E-health

Johnston RC, Worrall BB. Teleradiology assessment of computerized tomographs online reliability study (tractors) for acute stroke evaluation. Telemed J E Health 2003 9 227-233. 

Choi JY, Wojner AW, Cale RT, Gergen P, DeGioanni J, Grotta JC. Telemedicine physician providers augmented acute stroke care delivery in rural Texas An initial experience. Telemed J E Health 2004 10 S90-S94. 

U.S. Senate (2001), Testimony of Dr. Willie E. May, chief. Analytical Chemistry Division, Chemical Science and Technology Laboratory, NIST, before the Committee on Commerce, Science, and Transportation, Subcommittee on Science, Technology and Space, United States Senate on E-Health and Technology Empowering Consumers in a Simpler, More Cost Effective Health Care System 23 July, 2001. 

EPA OTS Preliminary assessment information rul e Health and safety data reporting rul e Final test rule... 

This definition needs some explanation. The viewpoints mentioned in it represent the stakeholders concerns about the system (the trustee) under consideration. A viewpoint can represent an individual user who decides about involving herself/himself in the co-operation with the system depending on its trustworthiness (consider for instance e-commerce or e-health applications) or can represent a class of users. An example of a latter is a non-profit institution which assesses a given Web service on behalf of its users (this is what Health On the Net foundation [1] does for the users of e-health services). A viewpoint can be highly formalized, for instance in the situation where the criteria to be met by the trust case (to consider it satisfactory) are documented and supported by regulations (like in the case for safety critical applications [2]) or are documented and widely accepted (which is the case for security critical systems [3]). For some viewpoints satisfactory may mean convincing and valid whereas for some other satisfactory may have more subjective interpretation. 

The stakeholders illustrated in Figure 7 are generic in the sense that in a specific situation they can be instantiated into more concrete entities. In the picture we also illustrate that the stakeholders can sometimes have conflicting concerns. The generic stakeholders can be further structured to differentiate between more specific viewpoints. For instance, for an e-health application, User can be further structured into Health Professional and Patient. Although both of them share the common concern why should I trust this system and get involved , their viewpoints differ concerning the trust objectives, their decomposition and interpretation of their importance. 

Figure 10. Fragment of a Trust Case for e-Health Application...

The tool is implemented in Java and is based on XML. Its architecture provides for high flexibility in changing and extending both, functionality and data formats. An example screen snapshot is shown in Figure 10. It presents a part of the trust case developed for an e-health application. Further details of this trust case can be found in [6],... 

The importance of the concept of trust case stakeholder and collaborative development of a trust cases became evident while applying our approach to complex e-Health applications. It seems to be even more important if we consider IT infrastructures supporting for instance electricity distribution where we face the problem of distributed responsibility and ownership of the system. 

Masera P Chawdhry and M Wilikens. The first version of software tool was developed by M. Jarzebski as a part of his M.Sc. Thesis. The application of this approach to e-Health is supported by the EU 6FR Integrated Project PIPS (Contract 507019) and Polish Committee of Scientific Research (grant 155/E-359/SPB/6,PR UE/DIE 281). The application to public key infrastructure is supported by Polish Committee of Scientific Research (grant 6T112003C/06280). 

Where sufficient toxicologic information is available, we have derived minimal risk levels (MRLs) for inhalation and oral routes of entry at each duration of exposure (acute, intermediate, and chronic). These MRLs are not meant to support regulatory action but to acquaint health professionals with exposure levels at which advers e health effects are not expected to occur in humans. They should help physicians and public health officials determine the safety of a community living near a chemical emission, given the concentration of a contaminant in air or the estimated daily dose in water. MRLs are based largely on toxicological studies in animals and on reports of human occupational exposure. 

Medscape TechMed. The rise and fall of e-health lessons from the first generation of internet healthcare, 2002. http //www.medscape.com/viewarticle/ 431144 print, accessed January 28, 2003. 

Von Knoop C, Lovich D, Silverstein MB, Tutty M. Vital signs e-health in the United States, 2002. http //www.bcg.com, accessed February 19, 2003. 

E-Health Insider. New automated lab is one of Europe s largest. 2004 Jan 27. (http //www.e-health-insider.com/news/item.cfm ID-634). 

Ginzberg, E. Health Services Research Key to Health Policy Harvard University Press Cambridge, Massachusetts, 1991. 

Thorpe, K.E. Health Care Cost Containment Results and Lessons From the Past 20 Years, Shortell, S.M., Reinhardt, U.E., Eds. 1992 227-274. 

Mortenson, L.E. Health care policies affecting the treatment of patients with cancer and cancer research. Cancer 1994, 74 (S7), 2204--2207. 

Gilliland, S.E., Health and nutritional benefits from lactic acid bacteria, FEMS Microbiol. Rev., 87, 175, 1990. 

Getzen, Thomas E. Health Economics Fundamentals and Flow of Funds. 2nd ed. New York, NY Wiley, 2004. Contains articles on all aspects of health economics theoretical contributions, empirical studies, economic evaluations, and analyses of health policy from the economic perspective. 

Few studies have prospectively documented the degree of functional impairment before or after specific treatments or have evaluated the pharmacoeconomic differences in treatments for premenstrual and perimenopausal disorders. Data on the economic burden (i.e., health care utilization, related costs, and the loss of productivity) from different menstrual-related disorders are still lacking. Several PMDD studies have reported greater improvement in psychosocial functioning and work capacity with SRls compared with placebo. In all studies, the degree of functional impairment was substantial at baseline and similar to that seen in studies of major depression. The functional improvement correlated with the improvement in premenstrual symptoms and was evident by the second cycle of treatment. 

Telemedicine—or the use of computers to interact with patients, physicians, and specialists who are separated in space—has been predicted by conservative professional analysts to grow yearly by 40% to markets worth several tens to hundreds of billions of dollars. Waterford Telemedicine Partners of NY has taken a geographically and technologically broader view and projected the curves into the future to a market of 300 billion or more. As noted previously, it is difficult to know whether these projections are being realized because of the question of what the definition of telemedicine is, that is, its scope (see, however, Ronald C. Merrell and Charles R. Doarn. Telemedicine and e-Health Is it time for a telemedicine breakthrough Telemedicine and e-Health 2008 14(6) 505-506). Their broader definitions include, besides patient-doctor interactions, all other health-professional interactions with insurance, FDA, CDC, and WHO, inquiries with specialists, and consultation with research universities, all of which could benefit from access to clinical records. 

The national e-Health Informatics System dynamically retrieves Jane s health records from various places where Jane has ever visited (e.g., physician s office system, hospitals, diagnostic labs) based on Jane s global person identifier and dynamically constructs an integrated health record up to date from birth, which includes Jane s genetic profiles and lifestyle data. The physician then analyzes Jane s personal health record for analysis of clinical and treatment history. 

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