Everybody talks about e-health these days, but few people have come up with a clear
definition of this comparatively new term. Barely in use before 1999, this term now
seems to serve as a general "buzzword," used to characterize not only "Internet medicine",
but also virtually everything related to computers and medicine. The term was apparently
first used by industry leaders and marketing people rather than academics. They created
and used this term in line with other "e-words" such as e-commerce, e-business, e-solutions,
and so on, in an attempt to convey the promises, principles, excitement (and hype)
around e-commerce (electronic commerce) to the health arena, and to give an account
of the new possibilities the Internet is opening up to the area of health care. Intel,
for example, referred to e-health as "a concerted effort undertaken by leaders in
health care and hi-tech industries to fully harness the benefits available through
convergence of the Internet and health care." Because the Internet created new opportunities
and challenges to the traditional health care information technology industry, the
use of a new term to address these issues seemed appropriate. These "new" challenges
for the health care information technology industry were mainly (1) the capability
of consumers to interact with their systems online (B2C = "business to consumer");
(2) improved possibilities for institution-to-institution transmissions of data (B2B
= "business to business"); (3) new possibilities for peer-to-peer communication of
consumers (C2C = "consumer to consumer").
So, how can we define e-health in the academic environment? One JMIR Editorial Board
member feels that the term should remain in the realm of the business and marketing
sector and should be avoided in scientific medical literature and discourse. However,
the term has already entered the scientific literature (today, 76 Medline-indexed
articles contain the term "e-health" in the title or abstract). What remains to be
done is - in good scholarly tradition - to define as well as possible what we are
talking about. However, as another member of the Editorial Board noted, "stamping
a definition on something like e-health is somewhat like stamping a definition on
'the Internet': It is defined how it is used - the definition cannot be pinned down,
as it is a dynamic environment, constantly moving."
It seems quite clear that e-health encompasses more than a mere technological development.
I would define the term and concept as follows:
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.
This definition hopefully is broad enough to apply to a dynamic environment such as
the Internet and at the same time acknowledges that e-health encompasses more than
just "Internet and Medicine".
As such, the "e" in e-health does not only stand for "electronic," but implies a number
of other "e's," which together perhaps best characterize what e-health is all about
(or what it should be). Last, but not least, all of these have been (or will be) issues
addressed in articles published in the Journal of Medical Internet Research.
The 10 e's in "e-health"
Efficiency - one of the promises of e-health is to increase efficiency in health care,
thereby decreasing costs. One possible way of decreasing costs would be by avoiding
duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced
communication possibilities between health care establishments, and through patient
Enhancing quality of care - increasing efficiency involves not only reducing costs,
but at the same time improving quality. E-health may enhance the quality of health
care for example by allowing comparisons between different providers, involving consumers
as additional power for quality assurance, and directing patient streams to the best
Evidence based - e-health interventions should be evidence-based in a sense that their
effectiveness and efficiency should not be assumed but proven by rigorous scientific
evaluation. Much work still has to be done in this area.
Empowerment of consumers and patients - by making the knowledge bases of medicine
and personal electronic records accessible to consumers over the Internet, e-health
opens new avenues for patient-centered medicine, and enables evidence-based patient
Encouragement of a new relationship between the patient and health professional, towards
a true partnership, where decisions are made in a shared manner.
Education of physicians through online sources (continuing medical education) and
consumers (health education, tailored preventive information for consumers)
Enabling information exchange and communication in a standardized way between health
Extending the scope of health care beyond its conventional boundaries. This is meant
in both a geographical sense as well as in a conceptual sense. e-health enables consumers
to easily obtain health services online from global providers. These services can
range from simple advice to more complex interventions or products such a pharmaceuticals.
Ethics - e-health involves new forms of patient-physician interaction and poses new
challenges and threats to ethical issues such as online professional practice, informed
consent, privacy and equity issues.
Equity - to make health care more equitable is one of the promises of e-health, but
at the same time there is a considerable threat that e-health may deepen the gap between
the "haves" and "have-nots". People, who do not have the money, skills, and access
to computers and networks, cannot use computers effectively. As a result, these patient
populations (which would actually benefit the most from health information) are those
who are the least likely to benefit from advances in information technology, unless
political measures ensure equitable access for all. The digital divide currently runs
between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female
people, and between neglected/rare vs. common diseases.
In addition to these 10 essential e's, e-health should also be
entertaining (no-one will use something that is boring!) and
- and it should definitely exist!
We invite other views on the definition of e-health and hope that over time the journal
will be filled with articles which together elucidate the realm of e-health.
Journal of Medical Internet Research