EHealth

eHealth (also written e-health) is a relatively recent termfor healthcare practice supported by electronic processesand communication, dating back to at least 1999.[1] Us-age of the term varies: some would argue it is inter-changeable with health informatics with a broad defi-nition covering electronic/digital processes in health[2]while others use it in the narrower sense of healthcarepractice using the Internet.[3][4][5] It can also includehealth applications and links on mobile phones, referredto as m-health or mHealth. Since about 2011, the in-creasing recognition of the need for better cyber-securityand regulation may result in the need for these special-ized resources to develop safer eHealth solutions that canwithstand these growing threats.

1 Forms of e-health

The term can encompass a range of services or systemsthat are at the edge of medicine/healthcare and informa-tion technology, including:

• Electronic health records: enabling the communi-cation of patient data between different healthcareprofessionals (GPs, specialists etc.);

• ePrescribing: access to prescribing options, printingprescriptions to patients and sometimes electronictransmission of prescriptions from doctors to phar-macists

• Telemedicine: physical and psychological treat-ments at a distance, including telemonitoring of pa-tients functions;

• Consumer health informatics: use of electronic re-sources on medical topics by healthy individuals orpatients;

• Health knowledge management: e.g. in an overviewof latest medical journals, best practice guidelines orepidemiological tracking (examples include physi-cian resources such as Medscape and MDLinx);

• Virtual healthcare teams: consisting of health-care professionals who collaborate and share infor-mation on patients through digital equipment (fortransmural care);

• mHealth or m-Health: includes the use of mo-bile devices in collecting aggregate and patient levelhealth data, providing healthcare information topractitioners, researchers, and patients, real-timemonitoring of patient vitals, and direct provision ofcare (via mobile telemedicine);

• Medical research using Grids: powerful computingand data management capabilities to handle largeamounts of heterogeneous data.[6]

• Healthcare Information Systems: also often refer tosoftware solutions for appointment scheduling, pa-tient data management, work schedule managementand other administrative tasks surrounding health

2 Contested definition

Several authors have noted the variable usage in theterm, from being specific to the use of the Internet inhealthcare to being generally around any use of com-puters in healthcare.[7] Various authors have consideredthe evolution of the term and its usage and how thismaps to changes in health informatics and healthcaregenerally.[1][8][9] Oh et al., in a 2005 systematic reviewof the term’s usage, offered the definition of eHealth as aset of technological themes in health today, more specif-ically based on commerce, activities, stakeholders, out-comes, locations, or perspectives.[10] One thing that allsources seem to agree on is that e-Health initiatives donot originate with the patient, though the patient may bea member of a patient organization that seeks to do this(see e-Patient).

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2 5 E-MENTAL HEALTH

3 E-Health data exchange

One of the factors blocking the use of e-Health tools fromwidespread acceptance is the concern about privacy is-sues regarding patient records, most specifically the EPR(Electronic patient record). This main concern has to dowith the confidentiality of the data. There is also concernabout non-confidential data however. Each medical prac-tise has its own jargon and diagnostic tools. To standard-ize the exchange of information, various coding schemesmay be used in combination with international medicalstandards. Of the forms of e-Health already mentioned,there are roughly two types; front-end data exchange andback-end exchange.Front-end exchange typically involves the patient, whileback-end exchange does not. A common example of arather simple front-end exchange is a patient sending aphoto taken by mobile phone of a healing wound andsending it by email to the family doctor for control. Suchan actions may avoid the cost of an expensive visit to thehospital.A common example of a back-end exchange is when a pa-tient on vacation visits a doctor who then may request ac-cess to the patient’s health records, such as medicine pre-scriptions, x-ray photographs, or blood test results. Suchan action may reveal allergies or other prior conditionsthat are relevant to the visit.

3.1 Thesaurus

Successful e-Health initiatives such as e-Diabetes haveshown that for data exchange to be facilitated either at thefront-end or the back-end, a common thesaurus is neededfor terms of reference.[11] Various medical practises inchronic patient care (such as for diabetic patients) al-ready have a well defined set of terms and actions, whichmakes standard communication exchange easier, whetherthe exchange is initiated by the patient or the caregiver.In general, explanatory diagnostic information (such asthe standard ICD-10) may be exchanged insecurely, andprivate information (such as personal information fromthe patient) must be secured. E-health manages bothflows of information, while ensuring the quality of thedata exchange.

4 Early adopters

Chronic patients over time often acquire a high level ofknowledge 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 so-lutions tend to be relatively easy to implement.

5 E-Mental Health

E-mental health is frequently used to refer to inter-net based interventions and support for mental healthconditions.[12] However, it can also refer to the use ofinformation and communication technologies that alsoincludes the use of social media, landline and mobilephones.[13] E-mental health services can include informa-tion; peer support services, computer and internet basedprograms, virtual applications and games as well as realtime interaction with trained clinicians.[14] Programs canalso be delivered using telephones and interactive voiceresponse (IVR) [15]

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

5.1 Advantages and Disadvantages

E-mental health has a number of advantages such as be-ing low cost, easily accessible and providing anonymityto users.[20] However, there are also a number of dis-advantages such as concerns regarding user privacy andconfidentiality. Online security involves the implementa-tion of appropriate safeguards to protect user privacy andconfidentiality. This includes appropriate collection andhandling of user data, the protection of data from unau-thorized access and modification and the safe storage ofdata.[21]

E-mental health has been gaining momentum in the aca-demic research as well as practical arenas in a wide vari-ety of disciplines such as psychology, clinical social work,

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family and marriage therapy, and mental health counsel-ing. Testifying to this momentum, the E-Mental Healthmovement has its own international organization, The In-ternational Society for Mental Health Online.[22]

5.2 Programs

There are at least four programs currently available totreat anxiety and depression. Two programs have beenidentified by the UK National Institute for Health andCare Excellence[23] as cost effective for use in primarycare. The first is Fearfighter[24] which is a text basedcognitive behavioral therapy program to treat people withphobias and the second is Beating the Blues,[25] an inter-active text, cartoon and video CBT program for anxietyand depression. Two programs have been supported foruse in primary care by the Australian Government. Thefirst is Anxiety Online,[26] a text based program for theanxiety, depressive and eating disorders, and the secondis THIS WAY UP,[27] a set of interactive text, cartoon andvideo programs for the anxiety and depressive disorders.There are a number of online programs relating tosmoking cessation. QuitCoach[28] is a personalised quitplan based on the users response to questions regardinggiving up smoking and tailored individually each time theuser logs in to the site. Freedom From Smoking[29] takesusers through lessons that are grouped into modules thatprovide information and assignments to complete. Themodules guide participants through steps such as prepar-ing to quit smoking, stopping smoking and preventing re-lapse.Other internet programs have been developed specifi-cally as part of research into treatment for specific dis-orders. For example, an online self-directed therapy forproblem gambling was developed to specifically test thisas a method of treatment.[18] All participants were givenaccess to a website. The treatment group was providedwith behavioural and cognitive strategies to reduce or quitgambling. This was presented in the form of a work-book which encouraged participants to self-monitor theirgambling by maintaining an online log of gambling andgambling urges. Participants could also use a smartphoneapplication to collect self-monitoring information. Fi-nally participants could also choose to receive motiva-tional email or text reminders of their progress and goals.An internet based intervention was also developed for useafter Hurricane Ike in 2009.[19] During this study, 1,249disaster-affected adults were randomly recruited to take

part in the intervention. Participants were given a struc-tured interview then invited to access the web interven-tion using a unique password. Access to the website wasprovided for a four month period. As participants ac-cessed the site they were randomly assigned to either theintervention. those assigned to the intervention were pro-vided with modules consisting of information regardingeffective coping strategies to manage mental health andhealth risk behaviour.

6 Cybermedicine

Cybermedicine is the use of the Internet to delivermedical services, such as medical consultations and drugprescriptions. It is the successor to telemedicine, whereindoctors would consult and treat patients remotely viatelephone or fax.Cybermedicine is already being used in small projectswhere images are transmitted from a primary care set-ting to a medical specialist, who comments on the caseand 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 hos-pital specialist who determines if referral is necessary.A Cyber Doctor,[30] known in the UK as a Cy-ber Physician,[31] is a medical professional who doesconsultation via the internet, treating virtual patients, whomay never meet face to face. This is a new area ofmedicine which has been utilized by the armed forces andteaching hospitals offering online consultation to patientsbefore making their decision to travel for unique medicaltreatment only offered at a particular medical facility.[30]

7 Self-Monitoring Healthcare De-vices

Self-monitoring is the use of sensors or tools which arereadily available to the general public to track and recordpersonal data. The sensors are usually wearable devicesand the tools are digitally available through mobile de-vice applications. Self-monitoring devices were createdfor the purpose of allowing personal data to be instantlyavailable to the individual to be analyzed. As of now, fit-ness and health monitoring are the most popular applica-tions for self-monitoring devices.[32] The biggest benefit

4 9 NOTES

to self-monitoring devices is the elimination of the neces-sity for third party hospitals to run tests, which are bothexpensive and lengthy. These devices are an importantadvancement in the field of personal health management.Currently, self-monitoring healthcare devices exist inmany forms. An example is the Nike+ Fuelband, whichis a modified version of the original pedometer.[32] Thisdevice is wearable on the wrist and allows one to set apersonal goal for a daily energy burn. It records the calo-ries burned and the number of steps taken for each daywhile simultaneously functioning as a watch. To add tothe ease of the user interface, it includes both numericand visual indicators of whether or not the individual hasachieved his or her daily goal. Finally, it is also synced toan iPhone app which allows for tracking and sharing ofpersonal record and achievements.Other monitoring devices have more medical relevance.A well-known device of this type is the blood glucosemonitor. The use of this device is restricted to diabeticpatients and allows users to measure the blood glucoselevels in their body. It is extremely quantitative and theresults are available instantaneously.[33] However, this de-vice is not as independent of a self-monitoring device asthe Nike+ Fuelband because it requires some patient ed-ucation before use. One needs to be able to make con-nections between the levels of glucose and the effect ofdiet and exercise. In addition, the users must also un-derstand how the treatment should be adjusted based onthe results. In other words, the results are not just staticmeasurements.The demand for self-monitoring health devices is sky-rocketing, as wireless health technologies have becomeespecially popular in the last few years. In fact, it is ex-pected that by 2016, self-monitoring health devices willaccount for 80% of wireless medical devices.[34] The keyselling point for these devices is the mobility of infor-mation for consumers. The accessibility of mobile de-vices such as smartphones and tablets has increased sig-nificantly within the past decade. This has made it easierfor users to access real-time information in a number ofperipheral devices.There are still many future improvements for self-monitoring healthcare devices. Although most of thesewearable devices have been excellent at providing directdata to the individual user, the biggest task which remainsat hand is how to effectively use this data. Althoughthe blood glucose monitor allows the user to take actionbased on the results, measurements such as the pulse rate,

EKG signals, and calories do not necessarily serve to ac-tively guide an individual’s personal healthcare manage-ment. Consumers are interested in qualitative feedbackin addition to the quantitative measurements recorded bythe devices.[35]

8 See also• e-Patient

• European Institute for Health Records

• European Health Telematics Association

• EUDRANET

• Enabledoc

• Health 2.0

• Health blog

• Health Informatics

• mHealth

• eHealth Ontario

• ReachOut.com by Inspire Foundation

• Technology and mental health issues

• eHealthInsurance

• Telemedicine

9 Notes[1] Della Mea, Vincenzo. “What is e-Health (2): The death

of telemedicine? extquotedbl. Journal of Medical Inter-net Research 3 (2): e22. doi:10.2196/jmir.3.2.e22. PMC1761900. PMID 11720964. Retrieved 2012-04-15.

[2] International Telecommunication Union. “Implementinge-Health in Developing Countries: Guidance and Princi-ples” (PDF). Retrieved 2012-04-15.

[3] “HIMSS SIG develops proposed e-health definition”,HIMSS News, 13(7): 12

[4] Eysenbach, G; Diepgen (Jan–Feb 2001). “The role ofe-health and consumer health informatics for evidence-based patient choice in the 21st century”. Clin Dermatol.19 (1): 11–7. doi:10.1016/S0738-081X(00)00202-9.

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[5] Ball, MJ; Lillis, J (Apr 2001). “E-health: transformingthe physician/patient relationship”. Int J Med Inform. 61(1): 1–10. doi:10.1016/S1386-5056(00)00130-1.

[6] Jochen Fingberg, Marit Hansen et al.: Integrating DataCustodians in eHealth Grids – Security and Privacy As-pects, NEC Lab Report, 2006

[7] Eysenbach, G. “What is e-health? extquotedbl.Journal of Medical Internet Research 3 (2): e20.doi:10.2196/jmir.3.2.e20. PMC 1761894. PMID11720962. 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 ScopingExercise to Map the Field”. Journal of Medical Inter-net Research 7 (1): e9. doi:10.2196/jmir.7.1.e9. PMC1550637. PMID 15829481. Retrieved 2012-04-15.

[9] Ahern, David K; Kreslake, Jennifer M; Phalen, JudithM; Bock, Beth. “What Is eHealth (6): Perspectives onthe Evolution of eHealth Research”. Journal of MedicalInternet Research 8. doi:10.2196/jmir.8.1.e4. Retrieved2012-04-15.

[10] Oh, Hans; Rizo, Carlos; Enkin, Murray; Jadad, Alejandro(24 February 2005). “What Is eHealth (3): A SystematicReview of Published Definitions”. Journal of Medical In-ternet Research 7 (1): e1. doi:10.2196/jmir.7.1.e1. PMC1550636. PMID 15829471.

[11] “e-Diabetes on the website of the Dutch Diabetes founda-tion”. Diabetesfederatie.nl. Retrieved 2012-04-15.

[12] Bennett, K; Reynolds, J; Christensen, H; Griffiths, KM(2010). “e-hub: an online self-help mental health ser-vice in the community”. Medical Journal of Australia 192(11): S48–S52. PMID 20528710.

[13] TheNHSConfederation (2013) “E-Mental Health: what’sall the fuss about? extquotedbl London, UK.

[14] Australian Government (2012) “E-Mental Health Strat-egy for Australia.” Canberra, Australia.

[15] National Institute for Health &Clinical Excellence (2008)“Computerised cognitive behaviour therapy for depres-sion and anxiety.” London, UK.

[16] American Psychiatric Association (2000) “Diagnostic andStatistical Manual of Mental Disorders.” Eigal Meirovich,Baltimore, US.

[17] Civljak, M., Sheikh, A., Stead, L.F. & Car, J.(2012) Internet-based interventions for smoking cessa-tion. “Cochrane Database of Systematic Reviews” 2010,(9) Art. No:CD007078. Retrieved 21st April, 2013, fromThe Cochrane Library Database.

[18] Hodgins, David C; Fick, GordonH;Murray, Robert; Cun-ningham, John A (8 January 2013). “Internet-based inter-ventions for disordered gamblers: study protocol for a ran-domized controlled trial of online self-directed cognitive-behavioural motivational therapy”. BMC Public Health13: 10. doi:10.1186/1471-2458-13-10. PMC 3545736.PMID 23294668.

[19] Ruggiero, KJ; Resnick, HS; Paul, LA; Gros, K; Mc-Cauley, JL; Acierno, R; Morgan, M; Galea, S (2012).“Randomized Controlled Trial of an Internet-Based In-tervention Using Random-Digit-Dial Recruitment: “TheDisaster Recovery” Web Project”. Contemporary ClinicalTrials 33 (1): 237–246. doi:10.1016/j.cct.2011.10.001.PMC 3253875. PMID 22008248.

[20] Andrews, G; Titov, N (2010). “Treating people you neversee: internet-based treatment of the internalising mentaldisorders”. Australian Health Review 34 (2): 144–147.doi:10.1071/AH09775. PMID 20521437.

[21] Bennett, K; Bennett, AJ; Griffiths, KM (2010). “SecurityConsiderations for E-Mental Health Interventions”.Journal of Medical Internet Research 12 (5): e61.doi:10.2196/jmir.1468. PMC 3057317. PMID21169173.

[22] http://www.ismho.org/

[23] http://www.nice.org.uk/

[24] http://www.fearfighter.com/

[25] http://www.beatingtheblues.co.uk/

[26] http://www.anxietyonline.org.au/

[27] http://thiswayup.org.au

[28] http://www.quitcoach.org.au/

[29] http://www.ffsonline.org/

[30] Allday, Erin (27 May 2007). “Online visits a boon forfar-off patients”. SFGate. San Francisco Chronicle.

[31] Butler, Patrick (7 December 2000). “Future care to beprovided by cyber doctors”. The Guardian. “Patients’ firstcontact with the NHS in 20 years time will be via inter-active ‘cyber-physicians’ accessed through domestic tele-vision sets, according to a government-sponsored study.”

[32] Paddock, Catharine (15 August 2013). “How self-monitoring is transforming health”. Medical News Today.

[33] http://www.fda.gov/medicaldevices/productsandmedicalprocedures/invitrodiagnostics/glucosetestingdevices/default.htm

6 11 EXTERNAL LINKS

[34] http://mobihealthnews.com/17498/by-2017-50m-consumer-wireless-health-devices-to-ship/

[35] http://www.cfah.org/blog/2014/self-monitoring-health-it-falls-short-of-providing-the-information-we-need

10 Further reading• Slack, Warner V. (2001). Cybermedicine (Seconded.). Jossey Bass. ISBN 0787956317.

11 External links• NorthWest EHealth

• TheMedicalisation of Cyberspace, by Dr AndyMiah& Dr Emma Rich

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12 Text and image sources, contributors, and licenses

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