information and communication technologies...

Information and Communication Technologies Transform the Practice of Medicine

ANDREW STRANIERI

TONY SAHAMAQueensland University of Technology, Australia

PATHIRAGE KAMAL PERERAIIM, University of Colombo

Overview

▪ Co-existence of medical systems

▪ Healthcare globally is in crisis

▪ Technologies are getting cheaper and more powerful

▪ eHealth is transforming health care by:▪ Tele-medicine▪ Electronic Health Records ▪ Standards in eHealth▪ Decision Support Systems ▪ Data mining in Health

▪ Healthcare system is transforming:▪ Global▪ Patients are becoming empowered▪ Privacy and Security challenges▪ Cultural change challenges

© Stranieri and Sahama 2014

Presenters and Contributors

▪ Associate Professor Andrew Stranieri. Health Informatics Researcher. Federation University, Australia [email protected]

▪ Dr Tony Sahama. Health Informatics Researcher. Queensland University of Technology, Australia http://staff.qut.edu.au/staff/[email protected]

▪ Dr Pathirage Kamal Perera. Indigenous clinician, researcher and academic. Institute for Indigenous Medicine, University of Colombo, Sri Lanka


http://staff.qut.edu.au/staff/sahama

Health Care Trends

Co-existence of medical systems


Co-existence of Allopathic and Other Medical Systems

Ingestive Remedial Energetic Other

Herbal Medicine Massage Acupuncture Dietary advice

Nutritional Medicine Reflexology Aromatherapy Yoga

Homeopathy Shiatsu Reiki Art therapy

Naturopathy Acupressure Magnet therapy Music therapy

Ayurveda Chiropractic Spiritual Healing Qi gong


Global trend: Co-existence of Allopathic and Other Medical Systems

▪ Co-existence means:▪ Patients anywhere in the world can

access health care from any tradition▪ Not necessarily, integrative medicine

Golden, I., Stranieri, A., Sahama, T, Pilapitiya, S., Siribaddana, S., and Vaughan, S. 2014 Informatics to support patient choice between diverse medical systems to IEEE HEALTHCOM 2014 - 1st International Workshop on Secure and Privacy-Aware Information Management in eHealth

Stranieri, A and Vaughan, S (2011) Coalescing Medical Systems: A Challenge for Health Informatics in a Global World in Smith, A and Maeder, A. 2010. (eds) Studies in Health Technology and Informatics Volume 161, 2010

Andrew Stranieri and Tony Sahama. Eds. (2012) Proceedings of the 3rd International Conference on Holistic Medicine ICHM 2013 Nov 17-19 2012. Sri Lanka. University of Colombo. ISBN 978-955-0460-39-7

▪ Examples▪ Germans access Ayurvedic treatment in Sri

Lanka▪ Australians access TCM specialists


Impact of co-existence

▪ Medical systems will ‘compete’ with each other compelling each to demonstrate their effectiveness

▪ The geographical ‘reach’ of each medical system is larger than ever

▪ Some medical systems will inevitably decline

Indicator Indicator

Shortage of HCP

Malawi has 250 doctors for

16 million

6 week wait for General

Practitioner in regional Australia

Rise of Chronic diseases

Diabetes in Australia 17%

Diabetes in Sri Lanka over

12%

Cost of health care

Australia 12% of GDP

US 17% of GDP

Equity

IndigenousAustralians life expectancy 20

years less

In US, low income


Co-existence: patients need information to choose

▪ How do patients choose:Emergency Palliative Acute Chronic

Effectiveness 10 5 8 7

Empathy 1 7 3 10Empowerment 1 7 4 10

Accessibility 5 3 6 4

Philosophical 1 6 4 8

Privacy 3 7 7 7


Global trend: Co-existence of Allopathic and Other Medical Systems

▪ Co-existence will continue because▪ Emerging super economies of China

and India have strong traditional medicines

▪ TCM, Others already popular in the West, WM already popular in East

▪ TCM, others (in West) provides good models of patient empowerment

▪ Chronic (lifestyle) conditions resistant to WM

▪ Challenges/Research▪ How to support patients to choose a medical

system ?▪ How to ensure Ayurveda ‘competes’ effectively

with other systems? ▪ How to ensure Ayurveda is accessible to

patients outside Sri Lanka ?


Health Care Trends

Healthcare globally is in crisis


Global Trend : Health Care Crisis

▪ Shortage of health care professionals particularly ▪ In rural areas▪ In emerging countries

▪ Rise of Chronic diseases

▪ Costs

▪ Equity

▪ Quality of healthcare-medical errors

Indicator Indicator

Shortage of HCPMalawi has 250 doctors for 16

million

6 week wait for General Practitioner in regional Australia

Rise of Chronic diseases

Diabetes in Australia 17%

Diabetes in Sri Lanka over 12%

Cost of health care Australia 12% of GDP US 17% of GDP

Equity

IndigenousAustralians life

expectancy 20 years less

In US, low income

Medical errors


Global Trend : Health Care Crisis

▪ Shortage of health care professionals particularly ▪ In rural areas▪ In emerging countries

▪ Rise of Chronic diseases

▪ Costs

▪ Equity

▪ Quality of healthcare-medical errors

Armstrong, B.K., Gillespie, J.A., Leeder, S.R., Rubin, G.L., & Russell, L.M., (2007). Challenges in health and health care for Australia. Med J Aust 2007; 187 (9): 485-489. Retrieved on the 16/6/2011 from http://www.mja.com.au/public/issues/187_09_051107/arm11047_fm.html


http://www.mja.com.au/public/issues/187_09_051107/arm11047_fm.html

eHealth

Technologies are getting more powerful and cheaper


Technological Maturity

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2004 2006 2008 2010

Proportion of people using the Internet for health purposes in each employment status

Full Time Work

Part Time Work

Retired/ Disabled

Others (includingunemployed andstudents)

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Proportion of people using the Internet for health purposes in each age category

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Proportion of people using the Internet for health purposes by gender

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Female


eHealth

Information and Communication Technologies (eHealth) are transforming the

practice of health care© Stranieri and Sahama 2014

A broad description

“eHealth aspires to be a secure unobtrusive, ubiquitous and cost effective means for technology to improve the quality of healthcare delivery by meeting the individual needs of a complex stakeholder network”.

(Black and Sahama 2014)

16© Stranieri and Sahama 2014

eHealth innovations

• Telemedicine. Practice of health care where patient and practitioner are remote

• Electronic Health Record. Virtual record of every health event a patient has through life

• Online information. Easy access online to information about health, condition, physicians, other patients

• Decision Support System. Software that helps less experienced health care professions make decisions like specialists

• Simulation, Computer Games. Software that simulates health care phenomena

• Data mining. The automated analysis of large healthcare datasets© Stranieri and Sahama 2014

Impact of the global trends on healthcare


Impact on Healthcare

• World is in a Healthcare Crisis

• Co-existence of Allopathic and Other Medical Systems

• Technologies are getting cheaper and more powerful

• eHealth is transforming the practice of healthcare

• Patient empowerment, choice

• Privacy, security challenges

• Disruption to the health care professions

• Challenges to legal systems

TRENDS IMPACT


Healthcare practice is changing

• Patients seek information to:• Validate doctors decisions• Self diagnose• Find relevant health care professionals

• Health care organisations:• Pressure to be efficient. Do more with fewer resources• New professional sub-division eg Cancer Nurse Practitioner. Nurse who is trained to

practice as a doctor for cancer.


Status of eHealth around the world


eHealth in allopathic medicine around the world

WESTERN MEDICINE

▪ Gorillas. Big ehealth spending but health outcomes not great. Slow, hard to change▪ USA▪ Canada▪ UK▪ Australia

▪ Deer. Nimble, quick to change. Smaller spending. Faster changes▪ Denmark▪ New Zealand

▪ Beginning to adopt Slovenia

▪ Not yet adopting. Emerging regions? (e.g., South East-Asian countries)

INDIGENOUS, AYURVEDIC

▪ Not yet much eHealth


eHealth for Ayerveda

Tele-medicine


Telehealth. Two kinds

• Synchronous. • Doctor in one place, patient in another at the same time use

video conference using internet. • Usually higher definition than skype,viber. • Sometimes with digital equipment eg digital stethoscope

• Asynchronous. Store and Forward• Doctor in one place, patient in another at different times

Health care professional uploads images, videos for specialists to access when they can


TeleHealth: Examples

• http://www.hd3dtelemedicine.com.au/

• Tele-dentistry into aged care facilities

• Tele-psychiatry with 3D Immersion


http://www.hd3dtelemedicine.com.au/

eHealth: More telemedicine

• http://www.hd3dtelemedicine.com.au/

• Tele-wound. Nurses in home to specialists

• Store and Forward

• Tele-oncology. Oncologist to Cancer nurse

• 2D video conferencing. Vidyo



Tele-health for Ayurveda

▪Challenges/Research▪ Tele-health consultations with foreign patients in their own

country following or before Indigenous/Ayurvedic treatment▪ Tele-Ayurvedic consultations between practitioners all over Sri

Lanka and Specialists in Colombo▪ Tele-Ayurvedic consultations between remote patients around

Sri Lanka and Specialists▪ Tele-consultations in the field to help train

Indigenous/Ayurvedic physicians© Stranieri and Sahama 2014

Tele-health References

HD3D Telemedicine. www.hd3dtelemedicine.com.auMARIÑO R, Clarke K, Manton DJ, Stranieri A, Collmann R, Kellet H, Borda A. Teleconsultation and telediagnosis for oral health assessment: an Australian perspective. In: K Raghavan, S Kumar (Eds.). Teledentistry. Springer. (In press). 2014Stranieri, A., Collmann, R and Borda, A. (2012) High Definition 3D Telemedicine: the next frontier? Global Telehealth. Australian Telehealth SocietyPulseIT http://www.pulseitmagazine.com.au/



http://www.pulseitmagazine.com.au/

eHealth for Ayurveda

Electronic Health Records


eHealth: Electronic Health Record

Virtual, online record of every health event a person encounters from before birth to after death

Currently, data is stored in each organization’s databases (or paper files) inaccessible to others

Leads to lost data, medical errors, patient/carer frustration

Hospital database

GP database

Dentist database

Pharmacydatabase

Psychologist database

…© Stranieri and Sahama 2014

eHealth: Private Database

Distributed database architecture for establishing an electronic health record

Hospital database

GP database

Dentist database

Pharmacydatabase

Psychologist database

…

Private Microsoft Healthvaulthttps://www.healthvault.com/lk/en

DEMO

Public Personally controlled electronic health record

http://www.ehealth.gov.au/ DEMO© Stranieri and Sahama 2014

http://www.ehealth.gov.au/

Stakeholder Requirements

Healthcare Provider Requirements

Patient Requirements

Sweet spot!

Concerned over the safety of their

sensitive information and

possible breaches of privacy

Expect better, faster, easy access

to as much information as

possible


Empowering, yet limited

However:

60% of GPs will neveruse the eHealth

records (Source: Online Poll by Australian Doctor Magazine July 2013)

Perception that it does not make the practitioner’s job

easier

Practitioner’s may not have full access

to clinical dataLitigation concerns

for practitioners

PCEHR data is collected by the government who own all IP rights

Sour

ce:

http

s://

ww

w.s

urve

ymon

key.

com

/s/p

cehr

cons

ulta

tion

An Australian Perspective

PCEHR provides patient controlled access to summary patient informationOpt-in modelEvent summary (critical information only)


National E-Health Transition Authority, "NEHTA BluePrint," 13 August 2010.© Stranieri and Sahama 2014

Accountable Systems

13


An IA Model: Accountable-eHealth Systems


Ehealth record for Ayurveda

▪Challenges/Research▪ Indigenous/Ayurvedic Patient Management Software is

emerging▪ Software for Indigenous/Ayurvedic hospitals exists ▪ Software for Ayurvedic physicians is emerging eg

http://www.sattvaayusoft.com/▪What is needed is affordable PMS for all physicians designed to

link to electronic health records and hospital systems▪ Systematic studies to discover Ayurvedic physicians attitudes

to recording consultations and eHealth records© Stranieri and Sahama 2014

Standards

Role of Standards in eHealth


eHealth: Standards

• Terminology standards. Names of health care concepts are exactly the same around the world

• Messaging standards. The format of a message from one computer to another is the standard so variables don’t get mixed up


SNOMED-CT Terminology Standard

Rheumatoid Arthritis

Inflammatory Disorder

Clinical Finding

Root

19 branches• ICD-10 International Classification

of Diseases

• Snomed-CT Ontology http://www.ihtsdo.org/snomed-ct/

DEMO

• Ontology with 300,000 concepts

• Each concept has a unique Concept ID


http://www.ihtsdo.org/snomed-ct/

Messaging Standard: HL7

Syntactic Interoperability

• Data exchange between two systems – process taking data structured under one schema for transformation to another

• How to ensure first names are not confused with surnames, blood pressure with age, etc

• Health Level 7 (HL7) http://www.hl7.org/

DEMO

▪ AEHIN http://www.aehin.org/

GP

Email a request for blood tests

Laboratory

Save the request for blood test and send a reply to the GP


http://www.hl7.org/

http://www.aehin.org/

Messaging Standard: HL7

MSH|^~\&|EPIC|EPICADT|SMS|SMSADT|199912271408|CHARRIS|ADTÂ04|1817457|D|2.5|PID||0493575^^^2ÎD 1|454721||DOE^JOHN^^^^|DOE^JOHN^^^^|19480203|M||B|254 MYSTREET AVE^^MYTOWNÔH^44123ÛSA||(216)123-4567|||M|NON|400003403~1129086|NK1||ROE^MARIE^^^^|SPO||(216)123-4567||EC|||||||||||||||||||||||||||PV1||O|168 ~219~C~PMA^^^^^^^^^||||277ÂLLEN MYLASTNAME^BONNIE^^^^|||||||||| ||2688684|||||||||||||||||||||||||199912271408||||||002376853

GP

Email a request for blood tests

Laboratory

Save the request for blood test and send a reply to the GP


eHealth Standards for Ayurveda

CHALLENGES• How can HL7 be deployed for

use in Ayurvedic messaging

CHALLENGES/Opportunities• How to expand Snomed-CT

to include terms from Ayurveda and other medical systems

First meeting on Ayurveda/SnomedSeptember 2014


DSS and CDSS

Role of Decision Support Systems in general and Clinical settings


Decision Support Systems

• Type 1 Provision of information that requires further processing and analysis by users before a decision can be made.

• Type 2 Trend analysis of patients’ clinical status and/or clinical alerts.

• Type 3 Use of inference engines and a knowledge base to generate recommendations.

• Type 4 Systems with autonomous learning capabilities (e.g., case-based reasoning, neural networks, discrimination analysis)

(CDSS) is an application that analyzes data to help healthcare providers make clinical decisions.


Decision Support Systems: Applications

• Alerts and Reminders: • Symptom management:• Diagnostic Assistance: • Prescription Support:• Image Recognition and

Interpretation:• Therapy Critiquing and

Planning: • Training• Other


eHR Data Sets

Data Handling Utility

Usage Checking Utility Accountability Utility

Message Handling Utility

Rules Management UtilityConsent Function

Accountability Function

IA Agent


HIS vs HIT


Proposed data warehouse model (Example: Cardiac Surgery) Multiple Profile Manager Overview

Sequence Diagram for Query Flow in Bucket Index using Bloom filter under AES-DAS model© Stranieri and Sahama 2014

eHealth: Online information

• Patient Empowerment Self diagnosis with internet information

• https://www.patientslikeme.com/

• http://www.healthdirect.gov.au/

• https://www.cochrane.org/


Health Information: PatientsLikeMe

• Self diagnosis with internet information • Quality of information varies


Health Information: Health Services Directory

Courtesy. Laurie Hawkins. Health Consultant

Designed as Software as a Service so can readily be deployed in an emerging region

www.echannelling.comhttp://www.nhsd.com.au/© Stranieri and Sahama 2014

Health Information: Better Health Channel

Australian Government funded project to maintain a quality web site with up to date and accurate information

Very expensive to maintain


Health Information for Ayurveda

▪ Implement a Health Services Directory in Sri Lanka.

▪ Discover how Sri Lankan’s Exploration into the patterns of access to online information in Sri Lanka

▪ Establish a ‘Trusted’ Ayurveda medicine repository of information for interested patients (English and other languages)


eHealth: Remote Patient Monitoring

• Stream data from patients body wirelesses sensor network to cloud databases

• Health Care Professionals anywhere can access the data

• Applications. Falls, Ventricular fibrillation, post operative early detection of sepsis

• Remote Patient Monitoring needs new architectures Balasubsamanian et al


Remote patient monitoring challenges/opportunities for emerging regions

• Field test of remote patient monitoring architecture. • Applications of remote patient monitoring eg early detection of sepsis

following hospital discharge. • Collect physiological data from patients wearing sensors and correlate

with Ayurvedic assessments• Automated Ayurvedic Pulse Detection


Remote patient monitoring Ayurvedic pulse detection

Deepa, N., Ganesh, A., (2012) Optical sensor for Indian Siddha Diagnosis System. Procedia Engineering 38 ( 2012 ) 1126 – 1131 Joshi, R. R., 2005 Diagnostics Using Computational NadiPatterns. Mathematical and Computer Modelling 41 (2005) 33-47

Ullrich, S. and Kuhlen, T., Haptic Palpation for Medical Simulation in Virtual Environments April 2012 (vol. 18 no. 4) pp. 617-625


Decision Support Systems: Tridhosa Assessment

Knowledge Based System

Knowledge Base

Inference Engine

UserFacts

Expertise

Weight below average for my build.

average for my build. above average for my build.

Weight loss tend to lose weight easily

maintain my weight easily I gain weight easily

Skindry, rough, especially in winter soft, ruddy oily, moist

Hair dry fine, thin, reddish, or prematurely gray thick, wavy

Skindry, rough, especially in winter soft, ruddy oily, moist

Hair dry fine, thin, reddish, or prematurely gray thick, wavy

Body size slim medium largebone Light, small bones, Pr Medium bone structuLarge, broad shoulders, Heavy b complexion Dark complexion, Tan Fair skin, sun burns eaWhite, pale, tans evenlyskin texture Dry, pigmentation an Freckles, many moles Soft, glowing and youthfulface shape Long, angular,Thin Heart-shaped,pointed Large, round, Fulleyes Small, black, sunken, Yellow , bright, grey, Big, beautiful, blue, calm, lovingeye lashes Scanty eye lashes Moderate eye lashes Thick / Fused eye lasheseye blinking Excessive Blinking Moderate blinking More or less stable


eHealth: Simulation

• Scenari-Aid www.scenariaid.com

• EdHeads http://www.edheads.org/activities/knee/

• SecondLife http://www.secondlife.com


http://www.edheads.org/activities/knee/

http://www.edheads.org/activities/knee/

Simulation for Ayurveda

• Design and implement simulations for Ayurvedic medicine

• Simulation for education of Western patients of Ayurvedic procedures


Data Mining

Data mining in Healthcare


Data mining

Extraction of potentially meaningful patterns from data (Frawley 91)


Data mining: medical applications

• Image retrieval and classification.

• Retrieve mammogram that are most similar to a current image, benign that look malignant and malignant that look benign. N-gram/neural network

Kulkarni, P., Stranieri, A., Kulkarni, S., Ugon, J., and Mittal, M. 2014. Hybrid Technique based on N-gram and Neural Networks for Classification of Mammographic Images. Second International Conference on Signal, Image Processing and Pattern Recognition (SIPP 2014) in Wyatt, D (Ed) Computer Sciences and Information Technology (CS&IT) Vol 4. 297-306


Data mining for Ayurveda

Challenges and Opportunities• Image analysis of tongue

Stranieri, Andrew & Sahama, Tony R. (2012) Data mining traditional Chinese medicine (TCM) lessons learnt from mining in law and allopathic medicine. In Song, Jian (Ed.) Proceedings of the 2012 IEEE 14th International Conference on e-Health Networking, Applications and Services (Healthcom), IEEE, Beijing, China.


Privacy and Security

Privacy and security including managing the risk in particular

when exchanging health information


Privacy and Security

A sociotechnical analysis

Tony Sahama , Leonie Simpson & Bill [email protected]


mailto:[email protected]

Privacy and Security in eHealth

Information and Communication Technologies (ICT) have the potential to improve many facets of modern healthcare service delivery

The implementation of electronic health records (EHR) systems is a critical part of an eHealth system

Despite the potential gains, there are several obstacles that limit the wider development of electronic health record systems

Among these are the perceived threats to the security and privacy of patients’ health data, and a widely held belief that these cannot be adequately addressed.


Our Hypotheses

We hypothesise that the major concerns regarding eHealth security and privacy cannot be overcome through the implementation of technology alone

Human dimensions must be considered when analysing the provision of the three fundamental information security goals: confidentiality, integrity and availability

A sociotechnical analysis to establish the information security and privacy requirements when designing and developing a given eHealth system is important and timely

A framework that accommodates consideration of the legislative requirements and human perspectives in addition to the technological measures is useful in developing a measurable and accountable eHealth system

Successful implementation of this approach would enable the possibilities, practicalities and sustainabilities of proposed eHealth systems to be realised.


SECURITY AND PRIVACY FOR EHRs① Critical Information Security Services

a) Confidentialityb) Integrityc) Availability

② Information Statesa) Transmissionb) Storagec) Processing

③ Security Measuresa) Technologyb) Policy & Practicesc) Education Training and Awareness

How do we understand these characteristics, attributes & measures as a Human?© Stranieri and Sahama 2014

LEGAL ISSUES FOR EHRs/SEHRs Privacy concerns

− Competing interests & emergency disclosure

− Data migration

− Non technical security breaches

− Function creep

Ownership of & access to records

− Public HCPs – records subject to public access laws

− Private HCPs – records ‘owned’ by HCP

− SEHR systems may require participation agreements


LEGAL ISSUES FOR EHRs/SEHRs (cont…,) Intellectual property (copyright) issues

− Do EHRs constitute intellectual property?− Who has copyright – HCP or Consumer?

Governance arrangements for SEHR systems− State governance− Privatised governance (self regulation)− SEHR systems may require participation agreements

Consent models for SEHR systems− Non consent model− Implied consent – opt out model− Implied consent + exceptions – opt out + exceptions− Express consent model− Express consent + exceptions – opt in + restrictions


Information accountability (IA) is a concept focused on appropriate-use of and after-the-fact accountability for information usage

Transparency and the presence of accountability mechanisms are necessary to build trust in the system and are also expected to act as a deterrent for intentional misuse

eHealth systems built to follow the principles of IA are called Accountable-eHealth (AeH) systems [13]

Figure 2 illustrates the role of IA in the eHealth domain. In this scenario, observe how patients’ healthcare information might flow in the eHealth environment.


① The three main aspects of the IAF: Legal, Social and Technological and their interrelationships are shown in Figures 3

② Accountable eHealth systems rely on appropriate legislation for the governance and regulatory mechanisms to be established

③ AeH systems in the Australian context depends upon the establishment of an appropriate underlying legal framework to adequately address a range of specific issues including information ownership, access and control, data breach notification and broader issues involved in the legal management of the system as a whole

④ The recent enactment of the Personally Controlled Electronic Health Records Act 2012 (Cth.)

⑤ And, advances but the implementation issues remain unresolved.


eHEALTH PROCESSES AND PROTOCOLS

1. While the process of converting existing physical health documents and medical records to digital versions or copies has begun, the development of effective large scale systems of EHRs is still a long way off

2. Public awareness and acceptance of EHRs is limited and the involvement of professionals (such as clinicians and healthcare decision makers) in this EHR journey varies around the globe. In many places, the owners or custodians of the medical/health data and information (e.g., PCEHR or PHR, EMR and EHR) are not yet clearly identified. It is important that a physical person (e.g., human) is responsible for the contents of the digital document (e.g, EHR, EMR & PHR)

3. The integrity and non-repudiation of these EHR documents and/or processes may be affected by the actions of the responsible person. Addressing this represents an ongoing challenge in both HIT policy and the related legislative debate

4. To better understand the information flow between public and professionals in a given eHealth scenario, we present a graphical view of in a sociotechnical perspective, by integrating a human dimension (Figure 4)

5. This graphical depiction has global application, without prejudicing country specific legal and/or legislative protocols.


EHR; PHR (PCEHR); EMR & IAF

▪PHR: is recognisable, individual information stored, collected, shared and controlled by individual (the public view)▪EMR: is amended, updated PHRs that managed by authorised clinicians and healthcare organisation (the professional view)▪IAF: is a concept focused on appropriate-use of and after-the-fact accountability for information usage.


A. We argue that an eHealth system should be designed to support improved healthcare services and/or to enhance the quality of clinical decision making processes

B. Such an eHealth system should consider the “critical pivotal point” (intersection of PHR, EMR, EHR and IAF, marked as Ω in Figure 4), seriously, from the outset of system design and development

C. We observe and hypothesise, such interconnections comprise with human behaviour, information flow, [for example, the state of the information: is it in storage, in transmission (being transferred from place to place) or in use (being processed)], and information accountability measures are aspects the majority of eHealth systems have failed to address [16].


① The three main aspects of the IAF: Legal, Social and Technological and their interrelationships are critical and important

② We explores issues related to information privacy in the context of measures being adopted for shared EHR systems in Australian context

③ EHR and SEHR systems must be designed so as to enhance security and minimise breaches. This is especially so in the case of SEHR systems where issues of access and use accentuate security concerns. Despite legislative initiatives designed to enhance security and minimise breaches, such as those outlined earlier, the integrity of records cannot be achieved through the application of technology alone and is especially difficult in large-scale schemes with a diverse user populations

④ We approach these issues from a sociotechnical approach - considering the perspectives of various stakeholders: patients, health professionals and privacy advocates in order to form a ‘context sensitive health informatics’ perspective. This approach is based on understanding information security and privacy measures as ‘human factors’ when implementing eHealth scenarios.


▪ Shared electronic health record (SEHR)▪ Understanding interaction between people and

information systems▪ Policy and Practices related to Information Management▪ Education and Training in the Security implications of

potential actions▪ Legal Challenges…..! untested legal initiativesRequiring future study on EHR vs SEHR


Wrap up

▪ Co-existence of medical systems

▪ Healthcare globally is in crisis

▪ Technologies are getting cheaper and more powerful

▪ eHealth is transforming health care by:▪ Tele-medicine▪ Electronic Health Records and their Challenges and Benefits. ▪ Standards in eHealth; trends and application development Examples▪ Decision Support Systems ▪ Data mining in Health

▪ Patient empowerment, policies, procedures and protocols

▪ Privacy and Security including managing the risk in particular when exchanging health information.


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