UK doctors must prepare for the rise of the ‘ePatient’

Doctors and other healthcare professionals must prepare for the rise of 'ePatients' in the coming years and keep apace with the evolving digital landscape.

This is according to the 2012 version of 'Learning to manage Health Information', a clinical education guide that has been running since 1999.

Its aim is to understand the digital world and healthcare professionals' working requirements within it.

This year's focus is on the rise of the ePatients, who come to surgeries armed with information found on the internet about their condition - and are often more digitally aware than their doctor.

The guide says that in the near future, clinicians will be dealing more and more with the ePatient, adding that: "today, such patients need not be mere recipients of care and can become key decision-makers in their treatment process."

It adds: "Self-management programmes can be designed specifically to reduce the severity of symptoms [...], whilst online communities of patients, sharing knowledge and information about specific conditions or providing mutual support are increasingly common."

This will also see patients work in partnership with their health and social care providers, meaning they can be given greater control over their health and lives - messages pharma is also keen to deliver.

The guide says that a good example of this is Renal PatientView, which provides online information about renal patients' diagnosis, treatment, and their latest test results.

There is a potential opportunity here for pharma, as the ePatient can be informed by the industry and may be looking on pharma websites - or industry-sponsored disease awareness campaigns - for information.

Things like the Renal PatientView are already being done by firms in the guise of smartphone/tablet apps, and will be familiar to pharma.

So there could room for the industry and the more digitally savvy healthcare professionals to work on digital campaigns together, as a way of delivering more information to the patient, and for both to learn from each other on what works, and what doesn't.

This could create a new relationship between pharma, patient and doctor - all within the regulations of European law and the ABPI Code, of course.

This is also a good indicator of how patients are using digital, with the guide seeing this as changing the relationship between doctor and patient, where "the power of knowledge is held as much by patients as by their clinicians", such is the strength of digital.

Pharma could learn much by how patients are using this sort of information, and arm patients with more information, whilst also increasing marketing opportunities.

Digitally savvy?

But pharma shouldn't get too giddy about these opportunities, as the guide does not paint the picture of an aspiring digital culture coming from today's healthcare professionals.

Its rather glum conclusion states: "Many healthcare professionals continue to have limited or no education in informatics and yet the expectations of them to manage information effectively is a current and increasing requirement".

Furthermore, one of the educational courses for healthcare professionals set out in this year's guide will raise some eyebrows.

Headed under 'NHS Elite', those who have completed this course must be able to "restore and empty files from the Recycle Bin" and be able to 'access help' - perhaps the most important one to learn if you're struggling to delete a file successfully.

And this is the 'elite' level of training - one wonders what the basic level might entail.

Writing for the Guardian's Healthcare Network, Dick Vinegar (a pseudonym, of course), a specialist in health and IT, says: "I get the impression that although [the team who write the guide] was set up in 1999 and has been bashing away relentlessly, it has not made much progress in educating the lumpen mass of clinicians to make them ready for the digital age."

He said that many of them still have not got their heads around simple systems like 'Choose and Book', e-prescribing and Summary Care records.

"Assuming that most clinicians have achieved some keyboard skills over the years and can write emails and manipulate spreadsheets, doesn't mean they have a real understanding of what they ought to know about IT or how it can improve the care they provide to patients and make their own lives easier.

"What is scary is how much there is for them [clinicians] to learn," he concludes.

Younger doctors and other healthcare workers coming through the ranks will be more digitally aware than those educated in the 1960s and 1970s, the guide adds, but it seems that both patients and pharma may have to wait a little bit longer for the 'eDoctor'. (

GlobalData Report: Telehealth will Change Healthcare World Forever

Over the years, there have been many instances when healthcare changed forever. The polio vaccine, which eradicated this dreaded disease and the use of chemotherapy, beginning in the early 20th century, are just two examples.

But nothing may change it – and the way it's practiced – more than telehealth, which holds the promise of medical care dispensed remotely to allow patients more freedom and convenience, and to lower healthcare costs, according to a new report by healthcare sector experts, GlobalData.

The way it works is that doctors fit patients with monitors which transmit data remotely to healthcare providers, giving a picture of patients' vital signs, glucose levels and other important readings, thereby keeping them out of the hospital but still under physician care, for intervention at any point. It also brings specialists to rural areas through the use of video conferencing.

It's catching on so much that late last year, the U.S. Department of Agriculture (USDA) recently announced that it will provide 34 states and one territory with funds from its Distance Learning and Telemedicine (DLT) program to improve access to healthcare and education, USDA Secretary Tom Vilsack announced in December.

The GlobalData study revealed that the telehealth market was valued at $13.2 billion in 2011, but will almost triple, soaring to $32.5 billion, by 2018, a compound annual growth rate (CAGR) of 14 percent.

And it's not just here in the U.S. In Asia it's a rapidly growing market, as well. "Growth in the Asia-Pacific region is expected to be driven by improved awareness of the model's potential for expanding the penetration of affordable medical care to the wider population, with the governments of India and China rapidly adopting and pushing telehealth to cater to the needs of the huge rural patient population," the report asserted.

According to GlobalData, the need to increase the reach of quality medical care to remote locations, reduce healthcare costs and enable the optimal usage of limited provider resources are all driving the growth of this marketplace.

And the accelerated growth of telecommunication technologies, increased adoption of related healthcare IT solutions and the readiness of companies and governments to invest are also reasons for its skyrocketing growth, the study noted. (

Security concerns of WHO staffers propel government into action

Prime Minister Raja Pervaiz Ashraf has instructed the Ministry of Interior to provide protection to all vaccinators working for the polio eradication initiative in Pakistan in a bid to restore their confidence.

The instruction was given in response to concerns expressed by the regional director of the World Health Organization (WHO) Dr. Ala Alwan, who was on a brief trip to Islamabad to attend a meeting of the National Task Force on Polio Eradication here Tuesday.

Dr. Alwan is reported to have expressed utter dissatisfaction over the pace of investigations into the Karachi shooting incident targeting polio staff of WHO. He urged the PM and the President to personally look into the matter and requested that security be provided to WHO staffers in the country. The fact that a joint investigation team was not constituted even after 10 days of the incident also aroused concern.

Dr. Alwan underscored the need to vaccinate the over 160,000 children who are being missed in Bara since September 2009 and requested the government's support to reach them with polio drops. Several other participants also pointed out that the threat to vaccinators is maligning the government's efforts, and that special protective cover should be provided to women vaccinators in particular.

The meeting was chaired by the PM and attended by top officials including chief ministers, governor of Khyber-Pakhtunkhwa, Prime Minister of AJK, minister for Inter-Provincial Coordination, Special Assistant to the Prime Minister Shahnaz Wazir Ali, Dr. Azra Fazal Pechuho, Polio Ambassador Aseefa Bhutto Zardari and members of the parliament.

"We are not just saving a life but entire humanity by implementing the polio eradication initiative. Saving the vulnerable and healing the ailing is in line with the teachings of our great religion Islam," the PM is reported to have said during the meeting. He directed the polio programme to redoubled its efforts to achieve the desired results.

The National Task Force met to discuss key challenges that need to be addressed in eradicating polio. The meeting started with Shahnaz presenting an overview of the polio situation. Pakistan has reported 27 cases so far in 2012 as against 71 during the same period last year.

The PM expressed serious concern over ban on polio immunisation by certain. He asked all district 'khateebs' to become active part of the initiative. "The government is fully committed; no religion on earth opposes polio campaign," he said. He also directed the governor of KP to ensure that polio campaigns are held without hindrance in all parts of Fata.

Aseefa said, the challenge of inaccessibility needs to be overcome with appropriate strategies; this is the responsibility of not only the communities but the state as well. "The number of children being missed as a result of ban on polio campaigns in North and South Waziristan and other parts of Fata is indeed alarming," she added. We need to continue to garner the support of religious scholars and fire-walling of areas with transit teams so that all children entering or exiting the area and moving to areas not affected by polio are protected with polio vaccine," Aseefa added. (

UN backs Filipino leader in contraceptives battle

MANILA, Philippines—The United Nations on Sunday expressed its support for a proposed law that would provide Philippine government funding for contraceptives and has pitted the popular president against the influential Roman Catholic church.

The bill promotes contraceptive use in a poor country with one of Asia's fastest-growing populations. The House of Representatives plans to decide Tuesday whether to end debate on the bill and put it to a vote, reigniting acrimony over an issue that has divided Asia's largest Roman Catholic nation for years.

Catholic bishops led a rally on Saturday by thousands of followers urging the bill's rejection and attacking President Benigno Aquino III for supporting it. An archbishop, Socrates Villegas, urged Aquino to focus on his promise to eradicate corruption and poverty and not promote "a culture of contraception" that "looks at babies as reasons for poverty ... a mistake and not a blessing."

The bill's supporters plan to hold their own rally Monday outside Congress.

Aquino's camp said Sunday he would not back off from supporting the Reproductive Health bill, which he promoted in his state of the nation address in Congress last month.

The United Nations said in a statement issued in Manila on Sunday that the bill, which aims to promote responsible parenthood and teach reproductive health in schools, would help reduce an alarming number of pregnancy-related deaths, prevent life-threatening abortions and slow the spread of AIDS.

"As in many other countries where similar policies have been introduced, enacting a law that would address the reproductive health needs of the Filipino people would, over time, vastly improve health and quality of life and support development," the U.N. said.

Countering a church argument that contraceptives foster abortions, which are outlawed in the Philippines, the U.N. said that by preventing unintended pregnancies, "a reproductive health law would help prevent recourse to life-threatening abortions."

It said the country's rapid population expansion could prevent millions of Filipinos from being lifted out of poverty, adding that "hopes of future prosperity could turn to dust" if the Philippines is unable to deal with the issue.

The bill pending in Congress would require the government to provide information on family planning methods, make contraceptives like condoms available free of charge to poor couples and introduce reproductive health and sexuality classes in schools. It would encourage families to limit their children to two.

Filipino church officials have blocked the passage of birth control legislation in past years, arguing that contraceptives are as sinful as abortions. Proponents of the bill want more openness toward birth control to prevent disease and reduce population growth.

Aquino, still popular after his 2010 landslide election victory, has backed birth control even if it means going against the dominant Catholic church. He said last year he was ready to face the consequences and risk excommunication if necessary. (

SBY Tells Indonesians To Stop Seeking Medical Treatment Abroad

President Susilo Bambang Yudhoyono told wealthy Indonesians stop heading overseas for medical treatment in a criticism of medical tourism delivered at the Health Ministry on Wednesday.

"Honestly, I'm not happy if our people go abroad for medical treatment because it only benefits neighboring countries," Yudhoyono said.

Indonesia's ministers need to set an example for the rest of the nation and only seek treatment at domestic health facilities, he said. It is a policy Yudhoyono says he has followed for years.

But he may be in the minority among Indonesians with the means to seek treatment at hospitals and health centers overseas. According to the Health Ministry, some 600,000 Indonesians leave the country for medical treatment every year. They spend an estimated $1.2 billion on treatment in nations with modern, and often better-equipped, health facilities.

Among those who sought medical care overseas was Yudhoyono's own wife, Ani Yudhoyono. The first lady traveled to the United States in June to undergo treatment for a nerve problem in her neck at Allegheny General Hospital in Pittsburgh, Pennsylvania.

"He feels concerned by the many Indonesians who seek medical treatment overseas, but the First Lady herself sought medical attention abroad," said the Golkar Party's Poempida Hidayatullan, a member of the House Commission IX that deals with health affairs.

Indonesia needs to change the perception of the nation's doctors, who have the necessary skills and knowledge to treat citizens here, Poempida said.

"For me, the perception that domestic health care is not that good is clearly because of an inappropriate and unintegrated policies and strategies in the health sector," he said.

The lawmaker urged the president to push for health care reform and a larger budget in an effort to boost the system's efficiency.

"This should encourage the development of the national health sector and this should have the president's special attention," Poempida said.

Yudhoyono told a crowd of reporters and Health Ministry officials on Wednesday that he was committed to continuing the development of the nation's health system. He also asked those thinking of heading overseas to consider scheduling an appointment at a domestic hospital instead.

"Our quality [hospital] and doctors are something to be proud of," Yudhoyono said. "Many of our doctors are smart and recommended by other countries."

But for those who still plan to leave Indonesia for treatment, there is little the president can do to stop them, he said.

"I could not forbid them, as I could not issue presidential decree banning our people from seeking medical help abroad," Yudhoyono said. (

RI research needs private sector: Expert

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Universities need to work with the private sector in their biotechnology research, otherwise their work will not reach the market and bring advantages to the public, a health expert has said.

Amin Soebandrio, a health expert with the Research and Technology Ministry, said any biotechnology research conducted by universities would languish in the laboratory if they did not work with manufacturing companies.

Pharmaceutical companies believed biotech products would not bring them commercial benefits but research by universities would change such assumptions, he said.

"In conducting biotechnology research, universities should work closely not only with the government but also with the private sector as they are the only ones who know what consumers need most," said Amin, who is also a microbiology scientist.

Through such partnerships, he said, universities could obtain research funding from the private sector for developing applicative products while the industry could get quality research for creating products for commercial markets.

Amin made the remarks on the sidelines of a gathering discussing the 2012 Local Biotechnology Leadership Camp (Biocamp), a competition held to select young researchers particularly in biotechnology development and biomolecular medicine.

Two researchers Reswita Dery Gisriani of the Bandung Institute of Technology (ITB) and Dodi Hamdani Sukiman of the PPM School of Management were selected for the competition. Reswita and Dodi will participate in the 2012 International Biocamp to be held from Aug.26 to 29 in Basel, Switzerland.

Reswita emphasized that biotechnology research focused on drug discovery and development. The process of translating scientific research to the manufacturing of drugs, vaccines or diagnostic tools was quite complicated, she added.

"It is a fact that only a few pharmaceutical companies are interested in developing research and technology on biotech drugs. Thus, it affects our efforts in working on biotechnology research," she told The Jakarta Post.

With the growing number of diseases – particularly those with limited medication choices such as age-related macular degeneration (AMD), health workers will need support from biotechnology research in the challenges that can no longer be dealt with through conventional medication.

With biotechnology research, proper diagnostic methods can be developed, enabling them to detect illnesses more accurately.

"Proper diagnostic tools are very important in particular to avoid mistakes in treatment of patients with the new types of diseases," said Reswita, who proposed the idea to improve people's access to quality biotechnology medicine by increasing the involvement of the private sector in social protection schemes delivered by the government during the July 4 qualifying contest. (

Traditional cures provide economic benefits

Harvard researcher finds the use of traditional, natural medicines offer economic benefits

For millions of people around the world being sick doesn't mean making a trip to the local pharmacy for medicines like Advil and Nyquil. Instead it means turning to the forest to provide a pharmacopeia of medicines to treat everything from tooth aches to chest pains.

But while questions persist about whether such natural remedies are as effective as their pharmacological cousins, one Harvard researcher is examining the phenomenon from a unique perspective, and trying to understand the economic benefits people receive by relying on such traditional cures.

As reported in a paper published this week in PLoS ONE, Christopher Golden, '05, a Post-Doctoral Fellow at the Harvard University Center for the Environment has found that, in the area of northwest Madagascar he studies, people annually receive between $5 and $8 in benefits by using natural medicines.

Though seemingly slight, those benefits add up to between $30 and $45 per household, Golden said, or anywhere from 43 to 63 percent of the median annual income for families in the region.

"We documented people using more than 240 different plant species to treat as many as 82 different illnesses," Golden said. "This data suggests that it can have quite an impact, financially."

It's an impact that may not be limited to Madagascar, or other regions where access to pharmaceuticals is limited.

As part of his analysis, Golden also compared the use of natural remedies with the prices that American consumers might pay if they were purchasing the pharmaceutical equivalent online - where prices are typically lower than on pharmacy shelves. To his surprise, the results showed that the average American could save anywhere from 22 to 63 percent of their annual health care bill, simply by using natural medicines.

"If Americans were relying on traditional medicines as much as people in Madagascar, it could save them a major percentage of their health care expenditures," Golden said.

Golden, however, was quick to emphasize that his study only examined the economics of the natural remedies versus pharmaceuticals, not whether they were equally effective.

"What we're trying to do is account for the economic value the local floral bio-diversity provides to people in this area of Madagascar," Golden said. "We're not assuming there is a medical equivalency - this study is about the perceived efficacy. The people who live in this region often have taken both pharmaceuticals and traditional medicines many times, but there is a perceived efficacy for these traditional medicines."

Measuring that perceived efficacy involved surveying 1,200 households in and around Maroantsetra, a city in the northeast corner of the island nation, to determine which natural medicines they used.

To establish the economic benefit of each natural remedy, Golden asked whether people would prefer to use the natural or pharmaceutical remedy for a given illness. If, for example, 60 percent of those asked said they preferred the traditional medicine, Golden established its value as being 60 percent of the price of its pharmaceutical cousin. (

World Hepatitis Day

The silent nature of viral hepatitis infection has an enormous impact on the capacity and willingness of governments across the world to develop and implement effective policy and health responses to these diseases.

The burden of viral hepatitis is stark, particularly in Asia Pacific where the prevalence is greatest, with approximately 340 million people living with chronic hepatitis B and hepatitis C. This is almost eight times the number of people in the region infected with HIV, tuberculosis (TB) or malaria (42 million). In 2011, the World Health Organisation's (WHO) south-east Asia office reported there are 120,000 deaths annually related to hepatitis C and 300,000 related to hepatitis B.

Viral hepatitis is a significant health problem, but its silent nature – there are no symptoms in the early phases, so people are often unaware that they are infected with hepatitis B and C until it is too late – has meant that the diseases have not had the same global and regional response as HIV, TB and malaria, and this lack of co-ordination continues to undermine global health efforts.

In 2010, there were signs that things were changing, with the agreement of a resolution on viral hepatitis by the World Health Assembly, but its implementation to date has been slow and unco-ordinated. Ahead of World Hepatitis Day on Saturday, this week's publication of a global framework by WHO is another important milestone, but it runs the risk of failing to deliver if the denial that exists around chronic hepatitis, among individuals and in health systems, is not addressed.

Hepatitis B, which is transmitted from mother to child or through bodily fluids, is prevented with a safe and effective vaccine. There has been some recent good news from China, which successfully reduced the number of children under five with hepatitis B from 5.5% in 1992 to less than 1% in 2005, according to WHO.

But there remain huge barriers for implementing vaccination programmes among babies and young people in the region. Although there is access to vaccines, the implementation can be problematic where there are fundamental weaknesses in health systems. In countries such as Papua New Guinea or Laos there are simply not the health services nor workers available to carry out vaccinations.

For most people with viral hepatitis, the infection has no obvious symptoms, meaning that their disease is likely to progress to a point where treatment has limited impact. Most people with viral hepatitis do not know they are infected. Even in countries such as Taiwan and Australia where hepatitis is recognised as a priority health issue, a sizeable proportion of people are yet to be diagnosed.

There are systemic barriers to testing in many countries in the region such as Vietnam, Singapore, Philippines, or Thailand where people are required to pay for testing. This essentially limits the number of people who know they are infected and the ability to reduce the impact of infection.

Hepatitis B infection is complex, and liver damage as a result of the infection occurs over many years. Most people with chronic hepatitis B will not require treatment, but will need to be monitored to identify when liver damage is taking place. Only about 15-25% of people need to receive treatment for the infection.

However, for people who do know that they have the infection, access to health services can be an issue. Of the 300,000 to 400,000 people living with chronic hepatitis B in Hong Kong, 80,000-90,000 people (25%) need treatment, and only half are being treated

Like many 21st-century health issues, viral hepatitis knows no borders. Migration and other movements of people mean that comprehensive and co-ordinated responses to the infection within and across countries are imperative if the burden of infection is to be reduced or eliminated.

In collaboration with the Australian Research Centre in Sex, Health and Society at La Trobe University, the Coalition for the Eradication of Viral Hepatitis in Asia Pacific (Cevhap) has developed a research plan to assist countries and the World Health Assembly to identify the essential elements of a strategic response to chronic viral hepatitis. This work is under way, with assessment of the policy in Taiwan, a needs assessment of people with chronic viral hepatitis across five locations in China, and support for the facilitation of partnership development initiatives in Malaysia and India.

Lessons from other international health issues such as HIV can support the development of effective policy and health responses to viral hepatitis. One lesson is the importance of broad-based partnerships in policymaking, something that has been woefully lacking in Asia. More important, however, is the need for WHO to establish a sustainable mechanism for international funding and implementation of the new global framework and the newly formed Global Hepatitis Programme, similar to those that exist for HIV, TB and malaria.

An effective policy framework can prevent new infections, ensure people can access clinical care, and reduce the burden of infection at an individual, country and regional level. That will only be possible if funding is increased considerably. The global response provided by UNAids, the Stop TB Partnership and the Rollback Malaria Partnership show what can be achieved if governments, the medical community, donor organisations and civil society work together.

Viral hepatitis can be eliminated with resources, co-ordination and willingness, but, as the world recognises the second WHO-endorsed World Hepatitis Day, a lack of funding remains the single greatest barrier to tackling these diseases. (