Consumer and Patient Use o Computers for Health Consumers of health services (patients, families and family caregivers)

are educating themselves on all aspects of health, wellness, and disease. Armed with this education, they are demanding a greater say in decisions that affect them and the persons they care about. The Internet has been has been a boon to healthcare consumerism. Caregivers routinely report the phenomenon of patients arriving for a visit with a ream of printouts related to their diagnosis or treatment, asking the physician or nurse to comment on the material's relevance to their particular case. Application Areas: Consumer Use of Computers for Health Information Seeking Information seeking about health matters is a common use of computers by patient and consumers. Information seekers declared that they used the Internet, because it is fast, anonymous and always available. By searching multiple sites and looking for commonality in the content, they are able to discern the accuracy of the information. The topics most frequently searched on, according to report, are diseases, treatments, and diets or nutritional information. Sponsorship of static contents sites varies widely. Healthcare organizations my offer their communities a public Web site that includes health articles developed by their own professional experts, or licensed from vendors. Ex: is the Mayo Clinic, whose public site, mayoclinic.com, provides a wealth of health information and tools. For profit entities pharmaceuticals firms, drugstore chains, and durable medical equipment vendors frequently sponsor public sites. Communication and Support Electronic mail continuos to be the "killer app" of the Internet. Many e-mail finds it particularly useful for healthrelated matter like - communicate informally with friends and family about health - use e-mail to keep family informed about the health status of one of the family - engage in online support groups whose focus is on particular disease or condition - communicate directly with their healthcare providers about their own or a family member's condition Online support groups can provide an indispensable, even life-saving resource to patients and families. A survey found that 90% of Internet users would like to be able to communicate to their doctor or doctor's staff because: - get a health reminders - get personalized information after the doctor's visit - ask question when a visit is not necessary - make appointments - renew prescription - get lab results Personal Health Records

The structure of computer-based personal health records varies widely, from those that simply collect text under major headings such as allergies, problems, drugs, procedures and so forth, to those that encode user's entries with ICD9 and CPT codes, or even with the broad range of terms found in the National Library of Medicine's Unified Medical Language system. Alternatively, consumers can subscribe to a Web site where their record will be held securely. Different from comprehensive medical-record keeping applications, a number of sites allow the consumers to keep a record of personal disease specific information. For example, MyDiabetes.com and MyAsthma.com allow the patient to record parameters specific to those disease, providing graphs, decisions aid, and a wealth of related materials geared to supporting the patient who has those conditions. The service improves the patient access to health information, improves communication with physicians and staff, promotes patient satisfaction, and improves office efficiency. The use of system enhanced the patients' understanding of their conditions and improved their communication with their physicians, with no reported adverse effect. Decision Support A broad range of decision-support applications is available to the interested consumer. Some incorporate multimedia presentations of patients who have the condition that is the subject of the search. Others incorporate statistics-based presentations on alternatives in areas such as treatment of early-stage prostate cancer or hormone replacement therapy. Some of those programs offer prognostic information based on personal information entered. There are smoking cessation programs available that survey the user about the readiness to change, then offer action steps appropriate to the user. Disease Management Patients or family caregivers are enrolled in a program and participate using one of a number of technologies. they may log on to an Internet portal to record parameters such as blood pressure, blood sugar, or peak flow: periodically complete a disease focused questionnaire that captures broader data about mental or physical function or use a device that captures physical parameters such as weight or blood sugar and connect it to a telephone or computer, causing the information to be relayed to nurses whose responsibility is to monitor the incoming data. There have been reports of reduced hospitalizations and reduced incidence of complications of chronic diseases by employing this technologies. ISSUES IN CONSUMER COMPUTING FOR HEALTH 1. Variability in Quality of Information Available to Consumers 2. Lack of Security in Internet-based Transactions 3. Uneven Accessibility Across Age, Ethnic, and Socioeconomic Groups 4. Educational and Cultural Barriers 5.physical and Cognitive Disabilities 6. Impact on relationships with Healthcare Providers Areas of Nursing that can be Applied to Consumer/Patient Computing 1. Deep expertise in patient education

2. Cultural diversity in the workforce and a strong ethnic of cultural sensitivity 3.Strong background in both patient and communityfocused research 4. Strong heritage of patient advocacy and patient empowerment Special Considerations in Designing Applications for Patients and Consumers 1. Lay versus professional nomenclature 2. General literacy and health literacy 3. Computer literacy and the digital divide 4. Special needs of the elderly 5. Accessibility to persons with disabilities 6. User-centered design DECISION SUPPORT FOR CONSUMERS Health-related decision making is challenging for patients for several key reasons: Layperson facing health crises simultaneously experiences many stressors, thus, their information processing skills are taxed repeatedly. It is complicated because of the problems and choices is itself complex and exceeds the knowledge and education of most laypersons It generally involves more than a single person. Two key groups must be considered: FAMILY MEMBERS and HEALTH CARE INDUSTRY (these may interfere with the patients right to self-determination and self-care)

for each possible health state or treatment in a pair-wise fashion, which then determines a preference ordering for all alternatives. Time-trade off (TT) Asks patient to determine the number of years that life in perfect health would be equally preferable to a longer period in the health state in question. The resulting ratio represents the preference for the poorer health state.

Standard Gamble Asks patient to determine the indifference point where living in specified health state is perceived to be equivalently preferable to a specific probability of death, which provides a preference ordering where alternatives that are equivalent to a higher probability of death are preferred.

b) Envisioning Treatment Options * Shared Decision Making Program (SDP) - designed for use in the clinic setting to aid patients facing complex treatment choices. - Self-reported and other data are entered into the program, which then tailor estimates of risks and benefits to specific patient situations. - It also presents videotaped interviews with individuals facing similar problems. c) Facilitating Data Management * HealthTouch- computerized health information system for health promotion and disease prevention for use in primary healthcare Decision Aids/Decision Support Systems (DSS) supports and enhances patients ability to choose a course of treatment that is consistent with their values along each of these three dimensions while simultaneously yielding optimal outcomes. Functions as an intelligent disease management agent, which can be used to remotely acquire and transmit health indicators such as heart rate and weight and can be used to prompt patients when it is time to take their medicines or perform physical therapy activities.

Shared decision-making- the relationship or collaborative decision-making which empowers patients to choose among the options available to them in consultation with their clinicians using personal values to frame the choice among alternatives

Computer Technology and Patient Decision-Making Functions: a) Assessing Utilities of Health Outcomes * Stanford Center for the Study of Patient Preferencepioneer in the use of computers and the Internet for lowcost elicitation of patient preferences for health states * Preference Assessment Tools (rating tasks through programs that elicit preferences): Visual Analog Scales (VAS) Uses visual representation of a linear scale with one end representing the best possible health state and other representing the worst possible health. Patients are asked to place the health state being evaluated in the position that best describes their preferences)

Applications: 1) Acute Disease DSS - narrowly focues on supporting the patient by providing for their informational and preference determination needs regarding a single episode of treatment choices * Comprehensive Health Enhancement Support System (CHESS)- a health promotion and support network application that operates as a module-based computer system for in-home or healthcare setting use.

Pair Wise Comparisons (PWC) Asks patients to evaluate their preferences

2) Chronic Disease Management DSS - have the capability to enable the patient to better monitor and treat these diseases resulting in increased lifespan and quality of life. *Components: Assessment- measures the patients health state along the key dimensions of physical condition, functional status and behavioral tendencies Information- used to provide information and guidance that is customized to the current health state of the patient Communication- provides an integrated mechanism for communicating with the clinician.