57
Lecture 8 -- E-Health
What is e-Health?
Broadly defined, e-health refers to the use of information technology resources, particularly the Internet, to
improve the efficiency and accuracy of health care delivery. However, outside of the two key themes of
technology and improved health care delivery, the specifics of the definition are fluid. Indeed, Oh et al.
found 51 unique published definitions of “e-health” in the literature.5. The most commonly cited definition
is Eysenbach’s:
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.
Specific e-health tools include:
Electronic health records (EHRs) in which a patient’s medical history is efficiently stored and easily and
securely accessible to the clinician (and often to the patient) online and/or from many clinical locations.
EHRs often include demographic data, prescribed and dispensed medications, known allergies,
immunizations, laboratory test results, diagnostic imaging results and other medical reports;7
Providing platforms and systems for smooth exchange of patient and clinical information among providers
across the system, as well as increased communication between providers and patients (such as secure
email and instant messaging with physicians);
Delivering health and health promotion information through the use of health websites (such as
www.webmd.com
,
www.healthfinder.gov
and
www.healthyontario.com
);
Telehealth and other methods of providing health information and services to patients through the
telephone and videoconferencing;
Web Health Portals that allow individuals to access health information, self-help guides and answers to
common health questions. Portals also enable patients to monitor and manage their conditions at home;
Online wait-list registries that enable providers to share real-time information about patients awaiting
medical procedures and allow consumers to choose the facility with the shortest wait.
Forms of e-health
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.);
Telemedicine
: physical and psychological treatments at a distance;
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
);
58
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.
Healthcare Information Systems
: also often refer to software solutions for appointment scheduling, patient
data management, work schedule management and other administrative tasks surrounding health.
The Digital Divide and Access to the Internet
Owning or having consistent access to computer technology, including hardware, software and Internet
connections, is essential for taking advantage of most consumer-oriented e-health tools. For example,
accessing medical records and EHRs, disease management resources, reminder emails, health information
websites and secure online communication with doctors all require that an individual regularly access the
Internet. But extensive research has shown that communication inequalities exist as the Internet and other
information technology is used substantially more by higher-income, more-educated, younger and
employed group
E-Health Literacy
In addition to basic literacy skills, the ability to understand and use e-health tools also requires that
individuals have a working knowledge of computers and Internet functions, a basic understanding of
science, and appreciation of the social context in which online health information is produced, transmitted
and received; in other words, that individuals are e-health literate. Norman and Skinner have defined e-
health literacy as “the ability to seek, find, understand and appraise health information from electronic
sources and apply the knowledge gained to addressing or solving a health problem.”51 According to
Norman and Skinner, there are six components to becoming an e-health literate person:
Traditional literacy
Information literacy
Media literacy
Health literacy
Computer literacy and
Scientific literacy52
E-health tools present challenges to individuals with low literacy in any one of those areas. Indeed,
“without moderate skills across all six literacies, effective e-health management will be unlikely.”
The Potential Benefits of e-Health
The implementation of diverse and coordinated e-health tools could have a dramatic effect on health care
delivery and performance in Ontario. Drawing upon research and experiences in other jurisdictions, the
benefits of e-health include improvements in quality, safety and efficiency of the health care system.
Significant evidence from these jurisdictions demonstrates the effectiveness, utility and benefits of e-health
tools, although the evidence is uneven across categories of tools and user groups. Some of the potential
benefits of e-health tools include:
1) Patient Empowerment
A recent trend in health care provision has focused on empowering patients by enabling and encouraging
them to be more active in the management of their own health. The thinking is that knowledgeable patients
are better able to make informed health care decisions, stay healthy, seek services when needed and
manage chronic diseases, than patients who are not as knowledgeable.
59
Patient empowerment is one of the key (and most often cited) benefits of increased health information
technology use. Most e-health tools give patients access to their medical files and improved (and direct)
access to a wide range of health information in order to enable them to make more informed health care
decisions.
2) Improved Patient Safety
E-health tools can improve patient safety by exposing diagnostic or drug errors, increasing the accessibility
of test results and alerting patients to take their medications at the right time. One U.S. study found that
interoperable e-health tools could prevent more than two million adverse drug events per year and prevent
190,000 unnecessary hospitalizations.16 Furthermore, the availability of complete patient health
information at the point of delivery together with clinical support systems (such as those for medication
order entry) can prevent additional errors or adverse events.
3) Better Communication between Providers and Patients
Consumer-oriented e-health tools allow for improved communication between providers and patients (for
example, through secure email or instant messaging with physicians).18 Secure email and web messaging
have been shown to be effective in facilitating communication between providers and patients, which
allows for better continuity of care and more timely health care interventions.19 Improved communication
between patients and health care professionals also leads to increased trust between them, more confidence
in patient self-care, increased compliance with chronic disease management and improved accuracy of
health records.
4) Adherence to Preventive Measures
Providing reminder systems for patients and clinicians can improve compliance with preventive service
protocols. For example, electronically generated reminders to patients for screening and follow-up
measures have been shown to increase adherence to these measures by 10 to 15 percent.21 Adherence to
preventive measures, in turn, reduces preventable illnesses and improves patient health.
5) Increased Access to Health Information
The Internet and e-health tools allow patients to access a wide variety of credible, relevant and current
health information online, 24 hours a day. Many websites, some of which are publicly funded are designed
to provide valid and useful information directly to patients. Furthermore, online health support groups can
provide social support and information to participants in an anonymous context at any time. Patients can
leverage their increased access to information to improve their health care and manage their diseases more
efficiently and effectively.
6) Better Chronic Disease Management and Prevention
Another potential benefit of e-health tools is that they facilitate the management of chronic diseases, like
diabetes. Ontario’s e-health Strategy is designed to effectively manage diabetes by providing individuals
with access to information, education and tools required to self-manage the disease.23 EHealth Ontario’s
goals are to improve the quality of life of Ontarians with the disease, reduce mortality and morbidity rates
and decrease the cost of the disease to Ontario’s health care system.
7) Improved Health Care System Efficiency
Finally, e-health tools are designed to significantly improve the efficiency of the health care system.
Currently in Ontario, almost all medical charts and prescriptions are still written out by hand, meaning that
information is prone to being misunderstood, lost or not updated. Moreover, there is often little continuity
of care as records are not easily shared among providers or across jurisdictions. Computerized e-health
tools could, therefore, lead to a substantial improvement in the maintenance, availability and accessibility
60
of patient data. They could also lead to more efficient and fluid sharing of health records among providers
at the health care system level.
Improved management of patient information will reduce duplication of services, reduce repeated and
unnecessary tests and diagnoses, prevent drug interactions of inappropriate prescriptions and realize
operational efficiencies. Moreover, increased use of e-health tools in Ontario could save money in the long-
term by reducing costs to the system of repeat diagnostic testing and redundant record-keeping. According
to Canada Health Infoway, fully implemented EHRs would lead to projected savings of six billion dollars
annually across the country while it would only cost about one billion dollars per year over ten years.