Commentary: Misguided about e-health

When Norwegian doctors think that e-health borders on the indefensible, something is wrong. Instead of burying their heads in the sand, doctors and researchers should find out how the new technologies can be used in the best possible way.

Debate is raging about the use of new technologies in the health sector. Can taking your own health measurements at home help to improve treatment and health services, for example? No, three Norwegian doctors commented recently in Aftenposten [a leading daily newspaper based in Oslo, Norway]. In their commentary “Naivt om den digitale pasienten” [Naivety about the digital patient], they write that trust in new technology borders on the indefensible. 

It is sad to see that Norwegian doctors believe members of the public cannot understand their own health data, and that they believe we should not collect and analyse valuable information about ourselves. 

Little understanding

For us, who have been working with e-health from a long time from a variety of perspectives, this commentary shows that understanding of the changes that technology is bringing to the health sector remains low, and that these changes generate fear rather than enthusiasm for new knowledge.

The technological revolution, which has already reached and disrupted so many other parts of society, is in the process of making inroads into the traditionally slow-moving health sector. Tablet PCs, online booking of appointments, apps on smartphones, self-diagnosis and wearable sensors will provide more knowledge to both health professionals and patients/citizens for preventing and coping with health problems.

The World Health Organization (WHO) writes that e-health “saves lives, saves money, improves the health of individuals and the population at large; strengthens health systems, promotes equity and social justice”.

Unimagined opportunities

One of the major objections that doctors in particular voice against self-measurement is that greater knowledge about one’s own health breeds greater concern. Of course it involves new challenges, but we believe that most people are capable of understanding and managing their own health in a modern information and communication society. 
e-health creates unimagined opportunities. In Norway, we are making progress with many exciting projects.

Through apps on their phone, people with diabetes can understand the relationship between their diet, level of activity, use of insulin and blood glucose values. When data are transformed into information and knowledge, people can see patterns in their own life and illness. Patients have achieved genuine long-term reductions in their blood glucose levels because it is easier for them to see what they need to change – and what they are doing right. Lower blood glucose is a goal for this group of patients and reduces the risk of delayed complications.

Motivation

For users who are trying to give up smoking, personalized encouragement and feedback sustains motivation long enough to enable more people to quit than admonitions from doctors have done. People who have had heart surgery stay motivated to comply with exercise programmes long enough to see the results. By using e-health, COPD patients get help from physiotherapists to exercise, take simple measurements and record simple information that provides motivation and understanding of their own body and health.

Modern data analysis enables fast searches through large amounts of data. This provides completely new possibilities for understanding contexts and finding the results of different treatments for rare, complex and multi-faceted disease profiles – to choose the one that gives the best results, taking into account what the patient thinks is most important. 

Yes, we can actually go so far as to say that analysis of data in the future will be equally – perhaps even more – valuable to our health compared with traditional health research. 

More research! 

It is not naive and unscientific to believe in the e-health revolution. We would rather argue that it is bordering on the indefensible not to see the enormous value inherent in wearable and home-based measurements for improving the health of the community and the individual. 

Further research on e-health is essential. We know that the IT industry will bring us new innovations faster than we can implement them. Instead of burying their heads in the sand, doctors and researchers should join forces to find out how the new technologies can be used in the best possible way. 

The patient’s role

We need greater insight into the mechanisms that work and those that do not work. Understanding about who finds motivation in which types of services and solutions – and those for whom they do not function. Just as in pharmaceutical medicine, there are differences in the way that individuals respond.

So far, research suggests that the use of e-health has little impact on the consumption of health services. It changes the patient’s role and it changes the way that the dialogue with the doctor develops, as well as the expectations that people have of their doctors and the health services. It can certainly be challenging in itself, but it is only part of a trend that has lasted longer than e-health.
 
Commentary article and debate, Dagens Medisin 05/2014
Per Hasvold / Nard Schreurs

Commentary article published in Dagens Medisin, a Norwegian newspaper for the health sector, on 6 March 2014.

Written by Per Hasvold, Research Section Manager for Home-based Services and Personal Health Systems at the Norwegian Centre for Integrated Care and Telemedicine (NST) and Nard Schreurs, Project Manager at IKT-Norge (the interest group for the Norwegian ICT industry) and former editor of the e-health magazine Computerworld IT-helse