Tailoring health information technology and eHealth solutions for consumers often referred to as Consumer Health Informatics (CHI), is a growing field but has not yet been rigorously reviewed. Johns Hopkins University’s Evidence-Based Practice Center saw the need to review the data available in this specialty field and prepared a detailed report “Impact of Consumer Health Informatics Applications”.
The report prepared by JHU for AHRQ, discusses issues and ideas on how to further CHI and its applications in the healthcare field. Investigators examined available information on breast cancer, diet, exercise, physical activity, alcohol abuse and smoking cessation, obesity, diabetes, mental health, asthma, and COPD.
They also studied the barriers that clinicians, developers, consumers, and their families or caregivers encounter that limit the utilization or implementation of CHI applications. The existing knowledge or the evidence supporting estimates on costs, benefits, and net value with regard to CHI applications was also studied.
Results show that while there may be a role for CHI applications to reach consumers at a low cost and can possibly eliminate the need for some activities currently performed by humans, it is likely that a more important role would be to enhance the efficacy of interventions currently delivered by humans.
Several studies compared the use of a CHI application with traditional therapy against traditional therapy alone. Many found that both groups exerted a significant effect on the outcome yet the CHI group had achieved even more benefits than traditional therapy alone.
Secondly, in the aggregate, the studies support the finding that at least three critical elements often found in CHI applications exert a significant impact on health outcomes such as individual tailoring, personalization, and behavioral feedback.
The reviewers also found that CHI applications may positively impact healthcare processes including medication adherence among asthmatics. CHI applications may also positively impact intermediate outcomes across a variety of clinical conditions and health behaviors, including cancer, diabetes mellitus, mental health disorders, smoking, diet, and physical activity. Strong evidence supports the positive impact of CHI on selected clinical outcomes but the data is insufficient to determine the impact of CHI on economic outcomes.
There are several barriers to using CHI applications including incompatibility with current care practices, professional staff perceptions of increased workload, poor social support and limited IT knowledge, literacy of consumers, cultural issues, and concerns about time, privacy, security, and control.
Although CHI tools and applications do not always require the involvement of a healthcare provider, it is likely that significant growth in the use of CHI tools will necessitate increasing provider and healthcare system competency with these emerging tools.
The report points out the need to develop uniform reporting and to improve the quality of work in this field. A national CHI applications design and registry along with a CHI applications trials registry with uniform reporting requirements needs to be developed.
The rapid growth and development of the internet combined with the rapid rise in the use of the internet to search for health related information suggests that individuals are drawn to using convenient and anonymous technologies for health purposes. If CHI applications and tools become available in a wider array of platforms, it may become easier to engage more people who are not actively managing their health.
For more information on this report, go to www.ahrq.gov/clinic/tp/chiapptp.htm, or email M. Chris Gibbons, MD, MPH, Associate Director, Johns Hopkins Urban Health Institute, Director for the Center for Community Health, and Assistant Professor, Public Health and Medicine at Mgibbons@jhsph.edu.
