e-Health has been defined as an application of Information and Communications Technologies (ICT) across the whole range of functions that affect health. There are sufficient variations on the meaning of the term e-Health and a recent publication of a systematic review of published definitions identified 51 definitions. The authors' hypothesis was that the lack of consensus on the definition makes it difficult for e-Health to advance.
While the term e-Health was coined in the 1990's, the subject has been around practically since the invention of the computer. According to Medline records, the first paper regarding the application of computers to healthcare appeared in 1952, only one year after the production of the first commercial computers.
However, several factors slowed the progress of these ideas:
- Health informatics' specialists work essentially behind the scenes, and communication of their results was limited until access to information technology became quicker and cheaper thanks to the Internet.
- At the time of the Internet bubble many healthcare dotcoms failed and left behind unmet promise.
- Communication among healthcare professionals did not appear to evolve on a daily basis, remaining largely paper based.
- And, last but not least, change management is itself in its early stages. Implementation of a large scale systematic change is very difficult and time consuming.
Now the question is what is different today, which will help e-Health to succeed. The difference is in the number of people online, the number of software languages in use, and the fact that people have measured and are aware of the importance of healthcare inefficiencies and costs and increasingly they are getting aware of the need to modernise the healthcare system.
Implementations of e-Health must demonstrate improved quality of care, better access, and cost benefit. Given the relative youth of the field of e-Health, evaluation and cost-benefit data of large-scale project has only recently become more available. The following examples have demonstrated their efficiency.
These sites may be health authority (local, regional or national) or private sector initiatives.
Medline or PubMed is a service of the National Library of Medicine that archives scientific medical publications, whose titles and abstracts are available to all, free of charge. Medline statistics indicated in June 2002, that the US government health websites are visited by more non-Americans than Americans and are among the most visited health sites in the world. http://www.ncbi.nlm.nih.gov/PubMed
NHS and NHS Direct
Three resources within the NHS, the UK National Health Service, facilitate consumer access to information and care. NHS.UK, produced by the NHS Information Authority and NHS Direct Online are websites and NHS Direct is a call center. NHS Direct Online provides health information online and access to a 24-hour nurse helpline via telephone. NHS.UK, available since July 2000, gives information on over 70,000 physical NHS sites providing health services to the public. NHS Direct call centers orient consumers to these sites. http://www.nhsdirect.nhs.uk
Orphanet, a European multi-lingual portal, devoted to orphan or rare disease, supported by funding from the French national health research institute, INSERM and the European Commission, is consulted in over 120 countries. OrphaNet's online encyclopedia and resource database offers information on well over one thousand rare diseases. OrphaNet also offers a free website creation tool and site hosting to patient associations. http://orphanet.fr
The for-profit consumer website NetDoctor operates online forums for depressed patients in several European countries. Visitors access articles about disease and treatments, take interactive tests, discuss with peers and submit questions to medical experts. Results demonstrate that people who use such a resource are more likely to seek professional help than those who do not.
Health on the Net (HON)
The most accurate and earliest of the quality seals for health websites is proposed by Health on the Net since 1996. More than 3,000 websites adhere to the HONCode, which is free of charge. Adherence implies that the website includes the author's credentials and the date of the last modification of clinical documents, ensures the confidentiality of data, indicates sources of funding, it's advertising policy and clearly identifies advertising.http://www.hon.ch
CancerNet online was established in 1994, as a website designed to enhance the patient-physician relationship, providing access in English, Spanish and German to the National Cancer Institute guidelines.http://www.meb.uni-bonn.de/cancernet
Web-based Professional Tools
FINPROG is a Finnish web-based system for individualised survival estimation in breast cancer. It provides clinicians with aid in prognostic classification and quantitative probabilities of survival. Users can obtain survival estimates based on actual data and explore the database. The source for the data is a Finnish national series of 2842 women with breast cancer. http://www.primed.helsinki.fi/finprog
Pediatric European Cardiothoracic Surgical Registry
The European Congenital Heart Surgeons Foundation created the European Congenital Heart Defects Database for the purpose of collecting data on congenital heart surgery procedures across Europe. Participation in the database is free of charge through the Internet for all participants. As of March 2001, 84 cardiothoracic units from 33 countries had registered in the database and data on 4,000 procedures had been collected. http://www.pediatric.ecsur.org/ecsur/new_index.nsf/Web-all/index
The National Poisons Information Service in the UK transferred its database TOXBASE to the Internet in 1999, making it available to all NHS health professionals. TOXBASE holds information on 14,000 toxic agents including pharmaceuticals, chemicals, household products and plants. Pharmaceuticals account for most queries. Inquiries to TOXBASE were found to be 3.4 times more frequent on the Internet than by telephone. http://www.spib.axl.co.uk
Continuing Medical Education (CME)
Twenty per cent of CME credits in the US are now obtained online, and the figure is growing. Any country that makes continuing medical education compulsory will tend toward these results.
WebSurg is an international distance education program and virtual surgical university, founded by Professor J Marescaux as an extension of the European Institute of Telesurgery (EITS) in Strasbourg, France. Websurg provides online video training and access to experts in English, French and Japanese. Between 1999 and 2002, the EITS trained over 7,000 international surgeons on site in the latest robotic and telesurgery techniques, while also broadcasting courses to conference sites around the world.http://www.Websurg.com
National Electronic Library for Health (NeLH)
Launched in the year 2000 'to provide health professionals with a core knowledge base of accredited and evaluated information', the NeLH is based around a central website including 70 information resources. One of the quantifiable benefits is the ability to purchase resources centrally. A cost-benefit analysis concluded that the investment in evidence-based content offer cost savings between