Supporting communication relationships and processes of patients by using computer-mediated communication technologies

The German health care system is undergoing a process of fundamental change. The central objective of this reform is two-fold: it aspires to reduce of the overall costs in the health care sector as well as to improve the overall quality of the health care system. The adoption of innovative eHealth technologies throughout Germany plays a vital role in this reform process. Until 2006, the development of a telematic platform for medical applications such as a national electronic health card, an electronic medical record system, electronic prescriptions and electronic patient discharge reporting. The creation of an integrative data exchange- and communication platform is supported by the definition of comprehensive process workflows across various sectors of the health care system (e.g. the definition of clinical pathways, implementations of disease management etc.). At the same time this reform provides new opportunities for patients to understand and actively participate in their own care process. In future the relationships in communication between attending physician / medical facilities and patient is rather characterised by an active dialog than by a one-way transfer of information. Furthermore, the exchange of experience between patients, e. g. in terms of self-help groups for persons with chronic illnesses, is becoming more and more important. However, there are further communication relationships of patients to health insurance companies and possibly to pharmacies or medical equipment stores. Therefore, a typical patient is integrated into a complex network of communication relationships. Classic synchronous and asynchronous ways of communication (face-to-face, telephone, Fax, mail) are only conditionally suitable for an efficient technical assistance of communication relationships. Computer-Mediated Communication (CMC) technologies offer innovative and efficient ways to support the patients communication (and of his relatives) with different communication partners and to reduce the duration of communication processes and length of communication channels. Chat / internet relay chat (IRC), instant messaging, audio- or videoconferencing and collaborative virtual environments are counted among the sychronous CMC technologies. Asynchronous CMC technologies include newsgroups / bulletin board systems, mailing lists, email, Voice Mail, Bulletin Boards or WIKIs. Considering the communication processes running in the context of the patients communication relationships it becomes apparent that these processes vary significantly in their parameter values for dynamics, knowledge ratio and the potential of structuring. The spectrum of process types goes from highly structured information transmission processes with a low ratio of knowledge transfer (Example: Make an appointment for a radiological examination) to very dynamic, partly ad hoc running knowledge processes (Example: exchange of experience between chronically sick persons). Depending on the types of communication processes different CMC technologies can be recommended. For example email and messaging systems are especially suitable for highly structured communication processes. Knowledge processes can be organized by using technologies for virtual environments, discussion forums or WIKIs. The basic functionality of the named CMC-Technologies can be usefully enhanced by add-on functionalities and services. Such add-on functionalities and services can include the controlling of communication flows (channel routing, topic routing, skill routing etc.), contextualization and personalization of communication, filtering and grouping of communication contents or the documentation and analysis of communication processes. They can help patients to make their communication relationships become much more efficient and satisfying. The presentation shows the different types of communication processes that can be found within patients communication relationships and gives a classification in categories and description of these types. Criteria will be developed and applied, which are suitable for selecting the right CMC technology for a special type of communication process. The concluding remarks focus on the question how these technologies can be supplemented by the named add-on functionali ties.