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Virtual healthcare teams: consisting of healthcare professionals who collaborate and share information on patients through digital equipment (for
transmural care);

eHealth (also written e-health) is a relatively recent term

for healthcare practice supported by electronic processes
and communication, dating back to at least 1999.[1] Usage of the term varies: some would argue it is interchangeable with health informatics with a broad denition covering electronic/digital processes in health[2]
while others use it in the narrower sense of healthcare
practice using the Internet.[3][4][5] It can also include
health applications and links on mobile phones, referred
to as m-health or mHealth. Since about 2011, the increasing recognition of the need for better cyber-security
and regulation may result in the need for these specialized resources to develop safer eHealth solutions that can
withstand these growing threats.

mHealth or m-Health: includes the use of mobile devices in collecting aggregate and patient level
health data, providing healthcare information to
practitioners, researchers, and patients, real-time
monitoring of patient vitals, and direct provision of
care (via mobile telemedicine);
Medical research using Grids: powerful computing
and data management capabilities to handle large
amounts of heterogeneous data.[6]

Forms of e-health
Healthcare Information Systems: also often refer to
software solutions for appointment scheduling, patient data management, work schedule management
and other administrative tasks surrounding health

The term can encompass a range of services or systems

that are at the edge of medicine/healthcare and information technology, including:
Electronic health records: enabling the communication of patient data between dierent healthcare
professionals (GPs, specialists etc.);

2 Contested denition

ePrescribing: access to prescribing options, printing

prescriptions to patients and sometimes electronic Several authors have noted the variable usage in the
transmission of prescriptions from doctors to phar- term, from being specic to the use of the Internet in
healthcare to being generally around any use of commacists
puters in healthcare.[7] Various authors have considered
Telemedicine: physical and psychological treat- the evolution of the term and its usage and how this
ments at a distance, including telemonitoring of pa- maps to changes in health informatics and healthcare
tients functions;
generally.[1][8][9] Oh et al., in a 2005 systematic review
Consumer health informatics: use of electronic re- of the terms usage, oered the denition of eHealth as a
sources on medical topics by healthy individuals or set of technological themes in health today, more specifically based on commerce, activities, stakeholders, outpatients;
comes, locations, or perspectives.[10] One thing that all
Health knowledge management: e.g. in an overview sources seem to agree on is that e-Health initiatives do
of latest medical journals, best practice guidelines or not originate with the patient, though the patient may be
epidemiological tracking (examples include physi- a member of a patient organization that seeks to do this
cian resources such as Medscape and MDLinx);
(see e-Patient).

3 E-Health data exchange

One of the factors blocking the use of e-Health tools from
widespread acceptance is the concern about privacy issues regarding patient records, most specically the EPR
(Electronic patient record). This main concern has to do
with the condentiality of the data. There is also concern
about non-condential data however. Each medical practise has its own jargon and diagnostic tools. To standardize the exchange of information, various coding schemes
may be used in combination with international medical
standards. Of the forms of e-Health already mentioned,
there are roughly two types; front-end data exchange and
back-end exchange.
Front-end exchange typically involves the patient, while
back-end exchange does not. A common example of a
rather simple front-end exchange is a patient sending a
photo taken by mobile phone of a healing wound and
sending it by email to the family doctor for control. Such
an actions may avoid the cost of an expensive visit to the
A common example of a back-end exchange is when a patient on vacation visits a doctor who then may request access to the patients health records, such as medicine prescriptions, x-ray photographs, or blood test results. Such
an action may reveal allergies or other prior conditions
that are relevant to the visit.


4 Early adopters
Chronic patients over time often acquire a high level of
knowledge about the processes involved in their own care,
and often develop a routine in coping with their condition.
For these types of routine patients, front-end e-Health solutions tend to be relatively easy to implement.

5 E-Mental Health
E-mental health is frequently used to refer to internet based interventions and support for mental health
conditions.[12] However, it can also refer to the use of
information and communication technologies that also
includes the use of social media, landline and mobile
phones.[13] E-mental health services can include information; peer support services, computer and internet based
programs, virtual applications and games as well as real
time interaction with trained clinicians.[14] Programs can
also be delivered using telephones and interactive voice
response (IVR) [15]
Mental disorders includes a range of conditions such as
alcohol and drug use disorders, mood disorders such as
depression, dementia and Alzheimers disease, delusional
disorders such as schizophrenia and anxiety disorders.[16]
The majority of e-mental health interventions have focused on the treatment of depression and anxiety.[14]
There are, however, programs also for problems as diverse as smoking cessation [17] gambling [18] and postdisaster mental health.[19]

3.1 Thesaurus
Successful e-Health initiatives such as e-Diabetes have
shown that for data exchange to be facilitated either at the
front-end or the back-end, a common thesaurus is needed
for terms of reference.[11] Various medical practises in
chronic patient care (such as for diabetic patients) already have a well dened set of terms and actions, which
makes standard communication exchange easier, whether
the exchange is initiated by the patient or the caregiver.

Advantages and Disadvantages

E-mental health has a number of advantages such as being low cost, easily accessible and providing anonymity
to users.[20] However, there are also a number of disadvantages such as concerns regarding user privacy and
condentiality. Online security involves the implementation of appropriate safeguards to protect user privacy and
condentiality. This includes appropriate collection and
In general, explanatory diagnostic information (such as handling of user data, the protection of data from unauaccess and modication and the safe storage of
the standard ICD-10) may be exchanged insecurely, and thorized
private information (such as personal information from
the patient) must be secured. E-health manages both E-mental health has been gaining momentum in the acaows of information, while ensuring the quality of the demic research as well as practical arenas in a wide variety of disciplines such as psychology, clinical social work,
data exchange.

family and marriage therapy, and mental health counseling. Testifying to this momentum, the E-Mental Health
movement has its own international organization, The International Society for Mental Health Online.[22]

part in the intervention. Participants were given a structured interview then invited to access the web intervention using a unique password. Access to the website was
provided for a four month period. As participants accessed the site they were randomly assigned to either the
intervention. those assigned to the intervention were pro5.2 Programs
vided with modules consisting of information regarding
eective coping strategies to manage mental health and
There are at least four programs currently available to health risk behaviour.
treat anxiety and depression. Two programs have been
identied by the UK National Institute for Health and
Care Excellence[23] as cost eective for use in primary
care. The rst is Fearghter[24] which is a text based 6 Cybermedicine
cognitive behavioral therapy program to treat people with
phobias and the second is Beating the Blues,[25] an inter- Cybermedicine is the use of the Internet to deliver
active text, cartoon and video CBT program for anxiety medical services, such as medical consultations and drug
and depression. Two programs have been supported for prescriptions. It is the successor to telemedicine, wherein
use in primary care by the Australian Government. The doctors would consult and treat patients remotely via
rst is Anxiety Online,[26] a text based program for the telephone or fax.
anxiety, depressive and eating disorders, and the second
Cybermedicine is already being used in small projects
is THIS WAY UP,[27] a set of interactive text, cartoon and
where images are transmitted from a primary care setvideo programs for the anxiety and depressive disorders.
ting to a medical specialist, who comments on the case
There are a number of online programs relating to and suggests which intervention might benet the patient.
smoking cessation. QuitCoach[28] is a personalised quit A eld that lends itself to this approach is dermatology,
plan based on the users response to questions regarding where images of an eruption are communicated to a hosgiving up smoking and tailored individually each time the pital specialist who determines if referral is necessary.
user logs in to the site. Freedom From Smoking[29] takes
A Cyber Doctor,[30] known in the UK as a Cyusers through lessons that are grouped into modules that
ber Physician,[31] is a medical professional who does
provide information and assignments to complete. The
consultation via the internet, treating virtual patients, who
modules guide participants through steps such as preparmay never meet face to face. This is a new area of
ing to quit smoking, stopping smoking and preventing remedicine which has been utilized by the armed forces and
teaching hospitals oering online consultation to patients
Other internet programs have been developed speci- before making their decision to travel for unique medical
cally as part of research into treatment for specic dis- treatment only oered at a particular medical facility.[30]
orders. For example, an online self-directed therapy for
problem gambling was developed to specically test this
as a method of treatment.[18] All participants were given
7 Self-Monitoring Healthcare Deaccess to a website. The treatment group was provided
with behavioural and cognitive strategies to reduce or quit
gambling. This was presented in the form of a workbook which encouraged participants to self-monitor their Self-monitoring is the use of sensors or tools which are
gambling by maintaining an online log of gambling and readily available to the general public to track and record
gambling urges. Participants could also use a smartphone personal data. The sensors are usually wearable devices
application to collect self-monitoring information. Fi- and the tools are digitally available through mobile denally participants could also choose to receive motiva- vice applications. Self-monitoring devices were created
tional email or text reminders of their progress and goals. for the purpose of allowing personal data to be instantly
An internet based intervention was also developed for use available to the individual to be analyzed. As of now, tafter Hurricane Ike in 2009.[19] During this study, 1,249 ness and health monitoring are the most popular applicadisaster-aected adults were randomly recruited to take tions for self-monitoring devices.[32] The biggest benet


to self-monitoring devices is the elimination of the necessity for third party hospitals to run tests, which are both
expensive and lengthy. These devices are an important
advancement in the eld of personal health management.

EKG signals, and calories do not necessarily serve to actively guide an individuals personal healthcare management. Consumers are interested in qualitative feedback
in addition to the quantitative measurements recorded by
Currently, self-monitoring healthcare devices exist in the devices.
many forms. An example is the Nike+ Fuelband, which
is a modied version of the original pedometer.[32] This
device is wearable on the wrist and allows one to set a 8 See also
personal goal for a daily energy burn. It records the calo e-Patient
ries burned and the number of steps taken for each day
while simultaneously functioning as a watch. To add to
European Institute for Health Records
the ease of the user interface, it includes both numeric
and visual indicators of whether or not the individual has
European Health Telematics Association
achieved his or her daily goal. Finally, it is also synced to
an iPhone app which allows for tracking and sharing of
personal record and achievements.
Other monitoring devices have more medical relevance.
Health 2.0
A well-known device of this type is the blood glucose
monitor. The use of this device is restricted to diabetic
Health blog
patients and allows users to measure the blood glucose
levels in their body. It is extremely quantitative and the
Health Informatics
results are available instantaneously.[33] However, this de mHealth
vice is not as independent of a self-monitoring device as
the Nike+ Fuelband because it requires some patient ed eHealth Ontario
ucation before use. One needs to be able to make con by Inspire Foundation
nections between the levels of glucose and the eect of
diet and exercise. In addition, the users must also un Technology and mental health issues
derstand how the treatment should be adjusted based on
the results. In other words, the results are not just static
The demand for self-monitoring health devices is skyrocketing, as wireless health technologies have become
especially popular in the last few years. In fact, it is expected that by 2016, self-monitoring health devices will 9 Notes
account for 80% of wireless medical devices.[34] The key
selling point for these devices is the mobility of infor- [1] Della Mea, Vincenzo. What is e-Health (2): The death
of telemedicine? extquotedbl. Journal of Medical Intermation for consumers. The accessibility of mobile denet Research 3 (2): e22. doi:10.2196/jmir.3.2.e22. PMC
vices such as smartphones and tablets has increased sig1761900. PMID 11720964. Retrieved 2012-04-15.
nicantly within the past decade. This has made it easier
for users to access real-time information in a number of [2] International Telecommunication Union. Implementing
peripheral devices.
e-Health in Developing Countries: Guidance and PrinciThere are still many future improvements for selfmonitoring healthcare devices. Although most of these
wearable devices have been excellent at providing direct
data to the individual user, the biggest task which remains
at hand is how to eectively use this data. Although
the blood glucose monitor allows the user to take action
based on the results, measurements such as the pulse rate,

ples (PDF). Retrieved 2012-04-15.

[3] HIMSS SIG develops proposed e-health denition,
HIMSS News, 13(7): 12
[4] Eysenbach, G; Diepgen (JanFeb 2001). The role of
e-health and consumer health informatics for evidencebased patient choice in the 21st century. Clin Dermatol.
19 (1): 117. doi:10.1016/S0738-081X(00)00202-9.

[5] Ball, MJ; Lillis, J (Apr 2001). E-health: transforming

the physician/patient relationship. Int J Med Inform. 61
(1): 110. doi:10.1016/S1386-5056(00)00130-1.
[6] Jochen Fingberg, Marit Hansen et al.: Integrating Data
Custodians in eHealth Grids Security and Privacy Aspects, NEC Lab Report, 2006
[7] Eysenbach, G. What is e-health?
Journal of Medical Internet Research 3 (2): e20.
PMC 1761894.
11720962. Retrieved 2012-04-15.
[8] Pagliari, Claudia; Sloan, David; Gregor, Peter; Sullivan,
Frank; Detmer, Don; Kahan, James P; Oortwijn, Wija;
MacGillivray, Steve. What Is eHealth (4): A Scoping
Exercise to Map the Field. Journal of Medical Internet Research 7 (1): e9. doi:10.2196/jmir.7.1.e9. PMC
1550637. PMID 15829481. Retrieved 2012-04-15.
[9] Ahern, David K; Kreslake, Jennifer M; Phalen, Judith
M; Bock, Beth. What Is eHealth (6): Perspectives on
the Evolution of eHealth Research. Journal of Medical
Internet Research 8. doi:10.2196/jmir.8.1.e4. Retrieved
[10] Oh, Hans; Rizo, Carlos; Enkin, Murray; Jadad, Alejandro
(24 February 2005). What Is eHealth (3): A Systematic
Review of Published Denitions. Journal of Medical Internet Research 7 (1): e1. doi:10.2196/jmir.7.1.e1. PMC
1550636. PMID 15829471.
[11] e-Diabetes on the website of the Dutch Diabetes foundation. Retrieved 2012-04-15.
[12] Bennett, K; Reynolds, J; Christensen, H; Griths, KM
(2010). e-hub: an online self-help mental health service in the community. Medical Journal of Australia 192
(11): S48S52. PMID 20528710.
[13] The NHS Confederation (2013) E-Mental Health: whats
all the fuss about? extquotedbl London, UK.
[14] Australian Government (2012) E-Mental Health Strategy for Australia. Canberra, Australia.
[15] National Institute for Health & Clinical Excellence (2008)
Computerised cognitive behaviour therapy for depression and anxiety. London, UK.
[16] American Psychiatric Association (2000) Diagnostic and
Statistical Manual of Mental Disorders. Eigal Meirovich,
Baltimore, US.
[17] Civljak, M., Sheikh, A., Stead, L.F. & Car, J.
(2012) Internet-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2010,
(9) Art. No:CD007078. Retrieved 21st April, 2013, from
The Cochrane Library Database.

[18] Hodgins, David C; Fick, Gordon H; Murray, Robert; Cunningham, John A (8 January 2013). Internet-based interventions for disordered gamblers: study protocol for a randomized controlled trial of online self-directed cognitivebehavioural motivational therapy. BMC Public Health
13: 10. doi:10.1186/1471-2458-13-10. PMC 3545736.
PMID 23294668.
[19] Ruggiero, KJ; Resnick, HS; Paul, LA; Gros, K; McCauley, JL; Acierno, R; Morgan, M; Galea, S (2012).
Randomized Controlled Trial of an Internet-Based Intervention Using Random-Digit-Dial Recruitment: The
Disaster Recovery Web Project. Contemporary Clinical
Trials 33 (1): 237246. doi:10.1016/j.cct.2011.10.001.
PMC 3253875. PMID 22008248.
[20] Andrews, G; Titov, N (2010). Treating people you never
see: internet-based treatment of the internalising mental
disorders. Australian Health Review 34 (2): 144147.
doi:10.1071/AH09775. PMID 20521437.
[21] Bennett, K; Bennett, AJ; Griths, KM (2010). Security
Considerations for E-Mental Health Interventions.
Journal of Medical Internet Research 12 (5): e61.
PMC 3057317.
[30] Allday, Erin (27 May 2007). Online visits a boon for
far-o patients. SFGate. San Francisco Chronicle.
[31] Butler, Patrick (7 December 2000). Future care to be
provided by cyber doctors. The Guardian. Patients rst
contact with the NHS in 20 years time will be via interactive cyber-physicians accessed through domestic television sets, according to a government-sponsored study.
[32] Paddock, Catharine (15 August 2013). How selfmonitoring is transforming health. Medical News Today.



10 Further reading
Slack, Warner V. (2001). Cybermedicine (Second
ed.). Jossey Bass. ISBN 0787956317.

11 External links
NorthWest EHealth
The Medicalisation of Cyberspace, by Dr Andy Miah
& Dr Emma Rich



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