Demographic Differences in Telehealth Policy Outcomes

Demographic Differences in Telehealth Policy Outcomes

Mary Schmeida (The Cleveland Clinic, USA) and Ramona McNeal (University of Northern Iowa, USA)
DOI: 10.4018/978-1-60566-002-8.ch036
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Abstract

This chapter is an analysis of demographic variables influencing policy outcomes with online health information searches in the general U.S. public. This study is based on The Internet and American Life Daily Tracking Survey, August 2006 from the Pew Research Center for the People and the Press. Multivariate regression statistical technique is used to explore changes in individual level behavior following the search for online medical information. The data show individuals in most need of healthcare services (poor, less educated, and minority groups) and those with a recent demand for services, are more likely to make changes to improve their health after accessing online medical information.
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Introduction

The public sector in the U.S. is increasingly using the Internet to provide information, deliver services, and interact with citizens, businesses, and other government agencies (West, 2003, 2004). There are numerous reasons for the government adoption of electronic government (e-government) practices that “refer to the delivery of information and services via the Internet or other digital means” (West, 2004, pp 2). E-government is expected to deliver services and information around the clock, making government more efficient and transparent to the public (Tolbert and Mossberger, 2006; West, 2003). The adoption of these practices may make government more responsive through its ability to provide communication options that are quicker and more convenient for users (Thomas and Streib, 2003).

Telehealth is an important example of e-government that takes on many forms. Although there is no consensus on its definition, the United States Congress defines telehealth as the use of electronic information and telecommunication technology to support long-distance clinical healthcare; patient and professional health-related education; public healthcare and administration (U.S. House of Representatives 2157, 2001). In practice, telehealth is understood as the inclusion of telemedicine plus other on-line social services.

Regardless of how telehealth is defined, this new medium for delivering medical services has been adopted with the goal to improve the accessibility of public and private healthcare, service quality and clinical outcomes. It is often implemented as a way to provide cost-effective healthcare. However, if we examine all the different aspects of telehealth in the U.S.—technology-enabled delivery, regulation and enabling legislation (state policies), and healthcare information available online, we find a unifying theme of broadening healthcare access. Telehealth practices may act to expand healthcare services through improving the dissemination of health information by Internet to the public, facilitating Internet based second opinions on disease management, improving consultative services to rural facilities and has the potential to reduce medical errors (Schmeida, 2005).

Despite the hopes for telehealth (as well as other forms of e-government), there is also a literature suggesting that these service delivery advancements will not live up to expectation. One barrier to the Internet for expanding healthcare access is the Internet cleavages that exist among United States citizens---people who do and do not use the Internet. These differences in Internet usage are based on a number of socioeconomic factors including age, income, education and race. The variation in Internet practices attributed to these socioeconomic factors has been linked to underlying inequalities in Internet access and technological skills, along with psychological barriers (Mossberger, Tolbert and Stansbury, 2003; Stanley, 2003). This suggests that e-government will only act to widen the gap between those that do and do not benefit from telehealth services.

Supporting this literature on Internet inequalities is research examining the differences in online health information searches among the various socioeconomic groups in the U.S. (Schmeida and McNeal, 2007). In exploring differences among socioeconomic groups in searching for Medicare and Medicaid information online, Schmeida and McNeal (2007; 2006) find some disparities are narrowing as the elderly and poor in need of these publicly subsidized health insurance programs are online searching for information at the U.S. Centers for Medicare & Medicaid Services Web site. Services and information obtainable at this Web site include eligibility criteria, enrollment procedures, Medicare plan options, local physicians and medical suppliers, pharmacy directory and healthcare chat rooms. In addition, beneficiaries can obtain personal information on their benefits and services. However, people without Internet access and experience, remain disadvantaged in accessing this critical information that can link them to needed healthcare services, suggesting that e-government service delivery advancements may not be living up to expectation.

Key Terms in this Chapter

Internet: A worldwide computer network that is capable of linking all network users.

Telehealth Policy: An electronic government policy that uses the Internet to improve accessibility of public and private and non-profit healthcare services in rural and urban areas, while improving the quality of services at lower service costs.

Electronic Government (e-Government): The delivery of information and services online through the Internet or other digital means (West, D.M., 2000; p. 2)

U.S. Internet Cleavages: Internet cleavages that exist among United States citizens---people who do and do not use the Internet, and can be based on a number of socioeconomic and psychological factors.

Telehealth: The term is often interchanged with telemedicine. There is no consensus on its definition. However, the United States Congress defines it as the use of electronic information and telecommunications technologies to support public health and health administration,long-distance clinical healthcare, patient and professional health-related education (H.R. 2157, 2001). An example of e-government.

Demographics: Population statistics about socioeconomic factors such as gender, age, education, income, marital status, ethnicity, etc.

Poisson Regression: A linear model, Poisson regression analysis is used when the response variable represents counts.

Technological Skill: Skills, such as being able to use a computer mouse and knowing how to find Internet information. Younger individuals are more likely to have developed these skills because of Internet exposure in school. A barrier to widespread e-government is lack of technological skill.

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Table of Contents
Preface
Athina A. Lazakidou
Acknowledgment
Athina A. Lazakidou
Chapter 1
Sanjay P. Sood, Sandhya Keeroo, Victor W.A. Mbarika, Nupur Prakash, Ankur Seth
It is claimed that seeds of ‘medical informatics’ were sown in 1960s.From this time until the 1990s experts have described the discipline as... Sample PDF
Medical Informatics: Thirty Six Peer-Reviewed Shades
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Chapter 2
D. John Doyle
E-health technology has started to become commonplace in the clinical world, with practitioners setting up their own Web sites to disseminate... Sample PDF
Medical Privacy and the Internet
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Chapter 3
Ana Ferreira, Ricardo Cruz-Correia, Luís Antunes, David Chadwick
This chapter reports the authors’ experiences regarding security of the electronic medical record (EMR). Although the EMR objectives are to support... Sample PDF
Security of Electronic Medical Records
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Chapter 4
György Surján
This chapter outlines the history of medical classifications in a general cultural context. Classification is a general phenomenon in science and... Sample PDF
The Cultural History of Medical Classifications
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Chapter 5
Spyros Kitsiou
A fundamental requirement for achieving continuity of care is commonly accepted to be the integration and interoperability of different clinical... Sample PDF
Overview and Analysis of Electronic Health Record Standards
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Chapter 6
Graham D. Bodie, Mohan J. Dutta, Ambar Basu
This chapter overviews an integrative model of e-health use that connects social disparities at the population level with individual characteristics... Sample PDF
The Integrative Model of E-Health Use
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Chapter 7
Firat Kart
In this chapter we describe a distributed e-healthcare system that uses service oriented architecture as a basis for designing, implementing... Sample PDF
A Distributed E-Healthcare System
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Chapter 8
Davor Mucic
In this chapter the author gives the short review over wide range of telepsychiatry applications. Furthermore, describes completely new and... Sample PDF
Telepsychiatry Within European E-Health
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Chapter 9
Azizah Omar
In this chapter the author discusses several marketing principles and issues related to pitfalls and successes of Telehealth application in the case... Sample PDF
Pitfalls and Successes of a Web-Based Wellness Program
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Chapter 10
Isabel de la Torre Díez
This chapter describes a Web -based application to store and exchange Electronic Health Records (EHR) and medical images in Ophthalmology... Sample PDF
A Web-Based Application to Exchange Electronic Health Records and Medical Images in Ophthalmology
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Chapter 11
Mario Ceresa
This chapter mainly focuses on biomedical knowledge representation and its use in biomedicine. It first illustrates the existent more relevant... Sample PDF
Clinical and Biomolecular Ontologies for E-Health
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Chapter 12
Roger Tait, Gerald Schaefer
The registration of corresponding patient volumes is often a pre-requisite for medical imaging tasks. Accurate alignment, however, usually results... Sample PDF
Distributed Medical Volume Registration
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Chapter 13
Bill Ag. Drougas
Internet today is one of the most useful tools for information, education and business or entertainment. It is one of the modern technology tools... Sample PDF
Electronic Commerce for Health Products Services-Problems- Quality and Future
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Chapter 14
Christos Bountis
This chapter introduces and reviews the concept of distributed knowledge management within the Healthcare environment and between Healthcare and... Sample PDF
Distributed Knowledge Management in Healthcare
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Chapter 15
Jelena Vucetic
This paper describes business and technological challenges and solutions for a successful emergency telemedicine venture called MediComm. Its... Sample PDF
An Analysis of a Successful Emergency Telemedicine Venture
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Chapter 16
Tammara Massey, Foad Dabiri, Roozbeh Jafari, Hyduke Noshadi, Philip Brisk, Majid Sarrafzadeh
This chapter introduces reconfigurable design techniques for light-weight medical systems. The research presented in this chapter demonstrates how... Sample PDF
Reconfigurable Embedded Medical Systems
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Chapter 17
Konstantinos Perakis
The evolutions in the field of telecommunications technologies, with the robustness and the fidelity these new systems provide, have significantly... Sample PDF
Third Generation (3G) Cellular Networks in Telemedicine: Technological Overview, Applications, and Limitations
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Chapter 18
Anton V. Vladzymyrskyy
This chapter introduces usage of telemedicine consultations in daily clinical practice. Author has describe process of teleconsultation, sample... Sample PDF
Telemedicine Consultations in Daily Clinical Practice: Systems, Organisation, Efficiency
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Chapter 19
Cheon-Pyo Lee, J. P. Shim
Ubiquitous healthcare has become possible with rapid advances in information and communication technologies. Ubiquitous healthcare will bring about... Sample PDF
Ubiquitous Healthcare: Radio Frequency Identification (RFID) in Hospitals
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Chapter 20
Rafael Capilla, Alfonso del Río, Miguel Ángel Valero, José Antonio Sánchez
This chapter deals with the conceptualization, design and implementation of an m-health solution to support ubiquitous, integrated and continuous... Sample PDF
Agile Patient Care with Distributed M-Health Applications
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Chapter 21
Žilbert Tafa
This chapter describes the very actual issues on mobile health (M-H) and home care (H-C) telecare systems, reviewing state of the art as well as... Sample PDF
Mobile Health Applications and New Home Care Telecare Systems: Critical Engineering Issues
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Chapter 22
José Antonio Seoane Fernández, Juan Luis Pérez Ordóñez, Noha Veiguela Blanco
This chapter presents an architecture for the integration of various algorithms for digital image processing (DIP) into web-based information... Sample PDF
A New System for the Integration of Medical Imaging Processing Algorithms into a Web Environment
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Chapter 23
Daniel Welfer
This chapter discusses the concept of open-source picture archiving and communication systems (i.e. PACS), which are low cost, and easy to... Sample PDF
PACS Based on Open-Source Software Components
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Chapter 24
Carolin Kaiser
This chapter introduces a case based reasoning (CBR) system for customizing treatment processes. The CBR system enables the generating of inpatient... Sample PDF
Case Based Reasoning for Customizing Treatment Processes
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Chapter 25
I. Apostolakis, A. Chryssanthou, I. Varlamis
A significant issue in health related applications is protecting a patient’s profile data from unauthorized access. In the case of telemedicine... Sample PDF
A Holistic Perspective of Security in Health Related Virtual Communities
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Chapter 26
Stamatia Ilioudi
This chapter aims to present various virtual learning environments for medical purposes in the world. More than ever, medical students and... Sample PDF
Virtual Learning Environments in Health
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Chapter 27
Jelena Vucetic
In the last decade, advances in medicine, telemedicine, computer technologies, information systems, Web applications, robotics and... Sample PDF
Multimedia Distance Learning Solutions for Surgery
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Chapter 28
Maria Andréia F. Rodrigues
This chapter shows how recent computing technologies such as collaborative virtual environments, high speed networks and mobile devices can be used... Sample PDF
Collaborative Virtual Environments and Multimedia Communication Technologies in Healthcare
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Chapter 29
Tiffany A. Koszalka, Bradley Olson
A major issue facing medical education training programs across the USA is the recent advent of universal mandatory duty hour limitations and the... Sample PDF
Transforming a Pediatrics Lecture Series to Online Instruction
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Chapter 30
Anastasia N. Kastania, Stelios Zimeras
In this chapter the authors investigate telehealth quality and reliability assurance. Various models and standards can be applied to assess software... Sample PDF
Quality and Reliability Aspects in Telehealth Systems
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Chapter 31
Kleopatra Alamantariotou
Recent statistics show that the World Wide Web has now grown to over 100 million sites: a phenomenal expansion in only 15 years (Mulligan 2007). It... Sample PDF
Quality of Health Information on the Internet
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Chapter 32
Kashif Hussain
This chapter provides a practical approach to computerized system validation (CSV) for the pharmaceutical organizations for the users dealing with... Sample PDF
A Practical Approach to Computerized System Validation
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Chapter 33
Bill Ag Drougas, Maria Sevdali
Ergophysiology as a division of the Physiology and helps us today to understand what happens in the human body and movement and how we are able to... Sample PDF
Organization and Evaluation of Experimental Measurements of Ergophysiological Data with the Method of SF12V2
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Chapter 34
Daniele Apiletti
Current advances in sensing devices and wireless technologies are providing a high opportunity for improving care quality and reducing the medical... Sample PDF
Ubiquitous Risk Analysis of Physiological Data
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Chapter 35
Manfred Doepp
In our energy diagnostic department we noticed more and more cases with irrational stimulus-reaction- patterns and with a chaotic regulation state... Sample PDF
Chaotization of Human Systems by Technical Electromagnetic Fields
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Chapter 36
Mary Schmeida, Ramona McNeal
This chapter is an analysis of demographic variables influencing policy outcomes with online health information searches in the general U.S. public.... Sample PDF
Demographic Differences in Telehealth Policy Outcomes
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About the Contributors