Homecare and Disease Prevention: Reviewing a Decade of Evolution - Privacy Still the Biggest Hurdle

Over a decade ago, while at the Agency for Health Care Policy and Research (AHCPR), now known as the Agency for Health Research and Quality (AHRQ), a vision was created by the author that projected two different concepts. One was the use of telemedicine in a homecare environment (in urban, suburban and rural areas) to offer particularly to the elderly population, suffering from a number of chronic conditions an environment which would allow to improve the quality of services while decreasing the costs of the (then and projected) "current" system. The second theme involved the potential use of genetic-related discoveries with personal health records for disease prevention purposes. While the homecare - telemedicine environment for the elderly with chronic diseases (has and) is evolving, the outcomes (cost and medical effectiveness) are not completely clear. The result is that what may be cost-effective in one country may not be in another one. The second premise, which involves the use of electronic health records, genetic discovery and intelligent agents, has moved much slower (if at all) than anticipated. In the US, at least, most of the barriers have been related to fears of privacy breaches. The combinations of Radio, Television, Computers and Telephones have become increasingly complex systems. These systems allow us to do a variety of actions that include: tele-banking, e commerce, tele-education, tele-work, tele-health, tele shopping, entertainment on demand, etc. In other words a family could stay home, get the food and water delivered, as well as any product bought from any store. While kids or adults could take courses at a distance, others in the family could tele-commute (i.e., work from home). A health care worker could visit any member of the family, or the family member could decide to visit specialist because of a specific condition/symptom or circumstance. So far, very few of these segments are interconnected and therefore most of these applications - - exist as silos. For example, many cable or satellite TV services have bidirectional communications. The services they provide today are multiple but mainly they have expanded the entertainment industry. The combination could result in a very powerful tool for the 21 century. The constant advancement in the areas of science and technology will allow us to reach new heights by helping humanity deal more effectively both medically and economically with all these diseases. A major challenge that we need to resolve is securing the privacy of the personal information