The Journal of eHealth Nursing

 This Month's Featured Online Article 

eHealth International: A Cutting Edge Company For A New Age In Health Care

Note: Interviews presented in this section are intended for informational purposes only.  The views expressed in this interview are not necessarily those of Carol M. Stock & Associates nor does Carol M. Stock & Associates purport to support or endorse any particular product or company. 

This month features an interview with Robert Pretlow, MD, President of eHealth International, an e-health monitoring and interactive healthcare website company.  For more information about eHealth International you can visit their website at www.ehealthintl.com.   You can also visit several of their interactive disease management websites at www.patientecare.comwww.wetbuster.com, and  www.blubberbuster.com.

Dr. Pretlow, What is eHealth International?

eHealth International is a global health care company that develops interactive web applications for health care, interactive disease specific websites for consumers and health care providers, and provides health  e-monitoring services.  Our mission is to improve health care delivery to consumers and to help render their health care easier and more convenient.

How do you define e-health?

E-health is the process of providing health care via electronic means, in particular over the Internet.  It can include teaching, monitoring ( e.g. physiologic data), and interaction with health care providers, as well as interaction with other patients afflicted with the same conditions.   About a year ago IBM coined the term "e-care" to describe electronic interaction between patients and their health care providers, and recently a new term, "e-monitoring", has originated to describe electronic monitoring of patient physiologic data at home.

E-health provides an opportunity for some patients to maintain independence longer and an opportunity for providers to monitor some conditions more closely. 

Why is e-health coming into vogue?

E-health is coming into vogue because consumers/patients are demanding it.  Look what has happened in the investment and retail areas.   Ten times more securities are now bought online than are purchased via a stock broker, and Amazon.com is now a major retailer.   The same thing is happening in health care.  Already patients bring in to their health care provider information they have collected over the Internet.  Patients are not afraid of the Internet and are embracing this new technology.  It is the health care community that is lagging behind.  Offices that don't "get wired" will lose patients in my view.

I also think that patients want and expect more from their health care providers especially when the technology is available to do so.  Some of us remember the days when doctors made house calls.  They brought health care to the patient's home.   Patients loved house calls.  Technology can now bring back a similar "house call" experience to the patient.   I also think that technology will be utilized to provide monitoring of chronic conditions, thus keeping people independent longer.  

How did you get into e-health Dr. Pretlow?

Well, as a pediatrician I experienced situations in practice that were less than satisfactory.  For example, caring for children with certain chronic problems such as bedwetting and obesity necessitated their coming to my office repetitively and consumed a lot of their time as well as my time.  In addition, I perceived that these children were socially isolated due to their condition(s).  I felt that there must be a better way to provide care to them.  More frequent contact with the child and the parent would have facilitated their treatment, but this was not practical.

As an electrical engineer, with the advent of the Internet,  I became aware that this new medium could provide solutions to the above type of chronic health care problems.   For example, interaction via the Internet could allow closer monitoring of patient conditions, reduce office visits, and could also provide support groups for my patients.

Two years ago my mother had significantly high blood pressure.  Her doctor had her purchase a home blood pressure monitor to better manage her problem.  My mother would take her pressure each day, write the values in a notebook, and every two weeks take the notebook to her doctor.  He would then adjust her medications.  But one day her pressure started rising. Over the next couple of days the systolic pressure exceeded 250, but she did not contact her doctor, because she "did not want to bother him."  So she had a stroke.  I feel that e-health could prevent situations like my mother's.  E-health and e-care can allow health care to finally become proactive rather than reactive.

What is e-monitoring?

E-monitoring utilizes  home monitoring devices, such as a typical home blood pressure monitor,  that are connected to the Internet and allow management of patients remotely.   For example, a patient takes their blood pressure at home in the conventional manner, but with e-monitoring, the data is also automatically transmitted via the Internet to either their provider or to a monitoring center.  We will soon also be able to utilize audio and even video in our communications with patients via the Internet, and this will greatly enhance monitoring/management capabilities.

What conditions do you feel can be monitored in this way?  

Current conditions where e-monitoring might be provided include: hypertension, diabetes (monitoring glucose), obesity (monitoring weight), CHF ( monitoring weight), asthma and COPD (monitoring spirometry/peak flow), and, in the near future, conditions utilizing oximetry monitoring.

Other e-monitoring conditions might include pre-eclampsia, anorexia, low birth-weight  infants, growth abnormalities, and arrhythmias.  I think that most chronic health conditions in children and adults could be managed and/or enhanced by e-monitoring.  

E-care and e-monitoring sound interesting, but what are the advantages?

Currently, the consumer or patient has many barriers to receiving timely care.  Patients must often travel long distances or in poor traffic conditions such as bad weather or traffic congestion and endure expensive parking in order to see their provider.

Making appointments by phone is frustrating and going to the doctor's office is time consuming and is not economically productive in regards to loss of work time.  Once in the office, the patient often waits long periods of time before actually being seen, patients may contract infectious diseases in the waiting rooms, and the general hassles are just plain irritating for the patient.  By utilizing e-health, patients can save time and get immediate information and answers to their health condition.  Patients also benefit by the possible improvement in their condition due to closer monitoring by their health care provider.

The health care provider can benefit from e-care and e-monitoring in the following ways: by managed care cost savings due to fewer office visits and less exacerbations of patient conditions as a result of closer monitoring and finer control.  Closer monitoring and more timely communication benefit both the patient and the provider.   

What are the disadvantages to e-health care as you see it?

The first comment of health care providers is that e-care and e-monitoring will consume more of their time.  They feel that they will have to learn a new technology and that caring for patients this way means that they will have to continuously look at patient data.  They also feel that they will loose the patient/ health care provider personal relationship if they utilize e-care and e-monitoring and that there will be a lack of certain physical assessment parameters.

Actually, since unneeded office visits are avoided, providers will have more time to review web data with the patient's chart available and potentially can communicate more efficiently by posting secure messages to the patient's individual secure "virtual care room" along with links to information sources.  This is more time efficient than a 5-10 minute office visit where the provider often feels rushed, is interrupted by other calls or staff, and where the provider might forget to tell the patient important information.  The patient might also either forget what the doctor told them or is afraid to ask their provider during a rushed office visit.  With e-health care both patient and provider communication can potentially improve.  E-health care has the potential to actually improve the quality of health care delivery.

The problem of inadequate physical assessment will be obviated or greatly reduced  when audio and video are more readily available, which will be shortly. 

How does e-monitoring work?

Typical home monitoring devices like a blood pressure monitor are connected to a personal computer (PC) in the consumer/patient's home which is in turn connected to the Internet.  The consumer/patient takes their blood pressure in the conventional way and the data is automatically transmitted to the Internet.  Once the data is transmitted, the user immediately sees their online personal web page where they can confirm that the readings have actually been received.  The data is presented and plotted with user friendly graphics so that the patient can compare their present and past trends.

The PC sends the readings to an Internet secure server where the data is stored in a database as well as posted on the patients personal data web page which their health care provider can access and view with a standard browser anywhere in the world where there is Internet access.  Moreover, the web page software will alert the provider by flashing and beeping if there is an abnormal value and will automatically send a high priority email to the provider. 

Once the health care provider views the data the health care provider can take immediate steps to intervene by contacting the patient either by telephone or by website real time messaging.   Or, the monitoring of data could be provided by a central agency such as a call center that could monitor the data 24 hours a day, seven days a week.

As I see it, e-monitoring can potentially increase the quality of health care delivery by providing timely monitoring of conditions where intervention can occur immediately and patients don't wait until the next office visit for advice.  I think that this can decrease health care costs for many chronic conditions and can improve patient compliance as well as improve patient satisfaction.  The patient really feels like part of the health care team when utilizing an e-monitoring system. 

What do you see as the barriers to providing e-monitoring?

Currently, I see four important barriers.  First, most provider's offices don't have personal computers, or if they do, they aren't hooked up to the Internet;  second, the staff does not have a basic knowledge of computer or Internet use and operation; and third, the staff does not know how to interact with patients using Internet communication.

Actually, most patients are more adapt at using computers and the Internet than their health care providers.  A recent study by Intel revealed that the medical industry is behind even the trucking industry in adoption of information  technology.  The technology is here, but the health care industry is not utilizing it.

The fourth problem is that consumers don't want to or can't afford to pay for e-monitoring, and 3rd party insurance reimbursement will take time to implement and adapt to this new way of health care delivery.  I think that once the insurance industry sees the potential cost savings in this area, they will embrace it.

How do offices and health care providers get into e-monitoring?  What will be required in equipment and software as well as staff training?

The office or health care organization  would contract with an e-monitoring company such as eHealth International to provide their patients with the devices and services.  It is no different than contracting for home health services or any other patient service. The office would need to be connected to the Internet as would the patient that is to be monitored.

eHealth International produces software that allows home monitoring devices to connect to  the Internet and additional software that provides the patient's data and information to the health care provider by means of database and real time patient data web pages. eHealth International is currently involved in pilot studies exploring the logistics of e-monitoring.   More information is on our Patient eCare website.

Well, now the big question. How can e-monitoring save money? And, what would it cost?

I think e-monitoring could potentially greatly reduce health care costs for chronic conditions by decreasing the number of expensive and time consuming office visits and by decreasing hospital admissions due to poor disease management.  E-monitoring could improve the control and management of disease conditions by providing more timely information to the health care provider.

The costs of e-monitoring would include the cost of a personal computer, which most consumers already have.  In addition, because the e-monitor instrument is identical to home monitors already in use, the instrument cost is the same.  For example, a home glucose monitor costs approximately $60 and an automatic home blood pressure monitor costs about $250.  Monitoring service costs would consist of the cost of the database management (about $10 a month per patient) and the fees of a monitoring center, like a call center for example,  if the provider does not want to do the monitoring. 

E-health Interactive Web Applications 

Well, lets talk about another health care area that eHealth International has developed, that of interactive e-health web applications.  What are interactive e-health web applications?

Interactive e-health web applications are websites that provide information and allow the consumer/patient to interact by clicking on buttons, entering data, writing on bulletin boards and so forth.

One example might be a picture of the human body that is posted on a website where the consumer could click on an area of the human body drawing and it would immediately show the user what a healthy organ looks like or what a damaged organ would look like after many years of a high fat diet intake or smoking.  A second example might be where a user would select a food item from a picture menu posted on the website and a calculator would show them how much exercise would be required of them to burn off the calories from that particular food portion.  A third example is an interactive x-ray anatomy lesson.

Interactive applications also include disease monitoring and management, or, to use IBM's term, "e-care."  For example, a diabetic patient  could enter their glucose values on a web page form and send it to their provider.  After viewing the data, the provider could then post an assessment, complete with the provider's picture, on the web page with recommendations to the patient to modify or continue the patient's treatment regime.  

Another example is where children with bed wetting are able to post their wetness results each morning using a website click-button form.  The website software can keep track of their results and actually give them positive reinforcement when they achieve a certain period of dryness (e.g. 2 nights  or 7 nights in a row) by automatically printing a positive message on the screen ("Way to go, Johnny!") and posting an "award" with their first name on it in the site "clubhouse".   Their provider can also review the child's results in real time, or at the convenience of the provider, and thereby manage the child's treatment.  (To see an assessment example, click here.  To see the awards example click here.)

What effect does this internet interactive e-health application have on the consumer?

Well, in the bedwetting example, internet interaction offers the child and parent contact and supervision without having to physically go to the providers office.  In addition the child receives positive reinforcement for good performance at the actual time of the accomplishment.  Children's response to real time re-enforcement is much better than at a later office visit.  The Internet can provide the needed real time re-enforcement in a cost effective and confidential manner.  

Bulletin boards and chat rooms can also be wonderful sources of information and support for patients, in an anonymous forum.  For example, children with bedwetting or obesity, often feel isolated because of the associated social stigmas.  The anonymity of chat rooms and bulletin boards removes the stigmas and social barriers, allowing the child to communicate with others with like problems and share openly.  These are two examples of how valuable this medium can be in promoting health care.  Bulletin boards do, however, require monitoring by the health care professional in order to prevent inappropriate use.  (To view these example sites go to www.wetbuster.com or www.blubberbuster.com.)

What other areas can interactive web site interaction be used in health care? 

Well, interactive web sites could be used for a whole host of other areas in health care.  Interactive web sites can and will revolutionize patient teaching and reinforcement of learning.    I see interactive web sites being used in most chronic incurable health conditions such as asthma and COPD, and in chronic curable conditions, such as in the bedwetting example above, where charting treatment progress is an important part of the curative process. 

I also see interactive web site interaction being used in electronic charting where the patient could add information on their progress in their patient record on an on going basis.  Patients are now also demanding that they be able to access their electronic medical records online.   Again, I would visualize that abnormal or contraindicated information would cause an alarm or signal to be sent to the provider who then could intervene as needed.  Interactive patient monitoring and management data will also feed directly into patient electronic medical records.

Where do you see the future of e-health, e-care, and e-monitoring going?

I see lots more of it!  Most patients want information that is up-to-date and relevant to their particular problem or complaint.  When a provider can refer them to on-line information, other resources, even bulletin boards or support groups on-line, patients respond, they feel "taken care of" and feel better about the best being done for them.  When we include patients as active participants in their own health care I think we will begin to see patient/provider partnerships like we never have before.

E-care and e-monitoring may be just what health prevention has been looking for, participatory tools that can provide teaching, accurate and timely information, and objective and necessary data in lively and interesting ways.  Real interaction for real people.  That's what it's all about.

Thank you Dr. Pretlow for your time and information on such a fascinating area of health care.  

Return to Journal of eHealth Nursing area

For more information on eHealth International you can link to their website at  www.ehealthintl.com

(c) Copyright 2000, Carol M. Stock & Associates.  All rights reserved.