e- Health

Dr. Dileep Bhale

Guest Lecture

Origin of e-health

The rapid progress in information and communication technologies inspired its use in healthcare to provide care to patients at a distance from the physician. This gave rise to telemedicine and at least in some branches of medicine it has become a part of routine core.

The term telemedicine was perceived to represent only the curative aspect of healthcare and telehealth was preferred to telemedicine to include homecare and nursing services.

The World Health Organisation has defined telemedicine and telehealth as follows:

"If telehealth is understood to mean the integration of telecommunications systems into the practice of protecting and promoting health, while telemedicine is the incorporation of these systems into curative medicine, then it must be acknowledged that telehealth corresponds more closely to the international activities of WHO in the field of public health. It covers education for health, public and community health, health systems development and epidemiology, whereas telemedicine is oriented more towards the clinical aspect."

The "dot com" era got many business corporations interested in healthcare. The Internet had matured by that time and it was being used for e-commerce. The term "e-health" was coined during this period of e-commerce, e-business and e-governance. "E-health" was initially used by businesses and not by academicians but some scientific journals adopted it probably due to the fear of being left behind. Many governments started using this term and it replaced telemedicine and telehealth in official publications.

"E-health" has been defined as, "The combined use of communication and information technologies in the health sector, both at the local site and at a distance, for clinical, educational and administrative purposes".

The Journal of Internet Research has given more elaborate definition of e-health :

"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."

E-commerce and e-health

E-health was promoted by businesses that were promoting e-commerce. It was therefore inevitable that the e-commerce model was applied to e-health. E-health is still considered a part of e-commerce because of its origin and use of e-commerce technologies.

E-health was expected to enhance communication between the healthcare organization and individuals, B2C, between healthcare organizations, B2B, and between individuals, C2C.

Because of the origin of e-health in e-commerce you will find that many times patients are called consumers.

Requirements for e-health

E-health implementation needs some foundation structures to be in place.

Telecom infrastructure

It is obvious that a strong ubiquitous telecom structure is essential for e-health. High bandwidths network without the usual 'last mile problem' is needed for successful e-health implementation.

Information exchange standards

After having a good telecom network there is a need for standards of information exchange. HL7 and XML are being used at many places but still much work is needed in this area.


The next requirement is nomenclature, a way of uniquely naming and identifying medical and related entities. Although it looks simple, after many years of work there is no comprehensive solution.

Clinical standards

Once the first three foundations are in place there is a need to consistently and comprehensively apply clinical diagnostic and treatment criteria.

Mind set

Finally it is important to convince the clinicians about the benefits of e-health so that they use it. It also involves the issues of access to information, confidentiality and privacy.

The "e"s in e-health

Gunther Eysenbach, editor of the Journal of Medical Internet Research, says that the "e" is e-health does not only stand for electronic and lists the ten "e"s in e-health.

Efficiency of healthcare is increased.

Enhancing the quality of care.

Evidence based practice is a requirement for e-health.

Empowerment of consumers and patients by making the knowledge bases and medical records available to them.

Encouragement of a new relationship between the patient and healthcare professional.

Education of professionals and consumers through online resources. Enabling information exchange and communication between healthcare establishments

Extending the scope of healthcare beyond its conventional boundaries.

Ethics. E-health raises new ethical issues such as online professional practice, informed consent, secrecy, privacy and equity.

Equity. E-health promises to make healthcare more equitable. There is a possibility that e-health may deepen the gap between "haves" and "have-nots". The populations, which would benefit the most from e-health, are likely to be the least benefited due to the "digital divide". This needs political measures from the governments.

Next       Back