Personal Health Informatics: The Evolving Paradigm of Patient Self Care

INTRODUCTION Biomedical informatics is a broad field that has been defined many times (Sullivan, 2001; Lorenzi, 2000; Van Bemmel & Musen, 1997). Biomedical informatics is the union of bioinformatics and medical informatics. Bioinformatics differs from medical informatics, in the same way that research differs from clinical medicine. A subset of medical informatics is the patient care aspect, known as clinical informatics. Clinical informatics relates to patient care and technology. Clinical informatics can further be described as the union of multiple aspects of patient care, involving physicians, patients and others, also known as "consumers". Consumer informatics is a subset of clinical informatics and has been well defined (Ferguson, 2001; Houston, Chang, Brown, & Kukafka, 2001; Dey, 2004), with the underlying theme being that "consumers" are using information technology to search, find and locate quality online health information (Kaplan & Brennan, 2001). Personal health informatics is also a subset of clinical informatics which differs from consumer informatics by focusing on the individual patient, rather than a "consumer." Consumer informatics is broad, encompassing many different types of users, whereas, personal informatics is narrow and entails only specific patient related self management. This article will serve to define the field of personal health informatics in relation to patients' attitudes, technologies and their applications for health information management of individual patients in order to maintain a healthy lifestyle. BACKGROUND The availability of online patient information, new resources, desire for self management and care is the basis of personal health informatics. Patients have a desire to diagnose, treat and manage their own healthcare needs. By making resources available online, patients are now able to educate themselves and understand the complexities of modern medicine. Modern medicine cannot be understood unless there is a clear distinction and comprehension between a disease and an illness (Kleinman, Eisenberg, & Good, 1978). Diseases are pathologic processes that necessitate clinical intervention by a physician (medical or surgical) in order to maintain patient health. Diseases range from simple to complex. Illnesses are temporary, self limiting conditions that provide an inconvenience to the patients, such as viral infections, difficulty sleeping, runny nose, etc. The difference between a disease and an illness is the pathological course. Diseases can lead to terminal states in a patient unless treated. Illness lead to temporary states of physical discomfort, which patients can normally allow to run their course, regardless of intervention, the physical state will return to baseline. Illnesses do not always require (medical or surgical) interventions, however, many patients seek advice on how to manage such symptoms and inconveniences. Online resources enable patients to educate themselves, to manage their health, and to ultimately distinguish between disease and illness, enabling them to either seek professional advice or self management and care. PATIENT RELATIONSHIPS The medical relationship of patient, physicians and their resources has changed over the years. From the early days of paternalistic medicine, to very self serving patients and their own desire for optimal health, much has been written on the evolution and change in the patient-physician care model (Conti & Gensini, 2008; Kaba & Sooriakumaran, 2007; Lazaro & Gracia, 2006). From the early days of medicine until today, the physician-patient relationship has been a sacred and protected entity. New technologies are allowing patients to change that relationship. Where technology used to be the addition (or value added component) to the modern relationship, now the physician is the value added component (Rohm & Rohm, 2007). Patients are beginning to go directly to health information technology prior to consultations with their physicians. …