ࡱ> '`{bjbjLULU .~.?.?G+ttttttt8(\,H>TT[[[HHHHHHH$Kh{M4Ht[[4HttTH"""tTtH"H""6R?ttAT, 4$2@GH0HN@`]N!B]N8AA|]Nt*F[" [[[4H4HQ"X[[[H$ Dtttttt NEW TECHNOLOGIES USED IN PERSON ORIENTED MEDICINE Ranko Stevanovi, Ivan Pristaa, Vanesa Benkovi, Lovorka Bilajac Introduction  In the beginning was the Word  in the past the communication in all parts of human society was based on the words - it implied communication "face to face" or by messenger, the people who convey information. Direct communication is surely the best way to communicate because of high level of emotional contact, developing empathy and psychological support to patients. However it is also very inefficient and impractical on a population level because it assumes that one should have as many doctors as there are patients, spending significant amount of day together. Later in the health system come writings, written data that no longer depend only on doctor/patient capabilities to memorize all of the relevant information. as doctors are unable to spend time with all patients, patients carried information together with medicine or even sew it into their sleeping pillow. Written information culminated at the beginning of seventies when data was stored in fast browsing storage facilities. However, patient without his/hers paper would be lost in communication system, until enough paper was collected. This led to a paradox known to us in everyday life: health workers were spending up to two thirds of their resources; time, strength and energy to make, store or find papers. Patients too were started to worry more on some significant paper then their own health. In communication, paper became more important than emotion, empathy and psychosocial support. In the meantime, the telephone (with not always most bright sound) and fax (also with no clearest image) communication came to stage. Luckily, these communication channels took over only smaller space, leaving the paper as most important communication media. Human word, warmness of the approach, empathy and emotion become unnecessary somewhat standing on the way of good data flow. From the beginning of eighties this problem is to be solved using newest communication and information technologies. Nowadays there is hardly any way to speak of communication in any sector without the usage of information and communication technologies. Little by little, they became unavoidable, so that even these who gave highest amounts of resistance towards introducing modern technologies cannot raise their cash, city transport ticket, stay in hotel or at least hear their closest family without it. This article provides a short review on specificity of types of information and communication technology in health system, relating to communication among medical professionals and patients and medical professionals among themselves. 1. An integral health information system Since, de facto, health or public health facility is a technological system itself, thus good process management enables optimal resources use. This leads to exact definition of business, processes and management decision making and to total quality management of business resources. In this case the information (analyzed data) becomes a business resource. an informational communication system guarantees at the same time higher patient data safety and standardization of good practice for most common acute and chronic diseases. This should enable basic content for deployment of efficient management or: BI (Business Intelligence), PHI (Public Health Intelligence), HCI (Health Care Intelligence, MI (Management Intelligence), KI (Knowledge Intelligence) etc. The primary goal of informatization is not savings, but rationing health spending. It is estimated that yearly at least 20-30% of resources spent in health may be used more rationally. In Croatian context it comes to the amount of more than 5 billion annually. Informatization should also enable necessary data and indications needed for the rationalization of resources. Based only on irrational drug prescription and irrational referrals to diagnostic and specialist consiliar examinations, one may pay out whole investment in informational system in primary care in less than two years. It is very important in deployment and development of such systems that they are oriented to person, a human being, not only as technological system working without human impact, annihilating direct communication of health workers and patients. 2. Telemedicine The word telemedicine is a two words compound: tele in Greek means distance, remote; thus telemedicine is a remote medicine or medicine on distance. The telemedicine is not a medical specialty, but more a way to perform and operate medical professions. Thus one may speak tele-cardiology or tele-pathology. A standard definition of telemedicine is easily taken form Bennet: Telemedicine is a system that supports the process of health care, enabling resources and means for more efficient data exchange. This enables many activities related to health care, involves users of health care as well as health care personnel, education, administration and treatments. (A. M. Bennet). Tele-medical delivery enables direct patient and doctor (or other medical staff) communication, regardless of their location, with hospital, specialists, home care, field nursing, diagnostics and all further connection protocols in treatment process. The system gives the opportunity of using diagnostic and therapy guidelines, guarantees equity in patient approach and makes necessary skills available on-screen. Such system connects groups of interest involved in special research, business or problem linking and networking (network ambulatory with opened access). In this way, the tele-medical system should provide collaboration of public health institutions, expert groups and individuals, linking and delegating work. This process prospers from multiplying results (synergy) of its stakeholders which should be most important part of digitalizing a complete health system. Such approach may open dimension such as connecting the data chain, quality of data (standardization), data based decision making and give space to new ideas and innovative solutions. New investments in business infrastructure are inevitable, but they will provide elements for new organization (new business rules), manage more transparency (transparent business culture) and be platform for redesign oriented to modern concepts. A division of medical applications of telemedicine is usually branched like this. same time same location (classic approach), same time different locations (video conference) and different time different location (diagnostic radiology). When observing new technologies, one may conclude that telemedicine has a most humane and individual approach and patients experience it as a great support. Telemedicine means faster data and faster medical decisions and the patient experiences care from both sides of the interface. 3. Internet Internet forerunner was ARPANET (Advanced Research Projects Agency NETwork) US Ministry of defense network project from sixties, designed for military needs. After that, network of connected computers becomes a toy in hand of scientists. In 1991 a Gopher service was developed in laboratories of University of Minnesota (US) that made Internet usage much easier. According to ideas of Tim Berners-Lee in year 1993 a first iteration of todays WWW was created in The European Laboratory for Particle Physics in Switzerland (CERN) as well as the first graphic oriented display - MOSAIC. Mosaic was developed at the National Center for Supercomputing Applications (NCSA) at the University of Illinois Urbana-Champaign beginning in late 1992 It`s clean, easily understood user interface, reliability and simple installation contributed to making it the application that opened up the Web to the general public. While often described as the first graphical web browser, Mosaic was preceded by the lesser-known Erwise and ViolaWWW. Two decades after Mosaic's introduction, most contemporary browsers, retain many of the characteristics of the original Mosaic graphical user interface and interactive experience as we know it today. The principle of designing local networks in companies that enable data and mail exchange was spread to word web, offering variety of services. As broadband penetration increases, number of internet users expands, thus most experts agree on one billion users by end of the decade. Various usage, especially in business word (banks, transport companies or similar) attracts series of unauthorized security breaches and hacking events. Internet becomes not so ideal and sage environment. Safety and privacy are more and more significant aspects that are carefully designed. In companies and institutions a SAFETY POLICY or POLICY of ACCEPTABLE USAGE must be respected from all whose computers are connected to web resources. Safety policies in business world are extremely restrictive, where everything that is not exclusively granted is thus prohibited. Granted or allowed actions are mostly ones that are inevitable for business process. Policies of this kind usually contain data needed to evade incidents: entries and exits registers, handling sensitive data, protecting computer equipment and local network and similar. What makes Internet communication special in medical context? Medical professionals need it as resource of their constant life long learning, finding necessary publications and information for their work (such as www.ncbi.nlm.nih.gov/pubmed or  HYPERLINK "http://bib.irb.hr/" http://bib.irb.hr/). Not to forget important connectivity of medical professionals in pairs and groups having common scientific, educational, research or business interest. Communicating with patients, once that safe and protected network is deployed, enables delivering diagnostics and letters of discharge to patient and to general practitioner (or family medicine specialist) simultaneously, directly to patient`s e-chart. Delivering safe messages with attachments presents excellent tool for performing administrative services in health system. However, internet usage must not replace a direct doctor-patient communication it must be a tool for advancing a person oriented medicine. Time and energy that was once used for administration, should be invested in better emotional patient contact and needed psychological support. 4. Web portal communication Web portal, usually defined as media unifying different information sources, enabling systematic data and access to numerous application, which would otherwise represent separate units. Examples of such portal having personalized options and access to data on one subject or portal are disease specific portals such as  HYPERLINK "http://www.diabetes-mellitus.hr" www.diabetes-mellitus.hr or a public health portal  HYPERLINK "http://www.zdravlje.hr/" http://www.zdravlje.hr/, health institutions  HYPERLINK "http://www.hzjz.hr" www.hzjz.hr, patient association  HYPERLINK "http://www.kuz.hr" www.kuz.hr, or health professionals  HYPERLINK "http://www.farmakoekonomika.hr" www.farmakoekonomika.hr). Web portal social capital values? Web portal communication holds important dimension previously connected only in a strict doctor-patient relationship, the trust. Nowadays citizens and patients visit health and medical portals with great amount of trust and confidence. Some of them enable anonymous login, people may confide their most intimate health problems (such as mental or sexual issues), issues with raising children or other personal issues. Forums are usually places where particular problems are discussed (obesity, pregnancy, adolescence) and interesting and usable answers may be found. Besides information, people may experience additional social capital of not being alone and connection with people who may offer help and comfort. This is a very important part of social and health life, especially when it is hard to reach professional, institutional or high quality psychological or other help. 5. Internet social networks communication (social networking) Following social capital values, it is inevitable to mention services of social networking primarily focused on creating community of similar thinking, mindset or actions, connecting people through internet. These are friends, families, academic communities and all sorts of communities connected to communicate; most known are Twitter, MySpace,  HYPERLINK "http://hr.wikipedia.org/wiki/Facebook" \o "Facebook" Facebook, Skyblog etc... Pages of social networks sometimes refer to health institutions web or some other health portals. 6. Mobile telecommunications (mobile phones) Mobile phones follow consistently the overall internet and computer progress. Besides usual functionalities of communication (voice calls and SMS), through internet users reach to various applications that are tailored according to needs and interests. How mobile phone communication supports personalized medicine? Sometimes even a nice word from other side of the wire brings more than one would expect. Not so rare, clinicians give patients their mobile phones, enabling them instant access, and more importantly, feeling of care and being safe for this connection. This also gives opportunity for doctors to evaluate therapy faster and more efficient than in appointing this event later in time. However, this is a personal decision, since equity and equality criteria should be applied to all patients equally. On the other hand, mobile phone may send a programmed SMS to patient as a reminder for regular therapy uptake, performing control check up or special hygiene or diet measure. Such tools may be of great help for patients in controlling disease and to health professionals in evaluating therapy process and disease outcome. 7. Mobile health Mobile health service may be observed as part of telemedicine and part of mobile communication. Estimates given by mobile phone industry say that in five years, mobile services will take over two thirds of services that are now performed by people and institutions. We are witnessing such changes when we pay our parking and bills by mobile phone, buy airplane and concert tickets. Some people have already experienced having mobile phone as and ECG device carried in left shirt pocket that monitors heart functions by day and night and alerting the system in case that vital parameters change. Mobile health system is not able to develop as long as there is no present 24 hour service on the other interface side, services that monitor results but demand surveillance and supervision of health professionals. CONCLUSION Digital technologies development became an inherent and inevitable part of health processes and tools, changing approach to communication with patients and inside health system itself. Partnership among helath, economy and IT professionals is more an more equal barrying usual milestons and issues faced at beginning of any partnership (initial investment, education and understanding of business and professional processes). Actors in such partnership find mutual solutions for more efficient, faster and more comfortable business and communication with patients, among professionals, institutions, sectors and states. This relationship that has a partner business approach of public institutions and companies has more advantages than usual buyer-performer (seller) relationship. It has better ways of more successful implementation and development of most digital communication health systems, unified in one common goal of improving health of citizens. REFERENCES Stevanovi, R. Pristaa, I. Ivi evi  Uhernik, A. Stani, A. Development and deployment of a health information system in transitional countries (Croatian experience) // Medical and Care Compunetics 2 / Bos, Lodewijk ; Lexminarayan, Swami ; March, Andy (ur.). Amsterdam : IOS Press, 2005. (82-88). Telemedicine / (ur. Klapan I, ikea I), ISBN 978-953-95168-0-0: Telemedicine Association Zagreb, 2005. NATO Advanced Resrarch Workshop  Remote Cardiology Consultations Using Advanced Medical Technology Applications For NATO Operations, (ed. Klapan Ivica, Poropatich Ronald), Zagreb, NATO Science Series, ISSN: 1566-7693, ISBN 1-58603-657-2, Amsterdam*Berlin*Oxford*Tokyo*Washington, DC, 2006 Stevanovi, Ranko; Klapan, Ivica. Establishment and development of e-Health information system in transitional countries (Croatian experience) // Telemedicine / Klapan, Ivica ; ikea, Ivo (ur.). Zagreb : Telemedicine Association Zagreb, 2005. Str. 84-91. Mauher, Mladen; Schwarz, Dragan; Stevanovi, Ranko; Varga, Siniaa. National, Regional and international interoperability of Croatian healthcare information system. // Journal of telecommunications and information technology. 4 (2005.) ; 5-17. Bennet, A. M., Rappaport, W. H., & Skinner, E. L. (1978). Telehealth handbook (PHS Publication No. 793210). Washington, DC: U.S. Department of Health, Education, and Welfare. Burrell, G. (1988). Modernism, postmodernism, and organizational analysis 2: The contribution of Michel Foucault. Organization Studies, 9, 221235. Cline, R. (1983). Interpersonal communication skills for enhancing physicianpatient relationships Maryland State Medical Journal, 32, 272278. df    %  &1Zb?GN[ĵӝ~z~v~v~r~v~n~n~vnrnjnfnjnjnrh h%)h'h$h$h?h8] h:+h:+mHsHhoCh?h?5CJaJhm]5CJaJhthtCJOJQJaJhthm]CJOJQJaJhthwCJOJQJaJhth=CJOJQJaJhm]5CJaJnH tH htht5CJaJnH tH (df U ?$dh`a$gdt $dha$gdm?>$dh`a$gdt$dh-D9DM a$gd:+$dh-D9DM `a$gdt$dh`a$gd?^gd 7$8$H$gdBz{I@N(/?CX`zUŹŲuhBh 5\ h65 hB5hBhB5hBh 56hBh 5 hm?>5 ho25 ht5 hthh?h5CJaJhm?>5CJaJh%)5CJaJh?h 5CJaJht5CJaJhthm?>h h$h'*U\"-.$%(456>KLNS]ghlmpu MN`amj-016CE¾hE hIhE5h~hE5h8 hqqhN~hIhI6hVVZhm?> hIhIh%)hthIhI5CJaJhm?>5CJaJhI5CJaJht5CJaJ hm?>5 h65hCh 55.$%56 !"$$#$$$(),X-$dh`a$gdKo$dh`a$gdE, : ! !!""#$$$$$"$#$$$,$;$E$n$p$q$r$%%%%%%%%%%%%%7&e&o&&&&& 'Ļ͚ͪͪͪ͢͢͢͢h@h@mH sH h@mH sH h@h hvhth4?5?$dh`a$gdI$dh`a$gdt $dha$gdA%y$dh`a$gd$dh`a$gdt$dh`a$gdKo_1`1111111111111222O2a233)313?3@3A3Y3Z3[3u3v3w3x33333333¾³ˆyneh %hA%y0JjhA%yU hA%yhA%yjhA%yUhhh0JjhhUhh0J hhjhhUhA%yh:hPAhO#qh'} hthA%yh6I5CJaJh5CJaJht5CJaJhth6IhTf'333333333333444243444>4?4A4Y4Z4[44444444444455/668788898:8~uh5CJaJht5CJaJhth;uhPA hA%y5\h h|5\ h|5\ h;u5\ hA%yhjhA%yUh %hA%y0JjhA%yUjhA%yUh*h:0J h:h:jh:Uh:hA%y*:8<8c8d8k8v8w888N9b9d9999999::::&:*:.:::::::::::::::Ͳwpib h[M5\ hc5\ hthch[M5CJaJhS5CJaJhc5CJaJh UO5CJaJhthkhSjhmh'@U hmh'@ hmhm h\8\hmhm\h\8h|h|5h| hth@3h'@5CJaJh|5CJaJh@35CJaJ&::;:;P;h;i;;;;;;;<G>N>]>>>3?4?5?E?F?G?:AAAAAqBrBsBuBBBBBɼymahh$5CJaJhth$5CJaJhthf5CJaJhlA5CJaJ hIh} ha ha hf5\ha hfh`yhth UO5CJaJhe*B5CJaJh UOhe*Bh[ hc5\ hRq 5\hShRq h[M h[M5\ hRq \h[Mh[M\%5?F?G?ArBsBtBuBBBFFFHIKM & F hh^hgd$$dh`a$gd$gd$$8dh^8`a$gdtdhgdI$dh`a$gda $dh`a$gdI$8dh^8`a$gd UOBBC+D,DDDEFFFFFHHIMMOOSPTPQ QQQQtttuufuguuutvvv*w,wwxxdyzz嫣|htyh:+6CJ]aJhtyh:+CJ\aJhtyh:+CJaJUhZCJaJhZhZCJaJhth$CJaJmHsHhJ7h$CJaJhJ7h$5CJaJh:+5CJaJh$CJaJh h$h$hfhhJ-MOP5QQetnuu,wzzzzzzzzz{{{{{$a$gdm?> & F hh^hgdty & F hh^hgdZ & F hh^hgd$Daly, M. B.,&Hulka, B. S. (1975). Talking with the doctor, 2. Journal of Communication, 25, 148152. Dewey, J. (1916). Democracy and education. New York: Macmillan. Dongier, M., Tempier, R., Lalinec-Michaud, M., & Meunier, D. (1986). Telepsychiatry: Psychiatric consultation through two-way television: A controlled study. Canadian Journal of Psychiatry, 31, 3234. Korsch, B. M., & Negrete, V. F. (1972). Doctorpatient communication. Scientific American, 227, 6674. Kreps, G. (1988). The pervasive role of information in health and healthcare: Implications for health communication policy. In J. Anderson (Ed.), Communication yearbook 11 (pp. 238 276). Menlo Stevanovi, Ranko; Stani, Arsen; Benkovi, Vanesa; Jovanovi, Aleksandar; Klapan, Ivica. (2006.) Uspostava i razvoj integralnoga zdravstvenog informacijskog sustava - pet hrvatskih inovacija // Knjiga radova: 3 Kongres Hrvatske udruge medicinskih sestara s meunarodnim sudjelovanjem / Matijaai Bodalec, Dubravka (ur.). 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