What

Is

eHealth

-LRB-

-RRB-

A

Scoping

Exercise

to

Map

the

Field

Background

Lack

of

consensus

on

the

meaning

of

eHealth

has

led

to

uncertainty

among

academics

policymakers

providers

and

consumers

This

project

was

commissioned

in

light

of

the

rising

profile

of

eHealth

on

the

international

policy

agenda

and

the

emerging

UK

National

Programme

for

Information

Technology

-LRB-

now

called

Connecting

for

Health

-RRB-

and

related

developments

in

the

UK

National

Health

Service

Introduction

The

application

of

information

and

communications

technology

-LRB-

ICT

-RRB-

in

health

care

has

grown

exponentially

over

the

last

years

and

its

potential

to

improve

effectiveness

and

efficiency

has

been

recognized

by

governments

worldwide

-LSB-

-RSB-

National

strategies

aimed

at

developing

health

information

infrastructures

and

infostructures

are

emerging

across

North

America

Australia

Europe

and

elsewhere

-LSB-

-RSB-

These

are

united

by

a

vision

to

improve

the

safety

quality

and

efficiency

of

patient

care

by

enabling

access

to

electronic

health

records

and

by

supporting

clinical

practice

service

management

research

and

policy

though

availability

of

appropriate

evidence

and

data

In

addition

these

strategies

emphasize

the

importance

of

standards

and

policies

for

ensuring

interoperability

and

data

security

and

many

incorporate

a

commitment

to

facilitate

consumer

empowerment

and

patient

self-care

through

provision

of

electronic

information

and/or

telemedicine

facilities

In

the

United

Kingdom

these

principles

are

reflected

in

the

National

Information

Strategy

for

Health

and

are

being

addressed

via

the

UK

National

Programme

for

Information

Technology

-LRB-

NPfIT

now

called

Connecting

for

Health

-RRB-

and

related

initiatives

-LSB-

-RSB-

While

such

initiatives

have

been

taking

place

the

focus

of

health

care

information

technology

-LRB-

IT

-RRB-

has

been

changing

from

an

emphasis

on

hardware

systems

architectures

and

databases

to

innovative

uses

of

technology

for

facilitating

communication

and

decision

making

coupled

with

a

growing

recognition

of

the

importance

of

human

and

organizational

factors

At

the

same

time

Internet

technologies

have

become

increasingly

pervasive

In

parallel

the

language

of

health

care

IT

has

been

changing

and

references

to

the

concept

of

eHealth

have

proliferated

in

international

health

policy

management

and

research

arenas

Despite

the

clear

interest

in

and

apparent

marketability

of

eHealth

it

was

not

evident

at

the

time

this

research

was

commissioned

what

exactly

was

meant

by

the

term

It

had

been

variously

used

as

a

synonym

for

health

informatics

telemedicine

consumer

health

informatics

and

e-business

as

well

as

more

specific

technological

applications

but

no

consensus

existed

on

its

conceptual

scope

and

it

was

unclear

whether

it

indeed

represented

a

new

concept

or

simply

a

linguistic

change

An

international

call

for

definitions

of

eHealth

posted

in

failed

to

generate

any

published

responses

and

the

call

was

updated

in

June

suggesting

that

this

is

still

a

grey

area

-LSB-

-RSB-

In

view

of

these

uncertainties

it

was

considered

important

by

the

UK

National

Health

Service

-LRB-

NHS

-RRB-

Research

and

Development

Programme

to

define

eHealth

and

to

assess

its

scope

and

value

for

the

future

of

health

care

in

particular

to

synthesize

the

available

evidence

relating

to

its

potential

impact

likely

trajectory

and

implications

for

service

development

and

organization

The

current

paper

reports

descriptive

work

to

profile

and

define

the

field

which

was

conducted

independently

of

but

complements

the

systematic

review

of

definitions

of

eHealth

provided

elsewhere

in

this

volume

-LSB-

-RSB-

This

work

produced

a

framework

for

locating

evidence

on

the

effectiveness

promise

and

challenges

of

eHealth

as

well

as

recommendations

for

future

research

which

are

reported

elsewhere

-LSB-

-RSB-

Potential

areas

of

eHealth

considered

at

the

outset

of

the

project

are

shown

in

Table

This

was

derived

by

group

discussion

among

the

research

team

utilizing

team

members

a

priori

knowledge

of

topics

and

issues

in

medical

informatics

-LRB-

drawing

on

backgrounds

in

health

care

research

practice

policy

and

computing

-RRB-

key

eHealth

discussion

papers

and

the

results

of

a

preliminary

Medline

search

suggesting

that

eHealth

is

closer

to

the

emerging

area

of

health

informatics

than

to

medical

informatics

as

a

whole

While

it

was

established

that

eHealth

is

about

the

use

of

information

technology

to

facilitate

patient

and

citizen

health

care

or

service

delivery

rather

than

technology

per

se

uncertainty

remained

about

what

specific

topics

or

issues

among

those

shown

fall

within

the

scope

of

or

have

relevance

to

the

concept

It

was

recognized

that

in

order

to

fully

explore

the

area

multiple

sources

of

information

would

need

to

be

examined

While

identifying

the

scope

of

eHealth

research

was

a

crucial

objective

the

published

research

literature

presents

a

filtered

record

of

activity

and

thinking

and

given

the

fast-moving

pace

of

the

field

and

its

importance

beyond

academia

nonresearch

sources

are

likely

to

yield

rich

information

about

the

current

status

of

eHealth

and

future

trends

For

this

reason

we

conducted

two

parallel

large

scale

reviews

one

focusing

on

the

medical

and

related

scientific

literature

and

the

other

drawing

on

alternative

sources

available

via

the

World

Wide

Web

including

independent

scoping

exercises

-LRB-

of

which

there

have

been

several

-RRB-

policy

documents

and

technology

reports

The

results

of

these

exercises

were

converged

in

order

to

derive

a

conceptual

map

and

are

considered

together

in

this

report

Table

Potential

eHealth

areas

and

issues

considered

at

the

outset

of

the

project

What

issues

currently

dominate

eHealth

What

is

going

on

in

eHealth

What

emerging

technologies

are

likely

to

impact

on

health

care

How

does

research

inform

eHealth

How

do

developments

in

eHealth

inform

research

Professional

Clinical

Informatics

Decision

aids

for

practitioners

-LRB-

eg

prompts

reminders

care

pathways

guidelines

-RRB-

Clinical

management

tools

-LRB-

eg

electronic

health

records

-LSB-

EHRs/EPRs

-RSB-

audit

tools

-RRB-

Educational

aids

-LRB-

guidelines

medical

teaching

-RRB-

Electronic

clinical

communications

tools

-LRB-

eg

e-referral

e-booking

e-discharge

correspondence

clinical

email/second

opinion

laboratory

test

requesting/results

reporting

e-shared

care

-RRB-

Electronic

networks

-LRB-

NHS-Net

and

disease-specific

clinical

networking

systems

-RRB-

Discipline/disease-specific

tools

-LRB-

eg

diabetes

informatics

-RRB-

Telemedicine

applications

-LRB-

for

interprofessional

communication

patient

communication

and

remote

consultation

-RRB-

Subfields

eg

nursing

primary

care

informatics

-RRB-

Electronic

Patient/Health

Records

-LRB-

EPR

EHR

-RRB-

Electronic

medical

records

Record

linkage

The

Universal

Patient

Indicator

Databases

and

population

registers

Achieving

multiprofessional

access

Technical

and

ethical

issues

Data

protection/security

issues

Patient

access

and

control

Integration

with

other

services

-LRB-

eg

social

work

police

-RRB-

Clinical

coding

issues

-LRB-

terminologies

etc

-RRB-

Healthcare

Business

Management

Billing

and

tracking

systems

Audit

quality

assessment

systems

Consumer

Health

Informatics

Decision

aids

for

patients

facing

difficult

choices

-LRB-

eg

genetic

screening

-RRB-

Information

on

the

web

and/or

digital

TV

-LRB-

public

information

and

educational

tools

for

specific

clinical

groups

-RRB-

Clinician-patient

communication

tools

Remote

Clinical

email

and

web-based

messaging

systems

for

consultation

disease

monitoring

service-oriented

tasks

-LRB-

eg

appointment

booking

prescription

reordering

-RRB-

Proximal

Shared

decision

making

tools

informed

consent

Mixed

On-line

screening

tools

-LRB-

eg

for

depression

-RRB-

and

therapeutic

interventions

-LRB-

eg

cognitive

behaviour

therapy

-RRB-

Access

and

equity

issues

-LRB-

data

protection

issues

the

Digital

Divide

-RRB-

Quality

issues

for

health

information

on

the

net

virtual

health

communities

New

Technologies

Satellite

communications

-LRB-

eg

for

remote

medicine

-RRB-

Wireless

networks

-LRB-

eg

within

hospitals

across

geographical

areas

-RRB-

Palmtop

technologies

-LRB-

for

information

for

records

-RRB-

New

mobile

telephones

Digital

TV

-LRB-

for

disseminating

health

information

communicating

with

patients

-RRB-

The

WWW

and

it

's

applications

for

health

-LRB-

issues

quality

control

confidentiality

access

-RRB-

NHS-Direct

etc.

Virtual

reality

-LRB-

eg

remote/transcontinental

surgery

-RRB-

Nanotechnology

Intersection

of

bioinformatics

and

health

informatics

Research

Input

Development

Need

for

user

involvement

in

product

conception

design

and

testing

Iterative

development

Needs

assessment

accessibility

and

usability

research

Multi-faceted

expertise

required

Implementation

Understanding

people

and

organizational

factors

eg

system

acceptability

resistance

to

change

etc.

Use

of

tailored

implementation

strategies

Innovative

methods

for

mapping

functional

and

technology

needs

eg

place

of

systems

in

the

organization

Knowledge

management

systems

approaches

communication

networks

models

organizational

development

to

map

pathways

EvaluationFormative

as

above

also

Outcome

assessment

to

establish

impact

of

new

systems

on

clinical

outcomes

processes

and

costs

-RRB-

Research

Outcomes

Potential

of

electronic

databases

such

as

population

registers

for

epidemiological

research

Research

into

the

impact

or

use

of

informatics

tools

suggests

appropriate

and

cost-effective

priorities

for

policymakers

Areas

of

cross-over

-LRB-

eg

bioinformatics

-RRB-

Methods

Assessing

the

Taxonomic

Structure

of

Research

Databases

and

the

Presence

of

eHealth

In

the

formative

stage

of

the

project

we

explored

the

subject

taxonomies

or

thesauri

of

multiple

databases

of

abstracts

in

order

to

identify

high-level

subject

headings

which

could

be

used

to

profile

the

volume

and

content

of

the

medical

informatics

literature

and

to

construct

searches

for

pertinent

evidence

In

the

case

of

Medline

the

thesaurus

containing

a

hierarchical

controlled

vocabulary

is

referred

to

as

Medical

Subject

Headings

or

MeSH

-LRB-

see

below

-RRB-

As

part

of

this

we

sought

to

assess

whether

eHealth

was

explicitly

represented

within

these

thesauri

A

further

objective

was

to

determine

the

ontological

structure

of

the

databases

in

relation

to

medical

informatics

and

eHealth

and

the

implied

relationships

between

alternative

subfields

The

databases

examined

were

Medline

-LRB-

PubMed

-RRB-

the

Cumulative

Index

of

Nursing

and

Allied

Health

Literature

-LRB-

CINAHL

-RRB-

the

Science

Citation

Index

-LRB-

SCI

-RRB-

the

Social

Science

Citation

Index

-LRB-

SSCI

-RRB-

the

Cochrane

Library

Database

-LRB-

including

Dare

Central

NHS

Economic

Evaluation

Database

-LSB-

NHS

EED

-RSB-

Health

Technology

Assessment

-LSB-

HTA

-RSB-

database

NHS

EED

bibliographic

-RRB-

and

Index

to

Scientific

and

Technical

Proceedings

-LRB-

ISTP

now

known

as

ISI

proceedings

-RRB-

all

of

which

predate

the

targeted

search

period

Exploring

the

Composition

of

the

Medical

Informatics

Literature

Using

the

Existing

MeSH

Thesaurus

MeSH

has

been

developed

-LRB-

and

is

constantly

updated

by

-RRB-

the

US

National

Library

of

Medicine

It

consists

of

sets

of

terms

naming

descriptors

in

a

hierarchical

structure

that

permits

searching

at

various

levels

of

specificity

At

the

most

general

level

of

the

hierarchical

structure

are

very

broad

headings

such

as

Anatomy

or

Information

Science

More

specific

headings

are

found

at

more

narrow

levels

of

the

eleven-level

hierarchy

such

as

Ankle

or

Medical

Informatics

There

are

descriptors

in

MeSH

Historical

trends

in

the

literature

indexed

by

the

individual

Medline

MeSH

terms

subsumed

within

the

broad

Medical

Informatics

category

were

assessed

for

the

period

to

and

part

way

through

Individual

MeSH

definitions

were

examined

to

assess

the

range

and

nature

of

the

topics

covered

and

to

clarify

which

are

most

clearly

related

to

common

conceptions

of

eHealth

-LRB-

eg

specific

applications

of

information

technology

-LRB-

IT

-RRB-

to

health

care

versus

technical

issues

-RRB-

The

number

of

publications

in

Medline

was

profiled

by

year

as

was

the

type

of

publication

subject

to

the

limitations

of

the

Medline

categorization

scheme

-LRB-

Randomized

Controlled

Trial/Controlled

Trial/Meta-analysis/Review

-RRB-

In

addition

the

MesH

tree

was

compared

with

an

expert-derived

taxonomy

from

the

International

Medical

Informatics

Association

-LRB-

IMIA

-RRB-

in

order

to

assess

its

coverage

of

key

areas

and

its

merits

as

a

means

of

identifying

appropriate

literature

Using

eHealth

as

a

Search

Term

Applying

eHealth

as

free-text

search

term

to

multiple

databases

offered

a

grounded

method

of

defining

the

field

as

represented

in

the

research

literature

In

order

to

identify

publications

specificially

relating

to

eHealth

and

to

place

the

concept

within

the

wider

medical

informatics

literature

all

the

databases

described

previously

were

searched

for

the

presence

of

the

word

eHealth

or

its

variants

in

the

title

or

abstract

for

the

period

January

to

December

-LRB-

search

string

Ehealth

OR

e-health

OR

e

health

-RRB-

Results

were

organized

to

show

the

number

of

articles

arising

each

year

the

journals

in

which

they

appeared

and

the

range

of

topics

covered

Profiling

the

Literature

From

Wider

Web-Based

Sources

Mixed

methods

were

used

to

-LRB-

a

-RRB-

identify

current

commentary

and

analysis

relating

to

the

emergence

nature

scope

and

potential

of

eHealth

and

-LRB-

b

-RRB-

locate

evidence

and

opinions

on

general

trends

in

technology

and

technology

adoption

with

direct

or

indirect

relevance

to

eHealth

now

or

in

the

future

Relevant

terms

-LRB-

including

e

health

e-health

ehealth

healthcare

information

technology

and

healthcare

computing

-RRB-

were

applied

singly

and

in

combinations

to

the

Google

search

engine

which

indexes

over

billion

URLs

and

ranks

results

by

relevance

and

link

popularity

In

addition

websites

previously

identified

as

being

likely

to

contain

information

relevant

to

eHealth

were

visited

directly

and

scrutinized

for

pertinent

information

In

some

cases

this

was

guided

by

the

results

of

preliminary

Google

searches

or

by

following

up

leads

suggested

in

documents

found

earlier

on

while

in

others

it

was

guided

by

the

existing

knowledge

of

team

members

As

the

searches

were

predominantly

opportunistic

and

iterative

in

nature

it

is

inappropriate

to

try

to

document

them

exhaustively

however

the

following

types

of

information

were

targeted

previous

exercises

to

map

scope

or

define

eHealth

white

papers

technical

reports

predictions

and

early

research

reports

on

aspects

of

technology

in

health

care

eHealth

related

policy

evaluation

and

trends

from

the

United

Kingdom

Europe

and

beyond

funding

programmes

for

eHealth

and/or

health-and-technology

focused

research

and

development

relevant

articles

from

computing

and

information

science-focused

academic

publications

eHealth

and

health

technology-focused

websites

web

logs

and

online

journals

online

ehealth

news

feeds

email

discussion

groups

and

email

newsletters

online

sources

with

a

focus

on

human-computer

interaction

usability

and

accessibility

with

specific

attention

on

health

care

issues

technology-oriented

news

websites

profiling

general

and

health-related

trends

and

developments

online

studies

reports

and

statistical

surveys

relating

to

general

technology

take-up

consumer

purchasing

trends

attitudes

and

strategies

of

consumers

and

clinicians

towards

adoption

of

technology

in

general

and

for

health

care-focused

tasks

in

particular

evaluation

of

the

effectiveness

of

technological

innovation

in

the

health

care

sector

and

beyond

Given

the

increasing

online

availability

of

refereed

academic

literature

there

was

inevitably

some

overlap

between

the

information

identified

by

the

two

searches

Aggregating

and

Analyzing

Definitions

of

eHealth

Scientific

abstracts

identified

using

the

key

word

search

were

examined

in

order

to

assess

the

presence

of

definitions

While

hand

searching

of

full

text

articles

was

not

a

primary

objective

this

was

done

where

easy

Web-based

access

to

this

information

was

available

In

the

case

of

Web-based

reports

or

commentary

the

definition

was

extracted

from

the

page

in

which

it

appeared

or

was

quoted

In

both

cases

the

initial

extraction

was

performed

by

one

research

fellow

and

the

results

checked

for

inclusion

eligibility

by

a

second

investigator

Our

aim

was

not

to

perform

an

exhaustive

and

systematic

review

of

definitions

-LRB-

because

of

time

constraints

-RRB-

but

to

aggregate

those

appearing

most

easily

and

commonly

in

the

research

and

wider

arenas

as

a

means

of

supplementing

our

wider

scoping

study

The

aggregated

definitions

were

then

analyzed

thematically

in

order

to

assess

the

applications

stakeholders

contexts

and

theoretical

perspectives

targeted

so

that

the

heterogeneity

of

conceptualizations

could

be

determined

They

were

also

considered

with

reference

to

the

perspectives

of

the

defining

individual

or

organization

and

associated

clarifications

within

the

source

document

Results

Assessing

the

Taxonomic

Structure

of

Research

Databases

and

the

Presence

of

eHealth

Of

the

databases

of

scientific

abstracts

consulted

only

Medline

has

a

comprehensive

hierarchical

taxonomy

of

descriptors

for

the

broad

field

of

medical

informatics

This

part

of

the

MeSH

tree

is

shown

in

Figure

Medical

informatics

is

also

represented

on

CINAHL

however

the

subtree

is

relatively

shallow

and

undifferentiated

forming

only

a

small

branch

of

the

higher

Information

Science

category

with

many

potentially

relevant

areas

subsumed

within

other

branches

That

eHealth

has

yet

to

be

explicitly

included

among

these

thesauri

indicates

the

relative

youth

of

the

topic

and

the

lack

of

an

agreed

conceptual

definition

The

literature

relevant

to

eHealth

is

thus

distributed

among

a

range

of

existing

MeSH

fields

The

Medline

MeSH

structure

for

Medical

Informatics

contains

main

subbranches

Public

Health

Informatics

Medical

Informatics

Computing

and

Medical

Informatics

Applications

Examining

the

definitions

of

these

and

their

lower

order

MeSH

descriptors

indicates

that

the

Medical

Informatics

Applications

tree

encompasses

the

greatest

number

of

component

categories

relevant

to

eHealth

taken

broadly

as

the

use

of

information

and

communication

technologies

to

facilitate

health

care

For

example

it

subsumes

the

lower-order

categories

of

Decision

Making

Computer

Assisted

-LRB-

which

subsumes

Computer

Assisted

Therapy

and

Diagnosis

among

others

-RRB-

Information

Systems

-LRB-

electronic

information

systems

networks

clinical

decision

support

-RRB-

and

Information

Storage

and

Retrieval

-LRB-

databases

laboratory

information

systems

etc

-RRB-

In

contrast

Medical

Informatics

Computing

is

mainly

characterized

by

an

emphasis

on

systems

and

hardware

although

it

does

contain

MeSH

descriptors

relevant

to

eHealth

most

importantly

Internet

which

may

appear

in

eHealth

publications

as

a

specific

technology

or

an

application

of

technology

Public

Health

Informatics

is

concerned

with

the

application

of

information

and

computer

sciences

to

public

health

practice

research

and

learning

Although

this

potentially

encompasses

eHealth-relevant

research

-LRB-

for

example

use

of

information

and

communications

technologies

for

population

health

surveillance

-RRB-

the

term

was

only

recently

introduced

and

has

yet

to

contain

any

subcodes

limiting

its

usefulness

at

the

present

time

While

the

broader

taxonomic

categories

each

have

their

own

character

there

is

clearly

overlap

between

them

For

example

decision

support

systems

appear

within

both

Medical

Informatics

Applications

and

Medical

Informatics

Computing

and

electronic

databases

are

a

common

feature

in

medical

informatics

applications

as

well

as

representing

a

type

of

system

Comparison

of

the

MeSH

tree

with

an

expert-derived

conceptual

map

endorsed

by

the

International

Medical

Informatics

Association

-LRB-

IMIA

-RRB-

revealed

interesting

differences

in

terms

of

the

breadth

of

included

concepts

and

their

structural

relationships

-LRB-

Table

-RRB-

-LSB-

-RSB-

For

example

human

and

organizational

factors

appear

to

be

underrepresented

within

Medline

while

applications

for

consumers

do

not

have

a

specific

MeSH

term

-LRB-

however

the

IMIA

taxonomy

also

appears

to

underrepresent

consumer

issues

-RRB-

This

reflects

the

historical

evolution

of

the

MeSH

hierarchy

which

has

been

added

to

as

the

need

arose

by

elaborating

upon

existing

structures

Nonetheless

all

the

main

areas

apparently

relevant

to

eHealth

were

encompassed

by

the

MeSH

tree

and

we

are

confident

that

using

it

as

the

basis

of

our

search

enabled

the

majority

of

pertinent

literature

to

be

identified

Figure

of

MeSH

descriptors

found

below

the

Medical

Informatics

descriptor

in

the

MeSH

tree

Table

Medical

informatics

scientific

content

map

endorsed

by

the

International

Medical

Informatics

Association

-LRB-

IMIA

-RRB-

-LSB-

-RSB-

Applied

Technology

Information

Technology

Infrastructure

Data-Infrastructure

Related

Applications

and

Products

Human-Organizational

Education

and

Knowledge

Algorithms

Bioinformatics

Biosignal

processing

Boolean

logic

Cryptology

Human

genome

related

Human

interfaces

Image

processing

Mathematical

models

in

medicine

Pattern

recognition

Archival-repository

systems

for

medical

records

EPR-CPR-EMR

Authentication

Chip

cards

in

health

care

Distributed

systems

Health

professional

workstation

Interfaces

Knowledge

based

systems

Networks

Neural

networks

Pen

based

Security

Speech

recognition

Standards

Systems

architecture

Telehealth

User

interfaces

Classification

Coding

systems

Concept

representation-preservation

Data

acquisition-data

capture

Data

analysis-extraction

tools

Data

entry

Data

policies

Data

protection

Database

design

Indexing

Syntax

Language

representation

Lexicons

Linguistics

Modeling

Nomenclatures

Standards

Terminology-vocabulary

Thesaurus

tools

Biostatistics

Clinical

trials

Computer-supported

surgery

Decision

support

Diagnosis

related

Disease

management

EPR-CPR-EMR

Epidemiological

research

Hosp

IS

Event-based

systems

Evidence

based

guidelines

Expert

systems

Health

services

research

Health

Information

Systems

management

Knowledge-based

systems

Laboratory

data

Image

processing

Operations/resource

management

Outcomes

research

and

measurement

Quality

management

Patient

identification

Patient

monitoring

Minimum

data

sets

Supply

chain

Telematics

Telemedicine

Assessment

Compliance

Cognitive

tasks

Collaboration

Communication

Economics

of

IT

Ethics

Implementation-deployment

Diffusion

of

IT

Evaluation

Human

Factors

Legal

issues

implementing

national

laws

Management

Managing

change

Needs

assessment

Organizational

redesign

processes

Organizational

transformation

Planning

Policy

issues

Privacy

Project

management

Security

Strategic

plans

Unique

identifiers

User-computer

interface

Bibliographic

Cognitive

learning

Computer

aided

instruction

Computer-supported

training

Consumer

education

Continuing

education

Digital

libraries

E-Business

Health/medical

informatics

education

Information

management

dissemination

Knowledge

bases

Knowledge

management

Learning

models

Online/distance

education

Clinical

Disciplines

Anesthesia

Behavioral

Cardio/Thoracic

Cardiovascular

Dentistry

Dermatology

Emergency

Medicine

Environmental

Health

Gastroenterology

Human

Genetics

Internal

Medicine

Neurosurgery

Nursing

Obstetrics

Gynecology

Ophthalmology

Orthopedics

Pathology

Pediatrics

Pharmacy

Primary

Care

Psychiatry

Radiology

Surgery

Urology

Exploring

the

Composition

of

the

Medical

Informatics

Literature

Using

Existing

Taxonomic

Systems

Figure

describes

trends

in

the

volume

and

nature

of

the

literature

indexed

by

the

Medical

Informatics

MeSH

descriptor

-LRB-

note

that

searching

for

MeSH

terms

in

PubMed

automatically

includes

the

more

specific

MeSH

terms

in

a

search

-RRB-

There

has

been

a

steady

growth

in

the

volume

of

medical

informatics

research

literature

The

annual

number

of

publications

increased

from

to

five-fold

Figure

of

publications

over

time

indexed

with

the

MeSH

descriptor

Medical

Informatics

Publications

indexed

with

MeSH

keywords

from

each

of

the

main

medical

informatics

MeSH

subtrees

-LRB-

medical

informatics

computing

medical

informatics

applications

public

health

informatics

-RRB-

all

follow

this

steady

upwards

trend

as

do

most

narrower

MeSH

-LRB-

eg

Information

Systems

Therapy

Computer

Assisted

-RRB-

However

the

frequency

of

publications

concerned

with

Clinical

Laboratory

Information

Systems

-LRB-

Figure

-RRB-

appears

to

be

decreasing

while

research

concerned

with

computer-assisted

diagnosis

increased

rapidly

in

-LRB-

Figure

-RRB-

A

breakdown

of

Medical

Informatics

MeSH

including

definition

year

of

introduction

number

and

type

of

publications

is

supplied

in

Multimedia

Appendix

Figure

of

publications

over

time

indexed

with

the

MeSH

descriptor

Clinical

Laboratory

Information

Systems

Figure

of

publications

over

time

indexed

with

the

MeSH

descriptor

Diagnosis

Computer

Assisted

Using

eHealth

as

a

Search

Term

As

mentioned

previously

there

are

currently

no

MeSH

or

equivalent

coding

categories

in

any

of

the

databases

searched

which

explicitly

incorporate

the

term

eHealth

or

its

variants

in

their

thesauri

This

suggests

that

articles

making

reference

to

eHealth

are

being

absorbed

within

existing

classification

schemes

such

as

Medline

's

Medical

Informatics

taxonomy

When

duplicates

across

databases

were

discarded

we

identified

a

total

of

publications

which

explicitly

referred

to

eHealth

in

the

title

abstract

or

journal

title

Of

these

most

were

represented

in

Medline

Appearing

only

in

the

Medline

database

were

-LRB-

-RRB-

articles

-LRB-

-RRB-

only

on

the

CINAHL

database

and

-LRB-

-RRB-

only

on

the

SCI

SSCI

and

ISTP

databases

Figure

illustrates

trends

in

the

volume

of

eHealth

publications

appearing

across

databases

over

time

This

shows

that

the

term

did

not

start

to

be

used

in

the

research

literature

until

References

to

eHealth

showed

a

dramatic

rise

in

to

and

despite

a

small

dip

in

a

general

upward

trend

persists

Note

that

we

also

retrieved

publications

from

the

Journal

of

Telemedicine

and

E-health

which

were

picked

up

due

to

the

journal

name

not

necessarily

because

they

dealt

with

eHealth

Figure

of

publications

found

using

the

search

term

eHealth

-LRB-

or

variants

-RRB-

in

research

databases

by

year

In

Which

Journals

Do

Publications

Using

the

Term

eHealth

Appear

In

our

study

publications

containing

the

term

eHealth

were

found

in

different

journals

A

research

fellow

classified

these

by

type

using

a

scheme

agreed

by

the

research

team

The

number

of

articles

appearing

within

each

journal

were

documented

Of

the

publications

found

across

multiple

databases

-LRB-

after

eliminating

that

were

clearly

irrelevant

-RRB-

appeared

in

clinical

journals

in

health-services

related

journals

in

finance-related

journals

in

legal

journals

in

journals

related

to

medical

education

and

in

other

journals

not

easily

categorized

The

journal

titles

with

the

most

articles

containing

the

term

eHealth

-LRB-

n

for

each

journal

-RRB-

were

the

Journal

of

Medical

Internet

Research

Managed

Care

Interface

and

Journal

of

AHIMA

American

Health

Information

Management

Association

The

majority

of

publications

were

IT-related

-LRB-

-RRB-

however

among

these

articles

were

published

in

the

Journal

of

Telemedicine

and

E-health

which

were

mainly

picked

up

due

to

the

journal

name

only

articles

actually

contained

the

term

eHealthin

the

abstract

or

title

Further

details

are

provided

in

Table

and

a

detailed

breakdown

of

journal

titles

is

given

in

Multimedia

Appendix

Table

Topical

areas

of

journal

titles

containing

articles

using

the

term

eHealth

Main

Topic

Area

More

Specific

Topics

Number

of

Publications

-LRB-

-RRB-

Information

Technology

Telemedicine

-LRB-

-RRB-

Medical

Informatics

-LRB-

-RRB-

Internet

-LRB-

-RRB-

Medical

Computing

-LRB-

-RRB-

Biotechnology

-LRB-

-RRB-

Others

-LRB-

-RRB-

Sub

total

-LRB-

-RRB-

Clinical

Specialist

Medical

-LRB-

-RRB-

Generalist

Medical

-LRB-

-RRB-

Nursing

-LRB-

-RRB-

Others

-LRB-

-RRB-

Sub

total

-LRB-

-RRB-

Health

Services

Management

-LRB-

-RRB-

Case

Management

-LRB-

-RRB-

Others

-LRB-

-RRB-

Sub

total

-LRB-

-RRB-

Finance

Sub

total

-LRB-

-RRB-

Legal

Sub

total

-LRB-

-RRB-

Education

Sub

total

-LRB-

-RRB-

Others

Sub

total

-LRB-

-RRB-

Total

-LRB-

-RRB-

Of

the

publications

listed

under

telemedicine

articles

were

published

in

the

Journal

of

Telemedicine

and

E-health

of

which

only

articles

actually

contained

the

term

e-health

What

Topics

are

Covered

in

the

Literature

Using

the

Term

eHealth

In

our

study

in

order

to

identify

the

topics

dealt

with

in

papers

explicitly

referring

to

eHealth

article

titles

and

abstracts

were

examined

by

a

research

fellow

and

classified

using

narrative

descriptors

This

indicated

that

the

most

common

topics

are

related

to

telemedicine

-LRB-

of

publications

-RRB-

or

the

Internet

-LRB-

-RRB-

while

some

-LRB-

-RRB-

are

concerned

with

issues

such

as

the

scope

of

eHealth

future

trends

or

progress

and

challenges

in

the

field

Note

that

this

view

is

possibly

biased

towards

the

telemedicine

field

as

all

articles

published

in

the

Journal

of

Telemedicine

and

E-health

were

retrieved

even

if

they

did

not

mention

eHealth

specifically

Other

topics

are

distributed

across

a

range

of

diffuse

areas

such

as

antiterrorism

and

medical

errors

of

which

is

represented

by

more

than

papers

-LRB-

hence

relevant

percentages

have

not

been

calculated

-RRB-

A

heuristic

summary

is

provided

in

Figure

which

highlights

the

key

topics

and

subtopics

identified

These

results

are

based

on

preliminary

analysis

further

validation

work

is

underway

Figure

of

topics

in

published

articles

using

the

term

eHealth

Definitions

of

eHealth

We

identified

definitions

of

eHealth

-LSB-

-RSB-

appearing

in

published

scientific

abstracts

and

Web-based

information

sources

-LRB-

Table

-RRB-

As

stated

previously

our

aim

was

not

to

perform

an

exhaustive

and

systematic

review

of

definitions

-LRB-

which

would

have

necessitated

hand

searching

of

full-text

articles

and

reference

lists

-RRB-

but

to

aggregate

the

most

salient

and

easily

accessible

examples

Since

many

research

databases

are

Internet

accessible

there

was

some

overlap

between

the

definitions

obtained

by

the

two

methods

however

they

did

yield

largely

unique

results

In

total

definitions

were

identified

Definitions

to

were

accessed

via

the

research

literature

and

to

via

the

independent

online

searches

while

and

emerged

from

both

searches

Definitions

were

analyzed

thematically

in

order

to

highlight

specific

technologies

applications

or

stakeholders

referred

to

and

other

theoretical

concepts

addressed

as

detailed

in

Table

Analysis

was

initially

performed

by

one

investigator

and

the

results

checked

by

two

others

thereby

establishing

agreement

Our

analysis

suggests

that

there

is

significant

variability

in

the

scope

and

focus

of

existing

definitions

of

eHealth

both

within

the

research

literature

and

relevant

sources

on

the

World

Wide

Web

In

terms

of

its

functional

scope

most

definitions

conceptualize

eHealth

as

a

broad

range

of

medical

informatics

applications

for

facilitating

the

management

and

delivery

of

health

care

Purported

applications

include

dissemination

of

health-related

information

storage

and

exchange

of

clinical

data

interprofessional

communication

computer-based

support

patient-provider

interaction

and

service

delivery

education

health

service

management

health

communities

and

telemedicine

among

others

A

few

narrow

the

concept

down

to

specific

applications

such

as

telemedicine

or

e-business

but

these

are

the

exceptions

While

the

range

of

applications

is

broad

a

general

theme

relates

to

communication

One

example

is

E-health

is

connectivity

it

is

transactional

it

is

clinical

It

is

informational

interactive

and

interventional

-LSB-

-RSB-

The

majority

of

definitions

-LRB-

n

-RRB-

specify

the

use

of

networked

information

and

communications

technologies

primarily

the

Internet

and

digital

data

thus

differentiating

eHealth

from

the

broader

field

of

medical

informatics

which

incorporates

harder

technologies

such

as

scanning

equipment

and

bioinformatics

research

which

tends

to

take

place

in

isolation

and

is

less

directly

applicable

to

health

care

service

delivery

It

is

acknowledged

that

the

Internet

has

the

reach

the

infrastructure

and

the

acceptance

to

achieve

widespread

change

-LSB-

-RSB-

and

it

is

envisaged

that

Internet

technology

may

rank

with

antibiotics

genetics

and

computers

as

among

the

most

important

changes

for

medical

care

delivery

-LSB-

-RSB-

Only

definition

makes

specific

reference

to

harder

technologies

such

as

nanotechnology

robotics

and

laboratory

tools

-LSB-

-RSB-

although

another

refers

to

Internet-compatible

ICTs

such

as

digital

TV

-LSB-

-RSB-

Of

the

definitions

identified

a

sizable

proportion

make

reference

to

telemedicine

or

telecare

either

explicitly

-LRB-

examples

-RRB-

or

in

terms

commonly

used

to

describe

these

areas

such

as

delivery

of

care

over

distances

In

most

cases

this

is

presented

as

part

of

a

wider

sphere

of

applications

although

the

definition

from

NHS

Wales

clearly

identifies

eHealth

with

telemedicine

and

telecare

-LSB-

-RSB-

We

identified

definitions

that

make

explicit

reference

to

business

or

e-business

although

others

contain

related

ideas

such

as

the

online

trading

of

goods

and

services

In

the

majority

of

cases

such

commercial

applications

are

presented

as

merely

one

expression

of

eHealth

In

terms

of

the

stakeholders

considered

to

be

the

users

or

targets

of

eHealth

many

definitions

emphasize

applications

for

providers

and

organizations

particularly

those

stressing

electronic

data

exchange

for

clinical

and

administrative

purposes

Others

emphasize

provision

of

information

education

and

services

to

consumers

including

patients

and

citizens

with

a

small

number

clearly

identifying

eHealth

with

consumer

health

informatics

-LSB-

-RSB-

Nevertheless

the

majority

appear

to

encompass

applications

for

all

stakeholder

groups

whether

specified

or

implied

by

the

breadth

of

the

definition

There

is

also

variation

in

the

degree

to

which

alternative

definitions

consider

wider

theoretical

issues

such

as

the

influence

of

eHealth

on

society

or

on

professional

behaviour

Several

highlight

the

changing

cultural

environment

of

health

care

particularly

growing

patient

empowerment

-LRB-

access

to

information

and

ability

to

use

it

-RRB-

and

point

to

the

potential

of

eHealth

to

facilitate

doctor-patient

communication

partnership

and

shared

decision

making

Others

emphasize

the

changes

required

to

ensure

that

eHealth

reaches

its

full

potential

recognising

that

it

requires

new

ways

of

working

and

attitudes

and

must

take

account

of

human

and

organizational

influences

affecting

technology

adoption

and

change

More

broadly

eHealth

is

said

to

require

a

fundamental

rethinking

of

health

care

processes

and

a

commitment

for

networked

global

thinking

to

improve

health

care

-LSB-

-RSB-

Overall

the

definitions

suggest

a

general

excitement

and

optimism

about

the

potential

of

this

rapidly

evolving

field

to

improve

health

care

processes

and

patient

outcomes

and

many

clearly

identify

projected

benefits

such

as

improved

clinical

decision

making

efficiency

and

safety

Table

Definitions

of

eHealth

identified

from

searching

databases

of

scientific

abstracts

and

wider

Web-based

information

sources

Definition

Source

Date

Technologies

Specified

Applications

Specified

Stakeholder

Focus

-LRB-

and

Other

Concepts

-RRB-

-RRB-

e-Health

is

a

consumer-centred

model

of

health

care

where

stakeholders

collaborate

utilizing

ICTs

including

Internet

technologies

to

manage

health

arrange

deliver

and

account

for

care

and

manage

the

health

care

system

Alvarez

-LSB-

-RSB-

based

on

Ontario

Hospital

e-health

Council

-LSB-

-RSB-

-LRB-

-RRB-

ICTs

including

Internet

General

manage

health

arrange

deliver

and

account

for

care

and

manage

the

health

care

system

Consumer

centered

but

also

emphasizes

collaboration

with

providers

-RRB-

Healthcare

delivery

is

being

transformed

by

advances

in

e-health

and

by

the

empowered

computer-literate

public

Ready

to

become

partners

in

their

own

health

and

to

take

advantage

of

online

processes

health

portals

and

physician

web

pages

and

e-mail

this

new

breed

of

consumer

is

slowly

redefining

the

physician/patient

relationship

Such

changes

can

effect

positive

results

like

improved

clinical

decision-making

increased

efficiency

and

strengthened

communication

between

physicians

and

patients

Ball

and

Lillis

-LSB-

-RSB-

Internetonline

processes

health

portals

physician

en-pages

email

General

healthcare

delivery

Consumers

-LRB-

Change

Citizen

empowerment

Physician/patient

relationship

communication

Improved

clinical

decision

making

efficiency

-RRB-

-RRB-

The

e-health

era

is

nothing

less

than

the

digital

transformation

of

the

practice

of

medicine

as

well

as

the

business

side

of

the

health

industry

The

Internet

is

the

next

frontier

of

health

care

Health

care

consumers

are

flooding

into

cyberspace

and

an

Internet-based

industry

of

health

information

providers

is

springing

up

to

serve

them

Internet

technology

may

rank

with

antibiotics

genetics

and

computers

as

among

the

most

important

changes

for

medical

care

delivery

Coile

-LSB-

-RSB-

Internet

The

practice

of

medicine

as

well

as

the

business

side

of

the

health

industry

Consumers

and

providers

-LRB-

Change

New

frontiers

Transformation

of

medical

practice

-RRB-

-RRB-

E-health

any

electronic

exchange

of

healthcare

data

or

information

across

organizations

reflects

an

industry

in

transition

The

Internet

clearly

drives

the

development

and

adoption

of

e-health

applications

standing

alone

it

has

the

reach

the

infrastructure

and

the

acceptance

to

achieve

widespread

change

DeLuca

and

Enmark

-LSB-

-RSB-

Internet

Electronic

exchange

of

healthcare

data

or

information

across

organizations

Not

specified

Implies

focus

on

professional

organizational

levels

-LRB-

Change

-RRB-

-RRB-

a

new

term

needed

to

describe

the

combined

use

of

electronic

communication

and

information

technology

in

the

health

sector

the

use

in

the

health

sector

of

digital

data

transmitted

stored

and

retrieved

electronically

for

clinical

educational

and

administrative

purposes

both

at

the

local

site

and

at

distance

Della

Mea

-LSB-

-RSB-

based

on

Mitchell

-LSB-

-RSB-

-LSB-

-RSB-

Combined

use

of

electronic

communication

in

and

IT

in

the

health

sector

Digital

data

transfer

Transmission

of

digital

data

locally

and

across

distances

for

clinical

educational

and

administrative

purposes

Professionals

and

organizations

-RRB-

e-health

is

the

use

of

emerging

information

and

communication

technology

especially

the

Internet

to

improve

or

enable

health

and

healthcare

Eng

-LSB-

-RSB-

based

on

Eng

-LSB-

-RSB-

-LSB-

-RSB-

Emerging

ICTs

especially

the

Internet

General

To

improve

or

enable

health

and

health

care

Not

specified

but

implies

consumers

and

providers

-RRB-

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

Eysenbach

-LSB-

-RSB-

Broad

definition

encompassing

many

aspects

of

health

informatics

but

focusing

on

the

Internet

and

related

technologies

Delivery

of

health

services

and

information

Not

specified

Implies

consumers

and

providers

-LRB-

a

state

of

mind

a

way

of

thinking

an

attitude

and

commitment

for

networked

global

thinking

to

improve

healthcare

-RRB-

-RRB-

Many

of

the

major

forces

of

change

impacting

health

care

today

have

technological

underpinnings

and

many

of

the

less

desirable

impacts

may

have

technological

solutions

Two

related

technological

forces

are

transacting

business

online

-LRB-

e-business

-RRB-

and

delivering

health

care

online

-LRB-

e-health

-RRB-

Ellis

and

Schonfeld

-LSB-

-RSB-

Internet

General

Delivering

healthcare

Delivering

implies

focus

on

professionals

-LRB-

Change.Relationship

between

eHealth

and

eBusiness

-RRB-

-RRB-

ehealth

includes

use

of

the

internet

or

other

electronic

media

to

disseminate

health

related

information

or

services

Gustafson

and

Wyatt

-LSB-

-RSB-

Internet

or

other

electronic

media

Dissemination

of

health

related

information

or

services

Implies

consumers

-RRB-

As

a

special

expression

of

e-business

in

the

health

service

the

sphere

of

e-health

has

developed

in

recent

years

which

increasingly

manifests

itself

in

the

internet

via

health

portals

Next

to

the

transmitting

of

medical

contents

the

offer

of

community

functions

and

the

trading

with

goods

from

the

medical

sector

these

health

portals

now

increasingly

provide

advisory

services

for

citizens

by

medical

experts

Khorrami

-LSB-

-RSB-

Increasingly

manifests

itself

in

the

Internet

via

health

portals

e-businessHeath

advice

Information

exchange

Community

functions

Advisory

services

for

citizens

ConsumersHealthcare

organizations

-RRB-

e-Health

-LRB-

use

of

interactive

communication

and

information

technologies

to

engage

in

health-related

activities

-RRB-

includes

not

only

telehealth-related

media

and

telecommunications

but

also

a

wide

array

of

consumer

and

healthcare

provider

activities

that

use

the

Internet

Maddox

-LSB-

-RSB-

Interactive

ICT

telehealth

internet

etc

General

health-related

activities

Consumer

and

healthcare

provider

-RRB-

technologies

with

practical

applications

that

have

the

potential

to

improve

both

quality

of

and

access

to

healthcare

Telemedicine

Health

Information

Systems

Databases

Genomics

Biotechnology

eLearning

Continuing

Professional

Development

Nanotechnology

Drug

Treatment

Technologies

Decision

Making

Tools

Diagnostic

Aids

eLibraries

Laboratory

tools

and

Robotics

are

all

innovative

or

disruptive

technologies

that

promise

a

better

health

for

our

children

McConnell

-LSB-

-RSB-

Wide

range

of

digital

technologies

Wide

range

of

informatics

applications

that

may

contribute

to

improved

quality

of

and

access

to

healthcare

Providers

and

patients

-LRB-

Quality

Access

Disruptive

technologies

-RRB-

-RRB-

e-Health

offers

the

rich

potential

of

supplementing

traditional

delivery

of

services

and

channels

of

communication

in

ways

that

extend

the

healthcare

organization

's

ability

to

meet

the

needs

of

its

patients

Benefits

include

enhanced

access

to

information

and

resources

empowerment

of

patients

to

make

informed

healthcare

decisions

streamlined

organizational

processes

and

transactions

and

improved

quality

value

and

patient

satisfaction

Nazi

-LSB-

-RSB-

Not

specified

Delivery

of

services

Communication

Access

to

information

and

resources

Patients

-LRB-

empowerment

satisfaction

-RRB-

Organization

-LRB-

efficiency

and

quality

-RRB-

-RRB-

the

use

of

the

Internet

for

health

purposes

Provost

et

al

-LSB-

-RSB-

Internet

General

Health

purposes

Any

-RRB-

a

means

of

applying

new

low

cost

electronic

technologies

such

as

web

enabled

transactions

advanced

networks

and

new

design

approaches

to

healthcare

delivery

In

practice

it

implies

not

only

the

application

of

new

technologies

but

also

a

fundamental

re-thinking

of

healthcare

processes

based

on

using

electronic

communication

and

computer-based

support

at

all

levels

and

for

all

functions

both

within

the

healthcare

service

itself

and

in

its

dealings

with

outside

suppliers

eHealth

is

a

term

which

implies

a

way

of

working

rather

than

a

specific

technology

or

application

Richardson

-LSB-

-RSB-

based

on

Silicon

Bridge

-LSB-

-RSB-

-LSB-

-RSB-

InternetNew

low-cost

electronic

technologies

such

as

web

enabled

transactions

and

advanced

networks

General

Healthcare

delivery

Electronic

communication

and

computer-based

support

at

all

levels

and

for

all

functions

Healthcare

delivery

-LSB-

and

-RSB-

processes

implies

organizational

professional

level

-LRB-

a

way

of

working

-RRB-

-RRB-

The

healthcare

industry

's

component

of

business

over

the

internet

Blutt

-LSB-

-RSB-

Internet

Business

Implies

organizations

-RRB-

The

application

of

the

Internet

and

other

related

technologies

in

the

healthcare

industry

to

improve

the

access

efficiency

effectiveness

and

quality

of

clinical

and

business

processes

utilized

by

healthcare

organizations

practitioners

patients

and

consumers

to

improve

the

health

status

of

patients

Broderick

and

Smaltz

-LSB-

-RSB-

Internet

and

related

technologies

Improvement

of

access

efficiency

effectiveness

and

quality

of

clinical

and

business

processes

Organizations

practitioners

patients

consumers

-RRB-

eHealth

includes

the

development

application

and

implementation

of

technology

to

improve

effectiveness

in

healthcare

But

it

also

includes

getting

it

out

there

wherever

it

's

needed

in

the

service

and

making

it

happen

across

the

service

It

includes

the

use

of

telemedicine

and

clinical

systems

used

for

diagnosis

and

care

pathways

We

also

apply

the

term

to

the

policies

and

protocols

that

assure

the

confidentiality

and

security

of

sensitive

data

Most

of

all

it

includes

those

aspects

that

support

major

change

of

working

practice

training

support

and

Organisational

Development

Chisholm

-LSB-

-RSB-

Technology

TelemedicineClinical

systems

for

diagnosis

and

care

pathwaysPolicies

and

protocols

Not

specified

but

implies

organizational/professional

focus

-LRB-

Importance

of

organizational

and

professional

behaviour

change

recognized

Also

confidentiality

and

security

issues

-RRB-

-RRB-

using

Information

and

Communications

Technologies

to

ensure

the

right

treatment

to

each

patient

specialised

to

each

individual

's

context

and

situation

and

to

deliver

healthcare

where

patients

and

providers

need

not

be

in

the

same

place

at

the

same

time

CSIRO

-LSB-

-RSB-

Un-dated

ICTs

Delivery

of

personalized

patient

care

Telemedicine

implied

Not

specified

Implies

provider

focus

but

also

interaction

with

patients

-RRB-

Put

simply

e-health

is

a

wide-ranging

area

of

social

policy

that

uses

new

media

technologies

to

deliver

both

new

and

existing

health

outcomes

In

the

UK

it

incorporates

everything

from

NHS

Direct

online

to

Internet

pharmacies

to

webcast

operations

involving

consultants

in

another

country

At

the

moment

the

main

focus

of

e-health

is

on

patient

empowerment

and

self-care

As

the

area

develops

e-health

could

expand

to

include

online

long-term

disease

management

personalised

health

checks

and

more

efficient

primary

care

services

due

to

informed

patients

accessing

the

healthcare

system

at

the

most

appropriate

point

GJW

Government

Relations

Ltd

-LSB-

-RSB-

New

media

technologies

On-line

health

informationLong-term

disease

management

and

patient

self-careTelemedicine

Patients

and

professionals

-LRB-

Patients

emphasized

-RRB-

-RRB-

something

to

do

with

computers

people

and

health

-LRB-

Centre

for

Global

e-Health

Innovation

-RRB-

Gustafson

-LSB-

-RSB-

Computers

in

general

Very

broad

computers

people

and

health

Implies

all

stakeholders

-RRB-

the

application

of

information

and

communication

technologies

-LRB-

ICT

-RRB-

across

the

whole

range

of

functions

which

one

way

or

another

affect

the

health

of

citizens

and

patients

European

Commission

-LSB-

-RSB-

ICTs

Broad

the

whole

range

of

functions

which

in

one

way

or

another

affect

the

health

of

citizens

and

patients

All

stakeholders

Providers

patients

citizens

-RRB-

the

emerging

world

of

e-health

can

be

defined

as

the

application

of

information

communication

and

video

technologies

to

the

delivery

of

timely

professional

and

safe

healthcare

European

Health

Telematics

Association

-LSB-

-RSB-

ICT

and

video

technologies

Broad

delivery

of

timely

professional

and

safe

care

Not

specified

Implies

professional

perspective

-RRB-

the

use

of

emerging

interactive

technologies

-LRB-

i.e.

Internet

interactive

TV

interactive

voice

response

systems

kiosks

personal

digital

assistants

CD-ROMs

DVD-ROMs

-RRB-

to

enable

health

improvement

and

health

care

services

For

this

Initiative

these

technologies

should

focus

primarily

on

health

behavior

change

and

chronic

disease

management

for

consumers/patients

Health

e-Technol-ogies

Initiative

-LSB-

-RSB-

Emerging

interactive

technologies

-LRB-

Internet

interactive

TV

interactive

voice

response

systems

kiosks

personal

digital

assistants

CD-ROMs

DVD

-RRB-

Enabling

health

improvement

and

health

care

services

chronic

disease

management

health

behaviour

change

Consumers

patients

-RRB-

the

use

of

ICT

to

support

and

improve

healthcare

Hoving

et

al

-LSB-

-RSB-

ICT

General

support

and

improve

health

care

Not

specified

-RRB-

eHealth

means

taking

the

most

recent

developments

in

computer

and

networking

technology

and

applying

it

to

the

problems

facing

the

healthcare

community

in

all

its

forms

eHealth

is

the

endeavour

to

produce

reliable

easy-to-use

highly-automated

accurate

systems

so

that

health

care

professionals

can

spend

less

time

and

resources

on

finalising

the

paperwork

and

more

time

doing

what

they

do

best

taking

care

of

people

's

health

IBA

eHealth

-LSB-

-RSB-

Un-dated

Recent

developments

in

computer

and

networking

technology

General

Applying

it

to

the

problems

facing

the

healthcare

community

in

all

its

formsSpecific

administrative

and

clinical

information

to

improve

efficiency

Professionals

-LRB-

improved

efficiency

-RRB-

-RRB-

The

e

is

for

electronic

Placed

before

the

word

health

it

implies

all

things

transmitted

and

technological

in

health

care

which

help

improve

the

flow

of

information

and

the

process

of

health

care

delivery

E

networks

integrate

isolated

towers

of

information

and

create

new

knowledge

through

the

creation

of

relational

databases

The

spectrum

of

E

is

broad

and

goes

beyond

the

use

of

a

computer

as

a

box

on

the

desktop

It

includes

wireless

communication

using

hand-held

devices

and

the

storage

and

function

by

the

microchip

which

is

revolutionizing

health

care

as

it

is

inserted

into

everything

we

use

to

diagnose

treat

record

sort

analyze

and

conclude

It

also

incorporates

electronic

forms

of

care

delivery

such

as

telemedicine

providing

health

care

over

a

distance

communicating

by

sound

and

image

transmission

E-health

is

connectivity

it

is

transactional

it

is

clinical

It

is

informational

interactive

and

interventional

Marcus

and

Fabius

-LSB-

-RSB-

Un-dated

Electronic

networks

relational

databases

Wireless

communication

All

things

transmitted

and

technological

in

health

care

which

help

improve

the

flow

of

information

and

the

process

of

health

care

deliveryElectronic

care

delivery

-LRB-

telemedicine

-RRB-

Sound

and

image

transmission

Not

specifiedConnectivity

communication

interactivity

intervention

-RRB-

the

health

services

organisation

and

societal

approach

to

health

and

health

services

which

result

from

the

introduction

of

and

increasing

access

to

new

digital

technologies

including

the

Internet

other

computerised

networks

and

tele

or

distant

health

care

facilitated

by

new

digital

technologies

NHS

SDO

Programme

-LSB-

-RSB-

New

digital

technologies

InternetOther

computerized

networks

Telemedicine

Health

service

organization

Societal

functions

OrganizationsSociety

-LRB-

citizens

-RRB-

-RRB-

More

commonly

known

as

eHealth

the

headings

of

Telemedicine

and

Telecare

are

themselves

subsumed

under

the

framework

category

of

health

informatics

which

basically

means

the

delivery

of

healthcare

and

medical

knowledge

through

the

application

of

advanced

information

and

computer

technologies

NHS

Wales

-LSB-

-RSB-

Advanced

information

and

computer

technologies

Telemedicine

and

Telecare

Not

specified

-LRB-

Identified

eHealth

with

telemedicine

-RRB-

-RRB-

The

big

difference

between

yesterday

's

knowledge-based

patient

care

and

that

of

tomorrow

is

a

fundamental

premise

that

patients

will

explore

the

web

world

with

a

desire

to

learn

more

about

their

condition

including

its

treatment

and

prognosis

This

has

evolved

into

the

concept

of

e-health

Podichetty

and

Biscup

-LSB-

-RSB-

Internet

Patient

information

and

decision

support

Patients

-LRB-

Cultural

shift

to

patient

participation

empowerment

in

health

care

-RRB-

-RRB-

eHealth

signifies

a

concerted

effort

undertaken

by

some

leaders

in

healthcare

and

hi-tech

industries

to

harness

the

benefits

available

through

convergence

of

the

internet

and

healthcare

Institute

-LSB-

-RSB-

Un-dated

Internet

specified

Not

specified

Implies

organizations

-LRB-

Harnessing

benefits

of

converging

internet

and

healthcare

-RRB-

-RRB-

eHealth

describes

the

application

of

information

and

communications

technologies

-LRB-

ICT

-RRB-

across

the

whole

range

of

functions

that

help

health

It

is

the

means

to

deliver

responsive

healthcare

tailored

to

the

needs

of

the

citizen

Silber

-LSB-

-RSB-

ICTs

Broad

the

whole

range

of

functions

that

help

health

Citizens

-LRB-

consumers

patients

public

-RRB-

-RRB-

E-health

is

a

new

term

used

to

describe

the

combined

use

of

electronic

communication

and

information

technology

in

the

health

sector

OR

is

the

use

in

the

health

sector

of

digital

data-transmitted

stored

and

retrieved

electronically-for

clinical

educational

and

administrative

purposes

both

at

the

local

site

and

at

a

distance

WHO

-LSB-

-RSB-

Un-dated

ICTsDigital

data

Clinical

educational

and

administrative

purposes

at

the

local

site

and

at

a

distance

Organizations/professionals

-RRB-

Using

the

internet

and

other

electronic

media

to

disseminate

or

provide

access

to

health

lifestyle

information

or

services

Wyatt

-LSB-

-RSB-

Internet

and

other

electronic

media

Access

to

health

and

lifestyle

information

or

services

Patients

public

-RRB-

e-Health

refers

to

all

forms

of

electronic

healthcare

delivered

over

the

Internet

ranging

from

informational

educational

and

commercial

products

to

direct

services

offered

by

professionals

non-professionals

businesses

or

consumers

themselves

e-Health

includes

a

wide

variety

of

the

clinical

activities

that

have

traditionally

characterized

telehealth

but

delivered

through

the

Internet

Simply

stated

e-Health

is

making

health

care

more

efficient

while

allowing

patients

and

professionals

to

do

the

previously

impossible

Wysocki

-LSB-

-RSB-

Internet

Delivery

of

informational

educational

and

commercial

products

Direct

delivery

of

servicesClinical

activities

traditionally

characterized

telehealth

Professionals

consumers

businesses

-LRB-

Making

health

care

more

efficient

while

allowing

patients

and

professionals

to

do

the

previously

impossible

-RRB-

-RRB-

E-health

is

a

very

broad

term

that

encompasses

many

different

activities

related

to

the

use

of

the

Internet

for

healthcare

Many

of

these

activities

have

focused

on

administrative

functions

such

as

claims

processing

or

records

storage

However

there

is

an

increasing

use

of

e-health

related

to

patient

and

clinical

care

American

Telemed-icine

Association

-LSB-

-RSB-

Internet

Administrative

functions

patient

and

clinical

care

Not

specified

Implies

organizational

and

professional

focus

-LRB-

increasing

use

of

eHealth

for

patient

and

clinical

care

-RRB-

Discussion

We

have

established

that

eHealth

is

a

new

term

which

has

yet

to

be

formally

represented

in

bibliographic

research

taxonomies

but

is

part

of

the

wider

field

of

medical

or

health

informatics

The

Medical

Informatics

MeSH

tree

encompasses

most

topics

likely

to

be

classed

as

eHealth

and

is

broadly

compatible

with

an

expert-derived

taxonomy

endorsed

by

IMIA

Since

eHealth

cuts

across

a

range

of

health

informatics

topics

a

new

MeSH

term

may

neither

be

necessary

nor

appropriate

at

the

present

time

Topics

related

to

eHealth

are

distributed

across

all

component

MeSH

trees

within

the

broader

field

although

most

are

represented

by

the

Medical

Informatics

Applications

tree

which

emphasizes

functions

of

technologies

rather

than

technologies

themselves

and

prioritizes

delivery

of

clinical

information

care

or

services

The

medical

informatics

literature

has

grown

steadily

over

the

last

years

although

research

on

some

topics

such

as

clinical

laboratory

information

systems

is

becoming

less

prevalent

while

that

on

others

such

as

computer-assisted

diagnosis

has

recently

increased

rapidly

reflecting

a

change

in

emphasis

from

systems

and

database

architectures

to

supportive

applications

Research

articles

explicitly

referring

to

eHealth

or

its

variants

begun

to

appear

in

and

are

accumulating

rapidly

The

majority

of

such

articles

are

indexed

by

Medline

although

others

appear

in

alternative

databases

Such

articles

are

published

in

a

wide

range

of

journals

spanning

information

science

to

law

but

they

are

most

commonly

represented

in

journals

related

to

health

care

information

technology

and

telemedicine

A

vast

array

of

topics

is

covered

by

research

articles

referring

to

eHealth

highlighting

the

diffuse

nature

of

the

field

and

the

lack

of

an

agreed

conceptual

definition

Definitions

of

eHealth

demonstrate

variation

in

the

breadth

and

focus

of

alternative

conceptualizations

At

the

extremes

these

range

from

the

highly

vague

and

diffuse

eg

something

to

do

with

computers

people

and

health

-LSB-

-RSB-

to

the

highly

specific

eg

the

healthcare

industry

's

component

of

business

over

the

internet

-LSB-

-RSB-

Nevertheless

most

conceptualize

eHealth

as

a

broad

range

of

medical

informatics

applications

for

facilitating

the

management

and

delivery

of

health

care

including

dissemination

of

health-related

information

storage

and

exchange

of

clinical

data

interprofessional

communication

computer-based

support

patient-provider

interaction

education

health

service

management

health

communities

and

telemedicine

among

other

functions

A

general

theme

relates

to

electronic

communication

which

is

supported

by

the

fact

that

most

definitions

specify

the

use

of

networked

digital

information

and

communications

technologies

primarily

the

Internet

This

differentiates

eHealth

from

its

parent

field

of

medical

informatics

which

encompasses

fixed

technologies

such

as

X-Ray

equipment

and

pure

bioinformatics

research

While

Internet

technologies

represent

the

prevailing

theme

there

is

sufficient

reference

to

applications

that

may

be

enabled

by

other

interactive

ICTs

to

suggest

caution

before

identifying

eHealth

exclusively

with

this

medium

This

is

supported

by

the

high

profile

of

decision

support

as

a

generic

topic

within

the

health

informatics

literature

which

may

for

example

take

the

form

of

clinical

decision

support

systems

or

patient

decision

aids

available

via

CD-ROM

Nevertheless

rapid

increases

in

bandwidth

and

desktop

computing

capability

make

it

likely

that

most

such

tools

will

soon

be

accessible

using

digital

networked

systems

Many

conceptualizations

of

eHealth

incorporate

telemedicine

and

although

most

do

so

as

part

of

a

wider

sphere

of

applications

some

authors

use

the

terms

synonymously

-LSB-

-RSB-

We

suggest

that

the

latter

is

more

likely

due

to

a

misuse

of

the

term

than

as

some

have

speculated

the

death

of

telemedicine

in

favour

of

eHealth

-LSB-

-RSB-

-LRB-

cited

in

-LSB-

-RSB-

-RRB-

While

telemedicine

is

certainly

a

theme

in

the

eHealth

literature

and

the

ICTs

used

in

this

area

are

common

to

many

eHealth

functions

it

clearly

represents

only

one

domain

of

the

broader

field

Similarly

while

several

definitions

extend

to

e-business

primarily

meaning

online

transactions

between

suppliers

and

purchasers

-LRB-

of

eHealth-related

articles

appear

in

journals

of

finance

-RRB-

most

of

these

portray

it

as

merely

one

application

of

eHealth

for

service

management

or

care

delivery

Most

definitions

appear

to

encompass

applications

for

all

stakeholder

groups

although

many

emphasize

support

for

providers

and

organizations

and

a

few

see

eHealth

as

an

application

of

consumer

health

informatics

or

even

narrower

as

the

use

of

internet

and

other

electronic

media

to

disseminate

or

provide

access

to

health

lifestyle

information

or

services

-LSB-

-RSB-

Our

review

of

eHealth

topics

in

the

research

and

Web-based

literature

also

indicates

that

the

concept

extends

across

stakeholder

groups

including

providers

patients

citizens

organizations

managers

academics

and

policymakers

A

tendency

has

been

noted

for

an

inclusive

model

to

predominate

in

Europe

and

a

narrower

consumer-focused

one

in

the

USA

possibly

reflecting

top-down

versus

bottom-up

health

systems

and

cultures

-LSB-

-RSB-

However

our

results

indicate

that

there

is

currently

more

overlap

than

difference

between

conceptualizations

emanating

from

either

side

of

the

Atlantic

with

the

inclusive

view

predominating

-LRB-

also

the

case

for

Australia

-RRB-

Even

of

those

conceptualizations

tending

toward

the

consumer

informatics

model

most

emphasize

interaction

with

professionals

rather

than

simply

passive

delivery

or

provision

of

information

to

citizens

or

patients

thus

drawing

in

the

professional

stakeholder

While

there

may

be

a

valid

argument

for

narrowing

eHealth

down

to

consumer

health

informatics

in

the

future

namely

to

circumscribe

the

field

and

thereby

make

it

more

manageable

analysis

of

the

existing

eHealth

landscape

suggests

that

the

concept

is

currently

more

inclusive

Existing

conceptualizations

also

vary

in

the

extent

to

which

they

consider

broader

issues

relating

to

the

place

function

or

promise

of

eHealth

in

the

modern

world

such

as

its

ability

to

promote

patient

self-care

and

communication

and

the

implications

of

this

for

the

doctor-patient

relationship

Many

see

eHealth

as

facilitating

the

transition

of

decision

making

control

and

responsibility

from

the

professional

to

the

empowered

consumer

consistent

with

conceptions

of

the

information

age

flipping

over

the

power

pyramid

of

health

care

-LSB-

-RSB-

The

human

and

organizational

changes

required

to

effect

new

ways

of

working

and

attitudes

also

represent

a

strong

theme

This

is

reflected

in

the

relatively

large

number

of

publications

identified

by

the

keyword

search

that

are

concerned

with

issues

such

as

challenges

to

implementation

as

opposed

to

specific

technologies

or

applications

We

therefore

agree

that

the

concept

incorporates

a

state-of-mind

a

way

of

thinking

an

attitude

-LSB-

-RSB-

Such

human

and

organizational

factors

appear

to

be

underrepresented

in

the

MeSH

Medical

Informatics

taxonomy

at

present

suggesting

that

a

review

may

be

warranted

to

bring

it

into

line

with

expert-derived

ontologies

such

as

that

endorsed

by

IMIA

More

broadly

eHealth

is

said

to

require

a

fundamental

rethinking

of

healthcare

processes

-LSB-

-RSB-

and

a

commitment

for

networked

global

thinking

to

improve

healthcare

-LSB-

-RSB-

but

there

is

clearly

a

general

optimism

surrounding

the

potential

benefits

of

this

rapidly

evolving

field

for

health

care

processes

and

patient

outcomes

Of

course

definitions

do

not

exist

in

isolation

and

the

source

documents

for

those

reviewed

provide

further

elaboration

For

example

Eng

provides

a

C

's

model

of

functions

and

capabilities

of

eHealth

-LRB-

content

connectivity

community

commerce

care

-RRB-

-LSB-

-RSB-

Eysenbach

lists

essential

E

's

in

eHealth

-LRB-

efficiency

enhancing

quality

of

care

evidence-based

empowerment

of

consumers

etc

-RRB-

-LSB-

-RSB-

and

Richardson

proposes

a

model

-LRB-

under

the

headings

of

clinical

applications

healthcare

professional

continuing

education

public

health

information

and

education

and

lifetime

health

plan

-RRB-

-LSB-

-RSB-

Yet

others

have

attempted

to

define

eHealth

in

terms

of

its

potential

role

during

a

patient

's

care

pathway

-LSB-

-RSB-

or

with

reference

to

the

settings

in

which

it

may

be

useful

-LSB-

-RSB-

Nonetheless

most

authors

have

successfully

distilled

their

concepts

within

the

definitions

they

provide

Converging

these

with

the

other

information

sources

documented

in

this

report

provides

a

fairly

comprehensive

overview

of

the

concept

and

enables

us

to

draw

broad

conclusions

about

its

nature

and

scope

In

an

editorial

on

the

website

Health

Informatics

Europe

Ahmad

Risk

posed

the

question

So

is

this

it

Does

eHealth

mean

web

health

informatics

-LSB-

-RSB-

Based

on

our

results

our

conclusion

is

largely

Yes

or

It

soon

will

be

recognising

that

the

parameters

of

the

field

currently

extend

to

other

interactive

ICTs

which

with

increasing

computing

power

bandwidth

and

wireless

capability

may

rapidly

be

accommodated

by

Internet

technologies

Based

on

our

analysis

of

the

place

of

eHealth

within

the

wider

informatics

field

and

the

nature

of

research

activity

and

general

commentary

on

the

topic

we

conclude

that

it

is

well

represented

by

the

global

definitions

suggested

by

Eng

and

Eysenbach

early

in

the

emergence

of

the

field

with

a

minor

change

to

the

latter

as

indicated

below

e-health

is

the

use

of

emerging

information

and

communications

technology

especially

the

Internet

to

improve

or

enable

health

and

healthcare

-LSB-

-RSB-

e-health

is

an

emerging

field

of

medical

informatics

referring

to

the

organization

and

delivery

of

health

services

and

information

using

the

Internet

and

related

technologies

In

a

broader

sense

the

term

characterizes

not

only

a

technical

development

but

also

a

new

way

of

working

an

attitude

and

a

commitment

for

networked

global

thinking

to

improve

health

care

locally

regionally

and

worldwide

by

using

information

and

communication

technology

-LRB-

adapted

from

Eysenbach

-LSB-

-RSB-

-RRB-

ehealth
internet
telemedicine
medical informatics