Keynote for the Australian 10th Annual Health Care Congress ( http://www.webcitation.org/5Vlz9j0HO ) in Sydney, 27th - 29th February 2008. Keynote contains a run-down of what ehealth is all about, and then focusses a fair bit on Personal Health Records (PHR 2.0) and Personal Health Applications. This is partly because the new Australian government under its new prime minister Kevin Rudd has set a couple of priorities for reforming health care, among them is "focussing on preventative health care and health promotion to help keep Australians healthy and out of hospital", which is a goal that can - in my opinion - be attained or at least greatly supported with Personal Health Records, or more specifically with what I call second generation PHRs or PHR 2.0. Contains screenshots of our Healthbook (TM) project, which was subsequently mentioned mentioned in the preliminary report of the 2020 Summit to the Prime Minister in Australia, see http://gunther-eysenbach.blogspot.com/search/label/healthbook

1. Associate Professor Department of Health Policy, Management and Evaluation, University of Toronto; Senior Scientist , Centre for Global eHealth Innovation, Division of Medical Decision Making and Health Care Research; Toronto General Research Institute of the UHN, Toronto General Hospital, Canada eHealth Transforming the dynamics of a complex health system (from a sickness model to a wellness model) Gunther Eysenbach MD MPH Gunther Eysenbach MD MPH

4. Traditional hospital-based health care system Obesity

6. • focussing on preventative health care and health promotion, to help keep Australians healthy and out of hospital

7. These are ALL problems where eHealth plays a critical role

8. Copyright ©2006 BMJ Publishing Group Ltd. Thun, M. J et al. Tob Control 2006;15:345-347 http://tobaccocontrol.bmj.com/cgi/content/full/15/5/345 Between 1991-2003, cancer mortality decreased by 12% 40% of this decrease is attributed to smoking cessation The importance of behavior change and prevention…

9. eHealth can support behavior change and prevention

11. Rewarding healthy lifestyle with “Healthmiles”

12. “ Cancers that affect Indigenous Australians to a greater extent than other Australians are largely preventable (eg, through smoking cessation, Pap smear programs and hepatitis B vaccination). “ Condon et al. MJA 2004; 180 (10): 504-507 http://www.mja.com.au/public/issues/180_10_170504/con10102_fm.html

17. eHealth is not medical (clinical) informatics Eysenbach G: Consumer health informatics. BMJ 2000;320:1713-16

18. Jennings K, Miller K, Materna S. Changing health care. Santa Monica: Knowledge Exchange, 1997 Smith R. The future of healthcare systems. BMJ 1997 May 24;314(7093):1495-6

19. www.jmir.org G. Eysenbach. What is eHealth? J Med Internet Res 2001; 3(2):e20 http://www.jmir.org/2001/2/e20

20. „ e-Health (...) refers to health services and information delivered or enhanced through the Internet or Internet-related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, a commitment for networked, global thinking, to improve health (care) worldwide by using information and communication technology .“ What is e-health? G. Eysenbach. What is eHealth? J Med Internet Res 2001; 3(2):e20 http://www.jmir.org/2001/2/e20

22. Efficiency and cost savings through home care? Romanov Comission Interim Report, 2002

23. Intelligent Home Care System Care-O-bot ( Fraunhofer Institute for Manufacturing Engineering and Automation )

24. http://www.vivometrics.com/

29. Enhancing quality through consumer “control”

30. Dr. med. G. Eysenbach (ey@yi.com) Universität Heidelberg, Abteilung für Klinische Sozialmedizin, Forschungsgruppe Cybermedizin Patienteninformation per Internet - eine Herausforderung für den Arzt

31. Enhancing quality

33. Patients, Physicians and the Internet The Boston Consulting Group, 2001

34. How do consumers search and appraise health information on the web today? My computer told me that I can trust you, based on the ratings of your previous patients...

37. Evidence-based eHealth: There is still a dearth of evidence

40. Globalization – geographic distances are meaningless

42. Homework tutors in Bangalore… … think about the possibilities for health

43. Changing delivery of care J. E. Gray, C. Safran, R. B. Davis, G. Pompilio-Weitzner, J. E. Stewart, L. Zaccagnini, D. Pursley. Baby CareLink: using the internet and telemedicine to improve care for high-risk infants. Pediatrics 106 (6):1318-1324, 2000.

48. Where clinical and preventive ehealth services meet: PHAs Clinical Medicine Health Care Delivery Preventive Medicine Public Health Personal Health Applications Patient Portals EHR/PHR Eysenbach 2008

53. © Gunther Eysenbach Patient data External evidence General health information Individual health information Literature Mass Media Internet Health Record Personally Relevant Health Information (PH) Patient Physician as infomediary Patient accessible electronic health records Medical knowledge

57. Patient data External evidence General health information Individual health information Literature Mass Media Internet Health Record Personally Relevant Health Information (PH) Patient Physician as infomediary Patient accessible electronic health records Medical knowledge

59. PHRs

60. PHRs

64. EMR “ Tethered” PHR/ PAEHR “ stand-alone” PHR PHR EMR Read only Read+Write/Annotate PHR PHR © Gunther Eysenbach, CC-BY

65. EMR EMR PHR Different providers “ interconnected” PHR © Gunther Eysenbach, CC-BY PHR PHR

66. Records at Financial institutions Personal Finance Records © Gunther Eysenbach, CC-BY

67. Tang et al, JAMIA 2006

70. Report recommendation from the National Committee on Vital and Health Statistics “Personal Health Records and Personal Health Record Systems” http://www.ncvhs.hhs.gov/0602nhiirpt.pdf http://www.webcitation.org/5VlINiXs3 (Feb, 2006).

72. Consumer Accountability

74. http://en.wikipedia.org/wiki/Image:Web20_en.png

75. Web 2.0 , a phrase coined by O'Reilly Media in 2004 [1] , refers to a supposed second generation of Internet -based services —such as social networking sites , wikis , communication tools, and folksonomies —that emphasize online collaboration and sharing among users. O'Reilly Media, in collaboration with MediaLive International, used the phrase as a title for a series of conferences and since 2004 it has become a popular (though ill-defined and often criticized) buzzword amongst certain technical and marketing communities. http://en.wikipedia.org/wiki/Web_2.0

76. Source: http://web2.wsj2.com/

78. S-Health: Convergence of social networking technologies and e-health S–Commerce: Beyond MySpace and YouTube http://www.competeinc.com/news_events/pressReleases/168/ http://www.webcitation.org/5VuPjJxo5

80. EMR EMR PHR PHR PHR Different providers PHR 2.0 ® © Gunther Eysenbach, CC-BY Community Other peoples’ PHR Other peoples’ PHR Other peoples’ PHR

83. “ eHealth is not (just) about improving health care , it is about improving health” (Gunther Eysenbach)

84. Thank you! Dr Gunther Eysenbach, Email: geysenba@uhnres.utoronto.ca, Associate Professor Department of Health Policy, Management and Evaluation, University of Toronto; Senior Scientist , Centre for Global eHealth Innovation, Division of Medical Decision Making and Health Care Research; Toronto General Research Institute of the UHN, Toronto General Hospital, Canada

85. Complexity in Health Care

86. Jones, P. (2000) Hodges' Health Career - Care Domains - Model: Health and Social Care Informatics http://www.p-jones.demon.co.uk/infone.htm http://www.webcitation.org/5Vpx3GDuM

87. http://en.wikipedia.org/wiki/Scale-free_network

91. World Obesity Map http://www.iaso.org/docs/pdf/review2003.pdf http://www.webcitation.org/5VvwTOs3l

92. World Carbon Emissions Map

93. World Happiness Map

94. “ Healthy” Food Choices http://www.carbonfootprint.com/calculator.aspx

96. “ Unhealthy Food Choices”

97. “ Unhealthy” choices: 3.547 tonnes