E-health: strengthening the positions of patients

What is e-health?

That is the most important question to start with, as quite a few definitions are in use. Eysenbach¹ defines e-health as 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.

The different definitions and names used to describe these services are often interchangeable: in addition to the word ‘e-health’ we see the concepts of telehealth, telemedicine and healthcare 2.0.

Telemedicine is remote medical care using communication technologies to connect healthcare providers and patients in different locations. Telemedicine is used to provide more efficient care, create cost savings and improve patients’ access to care.

Telehealth is more than remote care. Telehealth also uses communication technologies, but is aimed at patient education and public health training for healthcare professionals. E-health often involves commercial applications that use Internet technology to offer information, products and services.

The concept of m-health is the latest offshoot on the branch of healthcare applications. It involves applications using mobile telephony, often combined with mobile Internet technology.

Innovative ICT that serves to support or improve health and healthcare is reforming the medical community. After having been labeled as “promising” for decades, e-health and telemedicine are now making a breakthrough. Teleradiology, teledermatology and e-consults are now structurally being used in healthcare to create faster and better service delivery. Personal, mobile telemonitoring literally provides patients with freedom of movement. It supports patient empowerment, especially for the chronically ill, a topic high on the political and social agenda.

Since 2005 we have the association for e-health (NVEH) in the Netherlands. The membership of this association is not only open for healthcare organizations and professionals, but also for patients and anyone who has ‘a passion and interest for e-health and telemedicine’. This shows that the subject is not only an important issue amongst professionals in healthcare, but also amongst patients, businesses and in politics.

Home measurement and online transmission of coagulation values by patients, video contact between patients and home care workers, domotics, teleconsulting between doctors (for instance teledermatology), telemonitoring of patients with chronic diseases, and also Electronic Patient Records: these are all examples of e-health. In general there are many opportunities for GP’s to communicate with medical specialists and access their expertise. This will increase the quality of patient care in the GP practice.

E-health is an important key to sustainable healthcare. For affordable healthcare without the risk of compromising its quality or accessibility, a wide adoption of e-health services is essential. The development of e-health and telemedicine applications is going very slow. Even though we see (inter)national awareness that e-health can help to make existing healthcare processes more efficient and that it has the potential of being the ‘engine’ of modern patient-centered healthcare. While a lot is happening all over the world, the big rollout has not yet taken place.

Still, a steady progress in e-health development can be seen. For the chronically ill, Internet is the tool of choice to find information about their condition or illness and about its potential impact and treatment options – and they eagerly make use of this option. Because of this, the information gap between these patients and their GP’s and other healthcare providers is getting smaller. Especially chronically ill patients have emancipated themselves considerably in key areas like autonomy, citizenship and recognition of their practical expertise. As the confidence of patients is growing, a new concept has been added: patient empowerment. The patient now wants his GP to take his own strength, knowledge and abilities into account. Doctor and patient are now working together to solve health problems. GP’s, medical specialists, nurses and pharmacists have to deal with the so called ‘expert patient’ actively looking for information on various aspects of his illness.

Availability of online information about all aspects of health is almost inexhaustible. There are online platforms for almost every disease or condition. They provide a place for discussion and exchange of experiences and information about all aspects of the disease. Furthermore, the information provided on these platforms is often quite specific. A good example is a website for diabetics who love scuba diving, discussing how to deal with diabetics at a depth of fifteen meters below the surface.

A caveat that must be made is that not everyone has equal access to the Internet or possesses the skills to navigate online. Furthermore, not all patients are willing to assume the role of expert patient² (Henwood et al, 2003). Despite these concerns, the availability of more and more accessible information significantly strengthens the position of patients. And it enables them to make their own, more balanced judgments and healthcare choices.

Aliëtte Jonkers, medical journalist in Amersfoort, The Netherlands

1 G Eysenbach. J Med Internet Res. 2001 Apr–Jun; 3(2): e20. Published online 2001 June 18. doi: 10.2196/jmir.3.2.e20. PMCID: PMC1761894.

2 Henwood F, Wyatt S, Hart A, Smith J. ‘Ignorance is bliss sometimes': constraints on the emergence of the ‘informed patient’ in the changing landscapes of health information. Sociol Health Illn. 2003 Sep;25(6):589-607.