![SciPICH Logo](https://webarchive.library.unt.edu/eot2008/20090115020309im_/http://www.health.gov/scipich/images/smscipichtrans.GIF)
![SciPICH Publications - button/link](https://webarchive.library.unt.edu/eot2008/20090115020309im_/http://www.health.gov/scipich/images/pubstinyyel.GIF)
An Evidence-Based
Approach
Introduction:
Evaluation of IHC
Consumers & IHC
Evaluation
Developers &
IHC Evaluation
Policy Issues Relevant
to IHC
Health Care
Providers, Purchasers & IHC
SciPICH Final
Report
![SciPICH home icon and link](https://webarchive.library.unt.edu/eot2008/20090115020309im_/http://www.health.gov/scipich/images/hometrans.GIF)
|
|
Wired for Health and Well-Being: The
Emergence of Interactive Health Communication
Editors: Thomas R. Eng, David H. Gustafson
Suggested Citation: Science Panel on Interactive
Communication and Health. Wired for Health and Well-Being: the Emergence of Interactive
Health Communication. Washington, DC: US Department of Health and Human
Services, US Government Printing Office, April 1999.
Download in PDF format: [Entire Document] [References]
Executive
Summary
The rapid proliferation of information and communication
technologies that have emerged during the last several years has both hopeful and alarming
implications for the future. These technologies have already produced profound changes in
the US economy and continue to exert increasing influence on many aspects of daily life,
including personal health decisions and behaviors, health care delivery and financing, and
public health systems.
Evidence of this phenomenon is the growth of interactive
health communication (IHC): the interaction of an individualconsumer, patient,
caregiver, or professionalwith or through an electronic device or communication
technology to access or transmit health information, or to receive or provide guidance and
support on a health-related issue. IHC applications include health information and support
Web sites and other technology-mediated applications that relay information, enable
informed decisionmaking, promote healthy behaviors, promote information exchange and
support, promote self-care, or manage demand for health services.
The rapid evolution of IHC raises many questions about its
impact on public health and health care and our ability to evaluate it. To help clarify
these issues, the Office of Disease Prevention and Health Promotion of the US Department
of Health and Human Services convened the Science Panel on Interactive Communication and
Health (the Panel), a 14-member, non-Federal panel of experts in many aspects of health
and technology. This report summarizes the potential risks and benefits of IHC, the
underlying science or evidence base for IHC, mechanisms for improving IHC quality and
effectiveness, appropriate roles and responsibilities for IHC stakeholders, and relevant
major policy and research issues. The report also presents the Panels consensus
recommendations about national initiatives that are needed to achieve a preferred future
for IHC.
IHC applications have great potential to improve health and
well-being. Compared to more traditional media, interactive media may have several
advantages for health communication efforts. These include: improved access to
individualized health information; broader choices for users; potential improved anonymity
of users; greater access to health information and support on demand; greater ability to
promote interaction and social support among users, and between consumers and health
professionals; and enhanced ability to provide widespread dissemination and immediate
updating of content or functions.
IHC applications also may cause harm. A growing variety of
entities and individualsmany of whom lack adequate expertise and training in the
health and communication sciencesare developing, sponsoring, and disseminating IHC
applications. The proliferation of applications available to the general public, who may
not have the skills or background to evaluate the quality or relevance of applications,
raises concerns about their potential to cause harm, their impact on health care quality
and cost, the clinician-patient relationship, and the organization of medical systems.
Without appropriate attention to these and other issues, IHC applications may result in
inappropriate treatment, delays in care, damage to patient-provider relationships,
violations of privacy and confidentiality, wasted resources, delayed innovation,
unintended errors, and an increased technology and health gap.
To date, few IHC applications have been adequately
evaluated for quality or effectiveness. Some health communication interventions have been
shown to be efficacious, but research on the effectiveness of computer-based approaches is
limited. Potential benefits of evaluation include improved quality, utility, and
effectiveness of applications; reduction of likelihood of harm; better use of resources
for effective applications; greater participation of stakeholders in the application
development and implementation; and improved decisions about use of applications. The
Panel has developed an "evaluation reporting template" and a "disclosure
statement" to promote evaluation and assist developers in disclosing essential
information about their applications to potential purchasers and users.
The Panel has identified several stakeholder groups that
need to participate in IHC application development, evaluation, and quality assurance
activities if meaningful evolution and quality improvement of IHC is to occur. These
include consumers (e.g., patients, families, and caregivers), application developers,
purchasers, health professionals, and policymakers, all of whom have related roles and
responsibilities. Understanding the concerns, motivations, and perspectives of each
stakeholder may be valuable in establishing collaborative efforts and in arriving at a
consensus on appropriate directions and policy for IHC.
Currently, most health information policy discussions at
the national level are centered largely around issues related to health care,
provider-focused systems rather than consumer-focused applications. Major policy issues
that are relevant to the development, implementation, and evaluation of IHC applications
include standards, privacy and confidentiality, oversight and regulation, liability,
accreditation and certification, public investment in development and research, payment
and reimbursement, integration of IHC with health care and public health, and access to
IHC.
The Panel developed the following vision for IHC:
"Interactive health communication will play an
essential role in enhancing health, minimizing total burden of illness, and optimizing
relationships between individuals and health professionals."
The Panel proposes four overarching strategies to achieve
this vision: 1) strengthen evaluation and quality of IHC, 2) improve basic knowledge and
understanding of IHC, 3) enhance capacity of stakeholders to develop and use IHC, and 4)
improve access to IHC for all populations. The Panel considers widespread evaluation of
applications and dissemination of evaluation results to be the primary mechanisms to
improve quality of IHC and to ensure positive outcomes. Because of the newness of the
field, scientific knowledge about many aspects of IHC is very limited. Greater knowledge
is needed to improve the effectiveness of IHC, inform application design and
implementation, and, ultimately, further appropriate public policy. The Panel also
identified major gaps in resources available to application developers and shortcomings in
the skills of users. These deficiencies will need to be addressed to ensure the continued
development of innovative applications and the ability of intended users to take full
advantage of IHC. Finally, enhancing access to IHC for all populations is essential
because, without equitable access, evaluation efforts will be incomplete and the potential
for IHC to provide benefits to entire communities is not likely to be realized. Specific
recommendations under each major strategy follow.
Strategy 1. Strengthen Evaluation and Quality of IHC
- Purchasers of IHC applications should require developers to
integrate evaluation methods into product development and implementation as a condition of
purchase.
- Developers should publicly disclose information about their
IHC application including identity of developers and sponsors, purpose of the application,
source(s) of content (including disclosure of advertising), privacy protections, whether
and how the application was evaluated, and the results of evaluations.
- Developers of IHC applications should adopt voluntary
quality standards for application development.
- As a primary criterion for their review and rating of IHC
applications, individuals and organizations that conduct reviews of applications should
include information on whether and how the application was evaluated for effectiveness.
Strategy 2. Improve Basic Knowledge and Understanding of
IHC
- Public and private sector organizations with an interest in
health and technology should establish a formal process for identifying and addressing
current knowledge gaps and priority areas for basic and applied research, application
development, and demonstration projects.
- A cross-governmental and interagency initiative to
coordinate Federal and State funding in the area of IHC should be established.
- A long-term initiative to monitor and assess the health,
economic, and social impact of IHC should be established.
- Programs to monitor and analyze trends in IHC policy
development should be established for the purpose of improving policy.
- Entities responsible for assuring the quality of personal
health services, in conjunction with appropriate government agencies, should determine
where responsibility and authority rests for ensuring the privacy, confidentiality, and
security of IHC-related information.
Strategy 3. Enhance Capacity of Stakeholders to Develop
and Use IHC
- A clearinghouse for public domain objects and tools, raw
materials, and information resources for IHC applications should be established for public
use.
- Government agencies, foundations, and investors should
strongly encourage IHC developers to explore academic-industry collaborations and other
partnerships that enhance application quality and evaluation by funding developers who
propose these activities.
- Programs to monitor and improve public literacy in health
and technology should be supported by government agencies, private foundations,
corporations, and nonprofit organizations.
- Health professional schools should include IHC in core
curricula to promote its integration into clinical practice.
- Performance indicators that monitor health plan efforts to
help members and patients locate and critically assess health information and support
resources should be developed and implemented.
- Process and organizational models for effective
implementation of IHC applications should be developed and evaluated.
- Financial models should be developed and tested to determine
whether they support appropriate use of effective IHC applications.
Strategy 4. Improve Access to IHC for All Populations
- Entities with an interest in health and technology should
promote public and professional education about the availability, selection, and optimal
use of high-quality IHC applications.
- Public-private initiatives to enhance access to IHC among
the underserved should be established.
- Mechanisms and models should be established to fund the
development and implementation of orphan applications, including applications for
underserved populations.
There is little doubt that IHC applications will continue
to grow in utility and popularity and consumers will increasingly turn to them for health
information, communication, support, and health-related transactions. IHC has the
potential to dramatically improve the ways in which people prevent disease, maintain their
health, and recover from illness. However, for IHC to play a pivotal and positive role in
creating a healthier society, a broad range of stakeholders must participate in
application development and evaluation. An evidence-based approach to the development and
diffusion of IHC applications is central to the process of ensuring that such applications
are of high quality, effective, and accessible to all.
Return to Table of Contents
Comments: SciPICH@nhic.org
Updated: 05/01/08 |