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PubMed2005

The law of attrition.

In an ongoing effort of this Journal to develop and further the theories, models, and best practices around eHealth research, this paper argues for the need for a "science of attrition", that is, a need to develop models for discontinuation of eHealth applications and the related phenomenon of participants dropping out of eHealth trials. What I call "law of attrition" here is the observation that in any eHealth trial a substantial proportion of users drop out before completion or stop using the application. This feature of eHealth trials is a distinct characteristic compared to, for example, drug trials. The traditional clinical trial and evidence-based medicine paradigm stipulates that high dropout rates make trials less believable. Consequently eHealth researchers tend to gloss over high dropout rates, or not to publish their study results at all, as they see their studies as failures. However, for many eHealth trials, in particular those conducted on the Internet and in particular with self-help applications, high dropout rates may be a natural and typical feature. Usage metrics and determinants of attrition should be highlighted, measured, analyzed, and discussed. This also includes analyzing and reporting the characteristics of the subpopulation for which the application eventually "works", ie, those who stay in the trial and use it. For the question of what works and what does not, such attrition measures are as important to report as pure efficacy measures from intention-to-treat (ITT) analyses. In cases of high dropout rates efficacy measures underestimate the impact of an application on a population which continues to use it. Methods of analyzing attrition curves can be drawn from survival analysis methods, eg, the Kaplan-Meier analysis and proportional hazards regression analysis (Cox model). Measures to be reported include the relative risk of dropping out or of stopping the use of an application, as well as a "usage half-life", and prediction models reporting demographic usage discontinuation in a population. Differential dropout or usage rates between two interventions could be a standard metric for the "usability efficacy" of a system. A "run-in and withdrawal" trial design is suggested as a methodological innovation for Internet-based trials with a high number of initial dropouts/nonusers and a stable group of hardcore users.

Delivery of Health Care↗
PubMed2004

Telemedicine and eHealth in Norway: administration and delivery of services.

OBJECTIVES: This article reviews the situation in Norway concerning the administration and delivery of telemedicine and eHealth. METHODS AND RESULTS: By introducing the Norwegian hospital reform implemented in January 2002, the review provides the background allowing to understand the shift in strategy within this field in Norway. It also provides a historical context regarding the use and development of telemedicine in Norway. Since the implementation of the hospital reform, it can be argued that, presently, there has been a significant change in strategy from what can be described as a "muddling through"-strategy to a more rational approach, based on common and clearly defined goals. CONCLUSIONS: The hospital reform can be regarded as an important crossroads for the use of information and communication technology in Norway. The hypothesis put forward is that the development since the reform was implemented has strengthened both the willingness and the ability to make rational choices and take important steps forwards regarding the use of information and communication technology in the health sector in Norway, when discussing both telemedicine and eHealth.

Health Care Costs↗
PubMed2004

Information technology strategies for health and social care in Norway.

OBJECTIVES: Provide an introduction to national IT strategies for the health and social sectors, and point out major challenges for the future of eHealth and Telemedicine in Norway. METHODS: The information provided in this article is based on reviews of national strategies and plans, and contact with projects and users in the health and social sectors. CONCLUSION: IT in health and social services has the potential to improve welfare, while simultaneously improving the efficiency of the systems. IT in home- and community-care will provide the users with better services closer to home in the coming years. National strategies and action plans are important, but the funding necessary for the recommended actions must also be provided. Organisational issues are important.

Community Health Services↗
PubMed2004

Review on the state of telemedicine and eHealth in Iceland.

This article provides an overview of telemedicine and other eHealth activities in Iceland. Several telemedicine projects, which have been running since 1996, are described. The projects include teleradiology, teleobstetrics, telepsychiatry, maritime telemedicine, telemedicine in surgery, telepathology and a project for the use of telemedicine in various consultations. The role of the Icelandic Health-net for telemedicine, including projects for teleobstetrics and telemedicine for emergency medicine, is described with the projects included:. A few other eHealth activities, including electronic patient record and information systems, are also described.

Health Status↗
PubMed1993

Health care security and privacy, quality and safety.

Working group 6 of CEN/TC251 is concerned with the broad field of Security and Privacy, Quality and Safety in Health Care. In line with the priorities given by SOGITS, the first areas to be looked into, are those concerned with Data Protection in Health Care Information Systems. In order to successfully work on standardisation in this field, one has to take into account the generally low awareness for these problems, and the necessity to avoid increasing the gap between theory and practice. Work of WG6 will build to a large extent on the results of a related AIM-project (SEISMED). A sketch is given of ongoing work on this subject. Briefly, also other work items for WG6 are reviewed.

Computer Security↗
PubMed1993

Recommendations for an object oriented healthcare information model.

The need for a healthcare information model as a component in a framework of standards for healthcare data interchange is identified. Key requirements for a method to support development of a healthcare information model are defined and recommendations for development of an Object Oriented Healthcare Information Model are presented.

Computer Communication Networks↗
PubMed2001

Ngi and Internet2: accelerating the creation of tomorrow's internet.

Internet2 is a consortium of leading U.S. universities working in partnership with industry and the U.S. government's Next Generation Internet (NGI) initiative to develop a faster, more reliable Internet for research and education including enhanced, high-performance networking services and the advanced applications that are enabled by those services [1]. By facilitating and coordinating the development, deployment, operation, and technology transfer of advanced, network-based applications and network services, Internet2 and NGI are working together to fundamentally change the way scientists, engineers, clinicians, and others work together. [http://www.internet2.edu] The NGI Program has three tracks: research, network testbeds, and applications. The aim of the research track is to promote experimentation with the next generation of network technologies. The network testbed track aims to develop next generation network testbeds to connect universities and federal research institutions at speeds that are sufficient to demonstrate new technologies and support future research. The aim of the applications track is to demonstrate new applications, enabled by the NGI networks, to meet important national goals and missions [2]. [http://www.ngi.gov/] The Internet2/NGI backbone networks, Abilene and vBNS (very high performance Backbone Network Service), provide the basis of collaboration and development for a new breed of advanced medical applications. Academic medical centers leverage the resources available throughout the Internet2 high-performance networking community for high-capacity broadband and selectable quality of service to make effective use of national repositories. The Internet2 Health Sciences Initiative enables a new generation of emerging medical applications whose architecture and development have been restricted by or are beyond the constraints of traditional Internet environments. These initiatives facilitate a variety of activities to foster the development and deployment of emerging applications that meet the requirements of clinical practice, medical and related biological research, education, and medical awareness throughout the public sector. Medical applications that work with high performance networks and supercomputing capabilities offer exciting new solutions for the medical industry. Internet2 and NGI,strive to combine the expertise of their constituents to establish a distributed knowledge system for achieving innovation in research, teaching, learning, and clinical care.

Internet↗