F08 CPSC203 T09 GROUP 4

Master Ninja Team Members:

 * Pamneet Brar
 * Joyce Tu
 * Romell Bermundo
 * Riham Moussa 

Technology and Issue
Technology: Internet

Issue: Disseminating Healthcare

Statement: The history of healthcare was investigated and how it has evolved over the years. The positive and negative effects of healthcare through the internet were looked at. Has internet improved our health and the way we obtain information about our health or has it opened the door for more problems? 

Definition of Healthcare
The prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. Healthcare is the deterrence, treatment, and the management of illness, it is the protection of health through the services offered by all the health professionals’ i.e; doctors, nurses. The organised provisions of such services are known as the healthcare system. In most developed countries and many developing countries health care is provided to everyone regardless of their ability to pay. The National Health Service, established in 1948 by Clement Atlee's Labour government in the United Kingdom, was the world's first universal health care system provided by government and paid for from general taxation. Alternatively, compulsory government funded health insurance with nominal fees can be provided, as in Italy. Other examples are Medicare in Australia, established in the 1970s by the Labour government, and by the same name Medicare was established in Canada between 1966 and 1984. Universal health care contrasts to the systems like health care in the United States or South Africa.  The health care industry is considered an industry or profession which includes peoples' exercise of skill or judgment or the providing of a service related to the preservation or improvement of the health of individuals or the treatment or care of individuals who are injured, sick, disabled, or infirm. The delivery of modern health care depends on an expanding group of trained professionals coming together as an interdisciplinary team. Consuming over 10 percent of gross domestic product of most developed nations, health care can form an enormous part of a country's economy. In 2003, health care costs paid to hospitals, physicians, nursing homes, diagnostic laboratories, pharmacies, medical device manufacturers and other components of the health care system, consumed 16.3 percent of the GDP of the United States, the largest of any country in the world. 

History of Healthcare
In the past, there was no known cause for why people contracted illnesses. In England, people were taught by the church that getting sick was a punishment from God. All sorts of techniques were used in order to heal the patient although many techniques were unacceptable in today's standards. Techniques like bloodletting were used to get rid of bad blood that was accused of making you ill and trepanning was used to release bad spirits that are trapped in your head. Many times, the “doctors” or “professionals” were not professional at all. They were not very skilled and usually had another job not related on medicine. Butchers and barbers were employed to practice medical practices just because there was no one else to do it. The most qualified people at that time to practice on you would have been a monk from a monastery as they had basic medical knowledge. It was very common to get a post-surgery infection at the time as surgeons did not wash their hands and often operated in their street clothes. Operating rooms were filthy and unsanitary and tools were not sanitized. Harmful bacteria transferred from the tools or the doctor’s hands into the patient. About half of all surgery patients who survived the actual surgery typically died of infections that developed after the operation.  In 1870, French chemist Louis Pasteur and German physician Robert Koch separately established the germ theory of disease. This helped in the pioneering work of American physician Oliver Wendell Holmes and Hungarian obstetrician Ignaz Philipp Semmelweis. They showed that the high infant mortality rate and high mortality rate of women after giving childbirth was due to infectious bacteria transferred from unwashed hands. British surgeon and biologist Joseph Lister then heralded in a new era in which physicians used sterilized instruments and techniques to avoid infecting the patient. Another milestone that advanced healthcare was the discovery of anesthesia. It was discovered by physician Crawford Long. Before, doctors used alcohol, opium, and other drugs to numb the pain during surgery. Many patients suffered from shock and died during surgery. Longer and more complicated operations could now be done. By the end of 20th century, improved sanitation, discovery of vaccines, and antibiotics helped increase an average person’s life to and age of 76 years; whereas before, men and women were weak by the age of 40.  Doctors now knew that vaccines, better drugs, vitamins and surgical procedures, new instruments, and understanding of sanitation and nutrition have had a huge impact on human well-being. In the 1960s and 1970s, physicians and medical educators began to realize that just treating the disease after symptoms appears was very costly and that preventing it was better than just treating it. Some physicians specialized in preventative medicine which emphasized keeping patients healthy. They promoted ways so that patients would avoid risk factors for disease. Healthcare consumers grew more knowledgeable about the world of healthcare and medical information would be found in magazines, on the news, and on the internet. Not only can internet help consumers find information about different medical information. It could also help rural patients from traveling long trips to urban hospitals. Advances in computer and internet technologies created new possibilities for patients in the early 1990s. Telemedicine created live videos with sound and high-resolution images could be sent between two distant locations so that doctors can easily examine patients in offices that are thousands of miles away. This meant that healthcare professionals could monitor a patient’s heart rate, blood pressure, blood-oxygen levels without having the patient leave their home. 

Positive effects of the Internet Healthcare relationship
Outsourcing Healthcare As word (the internet) has spread about the high-quality care and cut-rate surgery available in such countries as India, Thailand, Singapore and Malaysia, a growing stream of uninsured and underinsured Americans are boarding planes for discount hip replacements and sophisticated heart surgeries. Procedures in Thailand and Malaysia, Dr. Arnold Milstein found, cost only 20% to 25% as much as comparable ones in the U.S. and top-notch Indian hospitals sell such services at an even steeper discount. If more private payers sent patients abroad for uncomplicated elective surgeries, the savings could be enormous. "This has the potential of doing to the U.S. health-care system what the Japanese auto industry did to American carmakers," says Princeton University healthcare economist Uwe Reinhardt. <BR> Reduced administration costs In 2007, the U.S. spent about $2.26 trillion on health care, or $7,439 per person. It spends $1,000 per year per person in administrative costs, which puts the cost of the system at over $250 billion. With the creation of better technology, U.S. can reduce the costs of healthcare due to inefficiencies.<BR> <BR> Self-help health care In a clinical trial, advice and medications delivered via the internet, along with home blood pressure (BP) monitoring, lets people with high blood pressure get their condition under control. Dr. Beverly B. Green, at the University of Washington in Seattle, and colleagues tested whether high blood pressure could be managed over the Internet without the need for visits to a doctor. The clinical trial included patients with uncontrolled high blood pressure and internet access. They were randomly assigned to usual care, or to home BP monitoring and Web services training, or to home monitoring, Web services training, and management by a pharmacist delivered through Internet communications. After 12 months, about one-third of the patients in the first two groups achieved a normal blood pressure. However, with the Internet-based pharmacist care, more than half the patients got their blood pressure down to normal.<BR> <BR> Reduced waiting times Today, patients can already reduce their waiting time by consulting available Internet tools. In Sweden, The Confederation of Greater Councils posts estimated waiting lists for many - but not all - Swedish hospitals and clinics. If you are prepared to travel to another city, you can cut your waiting time quite dramatically.<BR> <BR> Take one common surgery, a primary plastic hip replacement. In Stockholm and a couple of other cities you can be treated within a maximum of six weeks. Four out of five of the most available clinics are found in the Stockholm area. But if a patient insist on going to the nearest hospital and live in Gothenburg, Umeå or Arvika, he or she can count on waiting at least 104 weeks. For ordinary prostate surgery, a patient may wait four weeks in Stockholm and between 90 and 156 weeks in most parts of Sweden. (Details for a variety of services are posted in Swedish at http://sas.lf.se/appl/html/rapport/start_behandling.) Sharing health information to the public.<BR> <BR> Increases health literacy Governments and universities have traditionally produced large amounts of health information, which is now readily available online. The National Institutes of Health (NIH), in the United States produces comprehensive information on most major conditions. NIH is also home to the Clinical Trials Database that contains medical studies around the country and information about whether or not clinical trials are right for an individual. In addition, NIH provides a direct link to more than 9,000 medications on Medline. On the NIH site you will also find research on a wide range of subjects including Complementary and Alternative Medicine, Rare Diseases, Minority Health, Bioethics, and Social Science. And the Centers for Disease Control (CDC) is recognized as the leading US federal agency for protecting the health and safety of people in the US and abroad, with their focus on developing and applying disease prevention and control, environmental health, and health promotion and education activities.<BR> <BR> Most people prefer to investigate their health concerns in the privacy of their homes before trotting off to see the doctor. (In fact, a study done by The Pew Internet & American Life Project reported that 41% of Americans used the internet to determine whether or not they would seek medical help).<BR>

Negative effects of the Internet Healthcare relationship
<BR> Physician-Patient relationship The internet is used to find information of diseases, medical treatment, and the availability of clinical trails. When one needs to find information about a certain drug it’s as simple as typing it in a search bar the person is soon overwhelmed with pages of information. 55% of the people surveyed used the internet for health information but only 9% of those people talked their physician about their concerns. This could alter the patient-physician relationship. Physicians are hesitant to interact with patients via email because of fear of being overwhelmed with electronic messages, of breaches in security, and of liability.<BR> <BR> Misinformation Patients can access medical information easily but can also be easily misinformed. Some of the information available worries healthcare professionals. Websites trying to sell drugs such as vitamins and non-approved medications or websites that glorify anorexia can put patients at risk. Furthermore, patients might make a wrong diagnoses based on wrong information received. Even if the information if correct the quality could be poor. <BR> <BR> Security Concerns With websites like Americasdcotor, WebMD and CyberDocs there is the security concern. More than financial information, keeping healthcare information confidential is important. There is security set up to protect patients’ clinical information however there still is a possibility that the information could end up in the wrong hands. Health care information is susceptible to attacks which could alter, delete or divulge information despite the usage of passwords, encryption, and firewalls. It brings the question of who should the information be sent to and should it be sent with or without patient consent? When can you make exceptions? Many advocate groups see the internet as a risk to patient confidentiality since information is available to more users (e.g., insurers, direct marketers, and pharmaceutical benefits managers) thus more susceptible to a breach in security.<BR> <BR> Quality of Service Many applications on the internet relating to health must provide a certain quality of service. A failure to obtain medical records or images could put a patient a risk. Since the internet is always changing health care organizations may find it difficult keeping up. Difficulties in obtaining information and weaknesses in Web browser and search engine technologies could become a problem. Using video-on-demand requires high bandwidth in only one direction. If control signals sent to dosage equipment or medical monitoring are corrupted or degraded it could be dangerous. Even just receiving the medical records quickly is important. When looking at an MRI, CT scan or results from a patient’s X-ray, images can be anywhere from tens to hundreds of megabytes large. This could a lot of demand on the network. It could take a long time to transfer an image; also the quality of the image is very important. There is no guarantee of the quality of service. <BR> <BR> Publication Rights Electronic publishing is a very attractive idea for publisher because it is cheaper and more convenient however this allows readers to simply “cut and paste” information reducing revenues. Instead of purchasing rights to use the information it would allow health care professionals to give out information to patients through virtual library services or other forms of distribution.<BR> <BR> Liability Healthcare on the internet may open the doors for people with phony credentials posing as physicians. Furthermore, current physicians could use the internet for malpractice. Use of the Internet creates a host of new issues regarding licensure and liability. The rules or regulations regarding the control of online prescriptions are still unclear as of now. Also, when patients have to pay for services how will they know whether or not it is a legitimate provider. <BR> <BR>

Workforce It’s hard to keep up with the ever-changing technological demand thus finding and retaining a sufficient number of workforce might be difficult. This area of healthcare requires highly trained professional with knowledge in engineering, computers, information science, skilled users, researches, creators, and designers. Specifically, it will require individuals with expertise in healthcare, biomedicine, computing and communications. Important scientific issues would need to be covered to address certain issues, build practical systems and put strategies into place. <BR> <BR>

The Future
In the future internet will become more and more common in hospitals and doctors offices. New, interactive sites will replace traditional methods of providing healthcare. There will also be thousands more websites devoted to healthcare which will be visited by many more people. Websites will be rated and healthcare brands will be established. More people will use the internet to buy over-the-counter and prescription drugs. Online support groups will thrive where patients can interact with other patients with a certain disease since patients will be able to access it quickly and easily. Interactions between physicians and patients via e-mail will become a lot more common. Eventually physicians will begin to use electronic medical records. <BR>