Ehealth, the USA Patriot Act and other hurdles: the black lining on the silver cloud
Professor Eike-Henner W Kluge, Department of Philosophy, University of Victoria, Canada.
Ehealth promises to rationalise healthcare delivery through greater accessibility, quality and efficiency. However, it also presents a series of risks to patients’ health data that extend beyond merely technical issues and include professional, legal and ethical problems. Chief among these are threats to security and privacy posed by national legislation designed to enhance the ability of intelligence agencies to operate effectively; the absence of international standards and certification for health-information and healthcare professionals; a corresponding lack of international enforcement mechanisms; and, at a more fundamental level, a failure to appreciate the unique nature of electronic healthcare records in relation to the ethics of healthcare itself. This paper explains the nature of these issues and relates them to the raison d’ętre of ehealth. Special emphasis is focused on threats to security and privacy posed by the USA Patriot Act.

Choosing a health information technology vendor: guidelines for success
Davis Wright Tremaine LLP 2600 Century Square, 1501 Fourth Avenue, Seattle, WA 98101, USA
The successful implementation of health information technology (HIT) can provide extraordinary benefits for healthcare-related organisations. To realize the potential benefits while minimizing negative risks, buyers must be sure to make the wisest possible decisions. Without smart decision-making at the beginning of a new project or operation, a buyer is likely to have a troubled or failing HIT project within a year to 18 months. This article outlines the essential factors the buyers should consider in making the purchase.

 Peer mentoring in ICT: UK medical students sharing skills in developing countries
Eoin Young, Robert Melvin, Miriam Samuel and John Coombes. Pre-registration House Officers International Health and Medical Education Centre, University College London.
10 March 2004
The International Health and Medical Education Centre (IHMEC) at University College London runs an electives programme for final year students with an emphasis on development issues and building links with universities and students in developing countries. One of the recent projects, carried out by four final year students in conjunction with IHMEC and the Centre for Health Informatics and Multiprofessional Education (CHIME), was to assess the feasibility of peer mentoring in ICT to improve medical students' skills — a method already used in London.

Smartcards in healthcare
HBS Consulting
14 January 2004
The market for smartcards in healthcare is forecast to be 200m cards over the next five years. Manufacturers, however, see the healthcare sector as a sub-class of egovernment and are promoting multipurpose cards for everything from health to driving licences and evoting. Even European governments are contemplating combining card functions such as ID and health or even banking. This has brought public concern over confidentiality of information and the feasibility of managing multiple applications on one card. The concerns need to be addressed before there is more widespread rollout of multi-application cards

Machine learning helps physicians in diagnosing of mitral valve prolapse (PDF)
P. Povalej¹, M. Lenic¹, M. Zorman¹, P. Kokol¹, L. Lhotska², R. Pišot³
1. Laboratory for system design, Faculty of Electrical Engineering and Computer Science,
University of Maribor, Slovenia
2. Gerstner Lab, Czech Technical University in Prague, Faculty of Electrical Engineering, Czech Republic
3. Science and Research Centre of Koper, University of Primorska, Slovenia
29 October 2003
In this paper we present a multimethod approach for induction of a specific class of classifiers, which can assist physicians in medical diagnosing in the case of mitral valve prolapse. Mitral valve prolapse is one of the most controversial prevalent cardiac condition and may affect up to ten percent of the population and in the worst case results in sudden death. MultiVeDec is a general framework enabling researchers to generate various intelligent tools based on machine learning. In this paper we focused on various decision tree methods, which are capable of extracting knowledge in a form closer to human perception, a feature that is very important in medical field. The experiment included classifiers with various classical single method approaches, evolutionary approaches, hybrid approaches and also our newest multimethod approach. The main concern of the latest approach is to find a way to enable dynamic combination of methodologies to the somehow quasi unified knowledge representation. The proposed multimethod approach was capable to outperform all other tested approaches by producing classifier for diagnosing mitral valve prolapse with the highest overall and average class accuracy. More importantly, it was also capable to find some new knowledge important in diagnosing of mitral valve prolapse.

UK National Electronic Library for Health management briefing on IM&T strategy in the NHS: Information for Health in context 14.11.2002

Archetypes: knowledge models for interoperable, future-proof information systems Deep Thought Informatics 5.1.2001
A background paper on the concept of archetypes provides the theoretical basis for their implementation in GEHR, and other potential implementations. A knowledge-oriented development methodology is discussed, which proposes that the development of software, vocabularies and archetypes be independent, relatively open processes, designed to achieve systems capable of knowledge-level interoperability and future-proof software and information.
PDF of paper Paper (StarOffice format) and slides (PowerPoint format) of talk delivered at HL7 Orlando, Jan 2001.

Its time for Internet healthcare stakeholders to pull together iHealthcareWeekly 13.12.2000
"There is no going back. The 'e' in healthcare is here to stay."

A recipe for tomorrow's Intranets Health Data Management 13.12.2000
"Various ingredients are required to create next generation intranets, which promise more interactivity and functionality than their static predecessors. the question is: are healthcare CIOs willing and able to get in the kitchen?"

No time to plan for Intranets Health Data Management 13.12.2000
"Many provider and payer organizations are foregoing formal strategic planning and heeding urgent demands for next-generation intranets."

Intranets succumb to irresistible pull of e-health Health Data Management 13.12.2000
"The Internet and the e-health boom are helping shape the future of providers' and payers' next-generation intranets."

Gathering clinical evidence online American Medical News 6.12.2000
"Some physicians are checking specialized websites for answers to clinical questions. Just how helpful can a Web site be?"

Internet Healthcare Information Impacting Americans' Health Decisions, Survey Reports iHealthcare Weekly 29.11.2000 
"Internet users are using the Net to seek healthcare information more often than to shop, research stock prices, or check sports scores, according to a survey conducted by the Pew Internet and American Life Project"

PDAs: Handhelds for the holidays American Medical News 27.11.2000 
"With the expected convergence of the Internet and wireless technology, many computer-savvy physicians and industry observers strongly believe that physicians soon will be using personal digital assistants, or PDAs, for patient care"

Seal of approval for online health sites may be coming American Medical News 27.11.2000 
"An industry group proposes an accreditation program to help doctors and others know which health Web sites are reliable"

Take your time to master the handheld American Medical News 27.11.2000 
"You're walking down the hospital corridor, sorting through some scraps of paper with your list of tasks to do before heading off to your clinic. You see two doctors chatting with each other while staring intently at the small PCs in each of their hands"

Editorial: Security, integrity, and confidentiality British Journal of Healthcare Computing & Information Management November 2000
"As the twin behemoths of Information for Health and The NHS Plan slowly rise from their haunches, stretch, and begin to embark upon the enormous task of implementation across the country, so some of the potential implications begin to become apparent. The NHS Plan proposes a world where clinical — and indeed social care — data flows freely between all those properly concerned with the care of an individual patient/client; where regulatory bodies such as the Commission for Health Improvement (CHI), or the National Institute of Clinical Excellence (NICE), must be able rapidly to access a whole range of clinical data if they are to perform their allotted function; and where the patient can, through the Worldwide Web, obtain clinical advice from NHS Direct Online, or indeed from a whole range of sites. In that world, the issues of data security, of data integrity, of patient confidentiality, become of crucial importance — an importance that is no longer of theoretical or academic interest, but intense practical relevance. If those issues are not solved, The Plan itself is incapable of delivery."

Editorial: The Internet Promise, The Policy Reality Health Affairs   November 2000
"Tapping the vast potential of the Internet is rapidly becoming an integral component in the strategic thinking of health care providers, purchasers, and suppliers; many patients, too, have come to appreciate its power"

Networking Health: Learning From Others, Taking The Lead Health Affairs   November 2000
"The Internet provides one of the most compelling examples of the way in which government research investments can, in time, lead to innovations of broad social and economic impact. This paper reviews the history of the Internet's evolution, emphasizing in particular its relationship to biomedical computing and to the nation's health care system. Here I summarize current national research programs, emphasizing the need for greater involvement by the medical research community and leadership from federal health care agencies" 

Health Care Reform And The New Economy Health Affairs   November 2000
"The objectives and assumptions of health care reform have changed repeatedly during the past century and may now be entering a new historical phase as a result of the "new economy" rooted in information technology. In a high-growth context, proponents of reform may no longer feel obliged to bundle expanded coverage with tighter cost containment. At the same time, the new digital environment may facilitate innovations intended to inform and expand consumer choice and to improve quality. The new environment elevates "transparency" to a guiding principle. Health informatics has long been peripheral to reform and must now become more central" 

Two Old Hands And The New New Thing Health Affairs   November 2000
"Hatchets buried, Newt Gingrich and Ira Magaziner agree that the Internet could help to solve some of the problems they battled over unsuccessfully in the past" 

The Internet And Managed Care: A New Wave Of Innovation Health Affairs   November 2000
"Managed care firms have been under siege in the political system and the marketplace for the past few years. The rise of the Internet has brought into being powerful new electronic tools for automating administrative and financial processes in health insurance. These tools may enable new firms or employers to create custom-designed networks connecting their workers and providers, bypassing health plans altogether. Alternatively, health plans may use these tools to create a new consumer-focused business model. While some disintermediation of managed care plans may occur, the barriers to adoption of Internet tools by established plans are quite low. Network computing may provide important leverage for health plans not only to retain their franchises but also to improve their profitability and customer service" 

Vaporware.com: The Failed Promise Of The Health Care Internet Health Affairs   November 2000
"Contrary to the claims of its well-financed promoters, the Internet will not solve the administrative redundancies, economic inefficiencies, or quality problems that have plagued the U.S. health care system for decades. These phenomena are the result of economic, organizational, legal, regulatory, and cultural conflicts rooted in a health care system grown from hybrid public and private financing; cultural expectations of unlimited access to unlimited medical resources; and the use of third-party payers rewarded to constrain those expectations. The historic inadequacy of information technology to solve health care's biggest problems is a symptom of these structural realities, not their cause. With its revolution of information access for consumers, the Internet will exacerbate the cost and utilization problems of a health care system in which patients demand more, physicians are legally and economically motivated to supply more, and public and private purchasers are expected to pay the bills" 

Financing The Health Care Internet Health Affairs   November 2000
"Internet-related health care firms have accelerated through the life cycle of capital finance and organizational destiny, including venture capital funding, public stock offerings, and consolidation, in the wake of heightened competition and earnings disappointments. Venture capital flooded into the e-health sector, rising from $3 million in the first quarter of 1998 to $335 million two years later. Twenty-six e-health firms went public in eighteen months, raising $1.53 billion at initial public offering (IPO) and with post-IPO share price appreciation greater than 100 percent for eighteen firms. The technology-sector crash hit the e-health sector especially hard, driving share prices down by more than 80 percent for twenty-one firms. The industry now faces an extended period of consolidation between e-health and conventional firms" 

Beyond The Hype: A Taxonomy Of E-Health Business Models Health Affairs   November 2000
"This paper describes a business model of e-commerce, its application to health care, and the reasons why the health policy community should monitor its development. The business model identifies the market barriers health e-commerce firms must overcome and provides perspective on opportunities for building a health care data infrastructure that is capable of delivering both a private and a public good" 

The Impact Of The Internet On Quality Measurement Health Affairs   November 2000
"Consumers are eager for information about health. However, their use of such data has been limited to date. When consumers do consider data in making health care choices, they rely more on word-of-mouth reputation than on traditional quality measures, although this information has not necessarily been readily accessible. The Internet changes the exercise of quality measurement in several ways. First, quality information-including reputation-will be more readily available. Second, consumers will increasingly use it. Third, the Internet provides a low-cost, standard platform that will make it vastly easier for providers to collect quality information and pass it on to others. However, major barriers still stand in the way of public access to quality information on the Internet as well as of having that access actually improve patients' care" 

Patients, Physicians, And The Internet Health Affairs   November 2000
"The Internet will have a profound effect on the practice and business of medicine. Physicians, eager to provide high-quality care and forced by competition to offer online services, will introduce e-mail and patient-friendly Web sites to improve administrative services and manage common medical conditions. Patients will identify more health information online and will take more responsibility for their care. The doctor/patient relationship will be altered: Some aspects of electronic communication will enhance the bond, and others will threaten it. Patients will have access to vast information sources of variable validity. Many physician organizations are preparing for the electronic transformation, but most physicians are unprepared, and many are resistant" 

E-Health: Technologic Revolution Meets Regulatory Constraint Health Affairs   November 2000
"An Internet-driven health system poses new challenges for an area al ready thick with regulations" 

Self-Regulation: Who Needs It? Health Affairs   November 2000
"By developing and enforcing a well-designed set of rules, e-health codes of ethics can direct attention to the best-quality sites" 

Virtually Exposed: Privacy And E-Health Health Affairs   November 2000
"Privacy concerns are keeping consumers from reaping the full benefit of online health information" 

E-Health, HIPAA, And Beyond Health Affairs   November 2000
"The chair of the expert advisory board on health data outlines the most important issues in developing a secure health information system" 

Old Before Its Time: HIPAA And E-Health Policy Health Affairs   November 2000
"A law that predates the Internet explosion needs retrofitting to serve as a foundation for standardized data exchange" 

Traversing The Digital Divide Health Affairs   November 2000
"On doctoring with and without computers" 

Health Information, The Internet, And The Digital Divide Health Affairs   November 2000
"Through an analysis of recent data on adults' and children's computer use and experiences, this DataWatch shows that use of computers and the Internet is widespread and that significant percentages of the public are already using the Internet to get health information. The surveys also show that the Internet is already a useful vehicle for reaching large numbers of lower-income, less-educated, and minority Americans. However, a substantial digital divide continues to characterize computer and Internet use, with lower-income blacks especially affected. Implications for the future of health communication on the Internet also are explored" 

Health e-People: The Online Consumer Experience Informatics Review   15.11.2000
"Health on the Internet is maturing and going through lots of changes. e-Health start-ups are burning through their venture funding, going public, finding new niches, reaching new consumers. Established health care players are finding their voices in cyberspace. Consolidation and shakeout are probably not far away" 

Internet based repository of medical records that retains patient confidentiality BMJ 11.11.2000 
"A patient's medical record has always been a dispersed entity. Literally defined, it is the accumulation of medical information concerning the patient. Ideally, this information is bundled in a single folder with the patient's identification data on the cover. In real life, this information is scattered between several archives (computerised and paper based) in various locations, often under different identifier numbers. Much of the information in the records is obsolete, redundant, duplicated, or indecipherable to the extent that it does not benefit the patient at the point of care"

PROCUREMENT e-BOUND Healthcare Informatics   November 2000
"Using e-business for online healthcare supply procurement may lower costs, untangle supply chains and boost your bottom line--once you get over the bumps"

CREATING A WORLDWIDE CODE OF ETHICS Healthcare Informatics   November 2000
"Is it any surprise that members of the International Medical Informatics Association (IMIA), gathering at a time of great technological and professional ferment in the global health informatics community, would be swept up by the whirlwind of issues confronting the industry? When IMIA representatives from across Europe, North and South America, Asia and Australia met in Hannover, Germany, for their annual general assembly in late August, that's exactly what happened"

IT'S ALL ABOUT SPEED Healthcare Informatics   November 2000
"When patient outcome depends on what you do in the first hour, information retrieval has to meet the pace"

Images of the Future Healthcare Informatics   November 2000
"The time is coming when virtually all radiology images and data will be digital, integrated and online"

Bringing Radiology into the Digital Realm Healthcare Informatics   November 2000
"Implementing a PACS solution takes a solid vendor-provider partnership"

There's Gold in Them Thar' Databases Health Data Management November 2000 
"Some health care organizations are using sophisticated data mining applications to unearth hidden truths buried in their online clinical and financial information. But the lack of a standard clinical vocabulary and standard work processes is an obstacle CIOs must blast through to reach their treasure"

A Cure for Health Care's Identity Crisis? Health Data Management November 2000 
"As the government seeks to finalize HIPAA ID rules, health care CIOs and consultants evaluate the potential impact of standard identifiers on health care"

Data in a Heart Beat Health Data Management November 2000 
"Cardiologists at the Mid America Heart Institute monitor cardiac patient data remotely via the Internet"

Will free software come to the rescue of the UK's health service? ZDNet UK 30.10.2000 
"The cash-strapped NHS would benefit from adopting open source software such as Linux, according to health service experts"

Going beyond voice over IP   Health Service Computing October 2000
"David Rainey, General Manager, BT Health describes how two goals can be achieved with one system to save time, money and duplication. Simon Goodwin of Cornwall NHS Trust then describes how the system has been implemented in his Trust."

Geeks to Gestapo   Health Service Computing October 2000
"The Government has made it clear that it wants medical records to be stored electronically. Roy Lilley questions the real purpose behind the implementation of electronic health records."

When the Lights come on!   Health Service Computing October 2000
""Barry James is a consultant with a long standing interest in networking the NHS. He would be pleased to hear of experiences from anyone engaged in the GPnet programme. The lights have come on in Whitehall and even Quarry House is being illuminated as a result!
Question: will they now lift the blinds and let the NHS benefit a little too?

Mobilising healthcare – Why go wireless?   Health Service Computing October 2000
"With the advent of the Internet, wireless and handheld technologies, the health service now has the opportunity to embrace the most advanced IT infrastructure currently available in the UK. In particular, the move in the IT industry towards handheld devices and mobile technology has the potential to revolutionise communications in the health industry."

Direct to who?   Health Service Computing October 2000
"NHS Direct, in principle is a marvel, a serious investment in IT by the Government. There have been a few squeals of anguish from the medical profession that you can’t do healthcare by phone but by and large it is becoming enmeshed within the daily business of the NHS and seems to be a really good idea well implemented. Technically, the infrastructure it plans to provide to the NHS could be invaluable, and come to form the technical backbone for the electronic health record."

Musculoskeletal diseases   Health Service Computing October 2000
"Musculoskeletal diseases such as rheumatoid and osteoarthritis can be very distressing for patients and unsurprisingly there are a large number of supportive sites on the Internet. In this review we look at these sites and also what information is available for health professionals."

A Question of Duty: Legal Issues Resulting from Physician Response to Unsolicited Patient E-mail Inquiries JIMR 9.2000
"Patients have eagerly embraced the Internet and its email capacity to increase their knowledge and access to medical information. Along with access to countless patient support “chat rooms” and an ever-increasing volume of full text health and medical literature, the Internet also offers a virtually barrier-less opportunity to engage physicians in email dialogue. While this opportunity is seductive and cost-free to patients, physicians should exercise care and wariness in their email exchanges with patients — especially if the patient is unknown to them."

Anesthesiologists' Responses to an E-mail Request for Advice from an Unknown Patient JIMR 9.2000
"People are using the Internet as a method of getting medical advice. Some Web sites include the email addresses of physicians, and some people are contacting these physicians for advice. As many patients undergo surgery on a "day surgery" basis, they often have no opportunity to ask anesthesiologists for advice before surgery; these patients may be more likely than other groups to use Internet email to ask questions. It seemed that it would be useful to find out what, if any, advice anesthesiologists would give in response to email from an unknown patient."

Rating the "Raters": Legal Exposure of Trustmark Authorities in the Context of Consumer Health Informatics JIMR 9.2000
"There are three areas of potential legal exposure for an organization such as a trustmark authority involved in e-health quality rating."

Peer Review in a Post-Eprints World: A Proposal JIMR 9.2000
"Recently, a number of electronic biomedical preprints servers, which allow the archiving of electronic papers without prior peer review, have been established, most notably the Clinical Medicine & Health Research NetPrints website and the The Lancet's Electronic Research Archive. These mark an extension to clinical medicine and health research of a novel experiment in the provision of public access to electronic versions of preprints. However, until now the biomedical community has been slow to adopt this new form of communication."