eHealth

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eHealth (also written e-health) is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999.[1] Usage of the term varies: some would argue it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health[2] while others use it in the narrower sense of healthcare practice using the Internet.[3][4][5] It can also include health applications and links on mobile phones, referred to as m-health or mHealth. Since about 2011, the increasing recognition of the need for better cyber-security and regulation may result in the need for these specialized resources to develop safer eHealth solutions that can withstand these growing threats.

Forms of e-health[edit]

The term can encompass a range of services or systems that are at the edge of medicine/healthcare and information technology, including:

  • Electronic health records: enabling the communication of patient data between different healthcare professionals (GPs, specialists etc.);
  • ePrescribing: access to prescribing options, printing prescriptions to patients and sometimes electronic transmission of prescriptions from doctors to pharmacists
  • Telemedicine: physical and psychological treatments at a distance, including telemonitoring of patients functions;
  • Consumer health informatics: use of electronic resources on medical topics by healthy individuals or patients;
  • Health knowledge management: e.g. in an overview of latest medical journals, best practice guidelines or epidemiological tracking (examples include physician resources such as Medscape and MDLinx);
  • Virtual healthcare teams: consisting of healthcare professionals who collaborate and share information on patients through digital equipment (for transmural care);
  • mHealth or m-Health: includes the use of mobile devices in collecting aggregate and patient level health data, providing healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vitals, and direct provision of care (via mobile telemedicine);
  • Medical research using Grids: powerful computing and data management capabilities to handle large amounts of heterogeneous data.[6]
  • Healthcare Information Systems: also often refer to software solutions for appointment scheduling, patient data management, work schedule management and other administrative tasks surrounding health

Contested definition[edit]

Several authors have noted the variable usage in the term, from being specific to the use of the Internet in healthcare to being generally around any use of computers in healthcare.[7] Various authors have considered the evolution of the term and its usage and how this maps to changes in health informatics and healthcare generally.[1][8][9] Oh et al., in a 2005 systematic review of the term's usage, offered the definition of eHealth[10] as a set of technological themes in health today, more specifically based on commerce, activities, stakeholders, outcomes, locations, or perspectives. One thing that all sources seem to agree on is that e-Health initiatives do not originate with the patient, though the patient may be a member of a patient organization that seeks to do this (see e-Patient).

E-Health data exchange[edit]

One of the factors blocking the use of e-Health tools from widespread acceptance is the concern about privacy issues regarding patient records, most specifically the EPR (Electronic patient record). This main concern has to do with the confidentiality of the data. There is also concern about non-confidential data however. Each medical practise has its own jargon and diagnostic tools. To standardize the exchange of information, various coding schemes may be used in combination with international medical standards. Of the forms of e-Health already mentioned, there are roughly two types; front-end data exchange and back-end exchange.

Front-end exchange typically involves the patient, while back-end exchange does not. A common example of a rather simple front-end exchange is a patient sending a photo taken by mobile phone of a healing wound and sending it by email to the family doctor for control. Such an actions may avoid the cost of an expensive visit to the hospital.

A common example of a back-end exchange is when a patient on vacation visits a doctor who then may request access to the patient's health records, such as medicine prescriptions, x-ray photographs, or blood test results. Such an action may reveal allergies or other prior conditions that are relevant to the visit.

Thesaurus[edit]

Successful e-Health initiatives such as e-Diabetes have shown that for data exchange to be facilitated either at the front-end or the back-end, a common thesaurus is needed for terms of reference.[11] Various medical practises in chronic patient care (such as for diabetic patients) already have a well defined set of terms and actions, which makes standard communication exchange easier, whether the exchange is initiated by the patient or the caregiver.

In general, explanatory diagnostic information (such as the standard ICD-10) may be exchanged insecurely, and private information (such as personal information from the patient) must be secured. E-health manages both flows of information, while ensuring the quality of the data exchange.

Early adopters[edit]

Chronic patients over time often acquire a high level of knowledge about the processes involved in their own care, and often develop a routine in coping with their condition. For these types of routine patients, front-end e-Health solutions tend to be relatively easy to implement.

E-Mental Health[edit]

E-mental health is frequently used to refer to internet based interventions and support for mental health conditions.[12] However, it can also refer to the use of information and communication technologies that also includes the use of social media, landline and mobile phones.[13] E-mental health services can include information; peer support services, computer and internet based programs, virtual applications and games as well as real time interaction with trained clinicians.[14] Programs can also be delivered using telephones and interactive voice response (IVR) [15]

Mental disorders includes a range of conditions such as alcohol and drug use disorders, mood disorders such as depression, dementia and Alzheimer’s disease, delusional disorders such as schizophrenia and anxiety disorders.[16] The majority of e-mental health interventions have focused on the treatment of depression and anxiety.[14] There are, however, programs also for problems as diverse as smoking cessation [17] gambling [18] and post-disaster mental health.[19]

Advantages and Disadvantages[edit]

E-mental health has a number of advantages such as being low cost, easily accessible and providing anonymity to users.[20] However, there are also a number of disadvantages such as concerns regarding user privacy and confidentiality. Online security involves the implementation of appropriate safeguards to protect user privacy and confidentiality. This includes appropriate collection and handling of user data, the protection of data from unauthorized access and modification and the safe storage of data.[21]

E-mental health has been gaining momentum in the academic research as well as practical arenas in a wide variety of disciplines such as psychology, clinical social work, family and marriage therapy, and mental health counseling. Testifying to this momentum, the E-Mental Health movement has its own international organization, The International Society for Mental Health Online.[22] It also has its own academic peer review journals, such as the Journal of Medical Internet Research.[23]

Programs[edit]

There are at least four programs currently available to treat anxiety and depression. Two programs have been identified by the UK National Institute for Clinical Excellence [24] as cost effective for use in primary care. The first is Fearfighter[25] which is a text based CBT[disambiguation needed] program to treat people with phobias and the second is Beating the Blues,[26] an interactive text, cartoon and video CBT program for anxiety and depression. Two programs have been supported for use in primary care by the Australian Government. The first is Anxiety Online,[27] a text based program for the anxiety, depressive and eating disorders, and the second is This Way Up,[28] a set of interactive text, cartoon and video programs for the anxiety and depressive disorders.

There are a number of online programs relating to smoking cessation. QuitCoach[29] is a personalised quit plan based on the users response to questions regarding giving up smoking and tailored individually each time the user logs in to the site. Freedom From Smoking[30] takes users through lessons that are grouped into modules that provide information and assignments to complete. The modules guide participants through steps such as preparing to quit smoking, stopping smoking and preventing relapse.

Other internet programs have been developed specifically as part of research into treatment for specific disorders. For example, an online self-directed therapy for problem gambling was developed to specifically test this as a method of treatment.[18] All participants were given access to a website. The treatment group was provided with behavioural and cognitive strategies to reduce or quit gambling. This was presented in the form of a workbook which encouraged participants to self-monitor their gambling by maintaining an online log of gambling and gambling urges. Participants could also use a smartphone application to collect self-monitoring information. Finally participants could also choose to receive motivational email or text reminders of their progress and goals.

An internet based intervention was also developed for use after Hurricane Ike in 2009.[19] During this study, 1,249 disaster-affected adults were randomly recruited to take part in the intervention. Participants were given a structured interview then invited to access the web intervention using a unique password. Access to the website was provided for a four month period. As participants accessed the site they were randomly assigned to either the intervention. those assigned to the intervention were provided with modules consisting of information regarding effective coping strategies to manage mental health and health risk behaviour.

Cybermedicine[edit]

Cybermedicine is the use of the Internet to deliver medical services, such as medical consultations and drug prescriptions. It is the successor to telemedicine, wherein doctors would consult and treat patients remotely via telephone or fax.

Cybermedicine is already being used in small projects where images are transmitted from a primary care setting to a medical specialist, who comments on the case and suggests which intervention might benefit the patient. A field that lends itself to this approach is dermatology, where images of an eruption are communicated to a hospital specialist who determines if referral is necessary.

A Cyber Doctor,[31] known in the UK as a Cyber Physician,[32] is a medical professional who does consultation via the internet, treating virtual patients, who may never meet face to face. This is a new area of medicine which has been utilized by the armed forces and teaching hospitals offering online consultation to patients before making their decision to travel for unique medical treatment only offered at a particular medical facility.[33]

Pioneering online mechanism for self-assessment[edit]

Emotional intelligence and health are perhaps best handled when the person seeking it is able to direct, take decisions and monitor the experience at frequent intervals. With tremendous advancements in our understanding of psychology and technology, we now have the wherewithal to conceive and design online and self-controlled mechanisms that help individuals become more aware and conscious of their nature, introspect about where they want to go by asking important questions of themselves, and continuously assess their ability to cope with the complexities of life.

Freedomsway (https://www.freedomsway.net) started very early in this field of work and realized the need to use technology for improving the wellbeing of the world more than anything else. Freedomsway provides a pioneering and yet simple tool called MAP (Meta-Analysis Profile) which is designed to urge, encourage and motivate individuals to pose provocative questions that may open up a new line of thought or make one conscious of one's challenges and strengths. It subsequently provides an engaging visual output that indicates how the individual fared in the most important dimensions of life. The output provided and the wise and customized suggestions that accompany the individual's results are expected to inspire her to improve her wellbeing by adopting specific habits and ideas.

The tool is a powerful manifestation of the quote “If an egg is broken by outside force, life ends. If broken by inside force, life begins. Great things always begin from inside.” – Jim Kwik, learning expert

MAP (https://www.freedomsway.net/Freedomsway-You.aspx) is a scientifically designed tool and has been examined and reviewed by neuroscience experts and psychologists. The aspects addressed by MAP in order to improve one's mental health are indicated below:

  • Develop your potential
  • Feel a greater sense of control over your life
  • Develop a sense of purpose
  • Experience positive relationships
  • Be more productive and engaged
  • Have more positive thoughts and emotions like interest, confidence and affection.
  • Increase your attention span
  • Generate more ideas
  • See the bigger picture more easily
  • Be more creative and flexible in your thinking
  • Experience the state of Flow

See also[edit]

Notes[edit]

  1. ^ a b Della Mea, Vincenzo. "What is e-Health (2): The death of telemedicine?". Journal of Medical Internet Research (Jmir.org) 3 (2): e22. doi:10.2196/jmir.3.2.e22. PMC 1761900. PMID 11720964. Retrieved 2012-04-15. 
  2. ^ International Telecommunication Union. "Implementing e-Health in Developing Countries: Guidance and Principles" (PDF). Retrieved 2012-04-15. 
  3. ^ "HIMSS SIG develops proposed e-health definition", HIMSS News, 13(7): 12
  4. ^ Eysenbach G, Diepgen TL. The role of e-health and consumer health informatics for evidence-based patient choice in the 21st century. Clin Dermatol. 2001 Jan-Feb;19(1):11-7
  5. ^ Ball MJ, Lillis J. E-health: transforming the physician/patient relationship. Int J Med Inform. 2001 Apr;61(1):1-10
  6. ^ Jochen Fingberg, Marit Hansen et al.: Integrating Data Custodians in eHealth Grids – Security and Privacy Aspects, NEC Lab Report, 2006
  7. ^ Eysenbach, G. "What is e-health?". Journal of Medical Internet Research (Jmir.org) 3 (2): e20. doi:10.2196/jmir.3.2.e20. PMC 1761894. PMID 11720962. Retrieved 2012-04-15. 
  8. ^ Pagliari, Claudia; Sloan, David; Gregor, Peter; Sullivan, Frank; Detmer, Don; Kahan, James P; Oortwijn, Wija; MacGillivray, Steve. "What Is eHealth (4): A Scoping Exercise to Map the Field". Journal of Medical Internet Research (Jmir.org) 7 (1): e9. doi:10.2196/jmir.7.1.e9. PMC 1550637. PMID 15829481. Retrieved 2012-04-15. 
  9. ^ Ahern, David K; Kreslake, Jennifer M; Phalen, Judith M; Bock, Beth. "What Is eHealth (6): Perspectives on the Evolution of eHealth Research". Journal of Medical Internet Research (Jmir.org) 8. doi:10.2196/jmir.8.1.e4. Retrieved 2012-04-15. 
  10. ^ Jadad, Alejandro; Oh, Hans; Rizo, Carlos; Enkin, Murray; Powell, John; Pagliari, Claudia. "What Is eHealth: A Systematic Review of Published Definitions". Journal of Medical Internet Research (Jmir.org) 7. doi:10.2196/jmir.7.1.e1. Retrieved 2012-04-15. 
  11. ^ "e-Diabetes on the website of the Dutch Diabetes foundation". Diabetesfederatie.nl. Retrieved 2012-04-15. 
  12. ^ Bennett, K., Reynolds, J., Christensen, H., & Griffiths, K.M. (2010) e-hub: an online self-help mental health service in the community. "Medical Journal of Australia", 192(11) S48-S52.
  13. ^ The NHS Confederation (2013) "E-Mental Health: what’s all the fuss about?" London, UK.
  14. ^ a b Australian Government (2012) "E-Mental Health Strategy for Australia." Canberra, Australia.
  15. ^ National Institute for Health & Clinical Excellence (2008) "Computerised cognitive behaviour therapy for depression and anxiety." London, UK.
  16. ^ American Psychiatric Association (2000) "Diagnostic and Statistical Manual of Mental Disorders." Eigal Meirovich, Baltimore, US.
  17. ^ Civljak, M., Sheikh, A., Stead, L.F. & Car, J. (2012) Internet-based interventions for smoking cessation. "Cochrane Database of Systematic Reviews" 2010, (9) Art. No:CD007078. Retrieved 21st April, 2013, from The Cochrane Library Database.
  18. ^ a b Hodgins, D.C. , Fick, G.H., Murray, R. & Cunningham, J.A.(2013) Internet-based interventions for disordered gamblers: study protocol for a randomized controlled trial of online self-directed cognitive-behavioural motivational therapy "BMC Public Health" (13) 10.
  19. ^ a b Ruggiero, K.J., Resnick, H. s., Paul, L.A., Gros, K., McCauley, J.L., Acierno, R., Morgan, M. & Galea, S. (2012) Randomized Controlled Trial of an Internet-Based Intervention Using Random-Digit-Dial Recruitment: "The Disaster Recovery" Web Project "Contemporary Clinical Trials" 33 (1) 237-246.
  20. ^ Andrews G. & Titov, N. (2010) Treating people you never see: internet-based treatment of the internalising mental disorders, "Australian Health Review," 34,2 pg 144-147.
  21. ^ Bennett K., Bennett A.J. & Griffiths K.M. (2010) Security Considerations for E-Mental Health Interventions "Journal of Medical Internet Research" 12(5):e61
  22. ^ http://www.ismho.org/home.asp
  23. ^ http://www.jmir.org/
  24. ^ http://www.nice.org.uk/
  25. ^ http://www.fearfighter.com/
  26. ^ http://www.beatingtheblues.co.uk/
  27. ^ http://www.anxietyonline.org.au/
  28. ^ http://thiswayup.org.au
  29. ^ http://www.quitcoach.org.au/
  30. ^ http://www.ffsonline.org/
  31. ^ US term,http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/05/27/BAGOKQ2IEQ1.DTL
  32. ^ UK term,http://society.guardian.co.uk/health/story/0,,408225,00.html
  33. ^ Online visits a boon for far-off patients, Sfgate.com,http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/05/27/BAGOKQ2IEQ1.DTL

Further reading[edit]

(M = Medline, W = Wilson Business Abstracts, G = Google)

  • 1999 Mitchell (G) A new term is needed to refer to the combined use of electronic communication and information technology in the health sector. The use in the health sector of digital data – transmitted, stored and retrieved electronically – for clinical, educational and administrative purposes, both at the local site and at a distance.
  • 2000 JHITA (G) Internet-related healthcare activities
  • 2000 McLendon (M) Ehealth refers to all forms of electronic healthcare delivered over the Internet, ranging from informational, educational and commercial "products" to direct services offered by professionals, non-professionals, businesses or consumers themselves. Ehealth includes a wide variety of the clinical activities that have traditionally characterized telehealth, but delivered through the Internet. Simply stated, Ehealth is making healthcare more efficient, while allowing patients and professionals to do the previously impossible.
  • 2000 DeLuca, Emmark - Frontiers of Medicine (W) (M) E-health is the embryonic convergence of wide-reaching technologies like the Internet, computer telephony/interactive voice response, wireless communications, and direct access to healthcare providers, care management, education, and wellness.
  • 2000 Pretlow (G) E-health is the process of providing health care via electronic means, in particular over the Internet. It can include teaching, monitoring ( e.g. physiologic data), and interaction with health care providers, as well as interaction with other patients afflicted with the same conditions.
  • 2001 Eysenbach (M) e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology
  • 2001 Strategic Health Innovations (G) The use of information technology in the delivery of health care.
  • 2001 Robert J Wood Foundation (G) EHealth is the use of emerging information and communication technology, especially the Internet, to improve or enable health and health care.
  • 2001 Ontario Hospital eHealth Council (G) EHealth is a consumer-centred model of health care where stakeholders collaborate utilizing ICTs including Internet technologies to manage health, arrange, deliver, and account for care, and manage the health care system.
  • 2003 COACH (G) The leveraging of the information and communication technology (ICT) to connect provider and patients and governments; to educate and inform health care professionals, managers and consumers; to stimulate innovation in care delivery and health system management; and, to improve our health care system.
  • 2003 eEurope - eHealth2003 (G) The application of information and communication technologies (ICT) across the whole range of functions which one way or another, affect the health of citizens and patients.
  • 2003 Regional Office for the Eastern Mediterranean - World Health Organization (G) E-health is a new term for the combined use of electronic communication and information technology in the health sector OR is the use, in the health sector, of digital data-transmitted, stored and retrieved electronically-for clinical, educational and administrative purposes, both at the local site and at a distance
  • 2003 HMS Europe (G) The practice of leveraging the Internet to connect caregivers, healthcare systems and hospitals with consumers
  • The Medicalisation of Cyberspace, by Dr Andy Miah & Dr Emma Rich
  • Cybermedicine by Warner V. Slack, Jossey Bass publisher Second Edition