The benefits and barriers of eHealth

The benefits and barriers of eHealth

I’ve just finished weeks one and two of my first MOOC (Massive Online Open Course) on eHealth. I’ve designed websites for healthcare organisations including POSNOC, a website for a international breast cancer clinical trial, as well as Derby Hospitals Charity and Derby Private Health. In the days before I was a web designer, I also worked on print projects for NHS trusts and Bupa.

Despite having some experience of designing for health, I wanted to learn more. After all, the traditional method of design is for the designer to be briefed by the person commissioning the project. Without additional knowledge, the designer is often guided by a single person or a team of experts but they don’t necessarily have access to other expertise. User testing brings us closer to designing effective websites for both the organisation and user but what about industries or sectors where professional opinions differ? How do we know that the commissioners of our project have the right objectives to brief us with in the first place?

This is why I am learning about designing for health, not based on the opinions of a client, but those of people across the healthcare sector, and across the world. To be honest, I’ve felt a little out of place in parts of the course so far. When asked how I might design something to aid depression, I don’t have the expertise or training to know, but in this case I have been able to observe how hundreds of other healthcare professionals would solve the problem. Just reading though the comments and discussions has been really interesting.

Even though there are hundreds of comments and opinions, there is an emerging theme to the answers. People on the course are psychiatrists, pharmacists, biomedical engineers, nurses and many more types of healthcare professionals, and while there is a general consensus to the solution, there are all these little insights that come from individual experience. In addition to the healthcare professionals, there are software developers, IT professionals and UX designers making sure that concerns such as security, usability, accessibility and user experience are also addressed. If I were to get nothing else out of this course, just immersing myself into a topic that so many people are passionate about being involved in and improving has been refreshing.

As a way of learning, I am very taken with this MOOC. It’s much more immersive than reading articles or watching documentaries (although I enjoy both of these too). The course is structured for people to post their comments and engage with each other so I’ve been exposed to a lot of opinions and it’s been very eye-opening. The course I am taking is eHealth: Combining Psychology, Technology and Health at Future Learn.

So what is eHealth?

Generally speaking, the term eHealth refers to delivery of health services and information through technology. This could be a website, app, or even discussions between patients and doctors over Skype or IM. The course breaks eHealth into three domains: self-care and prevention; supportive Care; and societal health. Self care is patient-led, for example a person using an app to quit smoking or a person using a website to find health-related information.

Supportive care is where healthcare professionals are more involved, ideally working with patients. An example of supportive care might be an app for a diabetic patient to share data with their nurse so in their appointments, the nurse has the information beforehand and the appointment can focus on discussing the patient’s concerns or questions rather than gathering data.

Societal care is more about the big picture. For example, educating people about the spread of disease and infection across the world though educational or gaming applications.

What are the benefits of eHealth?

The course outlines several benefits including: access to care; equity; patient-centredness; effectiveness; plus more. Immediate benefits of access to care is that patients could get the medical advice they need without making trips to hospital or their GP. For people who struggle to make appointments within normal hours, part of their consultation could take place online. In a similar vein, equity means that patients who live in remote areas could seek consultation online rather than driving to a medical centre over an hour away, or people suffering from certain conditions could discuss their health with other suffers who understand without having to get to a physical support group.

Patient-centredness allows people to take responsibility for their own health. By helping patients learn about their health, and by giving them access to their health records, patients can make more informed decisions. Effectiveness can be improved with eHealth, for example in appointments where nurses have to input patient data, the data could already be being tracked through wearables and inputted automatically. This takes repetitive tasks away and means that appointments can focus on care.

What are the barriers?

To list just a few, barriers include: lack of stakeholder support; cultural, organisational and psychological factors; legal issues; and non-adherence. For eHealth applications to be effective, all stakeholders need to be invested. For example, if an app is designed for a nurse but they are not given training on how to use it and it is thrust upon them, they might not think it relevant and it might not fit into their work routine. Concerns might arise that are of a cultural factor, what if the use of technology means that human contact is taken away from vulnerable and elderly people. E.g. Paro the Robo-Seal. Then of course there are legal issues. What happens if a wrong diagnosis is made through an app? Who is responsible when a wrong decision is made? And then we have non-adherence. Will people engage with the technology? Will they use it obsessively for a few days and then forget about it. Will they use only a small percentage of the application and not use it to it’s full potential. Will they find motivation in using it and keep coming back to it. Will they understand it? Is it too complicated to learn?

In week one, we were asked whether we thought the benefits of eHealth outweighed the barriers. Looking through over 300 comments, the general consensus was that the benefits do, or at least will, outweigh the barriers even if we’re not quite there yet. Several comments suggested that the barriers need resolving before eHealth can become the status quo and that it needs to go hand-in-hand with traditional healthcare and not be seen as a replacement.

I agree that perhaps more time is needed before eHealth becomes fully accepted in society. Web design has been going for over 20 years and is still a relatively young industry and one that many people commissioning it don’t understand. So I think it’s going to take quite some time for eHealth to really establish itself. The education of it will need to be spread equally amongst the creators, designers, implementers and the users.