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e-Health

e-Health
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 bullet  Preamble  bullet  Definitions  bullet  Application areas  bullet  Benefits  bullet  Issues  bullet  National e-Health / IT programmes  bullet  References  bullet  Links

 bullet  Health information technology adoption, programmes and plans  bullet  Public reports on e-Health  bullet  Electronic Medical Records  bullet  Personal Health Records  bullet  CPOE  bullet  e-prescribing  bullet  e-Health Applications for public use

Preamble
"eHealth is the single-most important revolution in healthcare since the advent of modern medicine, vaccines, or even public health measures like sanitation and clean water". [Silber, 2003]

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The term e-Health (E-Health, eHealth ...) has been in use since the year 2000. e-health encompasses much of medical informatics but tends to prioritise the delivery of clinical information, care and services rather than the functions of technologies. No single consensus, all-encompassing definition of eHealth exists - the term tends to be defined in terms of a series of characteristics specified at varying levels of detail and generality (see next section). The term is not included in the MeSH taxonomy but most of the topics typically classified as being part of e-health are encompassed within the medical informatics MeSH tree.

Throughout many western national healthcare services, extensive e-Health infrastructures and systems are now viewed as central to the future provision of safe, efficient, high quality, citizen-centred health care. (Information on current national e-Health implementation programmes, centred on the deployment of national information infrastructures and electronic medical record systems is provided on OpenClinical.)

Though current technological developments are essentially limited to developed countries, e-Health is now a global topic. It was discussed at the United Nations World Summit on the Information Society in December 2003 and at the World Health Assembly in May 2005. The World Health Organisation has established various e-Health initiatives, such as the WHO Global Observatory for eHealth (GOe) in 2005 which aims "to provide Member States with strategic information and guidance on effective practices, policies and standards in eHealth". The World Summit on the Information Society (WSIS), held with the participation of 175 countries (second phase, 16-18 November 2005, Tunis), affirmed its commitment to "improving access to the world's health knowledge and telemedicine services, in particular in areas such as global cooperation in emergency response, access to and networking among health professionals to help improve quality of life and environmental conditions".

In Europe, e-Health forms a major part of the European Commission eEurope action plan. The EU has set out ambitious plans for its member states envisaging the definition of health data interoperability standards by the end of 2006, the implementation of health information networks by 2008 and "online services such as teleconsultation (second medical opinion), e-prescription, e-referral, telemonitoring and telecare" by the end of 2008.

Definitions
The EC defines e-Health very generally as:

"the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers" [EC]

The World Health Organisation offers the following more detailed definition:

"eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research" [WHO].

Claudia Pagliari and colleagues, in a very detailed discussion of the field of eHealth, offer the following wider definition which also covers human and organisational factors:
"e-health is an emerging field of medical informatics, referring to the organisation and delivery of health services and information using the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a new way of working, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology" [Eysenbach, 2001, adapted by Pagliari et al, 2005].

Gunther Eysenbach offers the following succinct definition on his homepage:

"eHealth = Medicine + Communication + Information + Society" [Gunther Eysenbach].

application areas

Key application areas of e-Health:

  • Electronic Medical Records (including patient records, clinical administration systems, digital imaging & archiving systems, e-prescribing, e-booking)
  • Telemedicine and telecare services; health information networks
  • Decision support tools
  • Internet-based technologies and services
e-Health also covers virtual reality, robotics, multi-media (e.g. CDROM), digital imaging, computer assisted surgery, wearable and portable monitoring systems, health portals.

e-Health technologies with the potential to have a significant future impact on patient care include Internet-enabled applications for chronic diseases which could help increase citizen empowerment in health maintenance and decision making supporting self-care.
Benefits
e-Health is expected to improve various aspects of healthcare (quality, cost-efficiency, access ...) by:

  • Supporting the delivery of care tailored to individual patients, where ICT enables more informed decision making based both on evidence and patient-specific data;
  • Improving transparency and accountability of care processes and facilitating shared care across boundaries;
  • Aiding evidence-based practice and error reduction;
  • Improving diagnostic accuracy and treatment appropriateness;
  • Improving access to effective healthcare by reducing barriers created, for example, by physical location or disability;
  • Facilitating patient empowerment for self-care and health decision making;
  • Improving cost-efficiency by streamlining processes, reducing waiting times and waste.
Issues

  • Lack of rigorous and generalisable evidence of the effectiveness and cost-effectiveness of eHealth applications and technologies.
  • R&D will need to address human and organisational factors affecting implementation, from the perspectives of both health service staff and consumers (patients and citizens). Evaluation studies equally will require a multidisciplinary approach.
  • Implementation and integration of eHealth systems into care processes are constrained by insufficient levels of systems interoperability (though moves to ensure standardisation in many current e-Health implementation programmes will reduce this).
  • The legal and ethical implications of using health imformation technologies and clinical decision support systems which may result in harmful effects in certain cases are not yet clear. (In awareness of this, the USA government in its 10 year Health Information Technology Plan is aiming to clarify the regulatory framework for electronic records and and incentive their use.) System developers need to employ quality and safety assurance methods to avoid clinical risks and legal liability.
  • The effects of eHealth tools on patient behaviour and the patient-clinician relationship are unclear.
  • Potential health inequalities resulting from the ‘digital divide’, particularly affecting the disabled and the elderly, need to be minimised.
  • The potential roles and influences of different eHealth media and settings (e.g. kiosks, workplace) need to be explored.
references: general

Silber D. Silber D. The case for eHealth. (Presented at the European Commission’s first high-level conference on eHealth May 22/23 2003.) European Institute of Public Administration 2003.

[]   [EC]

" The Case for eHealth is an independent report, researched and written for presentation at the European Commission’s first high level conference on eHealth, May, 2003. Representatives of the Health and Telecommunications ministries of 25 European states attended this unique gathering, focusing on quality e- Health implementations in Europe. The following reasons justify a dialogue with the ministers of Health and Telecommunications regarding eHealth

  • e-Health is the single-most important revolution in healthcare since the advent of modern medicine or hygiene.
  • There are numerous European e-Health achievements.
  • European expertise can satisfy national and international needs for health services.
The Case for eHealth is intended to encourage dialogue regarding next steps for health systems; this dialogue will involve policymakers, healthcare professionals, and citizens, each at their own level of involvement. "

Oh H, Rizo C, Enkin M, Jadad A. What is eHealth: a systematic review of published definitions. J Med Internet Res. 2005 Feb 24;7(1.

[PubMed]   [JMIR]

" Context: The term eHealth is widely used by many individuals, academic institutions, professional bodies, and funding organizations. It has become an accepted neologism despite the lack of an agreed-upon clear or precise definition. We believe that communication among the many individuals and organizations that use the term could be improved by comprehensive data about the range of meanings encompassed by the term. Objective: To report the results of a systematic review of published, suggested, or proposed definitions of eHealth. Data Sources: Using the search query string “eHealth” OR “e-Health” OR “electronic health”, we searched the following databases: Medline and Premedline (1966-June 2004), EMBASE (1980-May 2004), International Pharmaceutical Abstracts (1970-May 2004), Web of Science (all years), Information Sciences Abstracts (1966-May 2004), Library Information Sciences Abstracts (1969-May 2004), and Wilson Business Abstracts (1982-March 2004). In addition, we searched dictionaries and an Internet search engine. Study Selection: We included any source published in either print format or on the Internet, available in English, and containing text that defines or attempts to define eHealth in explicit terms. Two of us independently reviewed titles and abstracts of citations identified in the bibliographic databases and Internet search, reaching consensus on relevance by discussion. Data Extraction: We retrieved relevant reports, articles, references, letters, and websites containing definitions of eHealth. Two of us qualitatively analyzed the definitions and coded them for content, emerging themes, patterns, and novel ideas. Data Synthesis: The 51 unique definitions that we retrieved showed a wide range of themes, but no clear consensus about the meaning of the term eHealth. We identified 2 universal themes (health and technology) and 6 less general (commerce, activities, stakeholders, outcomes, place, and perspectives). Conclusions: The widespread use of the term eHealth suggests that it is an important concept, and that there is a tacit understanding of its meaning. This compendium of proposed definitions may improve communication among the many individuals and organizations that use the term. "

Pagliari C, Sloan D, Gregor P et al. What is eHealth ?: a scoping exercise to map the field. J Med Internet Res. 2005 Mar 31;7(1):e9.

[PubMed]   [JMIR]

" Background: Lack of consensus on the meaning of eHealth has led to uncertainty among academics, policymakers, providers and consumers. This project was commissioned in light of the rising profile of eHealth on the international policy agenda and the emerging UK National Programme for Information Technology (now called Connecting for Health) and related developments in the UK National Health Service. Objectives: To map the emergence and scope of eHealth as a topic and to identify its place within the wider health informatics field, as part of a larger review of research and expert analysis pertaining to current evidence, best practice and future trends. Methods: Multiple databases of scientific abstracts were explored in a nonsystematic fashion to assess the presence of eHealth or conceptually related terms within their taxonomies, to identify journals in which articles explicitly referring to eHealth are contained and the topics covered, and to identify published definitions of the concept. The databases were Medline (PubMed), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Science Citation Index (SCI), the Social Science Citation Index (SSCI), the Cochrane Database (including Dare, Central, NHS Economic Evaluation Database [NHS EED], Health Technology Assessment [HTA] database, NHS EED bibliographic) and ISTP (now known as ISI proceedings).We used the search query, “Ehealth OR e-health OR e*health”. The timeframe searched was 1997-2003, although some analyses contain data emerging subsequent to this period. This was supplemented by iterative searches of Web-based sources, such as commercial and policy reports, research commissioning programmes and electronic news pages. Definitions extracted from both searches were thematically analyzed and compared in order to assess conceptual heterogeneity. Results: The term eHealth only came into use in the year 2000, but has since become widely prevalent. The scope of the topic was not immediately discernable from that of the wider health informatics field, for which over 320000 publications are listed in Medline alone, and it is not explicitly represented within the existing Medical Subject Headings (MeSH) taxonomy. Applying eHealth as narrative search term to multiple databases yielded 387 relevant articles, distributed across 154 different journals, most commonly related to information technology and telemedicine, but extending to such areas as law. Most eHealth articles are represented on Medline. Definitions of eHealth vary with respect to the functions, stakeholders, contexts and theoretical issues targeted. Most encompass a broad range of medical informatics applications either specified (eg, decision support, consumer health information) or presented in more general terms (eg, to manage, arrange or deliver health care). However the majority emphasize the communicative functions of eHealth and specify the use of networked digital technologies, primarily the Internet, thus differentiating eHealth from the field of medical informatics. While some definitions explicitly target health professionals or patients, most encompass applications for all stakeholder groups. The nature of the scientific and broader literature pertaining to eHealth closely reflects these conceptualizations. Conclusions: We surmise that the field – as it stands today – may be characterized by the global definitions suggested by Eysenbach and Eng. "

Wyatt JC, Sullivan F. eHealth and the future: promise or peril? BMJ. 2005 Dec 10;331(7529):1391-3. Review.

[PubMed]   []

" Despite the futuristic sound of the scenario in the box below, all the technologies mentioned are available, and some, such as computer interviewing, have been used since the 1960s. Such a scenario raises questions about the nature of clinical practice and healthcare systems—for example, how much information and responsibility should be transferred to patients when technology allows it. This final article examines some of these issues, and ends the series where it started, with a reminder that health informatics is more about understanding people and new models of care than it is about technology... "

Shortliffe EH. Strategic action in health information technology: why the obvious has taken so long. Health Aff (Millwood). 2005 Sep-Oct;24(5):1222-33.

[PubMed]   [Healt Aff]

" Recent enthusiasm for the automation of medical records and the creation of a health information infrastructure must be viewed in the context of a four-decade history of anticipation and investment. To understand the current opportunities and challenges, we must understand both the evolution of attitudes and accomplishments in health care information technology (IT) and the cultural, economic, and structural phenomena that constrain our ability to embrace the technology. Because prudent IT investment could make a profound difference in U.S. health and disease management, our strategic response must begin with an understanding of the pertinent history plus the challenges that lie ahead. "

England I, Stewart D, Walker S. Information technology adoption in health care: when organisations and technology collide. Aust Health Rev. 2000;23(3):176-85. Review.

[PubMed]   []

" The implementation of advanced information systems is enabling great social and organisational changes. However, health care has been one of the slowest sectors to adopt and implement information technology (IT). This paper investigates why this is so, reviewing innovation diffusion theory and its application to both health organisations and information technology. Innovation diffusion theory identifies variables that influence the 'innovativeness' of organisations and the rate at which a technology diffuses. When analysed, these variables show why IT implementation has progressed at a slower rate in health compared with other industry sectors. The complexity of health organisations and their fragmented internal structure constrain their ability to adopt organisation wide IT. This is further impacted upon by the relative immaturity of strategic health IT which is complicated and unable to show quantifiable benefits. Both organisational and technological factors lead to the slow adoption of strategic IT. On the other hand, localised IT solutions and those providing measurable cost reductions have diffused well. "

David J. Brailer (national health information technology coordinator, U.S. Department of Health and Human Services - until May 2006) Interoperability: The Key To The Future Health Care System, January 2005.

[]   [NLM]

" The United States is building a point-of-care health information system to rival the worldwide network of electronic banking. Through health care information exchange and interoperability, clinicians will have access to a longitudinal medical record. This interoperability is a fundamental requirement for the health care system to derive the societal benefits promised by the adoption of electronic medical records (EMRs). ... "

Berner ES, Moss J. Informatics Challenges for the Impending Patient Information Explosion. J Am Med Inform Assoc. 2005.

[PubMed]   []

" As we move toward the era when health information is more readily accessible and transferable, there are a number of issues that will arise. This article will address the challenges of information filtering, context-sensitive decision support, legal and ethical guidelines regarding obligations to obtain and use the information, aligning patient and health professional's expectations in regard to the use and usefulness of the information, and enhancing data reliability. The authors discuss the issues and offer suggestions for addressing them. "

Haux R. Health information systems - past, present, future. Int J Med Inform. 2005 Sep 15;

[PubMed]   []

" In 1984, Peter Reichertz gave a lecture on the past, present and future of hospital information systems. In the meantime, there has been a tremendous progress in medicine as well as in informatics. One important benefit of this progress is that our life expectancy is nowadays significantly higher than it would have been even some few decades ago. This progress, leading to aging societies, is of influence to the organization of health care and to the future development of its information systems. Twenty years later, referring to Peter Reichertz' lecture, but now considering health information systems (HIS), two questions are discussed: which were lines of development in health information systems from the past until today? What are consequences for health information systems in the future? The following lines of development for HIS were considered as important: (1) the shift from paper-based to computer-based processing and storage, as well as the increase of data in health care settings; (2) the shift from institution-centered departmental and, later, hospital information systems towards regional and global HIS; (3) the inclusion of patients and health consumers as HIS users, besides health care professionals and administrators; (4) the use of HIS data not only for patient care and administrative purposes, but also for health care planning as well as clinical and epidemiological research; (5) the shift from focusing mainly on technical HIS problems to those of change management as well as of strategic information management; (6) the shift from mainly alpha-numeric data in HIS to images and now also to data on the molecular level; (7) the steady increase of new technologies to be included, now starting to include ubiquitous computing environments and sensor-based technologies for health monitoring. As consequences for HIS in the future, first the need for institutional and (inter-) national HIS-strategies is seen, second the need to explore new (transinstitutional) HIS architectural styles, third the need for education in health informatics and/or biomedical informatics, including appropriate knowledge and skills on HIS. As these new HIS are urgently needed for reorganizing health care in an aging society, as last consequence the need for research around HIS is seen. Research should include the development and investigation of appropriate transinstitutional information system architectures, of adequate methods for strategic information management, of methods for modeling and evaluating HIS, the development and investigation of comprehensive electronic patient records, providing appropriate access for health care professionals as well as for patients, in the broad sense as described here, e.g. including home care and health monitoring facilities. Comparing the world in 1984 and in 2004, we have to recognize that we imperceptibly, stepwise arrived at a new world. HIS have become one of the most challenging and promising fields of research, education and practice for medical informatics, with significant benefits to medicine and health care in general. "

References: international perspectives

Telehealth in the Developing World. Editors: Richard Wootton, Nivritti G. Patil, Richard E. Scott and Kendall Ho. Royal Society of Medicine Press and International Development Research Centre, 2009.

[IDRC]   []

" Health care is primarily about people-to-people interactions. It is about understanding, diagnosis, physical contact, communication, and, ultimately, providing care. By bringing people together, telecommunication technologies have the potential to improve both the quality of and access to health care in the remotest areas of the developing world. Telemedicine offers solutions for emergency medical assistance, long-distance consultation, administration and logistics, supervision and quality assurance, and education and training for healthcare professionals and providers.

"This book aims to redress the relative lack of published information on successful telehealth solutions in the developing world. It presents real-life stories from Asia, Africa, and Latin America. It is rich in practical experience and will be of interest to health professionals, development workers, and e-health and telehealth proponents interested in learning about, or contributing to the implementation of, appropriate solutions for 80% of the world’s population. "

Mishra, S.K. (2005) Current status of E-health in India. In: Busan, 23-25 June 2005, Busan, Korea.

[]   [OpenMED@NIC]

"India is a vast country of 1. 4 billion population occupying an area of 3,287,268 Sq. kms. It consists of 29 states and 6 Union Territories governed by a federal system. There is no national health insurance policy for the country. Government supported healthcare delivery follows a three tier system and is the primary responsibility of each state. The scale of e-health services in India has been very small so far considering it’s size, mostly limited to medical transcription, health awareness through portals, telemedicine, hospital management system and customer service using the internet."

Doupi P, Hamalainen P, Ruotsalainen P. eHealth in Europe: towards higher goals. World Hosp Health Serv. 2005;41(2):35-9, 41, 43.

[PubMed]   []

" Significant events are unfolding in the field of eHealth in Europe. eHealth has been a strategic priority of the European Commission in both the eEurope 2002 and 2005 Action Plans. But how are developments on the national level progressing? The authors contrast the status-quo of eHealth in the EU-15 with the latest trends and key action priorities in the EU-25 after the Union's latest enlargement in May 2004. The initiatives and actions of the European Commission are presented vis-a-vis those of national Member States, particularly in terms of strategic priorities and implementation actions. The review is accompanied by an analysis of expert feedback on eHealth drivers and barriers. "

Holliday I, Tam WK. E-health in the East Asian tigers. Int J Med Inform. 2004 Nov;73(11-12):759-69.

[PubMed]   []

" OBJECTIVE: The article analyzes e-health progress in East Asia's leading tiger economies: Japan, Hong Kong, Singapore, South Korea and Taiwan. It describes five main dimensions of e-health provision in the tigers: policymaking, regulation, provision, funding and physician-patient relations. METHODS: We conducted a series of fieldwork interviews and analyzed key healthcare websites. RESULTS AND CONCLUSION: Our main finding is that the development of e-health in the region is less advanced than might be expected. Our explanation focuses on institutional, cultural and financial factors. "

Alvarez RC. The promise of e-Health - a Canadian perspective. eHealth Int. 2002 Sep 17;1(1):4.

[PubMed]   [PubMed Central]

" Canadians value their health care system above any other social program. Canada's system of health care faces significant financial and population pressures, relating to cost, access, quality, accountability, and the integration of information and communication technologies (ICTs). The health-system also faces certain unique challenges that include care delivery within a highly decentralised system of financing and accountability, and care delivery to a significant portion of the population sparsely distributed across a landmass of 10 million square kilometres, in areas of extreme climatic conditions. All of these challenges are significant catalysts in the development of technologies that aim to significantly mitigate or eliminate these selfsame challenges.The system is undergoing widespread review, nationally, and within each province and territory, where the bulk of care provision is financed and managed. The challenges are being addressed by national, regional and provincial initiatives in the public, private and not-for-profit sectors.The promise of e-Health lies in the manner and degree to which it can mitigate or resolve these challenges to the health system and build on advancements in ICTs supporting the development of a health infostructure. Canada is actively developing and implementing technological solutions to deliver health information and health care services across the country. These solutions, while exciting and promising, also present new challenges, particularly in regard to acceptable standards, choice of technologies, overcoming traditional jurisdictional boundaries, up-front investment, and privacy and confidentially.Many organisations and governments are working to address these challenges. The Canadian Institute for Health Information (CIHI) will play an increasingly significant role in these initiatives, as the management of health information becomes a more crucial factor in the successful delivery of health care services in the new millennium. "

Rodrigues RJ, Risk A. eHealth in Latin America and the Caribbean: development and policy issues. J Med Internet Res. 2003 Jan-Mar;5(1):e4.

[PubMed]   [JMIR]

" This paper reviews trends and issues in health and in the information and communication technologies (ICT) market as they relate to the deployment of eHealth solutions in Latin America and the Caribbean. Heretofore designed for industrialized countries and large organizations, eHealth solutions are being proposed as an answer to a variety of health-system management problems and health care demands faced by all health organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational support of the new health care models being implemented in many countries. The authors examine those developments vis-a-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region. "

Drury P. The eHealth agenda for developing countries. World Hosp Health Serv. 2005;41(4):38-40.

[PubMed]   []

" Delivering eHealth in developing countries faces different health and socio-economic challenges to the developed one. But, if a global health infrastructure is to evolve, then developing countries need to play their part. So, whilst the context may differ, the localization-globalization of content issues needs to be jointly addressed. In providing robust and affordable connectivity, particularly to rural areas, developing countries can fully exploit the potential of handheld computers and wireless connectivity. Over such an infrastructure new ways of building capacity, both locally and globally, can be supported. Finally, an eHealth infrastructure can support the delivery of healthcare in communities, thereby supporting individuals and community development. "

links
 bullet  eHealthServer.com (EU)  bullet  What is eHealth? (European Commission)  bullet  eHealth (EC)  bullet  eEurope 2005 Action Plan (EC)  bullet  EU member states - progess on national eHealth roadmaps  bullet  ICT for Health portal - part of the ICT for Business and Citizens Directorate at the European Commission  bullet  ePractice.eu: EU eGovernment portal (covers e-Health)  bullet  eHealth Thesaurus (Health Canada)  bullet  WHO Global Observatory for eHealth (GOe)  bullet  World Summit on the Information Society, Geneva-Tunis, 2005  bullet  Health Information Network Europe  bullet  eHealth Initiative  bullet  Health information technology adoption, programmes and plans [OC]  bullet  Public reports on E-health [OC]  bullet  eHealth InfoSource cybersanté from Health Canada (conferences in Canada, documents, journals)  bullet  eHealthNews.EU Portal  bullet  eHealth Directory EU  bullet  Canadian eHealth Initiatives Database is a searchable database that currently profiles over 250 Canadian electronic health record, telehealth, education and training, privacy, and health information infrastructure projects and programs  bullet  eHealth in Germany (DIMDI: Deutsches Institut für Medizinische Dokumentation und Information)  bullet  Revista eSalud - journal of eHealth in Spanish (based in Málaga)  bullet  Centre for Global eHealth Innovation at the University of Toronto  bullet  Interactive Health Network (IHN) - "dedicated to using online technologies to combat health inequities"  bullet  The Telemedicine Alliance (European Space Agency, WHO, the International Telecommunication Union and the Information Society Technologies programme of the European Commission)  bullet  eGovernment factsheets on EU countries (includes e-Health) (EU eGovernment Observatory)  bullet  eGovernment News (includes e-Health) on EU eGovernment Observatory  bullet  Telemedicine & eHealth Directories 2004, 2005 (produced by International Telecommunication Union, World Health Organization, International Society for Telemedicine & eHealth, Med-e-Tel)  bullet  eHealth Competence Center, University of Regensburg Medical Center
acknowledgements
Claudia Pagliari, Division of Clinical and Community Health Sciences, University of Edinburgh
page history
Entry on OpenClinical: 13 September 2005
Last main update: 12 December 2005




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