Patient Empowerment through e-Health The vision of the empowered patient is still lagging behind reality, but now e-health offers the opportunity for patient empowerment. Potential beneﬁts include better health outcomes and higher cost-effectiveness. However, looking at the European situation, one realizes that a number of obstacles have to be overcome, before these beneﬁts can be reaped. Milon Gupta
he concept of patient empowerment emerged in the 1970s in the United States and Europe in the context of the civil rights movement. Patients and their organisations demanded a right to self-determination over decisions affecting their health. In addition to political pressure for giving consumers and patients more rights, there were also factors in the healthcare sector itself, which supported this trend. Alternative medicine and the growing number of alternative treatments, especially for chronic diseases, increased the choice available to the patients. A growing sensitivity to environmental factors influencing health further fuelled the push towards patient empowerment.
PATIENT EMPOWERMENT IN EUROPE
Most European countries have included patient empowerment in their healthcare policies via patient rights legislation and patient charters. However, considerable differences still persist across Europe: the approaches and the level of implementation vary significantly. Surveys of patients at the National Health Service (NHS) in the UK conducted in 2004 show that 47% of inpatients, 30% of outpatients, 36% of emergency patients, 32% of primary care patients, 39% of coronary heart disease patients, and 59% of mental health patients would have liked more information and choice in decisions about their care. While in Denmark the extended choice of hospitals was introduced in the early 1990s, similarly, in Norway free choice of hospital was implemented in January 2001. In other EU countries, like France and Germany, social insurance systems seek to limit patient choice, aiming to encourage the use of so-called “preferred providers” and to avoid multiple treatment by different doctors in order to lower costs. At the same time, both Germany and France have improved the patient rights for information access and strengthened their responsibility for their health. In 2002, the French Parliament adopted a “Patients Rights and Quality of the Health Care System” law, under which, patients are responsible for decisions regarding their health status. 14
PATIENT-EMPOWERING E-HEALTH APPLICATIONS
The European Commission has defined e-health as “the application of information and communications technologies across the whole range of functions that affect the health sector, from the doctor to the hospital manager, via nurses, data processing specialists, social security administrators and - of course - the patients.” The focus of the first phase of e-health development was on systems and applications, which facilitated the work of medical professionals and healthcare institutions. Although this contributed to the higher effectiveness of the healthcare system in general; e-health technologies like hospital information systems were designed to empower healthcare professionals and not the patients. In Europe, the focus has shifted in recent years towards more patient-centric e-health applications. Web-based health portals
Health portals on the Web are the most common e-health application for patient empowerment. According to a survey by EU project eHealth ERA, health portals have a share of 31% among all e-health applications classified as patientempowering. Nearly all EU countries have at least one national health portal - for example the UK e-health portal NHS Direct Online , which had 13.5 million users in 2006. In addition, some countries have specialised portals for specific groups of citizens or for specific health issues. These portals offer a varying degree of interactivity, ranging from information repositories with low interactivity to websites with high interactivity offering contacts to medical experts, consultation via videoconferencing, and training programmes. Physician-patient communication
Communication between physicians and patients in Europe is in most cases still limited to face-to-face consultations and telephone. Some studies in fact convey the impression that the majority of physicians and patients are not ready to use e-mail for health care purposes; many physicians have reservations about time demands, medicolegal risks, and doubts about the www.ehealthonline.org
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