EHealth

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eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. [1] Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". [2] A study in 2005 found 51 unique definitions. [3] Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health [4] while others use it in the narrower sense of healthcare practice using the Internet. [5] [6] [7] It can also include health applications and links on mobile phones, referred to as mHealth or m-Health. [8] Key components of eHealth include electronic health records (EHRs), telemedicine, health information exchange, mobile health applications, wearable devices, and online health information. These technologies enable healthcare providers, patients, and other stakeholders to access, manage, and exchange health information more effectively, leading to improved communication, decision-making, and overall healthcare outcomes.

Contents

Types

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

Contested Definition

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. [16] 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] [17] [18] Oh et al., in a 2005 systematic review of the term's usage, offered the definition of eHealth as a set of technological themes in health today, more specifically based on commerce, activities, stakeholders, outcomes, locations, or perspectives. [3] 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, as in the e-Patient movement.

eHealth literacy

eHealth literacy is defined as "the ability to seek, find, understand and appraise health information from electronic sources and apply knowledge gained to addressing or solving a health problem." [19] According to this definition, eHealth literacy encompasses six types of literacy: traditional (literacy and numeracy), information, media, health, computer, and scientific. Of these, media and computer literacies are unique to the Internet context, with eHealth media literacy being the awareness of media bias or perspective, the ability to discern both explicit and implicit meaning from media messages, and to derive meaning from media messages. The literature includes other definitions of perceived media capability or efficacy, but these were not specific to health information on the Internet. [20] Having the composite skills of eHealth literacy allows health consumers to achieve positive outcomes from using the Internet for health purposes. eHealth literacy has the potential to both protect consumers from harm and empower them to fully participate in informed health-related decision making. People with high levels of eHealth literacy are also more aware of the risk of encountering unreliable information on the Internet [21] On the other hand, the extension of digital resources to the health domain in the form of eHealth literacy can also create new gaps between health consumers. [20] eHealth literacy hinges not on the mere access to technology, but rather on the skill to apply the accessed knowledge. [19] The efficiency of eHealth also heavily relies on the efficiency and ease of use regarding technology being used by the patient. A high understanding of technology will not overcome the obstacles of overcomplicated technology being used by patients that are physically and mentally hindered. [22]

The population of elderly people surpassed the number of children for the first time in history in 2018. A more multi-faceted approach is necessary for this age group, because they are more susceptible to chronic disease, contraindications of medication, and other age-related setbacks like forgetfulness. Ehealth offers services that can be very helpful for all of these scenarios, making an elderly patient's quality of life substantially better with proper use. [23]

Data exchange

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. Each medical practice has its own jargon and diagnostic tools, so to standardize the exchange of information, various coding schemes may be used in combination with international medical standards. Systems that deal with these transfers are often referred to as Health Information Exchange (HIE). 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 via email to the family doctor for control. Such an action 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

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. [8] [24] Various medical practices 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

Patients living with long term conditions (also called chronic conditions) 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

E-mental health is frequently used to refer to internet based interventions and support for mental health conditions. [25] 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. [26] [27] 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. [28] Programs can also be delivered using telephones and interactive voice response (IVR). [29]

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. [30] [ page needed ] The majority of e-mental health interventions have focused on the treatment of depression and anxiety. [28] There are also E-mental health programs available for other interventions such as smoking cessation, [31] gambling, [32] and post-disaster mental health. [33]

Advantages and disadvantages

E-mental health has a number of advantages such as being low cost, easily accessible and providing anonymity to users. [34] However, there are also a number of disadvantages such as concerns regarding treatment credibility, user privacy and confidentiality. [35] 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. [36] Technical difficulties are another potential disadvantage. With almost all forms of technology, there will be unintended difficulties or malfunctions, which doesn't exclude tablets, computers, and wireless medical devices. Ehealth is also very dependent on the patient having functional Wi-Fi, which can be an issue that cannot be fixed without an expert. [4]

E-mental health has been gaining momentum in the academic research as well as practical arenas [37] 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. [38] However, e-Mental health implementation into clinical practice and healthcare systems remains limited and fragmented. [39] [40]

Programs

There are at least five programs currently available to treat anxiety and depression. Several programs have been identified by the UK National Institute for Health and Care Excellence as cost effective for use in primary care. [29] These include Fearfighter, [41] a text based cognitive behavioral therapy program to treat people with phobias, and Beating the Blues, [42] 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. [43] The first is Anxiety Online, [44] a text based program for the anxiety, depressive and eating disorders, and the second is THIS WAY UP, [45] a set of interactive text, cartoon and video programs for the anxiety and depressive disorders. Another is iFightDepression [46] a multilingual, free to use, web-based tool for self-management of less severe forms of depression, for use under guidance of a GP or psychotherapist.

There are a number of online programs relating to smoking cessation. QuitCoach [47] is a personalised quit plan based on the users response to questions regarding giving up smoking and tailored individually each time the user logs into the site. Freedom From Smoking [48] 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. [32] 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. [33] 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.

eHealth programs have been found to be effective in treating borderline personality disorder (BPD). [49]

Cybermedicine

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.

The field has also expanded to include online "ask the doctor" services that allow patients direct, paid access to consultations (with varying degrees of depth) with medical professionals (examples include Bundoo.com, Teladoc, and Ask The Doctor).

A Cyber Doctor, [50] known in the UK as a Cyber Physician, [51] 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. [50]

Self-monitoring healthcare devices

Self-monitoring is the use of sensors or tools which are readily available to the general public to track and record personal data. The sensors are usually wearable devices and the tools are digitally available through mobile device applications. Self-monitoring devices were created for the purpose of allowing personal data to be instantly available to the individual to be analyzed. As of now, fitness and health monitoring are the most popular applications for self-monitoring devices. [52] The biggest benefit to self-monitoring devices is the elimination of the necessity for third party hospitals to run tests, which are both expensive and lengthy. These devices are an important advancement in the field of personal health management.

Nike FuelBand NikeFuelband.jpg
Nike FuelBand

Self-monitoring healthcare devices exist in many forms. An example is the Nike+ FuelBand, which is a modified version of the original pedometer. [52] This device is wearable on the wrist and allows one to set a personal goal for a daily energy burn. It records the calories burned and the number of steps taken for each day while simultaneously functioning as a watch. To add to the ease of the user interface, it includes both numeric and visual indicators of whether or not the individual has achieved his or her daily goal. Finally, it is also synced to an iPhone app which allows for tracking and sharing of personal record and achievements. [53]

Other monitoring devices have more medical relevance. A well-known device of this type is the blood glucose monitor. The use of this device is restricted to diabetic patients and allows users to measure the blood glucose levels in their body. It is extremely quantitative and the results are available instantaneously. [54] However, this device is not as independent of a self-monitoring device as the Nike+ Fuelband because it requires some patient education before use. One needs to be able to make connections between the levels of glucose and the effect of diet and exercise. In addition, the users must also understand how the treatment should be adjusted based on the results. In other words, the results are not just static measurements.

The demand for self-monitoring health devices is skyrocketing, as wireless health technologies have become especially popular in the last few years. In fact, it is expected that by 2016, self-monitoring health devices will account for 80% of wireless medical devices. [55] The key selling point for these devices is the mobility of information for consumers. The accessibility of mobile devices such as smartphones and tablets has increased significantly within the past decade. This has made it easier for users to access real-time information in a number of peripheral devices.

There are still many future improvements for self-monitoring healthcare devices. Although most of these wearable devices have been excellent at providing direct data to the individual user, the biggest task which remains at hand is how to effectively use this data. Although the blood glucose monitor allows the user to take action based on the results, measurements such as the pulse rate, EKG signals, and calories do not necessarily serve to actively guide an individual's personal healthcare management. Consumers are interested in qualitative feedback in addition to the quantitative measurements recorded by the devices. [56]

eHealth During COVID-19

Online healthcare appointment via webcam Xiao Zhong Zheng Yuan Chang Jin Xing Telecare conference.jpg
Online healthcare appointment via webcam

The pandemic that impacted the entire world made it extremely difficult for vast amounts of people to receive adequate healthcare in person. Elderly citizens and people with chronic health conditions were at more risk than the average healthy human, therefore they were more adversely affected than most. The switch from in-person to telehealth appointments and interventions was necessary to reduce the risks of spreading and/or contracting the disease. [57] The forced use of telehealth during the pandemic highlighted its strengths and weaknesses, which accelerated the progression of this medium. The user feedback on eHealth during the COVID-19 pandemic was very positive, and consequently many patients and healthcare providers reported that they will continue to use this method of healthcare following the pandemic. [2]

In developing countries

eHealth in general, and telemedicine in particular, is a vital resource to remote regions of emerging and developing countries but is often difficult to establish because of the lack of communications infrastructure. [58] For example, in Benin, hospitals often can become inaccessible due to flooding during the rainy season [59] and across Africa, the low population density, along with severe weather conditions and the difficult financial situation in many African states, has meant that the majority of the African people are badly disadvantaged in medical care. In many regions there is not only a significant lack of facilities and trained health professionals, but also no access to eHealth because there is also no internet access in remote villages, or even a reliable electricity supply. [60]

Approximately 13 percent of people who live in Kenya have health insurance. A majority of the total health expenditure in sub-Saharan Africa was paid out-of-pocket, which forces millions into poverty yearly. A Kenyan service by the name of M-PESA may offer a solution to this problem. This mobile platform provides full transparency of patients needs and allows access to medical products and the ability to efficiently manage their funding. [61]

Internet connectivity, and the benefits of eHealth, can be brought to these regions using satellite broadband technology, and satellite is often the only solution where terrestrial access may be limited, or poor quality, and one that can provide a fast connection over a vast coverage area. [60]

Evaluation

While eHealth has become an indispensable facet of healthcare in the past 5 years, there are still barriers preventing it from reaching its full potential. Knowledge of the socio-economic performance of eHealth is limited, and findings from evaluations are often challenging to transfer to other settings. Socio-economic evaluations of some narrow types of mHealth can rely on health economic methodologies, but larger scale eHealth may have too many variables, and tortuous, intangible cause and effect links may need a wider approach. [62] There are no international guidelines for the usage of eHealth due to many variables such as ignorance on the matter, infrastructure issues, quality of healthcare professionals and lack of healthcare plans. It should also be stated that the effectiveness of eHealth is also dependent on the patient's condition. Some researchers believe that online healthcare may be most efficient as a supplement to in-person care. [61]

See also

Related Research Articles

<span class="mw-page-title-main">Telehealth</span> Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

A personal health record (PHR) is a health record where health data and other information related to the care of a patient is maintained by the patient. This stands in contrast to the more widely used electronic medical record, which is operated by institutions and contains data entered by clinicians to support insurance claims. The intention of a PHR is to provide a complete and accurate summary of an individual's medical history which is accessible online. The health data on a PHR might include patient-reported outcome data, lab results, and data from devices such as wireless electronic weighing scales or from a smartphone.

<span class="mw-page-title-main">Telerehabilitation</span> Delivery of rehabilitation services over the internet

Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.

<span class="mw-page-title-main">Health literacy</span> Ability to understand healthcare information

Health literacy is the ability to obtain, read, understand, and use healthcare information in order to make appropriate health decisions and follow instructions for treatment. There are multiple definitions of health literacy, in part, because health literacy involves both the context in which health literacy demands are made and the skills that people bring to that situation.

An e-patient is a health consumer who participates fully in his/her medical care, primarily by gathering information about medical conditions that impact them and their families, using the Internet and other digital tools. The term encompasses those who seek guidance for their own ailments and the friends and family members who go online on their behalf. E-patients report two effects of their health research: "better health information and services, and different, but not always better, relationships with their doctors."

Protected health information (PHI) under U.S. law is any information about health status, provision of health care, or payment for health care that is created or collected by a Covered Entity, and can be linked to a specific individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history.

<span class="mw-page-title-main">Health 2.0</span>

"Health 2.0" is a term introduced in the mid-2000s, as the subset of health care technologies mirroring the wider Web 2.0 movement. It has been defined variously as including social media, user-generated content, and cloud-based and mobile technologies. Some Health 2.0 proponents see these technologies as empowering patients to have greater control over their own health care and diminishing medical paternalism. Critics of the technologies have expressed concerns about possible misinformation and violations of patient privacy.

mHealth Medicine and public health supported by mobile devices

mHealth is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones, tablet computers and personal digital assistants (PDAs), and wearable devices such as smart watches, for health services, information, and data collection. The mHealth field has emerged as a sub-segment of eHealth, the use of information and communication technology (ICT), such as computers, mobile phones, communications satellite, patient monitors, etc., for health services and information. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery/sharing of healthcare information for practitioners, researchers and patients, real-time monitoring of patient vital signs, the direct provision of care as well as training and collaboration of health workers.

The use of electronic and communication technologies as a therapeutic aid to healthcare practices is commonly referred to as telemedicine or eHealth. The use of such technologies as a supplement to mainstream therapies for mental disorders is an emerging mental health treatment field which, it is argued, could improve the accessibility, effectiveness and affordability of mental health care. Mental health technologies used by professionals as an adjunct to mainstream clinical practices include email, SMS, virtual reality, computer programs, blogs, social networks, the telephone, video conferencing, computer games, instant messaging and podcasts.

<span class="mw-page-title-main">Remote patient monitoring</span> Technology to monitor patients outside of conventional clinical settings

Remote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings, such as in the home or in a remote area, which may increase access to care and decrease healthcare delivery costs. RPM involves the constant remote care of patients by their physicians, often to track physical symptoms, chronic conditions, or post-hospitalization rehab.

Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise. It uses information and communication technologies to facilitate understanding of health problems and challenges faced by people receiving medical treatment and social prescribing in more personalised and precise ways. The definitions of digital health and its remits overlap in many ways with those of health and medical informatics.

<span class="mw-page-title-main">Activity tracker</span> Device or application for monitoring fitness

An activity tracker involves the practice of measuring and collecting data on an individual's physical and psychological activity to keep track and maintain documentation regarding their health and wellness. Used for many groups even animals as seen in collar-mounted activity trackers for dogs. A lot of the data is collected through wearable technology such as wristbands which sync with mobile apps through Apple and Samsung. As daily technologies such as phones and computers have been innovated, it paved the way for such wearable tracking technologies to be advanced. There are a variety of stakeholders involved in the usage of activity tracking through wearable technology and mobile health apps, knowing how much they track ranging from fitness, mood, sleep, water intake, medicine usage, sexual activity, menstruation, and potential diseases raises the concern on privacy given a lot of data is collected and analyzed. Through many studies that have been reviewed, data on the various demographics and goals these technologies are used provide more insight into their purposes.

<span class="mw-page-title-main">Health information on the Internet</span>

Health information on the Internet refers to all health-related information communicated through or available on the Internet.

Joseph Antony Cafazzo is a Canadian biomedical engineer, educator, and researcher.

Digital therapeutics, a subset of digital health, are evidence-based therapeutic interventions driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. Digital therapeutic companies should publish trial results inclusive of clinically meaningful outcomes in peer-reviewed journals. The treatment relies on behavioral and lifestyle changes usually spurred by a collection of digital impetuses. Because of the digital nature of the methodology, data can be collected and analyzed as both a progress report and a preventative measure. Treatments are being developed for the prevention and management of a wide variety of diseases and conditions, including type 1 & type II diabetes, congestive heart failure, obesity, Alzheimer's disease, dementia, asthma, substance abuse, ADHD, hypertension, anxiety, depression, and several others. Digital therapeutics often employ strategies rooted in cognitive behavioral therapy.

Digital phenotyping is a multidisciplinary field of science, first defined in a May 2016 paper in JMIR Mental Health authored by John Torous, Mathew V Kiang, Jeanette Lorme, and Jukka-Pekka Onnela as the "moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices." The data can be divided into two subgroups, called active data and passive data, where the former refers to data that requires active input from the users to be generated, whereas passive data, such as sensor data and phone usage patterns, are collected without requiring any active participation from the user.

Digital medicine refers to the application of advanced digital technologies, such as artificial intelligence, machine learning, and big data analytics, to improve patient outcomes and healthcare delivery. It involves the integration of technology and medicine to facilitate the creation, storage, analysis, and dissemination of health information, with the aim of enhancing clinical decision-making, improving patient care, and reducing costs.

Health data is any data "related to health conditions, reproductive outcomes, causes of death, and quality of life" for an individual or population. Health data includes clinical metrics along with environmental, socioeconomic, and behavioral information pertinent to health and wellness. A plurality of health data are collected and used when individuals interact with health care systems. This data, collected by health care providers, typically includes a record of services received, conditions of those services, and clinical outcomes or information concerning those services. Historically, most health data has been sourced from this framework. The advent of eHealth and advances in health information technology, however, have expanded the collection and use of health data—but have also engendered new security, privacy, and ethical concerns. The increasing collection and use of health data by patients is a major component of digital health.

Mental health informatics is a branch of health or clinical informatics focused on the use of information technology (IT) and information to improve mental health. Like health informatics, mental health informatics is a multidisciplinary field that promotes care delivery, research and education as well as the technology and methodologies required to implement it.

<span class="mw-page-title-main">Internet-based treatments for trauma survivors</span>

Internet-based treatments for trauma survivors is a growing class of online treatments that allow for an individual who has experienced trauma to seek and receive treatment without needing to attend psychotherapy in person. The progressive movement to online resources and the need for more accessible mental health services has given rise to the creation of online-based interventions aimed to help those who have experienced traumatic events. Cognitive behavioral therapy (CBT) has shown to be particularly effective in the treatment of trauma-related disorders and adapting CBT to an online format has been shown to be as effective as in-person CBT in the treatment of trauma. Due to its positive outcomes, CBT-based internet treatment options for trauma survivors has been an expanding field in both research and clinical settings.

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