10 (κπζηηθφηεηα, εκπηζηεπηηθφηεηα θαη αθεξαηφηεηα) ησλ δεδνκέλσλ, επηθχξσζε, ειεθηξνληθή ππνγξαθή, αζχξκαηε ηερλνινγία, βηναηζζεηήξεο, έμππλεο θάξηεο, ηδεαηή πξαγκαηηθφηεηα Summary The present paper is a product of exploitation of many studies, from the American continent mainly, that they deal with the subject of electronic health. We make an, as much as possible, extensive report in the applications, the tendencies, the concerns and the proposals for the subject, located geographically in the U.S.A. and the E.U. Below is a synopsis for the content of the paper. The term Primary Health Care (PHC) describes the occupation with the main health problems of community and the provision of necessary services of prevention, promotion, treatment and re-establishment. The PHC can be benefited by the development of information and communications technology. Some of the modern possibilities are the distance learning, the clinical support and information services, the wiser use of drugs, the Computerized Patient Record, the usefulness for epidemiology and demography etc. The term e-health refers to Internet-mediated access to health care services, products, and capabilities. Internet based e-health operates anywhere, anytime, and with anyone. The Internet has made access to information, products, and services inexpensive (sometimes free), instant, and universal. With immediate access to worldwide databases, libraries, conference proceedings, records, support communities, and many other resources through the Internet, people can now retrieve updated information from their own homes rather than seeking professional advice. E-health may also serve as an acceptable alternative channel for obtaining health care for people who feel they cannot access traditional face-to-face consultations due to cost, inconvenience, or social stigma. E-health empowers individuals by allowing them to make their own decisions regarding their health. Because patients are more informed, they may practice healthier habits, which could help them reduce utilization of the health care system in general.
11 A sector that concerns us, particularly with regard to the provision of health services through Internet, is the quality of medical information that is available to the consumers. The medical information in the Internet is often inaccurate or misleading. That s why the involved parties for the guarantee of quality of information take in institutional level and also in the form of initiatives more and more actions available in the Internet. The clinical applications of e health, with which we dealt in the particular paper, are: Radiology "the electronic transmission of radiological images over a distance for the purposes of interpretation and/or consultation". Tele-radiology is needed in many rural communities, especially in emergencies. Trauma care often requires critical on the spot decisions that involve interpreting x-ray images. Tele-radiology allows professional in a rural location to transmit high quality pictures to a remote specialist for an instantaneous interpretation. Behavioral health care, involves the use of telecommunication and information technology by professionals to provide behavioral health services that include assessment and evaluation; mental status examinations; neuropsychological evaluations; crisis intervention; psychotherapy with individuals, groups, and families; accessing patient histories; fine-tuning diagnoses; monitoring patient progress; medication support; remote biofeedback; patient education; patient and family support; case management; preadmission and discharge planning; court commitment hearings; and case conferences A lot of types of technology are available to doctors. -Telephone. -Computer-Assisted Self-help Programs -Video - and Chat Rooms. The central questions facing behavioral e-health, which may potentially limit the services offered, are the legal and ethical ramifications, as well as the clinical utility of each Internet technology for specific patient populations. Hνme care. Telehome care can be defined as providing monitoring (telemetry) and home health care services at a distance, using advanced telecommunication and information technology. It includes a variety of services, such as physiologic monitoring, patient education, compliance reminders, and social support to isolated individuals. Telehome care provides service for the elderly, the chronically ill,
12 patients who have been recently discharged from the hospital, and many others restricted to their homes. The advantages of telehome care include easier accessibility to health care and more frequent social and clinical interaction with providers. Some of the programs are: - Senior Care - Public Health. - Comprehensive Programs - Disease management A key factor for the success of electronic health care is the right use of electronic files of patients. Accurate patient records are the most important patient resource in a health care facility. The advantages of maintaining accurate Computerized Patient Records (CPRs) are numerous: - Improved access - Reduced cost and reduced frequency of errors - Outcomes management and decision support - Protection for confidential information Of course the question of security (privacy, confidentiality and integrity) of the data is emerging. Security refers to the methods by which access to information is controlled and protected from accidental or intentional disclosure to unauthorized persons and from alteration, destruction, or loss. Certain recommended practices are: -Authentication -Passwords -Logons - Logoffs -Access controls -Nonrepudiation services -Electronic signature -System backup and disaster recovery procedures -Firewalls. -Virtual Private Networks (VPNs). -Patient education is primary. It is crucial for health care sites to inform patients about their privacy rights
13 As we continue, we throw a glance in the developments in Greece and in the European Union. - Pilot program of telehome care that is applied for about six months by the Hospital "ΧΣΖΡΗΑ" in collaboration with OTE and ATKOSoft. It concerns forty patients with chronic obstructive pneumonia. -HYGEIA NET: integrated network of health telematics applications, integrated network of telematics health services in Crete:7 hospitals, 16 health centers, 10 + community clinics, with action in: Home care, pre-hospital urgent medicine, primary care, hospital care, information for the citizen, informative infrastructure in health, continuing education, evaluation of services, growth of informative infrastructure in health etc. In Europe, all interested parties mention the need for a European strategy for the electronic health. They focus on implementation in a holistic, integrated approach: not only are the Information and Communications Technology tools necessary, but so are the development of skills and human resources and the deployment of interoperable infrastructures. Full exploitation of ehealth goes beyond local information systems and Internet based provision of information to integrated or linked ehealth systems, that serve the needs of citizens, patients, healthcare professionals, health service providers as well as policy makers. In the paper we mention the most important current e health programs in the EU. Continuously, we refer to the parameters of designing health services in the Primary Health Care section. These services should be designed in a way that citizens would be benefited the most. The parameters that will be taken into consideration are: Object, Users, Search of information, Data/Information, Means (Hardware and Software), Personnel, Buildings, Resources, Quality. A Primary Health Care service should have, apart from the purely medical services, and services of briefing, administrative transactions, information, education, preventive medicine, confrontation of extraordinary incidents, telemedicine, research, reference etc Ηn the future, health care will combine changes in the telecommunications marketplace and changes in the health care industry, leading to improved diagnosis and treatment and reduced costs of patient care throughout the world. It appears that
14 the technological trends mentioned below will play a leading part in the next decades: -Wireless Technology -Biosensors -Smart Cards -Virtual Reality Computers and communications technologies are changing the nature of daily life, as we know it. They will soon make specialty expertise available whenever and wherever needed. Patient information will be available not only for patients when they are assessed but also as part of electronic records that are available immediately and at any time. From e health we will pass to the personalized health. Key words Primary Health Care, e health, Computerized Patient Record, Internet, teleradiology, tele-behavioral health care, e Mail, chat rooms, e home care, security, privacy, confidentiality, data integrity, authentication, electronic signature, biosensors, smart cards, virtual reality.
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