E-Health - #14 AUTUMN ISSUE - European Medical Students' Association
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e-Health
AUTUMN
2018 ISSUE
#14
EDITORIAL
Dear EuroMeds enthusiast,
Our Editorial Team is honored to present to you the latest and greatest of EuroMeds!
Right before your eyes, lies the EuroMeds Autumn Assembly 2018 issue, with a
focus on e-Health! It was a great pleasure for our team to collaborate with the
Health Policy pillar on such a popular and industry revolutionizing topic as
e-Health. Hopefully, you will be enjoying the issue as much as we did while
accepting a record number of 16 articles from a number of countries and
faculties!
Information Technology (IT) has evolved remarkably especially in the last
decade. Today, knowledge once only available to a selected elite part of the
society is accessible to all of us, right at our fingertips. Anywhere. Anytime.
While some argue that this trivializes knowledge and paves the way for a huge
cloud of ‘’false facts’’, no medical student can turn their back to the fact that hav-
ing online access to patient history, diagnostic laboratory test results, and updat-
ed educational materials will direct our roles as medical students and in the future as
healthcare professionals to ways that are hard to comprehend today. Having the ability
to perform a surgery on a patient from hundreds of kilometers away by remotely controlling
very precise and advanced robots sounds like a chapter out of a science fiction novel, but unlike Frankenstein, this
technology leads us to a world where healthcare is much more accessible to many.
As the Editorial Team, we worked meticulously with our collaborators to help our readers have a glimpse of how
such a world would look / looks like. The moment you turn this page, you will be seeing a ‘’palette’’ of works. Some
of these articles will warm your heart with the previous or possible outcomes of e-Health utilization, while some will
invite you to visit your previous opinions on technology and health in general no matter which side you are on; others
may make you ask yourself ‘’Why aren’t we funding this?!’’ Following some of the articles, a number of questions may
surface, and at that moment you can have a look at our newly designed author tags, where you will find the email
addresses of the authors. Please do not hesitate: collaborators are waiting for your questions, comments, and inputs!
At the end of each article, you will find our reimagined ‘’Works Cited’’ section that will accompany your article follow
up research. Just scan the QR code placed within the box and see the sources that are used at the article!
While I am approaching the end of my last editorial entrance word by word, I would like to, once again,
acknowledge the amazing effort that has been put by our associate editors Christos Tsagkaris, M. Asim Masoom
Zubair, Hilkiah Kinfemichael, and our designers İhsan Selçuk Yurttaş, Claudiu Popescu, and Elena Prunici. You guys are
the real heroes!
I also would like to offer my thanks to Vice President of Capacity Tuğçe Çetin and General Assistant to Vice President
of Capacity Ece Çalışan for their sincere and complete support since the day I started my duty as the Editor in Chief.
Enjoy the issue!
Have a great assembly!
Burak Tunahan Ekincikli
EuroMeds Editor in Chief
2 | Autumn assembly Cluj - Napoca 2018 Euromeds
EDITOR IN CHIEF
Burak Tunahan Ekincikli
ASSOCIATE EDITORS
Cristos Tsagkaris
Asim Masoom Zubair
Hilkiah Kinfemichael IMPRINT
DESIGNERS
İhsan Selçuk Yurttaş
Dragoș Claudiu Popescu
Elena Prunici
CONTRIBUTORS
Eirini Balomenou, Roger Chamaa, European Medical Stdents’ Association (EMSA)
Association Européenne des Étudiants en Médecine
Ece Çalışan, Burak Tunahan Ekincikli,
Orhan Selim Ergin, Dimitris Floros, Leu is a non-profit, non-governmental organisation
Huang, Konstantinos Kalaitzidis, Berfin representing more than 150.000 medical students
from over 90 faculties across Europe. Founded in
Ece Karabulut, Korhan Kökçe, Lolita
1990, in Brussels, it is the voice of students within the
Matiashova, Bilge Nur Özdemir, Va- European Commission, the Council of Europe and the
sileios Rigas, Dorothy Martha Scordilis, United Nations. The association provides a platform for
Ergina Syrigou, Christos Tsagkaris, Ber- high-level advocacy, projects, trainings workshops and
kay Akad Ülker, İhsan Selçuk Yurttaş, M. international meetings. Its activities gather around
Asim Masoom Zubair, Saba Zubair Medical Education, Medical Ethics and Human Rights,
Health Policy, Public Health, Medical Science and
Tuğçe Çetin - Vice President of Capacity European Integration and Culture.
Ece Çalışan - General Assistant to
Vice President of Capacity OUR VISION
Shaping a solidary and united Europe, where
medical students actively promote health.
This publication has been made in
collaboration with Health Policy Pillar of OUR MISSION
EMSA. As the Editorial Team of Euro- EMSA empowers medical students to advocate
Meds, we would like to express our health in all policies, excellence in medical
gratitude to the director and assistants research, interprofessional healthcare education
of Health Policy Pillar for guiding us and the protection of human rights across Europe.
through the possible subtopics and
explanations. PUBLISHER
European Medical Students Association (EMSA)
EMSA General Secretariat
Do not forget to give C/O CPME
us feedback on the Standing Committee of European Doctors
issue and vote for the Rue Guimard 15
best article using the 1040 Brussels, Belgium
Tel. +32 273 272 02
link on the left!
www.emsa-europe.eu
info@emsa-europe.eu
This is a free publication of
European Medical Students’ Association.
Autumn assembly Cluj - Napoca 2018 Euromeds | 3
e CONTENTS
DOCTOR SEARCH ENGINE
1 Ece Çalışan
TELEMEDICINE AS A TREATMENT OPTION FOR
2 DIABETIC FOOT ULCERS
Christos Tsagkaris, Ergina Syrigou
EDUCATION OF TOMORROW: ELEARNING
3 Bilge Nur Özdemir
BIG DATA ANALYTICS APPLICATIONS IN TELEHEALTH AND
4
TELEMEDICINE
Konstantinos Kalaitzidis
EHEALTH IN MEDICAL CURRICULA: EHEALTH
APPLICATIONS IN MEDICAL CURRICULUMS
5 AND STUDENT AWARENESS İhsan Selçuk Yurttaş
10 REASONS WHY YOU SHOULD CONFRONT YOUR-
6 SELF WITH EHEALTH
Leu Huang
WAYS TO GET ENGAGED WITH EHEALTH
7 Leu Huang
SUSTAINABLE MEDICINE: INTRODUCING EHEALTH TO
SUSTAINABLE DEVELOPMENT GOALS
8 Christos Tsagkaris, Eirini Balomenou, Roger Chamaa, Vasileios Rigas
4 | Autumn assembly Cluj - Napoca 2018 Euromeds
CONTENTS e
WORDS SHARPER THAN A SURGEON’S KNIFE
9 Orhan Selim Ergin
THE WIRELESS NETWORK OF THE HEART: APPLICATIONS,
ADVANTAGES AND WEAKNESSES OF TELECARDIOLOGY
10 Christos Tsagkaris, Lolita Matiashova
BIG DATA IN HEALTHCARE SYSTEM WITH
OVERVIEW OF TURKEY AND THE WORLD
11 Berfin Ece Karabulut, Korhan Kökçe
SKIN CANCER IN THE ERA OF SOCIAL NETWORKING
PLATFORMS
12 Christos Tsagkaris, Dorothy Martha Scordilis
THE GREAT DIFFERENCE BETWEEN 0 AND 1: HOW
13
NUMBERS CAN SAVE LIVES
Burak Tunahan Ekincikli
PLUG YOUR BRAIN IN: THE BRAIN - COMPUTER
14
INTERFACES
Berkay Akad Ülker
TELEMEDICINE AND PEDIATRICS
15 Dimitris Floros
SOCIAL NETWORKING & ITS EFFECTS ON MENTAL
16 HEALTH - AN INSIGHT FROM LITERATURE
M. Asim Masoom Zubair, Saba Zubair
Autumn assembly Cluj - Napoca 2018 Euromeds | 5
Doctor
Search Engine
Ece Çalışan ...According to one study
Yeditepe University, Faculty of
conducted in the United
Medicine - Turkey
Kingdom, low health literacy
is associated with a 75% in-
ece.calisan97@gmail.com
creased risk of dying earlier
One of the most notable changes in patients with-
in the last decade is the increased health literacy than people who have higher
thanks to the Internet. 20 years ago, patients would
not be able to fully comprehend the disease they literacy levels...
were diagnosed with, but now it is not surprising for
one doctor to have a patient who knows everything
about their conditions even before the diagnosis. economic factors that surround the individual. We, future
doctors, may not control the socioeconomic factors
Health literacy can be defined as a person’s capaci- that our patients live in, but I believe that we can have
ty to understand and review the medical information a considerable influence on our patients’ health literacy.
that is given to them and their capacity to act accord-
ing to the information they obtained. According to one Patients’ health literacy skills have a direct influence
study conducted in the United Kingdom, low health on the doctor-patient communication. Doctors tend
literacy is associated with a 75% increased risk of dy- to interact less with the patients who don’t under-
ing earlier than people who have higher literacy levels. stand what is being said to them. Patients with low lit-
The study also reveals that an increased risk of heart eracy tend to ask fewer questions during their doc-
disease, diabetes, stroke, and asthma is also seen more tor visits. They also ask physicians to repeat their
frequently in people with low health literacy. It is safe to answers more often, which is a red sign that the
assume that health literacy is directly linked with the socio- physician should simplify the information to a more un-
6 | Autumn assembly Cluj - Napoca 2018 Euromeds
...While webpages like MayoClinic,
MedLine or WebMD are trustable and
accurate, these pages are not available
in languages other than English...
derstandable level. A lower understanding of the med- webpages like MayoClinic, MedLine or WebMD are trust-
ical condition leads to higher rates of adverse events able and accurate, these pages are not available in lan-
and readmissions. So, no matter how knowledgeable a guages other than English. When a patient cannot com-
doctor is, it is vital to communicate with patients clear- prehend medical information in English, they might be
ly and encourage them to read about their condition(s). left with a small content written in their mother tongues.
Also, patients who read about a medical condition online,
While health information seeking behaviors of our pa- do not often have the vital background information to
tients must be encouraged for their own good, we should judge the accuracy of the information. Misleading web-
also consider the other side of the coin. While using the sites can easily set patients to pursue treatment methods
Internet for health information can reduce patients’ anxi- that are not scientifically proven to be beneficial. One ex-
ety and give them a feeling of self-effi- ample to this can be the diet pills that
cacy, it may also have an antagonistic claim lives or permanently harm the
effect on them as well. If the person individuals in hopes of losing weight.
who is searching for health informa- ...Patients with health
tion online has the aim of reaching a
diagnosis, they are likely to misinter-
anxiety should be The safety and accuracy of the knowl-
edge on the Internet is not a matter that
pret benign physiological functions discouraged by their is to be taken lightly. When the Lancet
as disease symptoms. Such behaviors physicians from published an article that linked autism
may cause anxiety in patients. Patients to MMR vaccines, they actually caused
with health anxiety should be discour- doing such internet- the birth of the anti-vaccine move-
aged by their physicians from doing disease-explorations... ment. Parents who were scared to vac-
such internet-disease-explorations. cinate their children caused the deadly
comeback of some vaccine-preventa-
Another concern is raised about the ble childhood diseases. According to
reliability of the health information obtained online. the WHO, measles killed 35 people in Europe in 2017
Can our patients effectively use their health literacy as the disease spreads through unvaccinated children.
skills when it comes to searching for medical knowl- 15 European countries were hit by outbreaks. The Lan-
edge? How trustable are the web pages that they use cet retracted the article 12 years later, but the damage
to acquire knowledge from? Accurate and trustable was already done as the spread of wrong information
information is mostly presented in guidelines, arti- is uncontrollable in the social media era that we are in.
cles, and medical textbooks, but these sources are so
heavily loaded with medical jargon that a typical pa- To ensure that the patients acquire trustworthy
tient would not be able to comprehend them. While
Autumn assembly Cluj - Napoca 2018 Euromeds | 7
Andrew Wakefield and the Lancet paper published in 1998
knowledge online, the physi- should review the medical
cians need to check where the
knowledge is being sought ...before we can information presented in
healthcare websites and
from. But before we can rec-
ommend our patients sources
recommend our patients should push healthcare
websites to maintain up-to-
to read from, we must acknowl- sources to read from, we date and scientifically accu-
edge the Internet as a doctor’s rate information at all times.
friend rather than its enemy. must acknowledge the In- Websites that are declared
Physicians may get defensive
when a patient asks about in-
ternet as a doctor’s friend trustable should not con-
tain advertisements of any
formation that they have read rather than its enemy.... sort. Legal action must be
online. The defensive reply taken against webpages
causes a loss of trust in patients and platforms that spread
and thus must be avoided. We should know that if our scientifically wrong and misleading medical information.
patients come to us with a better understanding of their
condition, then we will have a much healthier communica- It is a necessity for the physician to promote and en-
tion between us and a better disease outcome. Informed courage health literacy while seeking the safety of
their patients in the vast pool of medical knowledge.
patients will better trust their doctors and will better com-
ply with the treatment. Medical paternalism might have
been necessary in the 18th century, but the surrogate
decision-making has no place in 21st century hospitals.
All in all, for the protection of the patients’ safety and
autonomy, there are many steps that should be taken
by governments’ institutions and relevant stakeholders.
Authorities, hand in hand with educational institutions
8 | Autumn assembly Cluj - Napoca 2018 Euromeds
as a Treatment Option For Diabetic Foot Ulcers
Christos Tsagkaris Ergina Syrigou
University of Crete, Faculty of UMF Carol Davila, Faculty of
Medicine - Greece Medicine - Romania
chriss20x@gmail.com ergina.syrigou.27@gmail.com
Diabetic foot ulcer (DFU) is a medical condition affecting al- The Benefits of Telemedical Applications in DFU Treatment
most one fifth of patients suffering from Diabetes Mellitus type
2 (DM2). Most of these patients may face ulcer exacerbation, When researched, the first benefits of eHealth versus stand-
severe infections or even amputation. (Bus, Hazenberg, Klein, ardized therapy for diabetic foot ulcer patients can be noted
& Van Baal, 2010) It is crucial to refer these patients to a spe- easily. In a randomized controlled trial carried out between
cialist that will treat and monitor them regularly. Nowadays, October 2010 and November 2014 on 374 diabetic foot ul-
monitoring and reassessment appear more and more costly cer patients, with the study end point being complete ulcer
whereas patients’ compliance is also doubtful. As a result of healing, amputation, or death, the pattern of two consulta-
this, a renovation of contemporary monitoring and treatment tions in the patient’s own home (with a doctor and a specially
approaches is highly needed. trained nurse present) and one consultation at the outpatient
clinic (193 individuals included) instead of standard practice
Since its dawn in the 1700s, telehealth has evolved greatly, (181 individuals), that consisted of three outpatient clinic vis-
currently stretching out to enforce numerous medical domains its, the two study groups showed similar results when it came
and specialties as it can successfully provide information that to wound healing and amputation. However, considering that
aid the diagnosis, monitoring and treatment of patients that the patient can undergo this process in the comfort of his own
suffer from a large number of disorders from a distance. Tele- house, telemedicine is the obvious choice. (Rasmussen et al.,
medicine has been introduced into the field of diabetes care 2015)
twenty years ago. Several studies have been conducted prov-
ing its efficacy. (Rasmussen et al., 2015) Nevertheless, tele- Nevertheless, the advantages of this type of aid provision
medical approach of diabetic foot has been poorly investigat- cannot be exploited if the public and the carriers are not ad-
ed, until now. equately educated. This effort should begin by demonstrating
the favors to the masses in a direct and simplified way so as
The purpose of this article is to investigate the advantages and to be clear what the institutions can offer. To start with confi-
disadvantages of telemedical treatment of DFUs. dentiality, the technological systems that are to be employed
Autumn assembly Cluj - Napoca 2018 Euromeds | 9
monitoring of foot temperature would significantly limit the
rates of re-ulceration in diabetes. The IR- thermometer for
self-inspection of the feet is used by measuring foot temper-
ature daily on six feet sites and recorded in a logbook. This is
highly useful in the case of a temperature difference of more
than 2.2 degrees celcius between corresponding sites of the
right and left foot, when the users are advised to decrease
their activity level and contact the diabetes nurse immediately
so action can be taken. Other methods include liquid crystal
thermography that can best produce temperature readings of
the entire foot in one measurement with integrated tempera-
ture sensing thermistors, two under each foot. These devices
continue to be improved each year, making the work of phy-
sicians as well as patients remarkably easier, leaving us little
ensure that each patient can be assured of the conservation of space for excuses when having to choose between standard
his privacy and confidentiality through a secure infrastructure and telehealth approaches. (Tchero et al., 2017)
and encryption system. The same process of course applies to
the medical stuff. (Matteoli et al., 2015) However, what is not to be ignored is maybe one of the pri-
mary beneficial outcomes of the expansion of the eHealth do-
A study that took place in Australia in 2015 to exhibit ways of main: participation of interdisciplinary teams. The assets are
educating the medical personnel offered a variety of ideas plentiful. Findings from several researches show that involving
as means to this end. As a first, virtual clinics where clinicians a multidisciplinary group in the design of a clinical database
will provide clinical teaching, facilitating a virtual clinic that is results in modification to the database to align better with
transmitted to participating metropolitan, regional, rural and the needs of the health professionals using it, leading to an
remote training sites. Second suggestion would be telehealth improved quality of services and reporting targets, reducing
real-patient learning training sessions, during which consult- the cost and time required to deliver care, and improved com-
ing will be provided for participating practices and students. munication between the healthcare team, something that is of
The trial will then use telehealth consulting as a real-patient extreme importance when dealing with a condition as urgent
learning experience for students, GP trainees, GP preceptors, as ulceration of the foot. (Singh, Vangaveti, Kennedy, & Mala-
and trainees and the simultaneous adoption of a new, inno- bu, 2016) The potential reduced treatment time for patients
vative model of teaching like the one of vertically integrated and improved coordination of care and the ability to connect
teaching where all levels of learner, from undergraduate to primary care providers with specialists were further added to
vocational, contribute to a learning environment. (ex. commu- the list of favors alongside their obvious accompanying effect
nities of practice (CoPs)) Such propositions give us the chance of also curtailing the time it took to decide on and adopt a new
to look through a new window and expand the services we are treatment pattern, an action that in most of the cases when it
already in a position to offer. (Rasmussen et al., 2015; Tchero comes to DFU can make the difference between the ampu-
et al., 2017) tation of a limb or not. The agenda further boosted by trials
supporting that through the use of a large virtual database and
Fortunately, this can nowadays be easily achieved by means structure where also students can participate, learn from and
of the vast array of technological devices that are available. interact with patients, preparing themselves better in this way
Besides telephones, videophones and specialized telemedi- for their future career, enriching their knowledges and offering
cine workstations, emerging appliances make it even easier to even more ideas to the medical community to be exchanged,
monitor and further assist the individual with diabetic foot ul- we cannot dismiss that the continuation of this project in a
cer. The photographic foot imaging device is the first example, worldwide status can only result to be constructive for all the
a camera module featuring a charge-coupled device image individuals involved. (Bus et al., 2010; Matteoli et al., 2015)
sensor (with a resolution of 4 pixels/mm2), light sources, mir-
ror, glass plate, foot supports, and a computer, all contained in Considerations on Telemedical Treatment of DFU
an ergonomically designed device. It produces three images
under different lighting conditions (diffuse and medially and Telemedicine has always been considered controversial. When
laterally oriented, to improve perception of three-dimensional it comes to diabetic foot care, several telehealth related draw-
foot contours) that are automatically saved on a personal com- backs have appeared besides the positive features already un-
puter that is then passed onto the carrier, and it’s usually the derlined. The drawbacks may be divided in general telemedi-
first option recommended for such a therapy module. (Hazen- cine related drawbacks and in DFU related drawbacks.
berg et al., 2012)
General telemedicine drawbacks that apply to DFU care in-
Scanning of foot temperature with IR-thermometer is another clude deficit of doctor patient communication, lack of health
important notion as specific trials have shown that at home,
10 | Autumn assembly Cluj - Napoca 2018 Euromedsprofessionals and patients training and weaknesses of the in-
surance system. First, telemedical applications may imperson-
alize doctor – patient communication. Speaking with a screen
or a wire is not equal to sitting in front of another person and
building a relationship based on trust, common interest and
commitment to better health. A wealth of evidence illustrates
psychological and practical reasons why this form of commu-
nication is not similar to the traditional interview and clinical
examination. (Rasmussen et al., 2015) This is a considerable
weakness given that nowadays research is conducted in order
to formulate a personalized and compassionate doctor patient
communication model. (Singh et al., 2016)
Furthermore, evidence suggests that the insurance system in that patients reported high satisfaction with eHealth tools for
many countries, including the USA, cannot be easily adapted connecting them with their carriers and for enhancing their un-
to this kind of medical services. As a result of this, both medical derstanding of their condition., Across further three papers, it
professionals and patients might face difficulties concerning was consistent that patients indicated that they would recom-
payments and prescriptions. (Rasmussen et al., 2015) Finally, mend various eHealth services/tools to other patients under-
patient privacy is nowadays a trend applying to DFU care as going treatment. (Rasmussen et al., 2015; Singh et al., 2016)
well. To secure these data from any violation, databases or Furthermore, it was identified that both primary and tertiary
mailing lists should include so many safeguards that they may health professionals involved in the delivery of DFU care were
become dysfunctional. (Singh et al., 2016) supportive of the use of technologies to improve their inter-
action pathways. Statistically speaking, on average, telehealth
DFU related drawbacks include low quality images, structural appointments reduce participants’ travel by 426 km per round
deficits of 2D and 3D imaging and statistical data illustrating trip and telehealth coordinators rated 85% of patients and 92%
complications in DFU patients treated exclusively via telemed- of caregivers as comfortable or very comfortable during tele-
icine services. Telemedicine requires a minimum training even health. Satisfaction scales completed by patient-caregiver dy-
in case everyday equipment such as smartphones and tablets. ads show high satisfaction with telehealth. Sadly, even though
Elderly health professionals and patients all over the globe the will to promote this way of communicating and helping
struggle to use properly such equipment. Moreover, genera- others is there, several barriers still need to be overcome. (Ras-
tions of health professionals have been taught systematically mussen et al., 2015) Communication problems obstructing the
that making a diagnosis without meeting the patient himself on-time intervention of the staff, technological barriers such as
is in most cases malpractice. Even though telemedicine is to firewalls and reticence or lack of time for using communication
bridge this gap, perhaps this legacy will take time to wear of. systems, coupled with technical problems and low number of
At the same time, patients suffering from DFU are in most cas- trained personnel keep aggravating the conditions which pa-
es over 60 years old and thus they may not be able to use the tients and medical crew are called to work under. In a time-
technology properly. (Singh et al., 2016) line when the risk for developing foot ulcers is 25% high in
patients with diabetes and in every 30 seconds, one lower limb
What is more a picture cannot depict special features of DFU amputation in diabetes patients occurs, everything humanely
such as exudation or stiffness. Given that these characteristics possible should be done to ameliorate the way we learn, pre-
consist of a sine qua non aspect of monitoring, this deficit is a vent, monitor and treat such conditions. (Matteoli et al., 2015;
major weakness of telemedical DFU care. Plus, evidence from Tchero et al., 2017) We are confident however that with the
meta-analyses suggests that the mortality of DFU patients due implementation of the ways mentioned above, the public will
to unknown complications has been increased in patients be informed of the benefits sooner rather than later in order to
treated exclusively through telehealth services. This could be further increase the coverage of this so extraordinary network
attributed to the fact that doctors in telemedicine frame are that can make the simple difference between life and death.
not able to perform physical examination and correlate imag-
ing and measurements to the general condition of the patient.
In this frame, it appears that telemedicine violates the principle
of treating the patient and not the disease. (Bus et al., 2010;
Rasmussen et al., 2015)
Conclusion
In a nutshell, we can all grasp the potential of this way of pro-
viding health care to people with DFU. Several papers state
Autumn assembly Cluj - Napoca 2018 Euromeds | 11der a wide range of contexts. Each person has different learn-
Bilge Nur Özdemir ing capacities and types. Some learn visually, some by listening,
while some combine them all… With development of technolo-
gy, learning itself is now changing and evolving; like many other
Hacettepe University, Faculty of
aspects of life.
Medicine - Turkey
bilge_ozd_06@hotmail.com As members of digital natives, we are able to reach out to every
information we need for our education in a few seconds via tu-
torials, case-based programs, hypermedia, web links and many
others. The term ‘’eLearning’’ is created to cover exactly that!
We are living in an era of technology, where most parts of our eLearning is the integration of technology into the learning pro-
lives are connected to the art of science. It’s a world where chil- cess; it is utilizing technology to reach educational curriculum
dren are “growing up digital.” As they grow, digital natives/gen- outside of a traditional classroom without certain restrictions of
eration Y/net generation is increasing in population. And guess traditional education. [1]
what, we ourselves ARE members of this very generation. Being
surrounded with technology all of our lives, we are filled with E-learning, abbreviation of electronic learning, is considered
technical skills and learning preferences for which tradition- synonyms for web-based learning, online learning, distributed
al education is not quite prepared for. We need
something more! This is why e-Learning comes
into the game: to satisfy hungry minds of digital
natives!
As human beings, we receive a tremendous
amount of input every single second. We use
and process these inputs to create appropriate
outputs. That usage and processing also leads to
‘learning’.
Learning, by definition, is the process of absorb-
ing the information to increase knowledge, skills
and abilities and make use of these concepts un-
12 | Autumn assembly Cluj - Napoca 2018 Euromedsan example done in England, go to citation
#5). Most of the universities worldwide now
offer courses online, either free or with in-
significant charges compared to the normal
tuition fees. Efforts are variable and numer-
ous: videotaping the lessons and delivering
them online, recording lessons to help stu-
dents catch-up, building virtual reality labs
for classes like anatomy... Some of the insti-
tutions have taken it a step further by hiring
professionals to create most thriving experi-
ences possible.
Using social media for formal learning: Al-
though it is mostly used for entertainment,
social media can also be used as a source of
education too, when contents are aligned to
learning objectives and personal interests.
Some of the companies have already creat-
learning, computer-assisted instruction, or internet-based learn- ed extra tools to improve learning!
ing. It is usually mistaken with distance learning and blended
learning, but they are not entirely identical. Distance learning There are different types of e-learning. One of the classifications
only necessitates tutor and students to be away from each oth- divides them into two: synchronous and asynchronous.
er. E-learning has a broader usage and distance learning relies
on eLearning. Blended learning is the mixed mode of delivery, Synchronous delivery refers to real-time, instructor-led e-learn-
combining traditional classroom learning with eLearning tech- ing. Like within an online classroom, all learners receive infor-
niques, in which teachers mainly act as ‘personal trainers’, direct mation simultaneously and can communicate directly with other
their students to the best method individually and help them learners. Teleconferencing, chat forums, and instant messaging
with their journey. are some exemplary ways of synchronous delivery.
Becoming popular recently, one may fall into the error of think- With asynchronous delivery, the transmission and of informa-
ing that eLearning is something new. Although being called as tion do not occur at the same time. The learners are mostly re-
‘eLearning’ since a CBT (Computer-Based Training) seminar in sponsible for their self-instruction and learning.
1999, its fundamentals date back to 19th century. In the 1840s
Isaac Pitman, a qualified teacher, used distance courses to ed- Benefits
ucate his pupils. Pitman was sending assignments to his pupils
and receiving them back once the work is done, via mail. [2] There are lots of reasons why members of the learning com-
Ever since that day, each and every effort put in education and munity hop on board to the eLearning train. Let’s see some of
technology helped eLearning to flourish and become what it is them:
today.
Time flexibility: One of the main problems that keep people
Qualified health workers are fundamental to ensure equitable from being educated more is the timing availability of traditional
access to health services, effective treatments, set the most ap- courses. A key advantage of eLearning is that one can schedule
propriate precautions to prevent diseases –especially communi- new courses according to the current schedule; it helps learners
cable ones– and achieve universal health coverage. Despite its to transcend time!
importance, number of qualified health workers was far behind
Millennium Development Goals (MGDs) 2015 that was set by Location, ease of access: Using eLearning, one can attain a
UN in many countries due to lack of adequate training and mi- course that is given miles away and can ask questions to the
gration, in other words, brain drainage of qualified staff. This sit- top-of-their-field experts and build multiple-level relationships.
uation worsens day by day. [3] eLearning is a hope to help tackle This feature is especially beneficial for dispersed settlements
the estimated shortage in health workers. Ranks are hoped to and territories without qualified education. In addition, one
increase if the goals are to be achieved by elearning. [4] doesn’t have to give up on education because of travelling or
moving out, education is portable unlike armful of books and
With the changing standpoint in education, universities and ed- hard-to-reschedule courses! Language? Never a problem,
ucation companies have already started to change their strate- thanks to translators!
gies. They are doing researches about this trend topic (to see
Autumn assembly Cluj - Napoca 2018 Euromeds | 13Anonymity: It’s not always easy to comment or dis-
cuss on certain topics. eLearning may ensure that
different opinions are shared by using anonymity.
There is so much more to add when we talk about
eLearning’s benefits in health sciences. Our lectures
are numerous, and they all are ‘vital’ because a mis-
understanding or ignoring a small thing may cause
unexpected deaths of our patients by our hands.
eLearning helps us master the most difficult cours-
es. Using videos, apps, 3D images, online quizzes,
PDFs of textbooks, sometimes even just looking
at pictures accelerate and straighten our way of
learning. By addressing all types of learning, per-
sonalizing education and directing us according to
our own needs, eLearning helps us to hit the bull’s
eye. In addition, health education does not have the
same quality worldwide. eLearning offers the edu-
Cost: eLearning costs are substantially lower compared to tra- cation to those who cannot afford quality education
ditional learning. It’s reasonable when you think about prices of and/or education tools.
textbooks and their PDF versions!
Medicine requires practice. There is not much of a survival
Up to date and revised: Contents online are way easier to up- chance when you intubate a real patient for the first time if you
date and revise than printed ones, which helps to create a more haven’t practiced it in a realistic way. By creating almost-real ex-
up-to-date learning platform. Additionally, consider the trees periences and an atmosphere to practice as much as needed,
saved! eLearning helps to attain and master the skills professions re-
quire.
Amusement: Some topics are harder to imagine and under-
stand. ’Gamification’ methods of eLearning would ease the pro- Medicine is not only 6 years of education, it’s a lifetime journey.
cess and engage users. New information, which can be the nuance between life and
death, comes up so often, and we have to comprehend them
Storage: Moreover, online learning enables us to watch neces- all in order to become the best versions of our doctor-selves.
sary courses as much as it’s required, also to stop and continue This attribute is called CME. (Continuing Medical Education)
later on when we feel distracted. Its huge capacity to store cre- eLearning doesn’t only contribute to undergraduate education
ates world’s largest and easiest-to-use library. of ours, it also helps us after graduation. Being easy to update,
adjoin, write in and search, eLearning upgrades health to the
Personalization: eLearning switches the emphasis of learning next level indisputably. Visualization is very important for med-
from instructor-centred to learner-centred in which participant icine. eLearning may change obtaining, interpreting and stor-
is more active user rather than passive receiver of information ing methods of X-rays, ECGs, ultrasounds and many other scan
and can fulfill requirements of self-directed learning. eLearning types. Searching for the article you need among many others
allows learners to address their own needs, provides flexibili- that have been accumulated for years in any second at any
ty to complete learning at a student’s own speed and intensi- place, discussing your methods with your colleagues simultane-
ty, anytime and anywhere! By this way, learners can control the ously whom are miles away, comparing your work or methods,
content, learning sequence, styles, time and pace. Besides that, adding your findings to online storage, making your voice heard
using ‘micro-learning’, one can divide topics into suitable small- are just examples of how everyone can benefit from eLearning.
er parts and make it easier to conquer.
Drawbacks
Feedback: Online education is easier to track. Evaluating one’s
performance and creating an action plan on it is more certain Not everything is set and clear about eLearning. Let’s discuss
because it is based on objectives that were set by professionals. some of the weaknesses:
It is also easier for an educator to get a solid and instantaneous
feedback. With all that, eLearning increases accountability. Need for hardware and software knowledge: Although you don’t
have to be a top-class computer engineer, some level of knowl-
Heterogeneity: Not every human being is the same. By mixing edge on internet tools are needed to get the best out of eLearn-
different lectures, one can create a new path that serves one’s ing. Furthermore, to create their own eLearning style, educators
interests and abilities. need to upgrade their IT skills. For this only, there is a new field
of work in which experts help educators and universities to cre-
14 | Autumn assembly Cluj - Napoca 2018 Euromedsate the best eLearning platforms possible.
Need for internet connection: There are still
problems with internet connection especially
in rural areas. Offline computer-based eLearn-
ing is alternative to this problem, nevertheless
providing technological devices and internet
to citizens ought to be one of the priorities of
each government.
Isolation: This one is among the major con-
cerns reported. A classroom is filled with peers.
Once classrooms are abandoned and students
don’t need to leave home to get compulsory
education, it may cause them to become aso-
cial, lonely and isolated. Though synchronous
delivery would partly solve this problem, stu-
dent-student, student-teacher and teach-
er-teacher interaction as well as tutor support
will still lack a great deal. Yet, one should remember that class-
Distractions: Internet is full of distractions. One may easily be-
room is not the safest place for everyone. Remember, bullying is
come hooked on other faces of internet. Well, this is always a
one of the major problems of contemporary education.
danger. Deciding and obeying is up to the user.
Lack of hands-on experience: Hands-on experience is obligato-
Quality education has a lot of ‘to-do’s to check. For Ehlers, al-
ry to become a professional for most of professions. Acquiring
though it’s user specific, it mainly depends on structure, context,
required communication skills and supervision of experienced
process, output and impact. [6] No matter what, let’s face it, we
colleagues is crucial for fields like medicine. Some psychomo-
have problems in education, both in quality and quantity. There
tor skills, physical examination and surgical techniques can only
was a TED Talk I’ve watched a while ago, when Monique Markoff
be learned by direct observation and practice. eLearning will
asked ‘What if every child had their own teacher?’, it hit me: It
undoubtedly create a platform for such occasions but it’s ques-
may not be possible to assign one student per teacher, but with
tionable whether this will be enough or not.
the technology we have, we can educate each child (and doc-
tor-to-be, for that matter) individually.
Evidence based knowledge related issues: Although we can ac-
cess a plethora of websites, not all are trustworthy. One needs
We don’t know if it will solve our problems in education, but
to peruse thoroughly for quality assurance and factual content
eLearning is here to stay. Its implementation into our curricula
before trusting any of them.
is not a question of ‘if’ but a ‘when’. It has benefits and draw-
backs, like any other innovation; problems will be solved by
Motivation: We mostly get motivated when we’re surround with
time and usage, benefits will expand. Blended learning, a way
other motivated people. A traditional classroom and school
of complementing the traditional learning by combining tradi-
system is good at providing this. Will eLearning be enough?
tional learning and eLearning, can be used as a stepping stone
We’ll see! Yet, one should remember motivation and emulation
for eLearning until drawbacks are solved. We should integrate
sometimes turn into jealousy and greed and cause crises in tra-
eLearning into our current curricula carefully with a comprehen-
ditional learning.
sive needs assessment and a well-devised plan. Digging a little
Health: Technological devices may have a negative impact on
deeper each time, we can reach to the optimal education that’s
health. Long hours of working may severely damage health by
required.
hurting spine, eyes, and many other parts of our body; inactivity
may increase rates of obesity. Precautions for threats are count-
less: sit properly, adjust the lightning, take regular breaks…
To the leading edge...Toward being the best!
These won’t solve the problem exactly but will at least decrease
the severity.
Sanctity of teaching: Many cultures consider teaching as sacred.
Some fear teaching will extinct with eLearning. Teaching may
transform with eLearning, but this isn’t necessarily a bad thing.
Teachers may need to know more about computers and tutor-
ing, and this will only encourage them to improve themselves.
Autumn assembly Cluj - Napoca 2018 Euromeds | 15Konstantinos Kalaitzidis stantial role through the analyzing of patient related data
that will save time, money and further resource expenses.
As one of the most important benefits of big data in tele-
University of Applied Sciences of
Thessaly, Faculty of Computer health is the clear observable results in the improvement
Science and Engineering - Greece
of the patients’ life, reductions at the number of patients
kon.kalaitzidis@gmail.com visiting hospitals and reduction in mortality rates, it is im-
portant to understand how this technology works. [1]
One of the most significant ways this technology oper-
ates is through the transmission of data from patients’
wearable devices to the cloud or even local servers
Today at anything digital, all we observe is data. We
where data that have been gathered can be processed,
find ourselves on the frontier of a steady but progres-
analyzed by the patients’ doctor and sent back for imme-
sive change in the way we think and experience health-
diate and precise feedback. [1]
care. The technology advancements made in telehealth
through big data analytics aim to provide patients with
Besides applications related to telehealth, big data ana-
preventive assistance in disease deterioration and ad-
lytics have also a wide range of applications in telemed-
vanced monitoring of their health condition, all person-
icine, which is a sub-field of telehealth. Patients, this time
alized and configured precisely to the medical parame-
around, can benefit from this technology so as to obtain
ters provided by medical personnel. [1] This technology,
a better understanding of their state of health. Also, it
as an immediate result, offers new business models and
would not be mandatory
possibilities for the healthcare sector.
for patients to visit hospitals
for routine checkups, since
Development of these new business models occurs as a
that could be done directly
natural consequence from the increasing levels of chron-
from the wearable devices
ic diseases worldwide and also due to the economic
and transmitted through
restraints put on hospitals to reduce expenditures. [1]
the Internet to doctors who
Additionally, by their nature, chronic diseases require
can analyze all of their met-
tremendous resources for patient rehabilitation and for
rics and possibly prescribe
long-term and distance care.
alterations in their medica-
tions in an evidence based
Big data analytics in particular is expected to play a sub-
way from any distance. [2]
16 | Autumn assembly Cluj - Napoca 2018 EuromedsOne of the most useful applications of big data in tele-
There is no wonder why Healthcare IT investors are close- medicine is drone assistance for disaster relief. [2] Peo-
ly following all advancements made in this field, pro- ple who might find themselves in life-threatening situa-
viding that analytics and telehealth have already raised tions can be saved by drones, operated by professionals
huge capital investment, $187 million and $171 million who send them to the place of the accident, observe and
respectively by 2016. [2] provide valuable intel by collecting and transmitting data
to the emergency medical personnel or by dropping im-
Distanced Patient Monitoring
IoMT (Internet of Medical Things) are devices with in-
ternet connection that communicate with each other as
well as with internet cloud systems. The goal here is the
exploitation of these devices in order to analyze the in-
formation collected and derive valuable metrics that will
contribute to the decision-making of doctors in the iden-
tification of potential health anomalies of the patient that
require immediate medical intervention. [2]
In a nutshell, what medical personnel aim to achieve with
this technology is to keep track of the patients’ health
from distance. Technologically, all this is based on re- portant medical equipment like defibrillators in hold of
al-time tracking of datasets that concern vital patient the arrival of emergency services. [2]
Big Data Visual Analytics and Prediction Modeling
Big data visual analytics is the process of healthcare en-
tities being able to organize and analyze large amounts
of data that are related to clinical and business insights.
[1] Statistical, contextual, quantitative, predictive, and
cognitive fields are all put to use in favor of achieving
measurements, such as the respiratory system, blood fact-based results that will eventually be used in all kinds
pressure and heart rate. [2] of management, educative and quantification process of
the healthcare organization. [1]
Ultimately, this technology can also for help in promot-
ing a healthier lifestyle for patients, reduce unnecessary
patient visits to the hospital and provide for immediate
medical intervention when necessary. [2]
Precise Diagnosis
Patients who live in significant distances from their doc-
tor’s office have the ability to ask for advice through the
web. The doctor can provide precise recommendations
obtained from the patients’ metrics (transmitted by the
wearable device) and the patients’ medical history. [2] All
of the datasets regarding the health condition of the pa-
tient are available to the doctor in real-time. Big data visual analytics is consisted of four types of an-
alytics. [1] Descriptive, predictive, prescriptive, and dis-
With real-time metrics being transmitted over-the-air covery analytics. This complete set of analytics is
from the patients’ wearable devices to the cloud, ana- responsible for all of the analyzing concerning patient
lyzed and then interpreted in a visually comprehensible data. [1]
way for the doctor, distance and precise diagnostics is
now a reality. From the previously mentioned four types of analytics,
predictive analytics has proven its potential in reduc-
Drone Utilization for Accidents ing the number of preventable mortalities. [1] One way
of taking advantage of predictive analytics is to exploit
Autumn assembly Cluj - Napoca 2018 Euromeds | 17It is to the greatest interest of all that healthcare
exploits technologies such as these ones so as to
provide healthcare professionals and patients with
the best and most effective services possible.
available data to identify patients with a high-risk factor
and thus proactively take immediate actions that will Finally, the applications of big data analytics in telehealth
potentially avert the patient from future visits to the hos- and telemedicine can lead to substantial reductions in
pital, reducing potential unnecessary costs for both the unnecessary costs from patient visits to the hospital and
patient and healthcare services. [1] other healthcare facilities while at the same time deliver
business plan alternatives for healthcare organizations.
Another use of predictive analytics is the creation of pre- Medical professionals can be aware of their patients’
dictive models based on the patients’ medical history health condition at any time and even provide their ser-
and the development of future potential trends that will vices remotely.
assist the individual in avoiding future health issues. [1]
Predictive analytics use statistical techniques, machine In contrast to the significant benefits of big data in
learning and modelling for the construction of these pre- healthcare, it is important to note that the all increasing
dictive models. datasets is expected to cause some stress in the process-
ing, analyzing and the managing of all this data. This fact
Inputs for creating prediction models can be the patient calls for immediate upgrade to the latest technology in-
history that is interpreted into data. That data is fed to frastructure in hospitals and other healthcare facilities.
the system for analyzing and then extracted into a visual-
ly interactive way that is comprehensible by healthcare
professionals. [1]
18 | Autumn assembly Cluj - Napoca 2018 EuromedseHealth in
Medical
Education
Curricula
eHealth Applications in Medical Curriculums and Student Awareness
the outbreak of tuberculosis all across the world. As a re-
İhsan Selçuk Yurttaş sult, in the mid-20th century, pulmonology has evolved
to become a speciality[1] upon the community’s needs.
Today, we need oncologists, surgeons specialized in on-
Gazi University, Faculty of
Medicine - Turkey co-surgeries, because every year about 14 million peo-
ple are diagnosed with cancer [2].
yurttasihsanselcuk@gmail.com As we look at our occupation’s development in differ-
ent eras, we can confidently say that giving health care
is about adopting the changes. And this motto used by
Medical Education enthusiasts captures the situation
F rom the beginning of the history, doctors or peo-
ple whose mission was to provide healthcare to others
very beautifully:“Education is the real agent for change”.
Why is eHealth knowledge important for a doctor?
have always been adapted to what community actually
needed. As we look at the Middle Age, Black Death was Today, thanks to the blessings technology brought us,
crashing people; so doc- people are more connected to each other. You can deliv-
tors tried to block the dis- er your idea to someone who is across the world, gather,
ease from spreading, also produce information and even give action to huge mobs.
worked for a proper treat- Technology had not just improved connections & com-
ment. As we come closer munication. Through technology, we have developed
in the timeline, in the 20th new techniques, new inventions and improved our skills
century, we see that res- in health care providing. Everything seems OK, right? Not
piratory system disorders exactly. As we talk about social accountability on our oc-
Doctor wearing Mask, Black Death Era have raised because of cupation in this era, the community expects to get health
Autumn assembly Cluj - Napoca 2018 Euromeds | 19ask the “What is up with
the eHealth and edu-
Universal Health cation?” question. Let
me answer: As we say
Coverage means ensuring we have evaluated our-
selves in eHealth and
that must be in long
that everyone, everywhere term, we should up-
date our curriculums in
can access essential quality order to provide social
accountability and uni-
health services without versal health coverage.
We go for a little search
for PubMed about “medical education and eHealth”
facing financial hardship. and surprise, there aren’t any good matches. Upcoming
results are generally about outcomes of eHealth tech-
niques’ integration in rotations/internships programs.
These programs generally include “telemedicine in ed-
ucation process” [6]
care over what they are using, what technology brought As we can not make an evaluation about the whole
them. They search what they process, we are able to take
want, they use apps, websites feedback from a couple of
to fulfil these claims. [3] To
“fight” with needing, we have
...with the power of different studies which sug-
gest that raising eHealth
to “shoot them with their own information and awareness and also using it in
gun”: We should use technol- formal education [7]. In these
ogy! communication technologies, studies; residents, fellows
Actually, not just for requests, we can provide health care to and medical students are giv-
with the power of information ing positive feedbacks and
and communication technol- everyone, everywhere. willing telemedicine to be in-
ogies, we can provide health- tegrated into their whole cur-
care to everyone, everywhere. riculum.
WHO says, Universal Health
Conclusion
As we say our education is the agent of change, devel-
oped by the community, we are far away from fulfilling
social accountability and so providing healthcare univer-
sally. We see that there are some pilot studies suggesting
eHealth integration in curriculas. We are talking about
technology more and more in every case. But raising
awareness in medical schools would be better for a doc-
tor, because of lack of time and energy in occupational
life. Also, by high motivation and bright minds, medical
students can improve current techniques and even de-
velop new techniques in order to achieve local and uni-
versal goals of tomorrow’s medicine.
Coverage cannot be reached without
information and communication technologies, which is
eHealth, from the early 2000s. [4]
Medical Education Curricula and eHealth: Situation and
Awareness in Students
As we define and understand what eHealth, now you’ll
20 | Autumn assembly Cluj - Napoca 2018 Euromeds10 Reasons
Why You Should
Confront Yourself With
eHealth
Leu Huang
Charité University Hospital
Berlin - Germany
leu.huang@charite.de
T
1. echnology is not able to replace human instinct
and empathy - a robot can’t and won’t replace us guid-
ing patients and their families through whole disease
management processes, hold a patients’ hand and
see the needs of a patient beyond their medical con-
dition. Empathy and our gut instinct make us human.
2. In times of artificial intelli- Ray Kurzweil, a well known futurologist
gence and clinical decision-mak- humans. Complex technologies require competent
ing systems, computers will professionals to understand and use it. Machines have
be able to take over a lot of been invented to help, serve and assist us, not to re-
diagnostics which will require place us. We are on the same page working in one team.
us to have critical thinking
skills to not rely on everything 4. Telemedicine enables us to communicate dif-
and become lazy (check out ficult cases with experts from all over the world
the app Ada). Who takes re- Ada and can provide people living in rural areas with
sponsibility in case of machine access to medical care for. ( check the app Figure 1).
failure or a wrong therapy recommended by a soft-
ware? How can patients own and protect their sensi- 5. Digital communication and clouds can take the bur-
tive health data? eHealth brings ethical issues which den of paperwork from us and improve efficiency by
we have never faced before and should be aware of. using centralized information instead of duplicative
diagnostics and interventions. Making use of all ex-
3. Futurologists such as Ray Kurzweil have been isting data brings us to the buzzwords big data sci-
predicting the dates of “singularity” (the day ma- ence. Making use of the huge amounts of data from
chines over exceed humans), but seen from anoth- all over the world offers the possibility to move for-
er perspective, it has never been a race of tech vs ward in researching rare and (up until now) non-cur-
Autumn assembly Cluj - Napoca 2018 Euromeds | 21You can also read
