Monitor http: //www. informedix. com/overview. htm

Telemedical Library Telemedical Library

Point of Care Coagulation Monitors http: //www. coaguchek. com, http: //www. devicelink. com/mddi/archive/00/04/0 09. Point of Care Coagulation Monitors http: //www. coaguchek. com, http: //www. devicelink. com/mddi/archive/00/04/0 09. htm lhttp: //www. pointofcare. net, http: //www. itcmed. com, http: //www. hemosense. com/

Timex Bodylink Timex - Body. Link Timex Bodylink Timex - Body. Link

Timex Ironman Timex Ironman

Telemedicine Telemedicine

Commerce Using the Web for Health. Care Business Commerce Using the Web for Health. Care Business

What to Do with a Web Page • Market (Virtual Welcome Wagon) • Inform What to Do with a Web Page • Market (Virtual Welcome Wagon) • Inform (Hours, Staff, Services, Location) • Sell (HBA, OTC, DME, Comp. and Alt. Medicines, Services, Specials/Promotions) • Communicate (Refills, POE, DSM, Feedback, IVR, Chats, Ordering) • Educate with Health Content and Links

Why should I put my practice on the Internet? · You can put information Why should I put my practice on the Internet? · You can put information on your site for prospective patients · Patients can access your Internet site 24 hours a day, 7 days a week · You can provide information on your Internet site for your existing patients · If you prefer, you can answer questions from patients through E-mail · There are no incremental costs, such as postage or printing · You can include maps on your sites that help patients find you · You can post newsletters on your site, thus saving money.

My Web-site, what do I need? You need three things: • 1. A Domain-Name My Web-site, what do I need? You need three things: • 1. A Domain-Name • 2. Web-Space (Hosting Service) • 3. A Program, which can save your documents in HTML.

Example : WWW. Bigstep. Com www. clinpharmacologist. bigstep. com Example : WWW. Bigstep. Com www. clinpharmacologist. bigstep. com

Registering your web address Registering your web address

Professional Education on the Web Professional Education on the Web

Example : OSU NTPD Program www. osunptd. com Example : OSU NTPD Program www. osunptd. com

Objectives • Review Education on the Web • Demonstrate Web Based Education • Discuss Objectives • Review Education on the Web • Demonstrate Web Based Education • Discuss possible outcomes of a Web Based Program

Consistency • Design a common interface for all courses • Use common , identifiable Consistency • Design a common interface for all courses • Use common , identifiable elements for video , audio , and text feedback

Developing the Feeling of “Being on Campus” • How do you replace the classroom? Developing the Feeling of “Being on Campus” • How do you replace the classroom? • Does the internet reduce the student to student interaction • Email, Bulletin boards, Virtual Class rooms • Identify faculty and students with their personal web pages that can include audio, video, text information

Faculty Training • Faculty need to become proficient in creating web based presentations • Faculty Training • Faculty need to become proficient in creating web based presentations • Learn how to use communications technologies to communicate with students: email, chat room, live video on the web to communicate • Have a clear understanding of the advantages of online learning e. g. increase communication , highly visual medium, speed of learning fit to the student, time of learning set by the student • Clear understanding of disadvantages: slow online access, maintaining student motivation, not the same as a real classroom

Student Training • Online training, CD ROM, on campus training session • Each student Student Training • Online training, CD ROM, on campus training session • Each student needs basic computer skills • When course implements new technology, training of students and faculty critical

Academic Concerns of WWW • • Loss of personal, face to face interaction Cheating Academic Concerns of WWW • • Loss of personal, face to face interaction Cheating Student tracking issues Possibility of a decrease in professional respect for online graduates

Potential Academic Benefits • Opens up the ability to implement CQI to the educational Potential Academic Benefits • Opens up the ability to implement CQI to the educational process • Opportunity to perform educational research to evaluate impact of the educational process • Allows implementation and assessment of newly developed , online clinical tools for patient care • Much finer control of the students progress via instantaneous , online assessment and feedback

Potential Financial Benefits • Use the medium to innovate in clinical practice • Develop Potential Financial Benefits • Use the medium to innovate in clinical practice • Develop and test teaching, patient management tools that have general value • Develop online teaching that serves the Professional program and can be modified for continuing education on-line

General Capabilities of a WWW Educational System • • • Outcome Assessment Student Tracking General Capabilities of a WWW Educational System • • • Outcome Assessment Student Tracking Lecture Notes/Slides/Audio/Video Assignments Course evaluation

Academic Issues • Allow a number of development tools that reflect differences in courses Academic Issues • Allow a number of development tools that reflect differences in courses and teaching styles • Intellectual Property issues