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What is e-health?
Everybody talks about e-health
these days, but few people have come up with a clear definition of this
comparatively new term. Barely in use before 1999, this term now seems to
serve as a general "buzzword," used to characterize not only
"Internet medicine", but also virtually everything related to
computers and medicine. The term was apparently first used by industry
leaders and marketing people rather than academics. They created and used
this term in line with other "e-words" such as e-commerce,
e-business, e-solutions, and so on, in an attempt to convey the promises,
principles, excitement (and hype) around e-commerce (electronic commerce)
to the health arena, and to give an account of the new possibilities the
Internet is opening up to the area of health care. Intel, for example,
referred to e-health as "a concerted effort undertaken by leaders in
health care and hi-tech industries to fully harness the benefits available
through convergence of the Internet and health care." Because the
Internet created new opportunities and challenges to the traditional
health care information technology industry, the use of a new term to
address these issues seemed appropriate. These "new" challenges
for the health care information technology industry were mainly (1) the
capability of consumers to interact with their systems online (B2C =
"business to consumer"); (2) improved possibilities for
institution-to-institution transmissions of data (B2B = "business to
business"); (3) new possibilities for peer-to-peer communication of
consumers (C2C = "consumer to consumer").
So, how can we define e-health in the
academic environment? One JMIR Editorial Board member feels that the term
should remain in the realm of the business and marketing sector and should
be avoided in scientific medical literature and discourse. However, the
term has already entered the scientific literature (today, 76
Medline-indexed articles contain the term "e-health" in the
title or abstract). What remains to be done is – in good
scholarly tradition – to define as well as possible what we are talking
about. However, as another member of the Editorial Board noted,
"stamping a definition on something like e-health is somewhat like
stamping a definition on 'the Internet': It is defined how it is used -
the definition cannot be pinned down, as it is a dynamic environment,
constantly moving."
It seems quite clear that e-health
encompasses more than a mere technological development. I would define the
term and concept as follows:
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.
This definition hopefully is broad enough
to apply to a dynamic environment such as the Internet and at the same
time acknowledges that e-health encompasses more than just "Internet
and Medicine".
As such, the "e" in e-health
does not only stand for "electronic," but implies a number of
other "e’s," which together perhaps best characterize what
e-health is all about (or what it should be). Last, but not least,
all of these have been (or will be) issues addressed in articles published
in the Journal of Medical Internet Research.
The 10 e’s in
"e-health"
- Efficiency
– one of the promises of e-health is to increase efficiency
in health care, thereby decreasing costs. One possible way of
decreasing costs would be by avoiding duplicative or
unnecessary diagnostic or therapeutic interventions, through
enhanced communication possibilities between health care
establishments, and through patient involvement.
- Enhancing
quality of care –
increasing efficiency involves not only reducing costs, but at
the same time improving quality. E-health may enhance the
quality of health care for example by allowing comparisons
between different providers, involving consumers as additional
power for quality assurance, and directing patient streams to
the best quality providers.
- Evidence
based –
e-health interventions should be evidence-based in a sense
that their effectiveness and efficiency should not be assumed
but proven by rigorous scientific evaluation. Much work still
has to be done in this area.
- Empowerment
of consumers and
patients – by making the knowledge bases of medicine and
personal electronic records accessible to consumers over the
Internet, e-health opens new avenues for patient-centered
medicine, and enables evidence-based patient choice.
- Encouragement
of a new relationship
between the patient and health professional, towards a true
partnership, where decisions are made in a shared manner.
- Education
of physicians through
online sources (continuing medical education) and consumers
(health education, tailored preventive information for
consumers)
- Enabling
information exchange
and communication in a standardized way between health care
establishments.
- Extending
the scope of health care beyond its conventional boundaries.
This is meant in both a geographical sense as well as in a
conceptual sense. e-health enables consumers to easily obtain
health services online from global providers. These services
can range from simple advice to more complex interventions or
products such a pharmaceuticals.
- Ethics
– e-health involves new forms of patient-physician
interaction and poses new challenges and threats to ethical
issues such as online professional practice, informed consent,
privacy and equity issues.
- Equity
– to make health
care more equitable is one of the promises of e-health, but at
the same time there is a considerable threat that e-health may
deepen the gap between the "haves" and
"have-nots". People, who do not have the money,
skills, and access to computers and networks, cannot use
computers effectively. As a result, these patient populations
(which would actually benefit the most from health
information) are those who are the least likely to benefit
from advances in information technology, unless political
measures ensure equitable access for all. The digital divide
currently runs between rural vs. urban populations, rich vs.
poor, young vs. old, male vs. female people, and between
neglected/rare vs. common diseases, .
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In addition to these 10 essential e’s,
e-health should also be
- easy-to-use,
- entertaining (no-one will use
something that is boring!) and
- exciting
- and it should definitely exist!
We invite other views on the definition
of e-health and hope that over time the journal will be filled with
articles which together elucidate the realm of e-health.
Gunther Eysenbach
Editor,
Journal of Medical Internet Research
Acknowledgements
Based on the author's speech delivered at
UNESCO (Paris), June 2001, Conference of the International Council for
Global Health Progress: Global health equity – Medical progress &
quality if life in the XXIst century.
The article was partly stimulated by the question "what is ehealth?"
asked by A. Risk on various mailing lists and in Health Informatics Europe
 http://hi-europe.co.uk/files/2001/9996.htm
.
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This is a
non peer-reviewed article (reviewed only by the Editorial
Board). Submitted 17.6.01, accepted 18.6.01, published
18.6.2001, minor corrections made 22.6.01
Please cite
as:
Eysenbach G. What is e-health? [editorial].
Journal of Medical Internet Research 2001;3(2):e20
<URL: http://www.jmir.org/2001/2/e20/>
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