Risks related to the use of eHealth technologies : An exploratory study

More awareness is needed about the risks of e-Health technology. While information regarding its potential is abundant, the risks associated with the use of information (including mobile) and communication technology in health care have scarcely been addressed. In order to implement e-Health technology successfully and safely, the evaluation of their benefits should be integrated into and complemented with systematic risk assessment. This is the main recommendation resulting from an exploratory literature study that was performed at the request of the Dutch Health Care Inspectorate. A review of scientific literature identified no systematic studies (randomized controlled trials) that directly investigated the risks of e-Health technology. However, many unintended, ‘secondary’, outcomes have been reported that indicate risks for patient safety or quality of care at the level of the technology, the end-user (patient, professional) or the organization. They vary from high time consumption, adverse effects, usability problems, limited server access and malfunctioning devices due to improper use or financial issues. Similar outcomes were found through searching ‘grey’ sources accessed through the internet. From the combined scientific and grey sources, we found anecdotal evidence for a wide variety of risks in e-Health, of which the magnitude is largely unknown. Confirmation of these findings was obtained from several other recent, authoritative reports. E-Health interventions are being increasingly used in Dutch health care. It is, therefore, important that tools currently used for risk management are applied to e-Health as well. A reliable system to report, identify, document and monitor risks would help to increase transparency in this field.

[1]  B. Wakefield,et al.  Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. , 2008, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[2]  Nicol Nijland,et al.  A Holistic Framework to Improve the Uptake and Impact of eHealth Technologies , 2011, Journal of medical Internet research.

[3]  Melinda Beeuwkes Buntin,et al.  The Benefits of Health Information Technology , 2011 .

[4]  Seth Wolpin,et al.  Randomized Controlled Trial of an Internet-Based Versus Face-to-Face Dyspnea Self-Management Program for Patients With Chronic Obstructive Pulmonary Disease: Pilot Study , 2008, Journal of medical Internet research.

[5]  Altamiro Costa-Pereira,et al.  Web-based or paper-based self-management tools for asthma--patients' opinions and quality of data in a randomized crossover study. , 2007, Studies in health technology and informatics.

[6]  J Wierdsma,et al.  Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial , 2012, BMJ : British Medical Journal.

[7]  Seewon Ryu Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2) , 2012, Healthcare Informatics Research.

[8]  G. Guyatt,et al.  Telecare for patients with type 1 diabetes and inadequate glycemic control: a randomized controlled trial and meta-analysis. , 2004, Diabetes care.

[9]  Christopher B Frueh,et al.  Telemedicine for anger management therapy in a rural population of combat veterans with posttraumatic stress disorder: a randomized noninferiority trial. , 2010, The Journal of clinical psychiatry.

[10]  S. Ziebland,et al.  Health and Illness in a Connected World: How Might Sharing Experiences on the Internet Affect People's Health? , 2012, The Milbank quarterly.

[11]  G. Eysenbach,et al.  Asynchronous and Synchronous Teleconsultation for Diabetes Care: A Systematic Literature Review , 2010, Journal of diabetes science and technology.

[12]  C. Anandan,et al.  The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview , 2011, PLoS medicine.

[13]  H. Ossebaard iHealth: supporting health by technology , 2012 .

[14]  S. Silow-Carroll,et al.  Using electronic health records to improve quality and efficiency: the experiences of leading hospitals. , 2012, Issue brief.

[15]  David B Abrams,et al.  Critical issues in eHealth research. , 2007, American journal of preventive medicine.

[16]  Manuela A Joore,et al.  Process evaluation of a nurse-led telemonitoring programme for patients with asthma , 2007, Journal of telemedicine and telecare.

[17]  R. Bauer,et al.  An intervention for VA patients with congestive heart failure. , 2010, The American journal of managed care.

[18]  Anastasia Papazafeiropoulou,et al.  An evaluation framework for Health Information Systems: human, organization and technology-fit factors (HOT-fit) , 2008, Int. J. Medical Informatics.

[19]  R. Farré,et al.  Validity of spirometry performed online , 2010, European Respiratory Journal.

[20]  Marloes G. Postel,et al.  Effectiveness of a Web-based Intervention for Problem Drinkers and Reasons for Dropout: Randomized Controlled Trial , 2010, Journal of medical Internet research.

[21]  Nicol Nijland,et al.  Factors Influencing the Use of a Web-Based Application for Supporting the Self-Care of Patients with Type 2 Diabetes: A Longitudinal Study , 2011, Journal of medical Internet research.

[22]  Reinier Akkermans,et al.  Web-Based Targeted Nutrition Counselling and Social Support for Patients at Increased Cardiovascular Risk in General Practice: Randomized Controlled Trial , 2004, Journal of medical Internet research.

[23]  Mack T Ruffin,et al.  Effect of Preventive Messages Tailored to Family History on Health Behaviors: The Family Healthware Impact Trial , 2011, The Annals of Family Medicine.

[24]  N F de Keizer,et al.  Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost , 2011, The British journal of dermatology.

[25]  R. Gomis,et al.  Telecare in a structured therapeutic education programme addressed to patients with type 1 diabetes and poor metabolic control. , 2006, Diabetes research and clinical practice.

[26]  M. Bujnowska-Fedak,et al.  The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland. , 2011, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[27]  D. Chou Health IT and Patient Safety: Building Safer Systems for Better Care , 2012 .