Here's a definition for e-health from Canada:
{A]n overarching term used to describe the application of information and communications technologies in the health sector. It encompasses a range of purposes from purely administrative through to health care delivery.
This definition seems to me to provide a good start but, in my opinion, is insufficient. It doesn't touch on the notion of health information acquisition by consumers via the web, which is one of the most far-reaching aspects of e-health. This pursuit of knowledge by healthcare consumers is critical because it it allows them to educate themselves and prepares them to take more responsibility for their own health. Keeping all of this in mind, I now want to turn to a recent article that raises the issue of the "health" of "e-health" (see: Just how healthy is e-health?). Below is an excerpt from it:
Those new gizmos doctors are using -- electronic medical records, e-prescribing systems, image databases that can store X-ray images digitally, even telemedicine -- have a lot of allure. Medical groups and hospitals are adopting the technologies, hoping they'll bring organization and efficiency, minimize errors, save money and ultimately make patients healthier. Governments are believers: The Obama administration has committed to a $38-billion e-health investment, and the National Health Service in Britain has invested more than $19 billion in its own initiative. But a group of Britain-based researchers reported Tuesday in the journal PLoS Medicine that such faith in e-health technologies might be premature. The team, led by Aziz Sheikh of the University of Edinburgh, looked at 53 "reviews" and 55 "supplementary reviews" of e-health initiatives around the world -- systematically reviewing the systematic reviews, they said (see: The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview). They found that the literature, by and large, had done a poor job of proving that e-health tools offered significant benefits. Evidence showing positive outcomes was "weak and inconsistent" and "modest," the researchers said, and there was little to show that the tools saved money. The researchers also found that studies glossed over the potential risks created by electronic health technology. They noted that sometimes adopting e-health programs was complicated and forced physicians to spend valuable time that otherwise might be devoted to patient care. They also said decision-support tools could lead doctors to lean too heavily on the technology when assessing patients.
Copied from the Background and What Did the Researchers Do and Find portions of the Editor's Summary of the article, here are two quotes:
Often accompanied by large costs, any large-scale expenditure on eHealth—such as electronic health records, picture archiving and communication systems, ePrescribing, associated computerized provider order entry systems, and computerized decision support systems—has tended to be justified on the grounds that these are efficient and cost-effective means for improving health care.
In their systematic review of systematic reviews, the researchers included electronic health records and picture archiving communications systems in their evaluation of category 1, computerized provider (or physician) order entry and e-prescribing in category 2, and all clinical information systems that, when used in the context of eHealth technologies, integrate clinical and demographic patient information to support clinician decision making in category 3.
As I understand the scope of this article and the authors' definition of e-health, this meta survey pursued only a clinician-centric perspective of e-health. It excluded the views of physician-diagnosticians (e.g, pathologists, radiologists) and also the views of patients and healthcare consumers. The only reason that PACS were included in the review was that clinicians use these systems to access and review radiology images.
Let us run the following thought experiment. If we were to simultaneously unplug the LISs and RISs. and PACSs in all of the pathology pathology and radiology departments in the U.S., healthcare delivery would grind to a halt. Nada! Nothing! No diagnostic data and no significant impatient care. Most inpatient most operative procedures care would stop. Does this suggest to you that very little in the way of "positive outcomes" has resulted from the use of these computerized systems?
My quibble with the authors of this article is largely a definitional one. In other words, I think that the authors' conclusions were largely correct vis-a-vis the value of the current EMRs, order-entry systems, computerized and decision-support systems from the clinicians' perspective. I just object to their use of the all-encompassing term e-health in the title. Let's reserve it for a much broader use. I would have much preferred if they had used a term like clinicians' e-health tools. A little awkward but it would have made me much happier.
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