Level 2: Services Without In-Person Contact Between Provider and Client

  • Thomas Wetter
Part of the Health Informatics book series (HI)


Level 2 Consumer Health Informatics services are defined as offered by health professionals to lay clients without personal contact during routine operation. Such services exist in wide variation. Medically they reach from health awareness through well-being and healthy behavior to therapy adaptation for severe diseases such as asthma or depression. Organizationally they reach from one stop shop advice gathering through various logistics, convenience, locator, recommendation and clinical pre-screening to accomplished medical treatments including delivery of prescription drugs. When such services implement practice of medicine they are in conflict with present health legislation, even if their disclaimers try to suggest that they only provide information. Some services have demonstrated sufficient potential for change of legislation to be considered.


Virtual services Health awareness Online coaching Online therapy Online pharmacy Locator services Mobile apps 


  1. 1.
    Anderson P, Jacobs C, Rothbaum BO. Computer-supported cognitive behavioral treatment of anxiety disorders. J Clin Psychol. 2004;60(3):253–67. doi:  10.1002/jclp.10262.PubMedCrossRefGoogle Scholar
  2. 2.
    Anhøj J, Nielsen L. Quantitative and qualitative usage data of an internet-based asthma monitoring tool. J Med Internet Res. 2004;6(3):e33. doi:  10.2196/jmir.6.3.e23.CrossRefGoogle Scholar
  3. 3.
    Bergström J, Andersson G, Ljótsson B, Rück C, Andréewitch S, Karlsson A, Carlbring P, Andersson E, Lindefors N. Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry. 2010;10(54):1471–244X. doi:  10.1186/1471-244X-10-54.Google Scholar
  4. 4.
    Bauer S, Moessner M. Harnessing the power of technology for the treatment and prevention of eating disorders. Int J Eat Disord. 2013;46:508–15. doi:  10.1002/eat.22109.PubMedCrossRefGoogle Scholar
  5. 5.
    Boyington AR, Wildemuth BM, Dougherty MC, Hall EP. Development of a computer-based system for continence health promotion. Nurs Outlook. 2004;52:241–7. doi:  10.1016/j.outlook.2004.04.014.PubMedCrossRefGoogle Scholar
  6. 6.
    Curioso WH, Blas MM, Nodell B, Alva IE, Kurth AE. Opportunities for providing web-based interventions to prevent sexually transmitted infections in peru. PLoS Med. 2007;4(2):e11. doi:  10.1371/journal.pmed.0040011.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Cuijpers P, Boluijt P, van Straten A. Screening of depression in adolescents through the internet. Eur Child Adolesc Psychiatry. 2008;17:32–8 doi:  10.1007/s00787-007-0631-2.PubMedCrossRefGoogle Scholar
  8. 8.
    Cuijpers P, Reynolds CF, Donker T, Li J, Andersson G, Beekman A. Personalized treatment of adult depression: medication, psychotherapy, or both? A systematic review. Depress Anxiety. 2012;29:855–64. doi:  10.1002/da.21985.PubMedCrossRefGoogle Scholar
  9. 9.
    Gorber SC, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res. 2009;11(1):12–24. doi:  10.1093/ntr/ntn010.CrossRefGoogle Scholar
  10. 10.
    Hill-Kayser CE, Vachani C, Hampshire MK, Jacobs LA, Metz JM. An internet tool for creation of cancer survivorship care plans for survivors and health care providers: design, implementation, use and user satisfaction. J Med Internet Res. 2009;11(3):e:39. doi:  10.2196/jmir.1223.
  11. 11.
    Hou JG, Murphy P, Tang AW, Khandelwal N, Duncan I, Pegus CL. Impact of an online prescription management account on medication adherence. Am J Manag Care. 2012; 18(3):e86–90.PubMedGoogle Scholar
  12. 12.
    Hsiung RC. The best of both worlds: and online self-help group hosted by a mental health professional. Cyberpsychol Behav. 2000;3(6):935–50. doi:  10.1089/109493100452200.CrossRefGoogle Scholar
  13. 13.
    Jena AB, Goldman DP, Foster SE, Califano JA. Prescription medication abuse and illegitimate internet-based pharmacies. Ann Intern Med. 2011;155:848–50. doi:  10.7326/0003-4819-155-12-201112200-00008.PubMedCrossRefGoogle Scholar
  14. 14.
    Kirshenbaum AP, Olsen DM, Bickel WK. A quantitative review of the ubiquitous relapse curve. J Subst Abuse Treat. 2009;36(1):8–17. doi:  10.1016/j.jsat.2008.04.001.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. doi:  10.1046/j.1525-1497.2001.016009606.x.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Liu W-T, Huang C-D, Wang C-H, Lee K-Y, Lin S-M, Kuo H-P. A mobile telephone-based interactive selfcare system improves asthma control. Eur Respir J. 2011;37:310–7. doi:  10.1183/09031936.00000810.PubMedCrossRefGoogle Scholar
  17. 17.
    Orizio G, Schulz P, Domenighini S, Bressanelli M, Rubinelli S, Caimi L, Gelatti U. Online consultations in cyberpharmacies: completeness and patient safety. Telemed e-Health. 2009;15(10):1022–5. doi:  10.1089/tmj.2009.0069.CrossRefGoogle Scholar
  18. 18.
    O’Connor EA, Whitlock EP, Gaynes B, Beil TL. Screening for depression in adults and older adults in primary care: an updated systematic review, volume 75 of evidence synthesis. Rockville: Agency for Healthcare Research and Quality; 2009. AHRQ Publication No. 10-05143-EF-1.Google Scholar
  19. 19.
    Cohen R, Elhadad M, Birk O. Analysis of free online physician advice services. PLoSONE. 2013;3(8):e59963. doi:  10.1371/journal.pone.0059963.CrossRefGoogle Scholar
  20. 20.
    Riffe D, Lacy S, Fico FG. Analyzing media messages. Using quantitative content analysis in research. Mahwah: Lawrence Erlbaum; 2005.Google Scholar
  21. 21.
    Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW, Gorman JM, Papp LA. Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997; 154:1571–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Strecher VJ, McClure JB, Alexander GL, Chakraborty B, Nair VN, Konkel JM, Greene SM, Collins LM, Carlier CC, Wiese CJ, Little RJ, Pomerleau CS, Pomerleau OF. Web-based smoking-cessation programs. Results of a randomized trial. Am J Prev Med. 2008;34(5):373–81. doi:  10.1016/j.amepre.2007.12.024.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Spek V, Nykliček I, Smits N, Cuijpers P, Riper H, Keyzer J, Pop V. Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: a randomized controlled clinical trial. Psychol Med. 2007;37:1797–806. doi:  10.1017/S0033291707000542.PubMedGoogle Scholar
  24. 24.
    Thompson DA, Lorenzo P, Christakis DA. Parent use of touchscreen computer kiosks for child health promotion in community settings. Pediatrics. 2007;119(3):427–34. doi:  10.1542/peds.2006-2669.PubMedCrossRefGoogle Scholar
  25. 25.
    van Bastelaar K, Cuijpers P, Pouwer F, Riper H, Snoek FJ. Development and reach of a web-based cognitive behavioural therapy programme to reduce symptoms of depression and diabetes-specific distress. Patient Educ Couns. 2011;84:49–55. doi:  10.1016/j.pec.2010.06.013.PubMedCrossRefGoogle Scholar
  26. 26.
    van Voorhees BW, Hsiung RC, Marko-Holguin M, Houston TK, Fogel J, Lee R, Ford DE. Internal versus external motivation in referral of primary care patients with depression to an internet support group: randomized controlled trial. JMIR. 2013;15(3):e42. doi:  10.2196/jmir.2197.PubMedCentralPubMedGoogle Scholar
  27. 27.
    Watts S, Newby JM, Mewton L, Andrews G. A clinical audit of changes in suicide ideas with internet treatment for depression. BMJ Open. 2012;2:e001558. doi:  10.1136/bmjopen-2012-001558.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Thomas Wetter
    • 1
    • 2
  1. 1.Institute for Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Biomedical Informatics and Medical EducationUniversity of Washington School of MedicineSeattleUSA

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