E-Health

The general term “e-health” has been used to refer to any health care services delivered over the Internet. However, the term more accurately describes an emerging field in which medical informatics, public health administration, and business intersect for delivery or enhancement of health services and information.

Electronic health care delivered over the Internet ranges from informational, educational, and commercial products to direct services offered by professionals, non-professionals, and businesses. These can be broadly characterized as

• Consumer information services that provide general health and wellness information or are targeted to specific populations, diseases, or issues. These services can be nonprofit or commercial.
• Support groups, including chat rooms, Web sites, e-mail, and newsgroups in which patients and families share information, feelings, or ideas. Some of these groups are moderated by a health professional, but most are unconstrained discussion groups for exchange of ideas and advice.
• Health-related products sales, including prescription and nonprescription drugs, medical devices, literature, and other products. Some sites require written prescriptions before filling orders for drugs, whereas others supply any requested medication or device regardless of physician's prescription or even regulatory approval.
• Medical diagnosis and advice can consist of basic answers to consumers' questions or more sophisticated diagnostic and treatment recommendations based on a patient's answers to specific questions. The latter consultations generally charge a fee, which may not be reimbursable by insurance.
• Contract health services are information and services for a closed set of consumers under contract with an insurance plan or employer. These sites may provide information about wellness and disease prevention as well as describing the health benefits program.
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• Business support services to assist health care providers with billing, record maintenance, and database access.

In addition to these Web-based e-health services, e-mail is increasingly used by patients and health care providers to schedule appointments and procedures as well as for communication between patient and provider.

The goals of the e-health initiative have been to lower health care costs, provide high-quality health care information, and increase access. However, the rapid growth in the number of e-health sites, the volume of information, and consumer access to knowledge previously available only to professionals have raised concerns. Consumers are now able to access the same medical databases, libraries, and research publications as health care professionals and, as a result, have become empowered to take more responsibility for their own health care decisions and to rely less on individual practitioners. The increasing sophistication of health care knowledge by the public has the potential to make the relationship between patient and physician more egalitarian and requires adjustments on the part of both.

The relative lack of regulation of the Internet has also raised concerns about confidentiality, privacy, and security of personal health information. Health care professionals and the public rightly fear that breaches of security might limit insurance coverage and job opportunities, or prompt malpractice claims. Before any e-health applications that are intended to reduce costs, such as electronic health records, reduction of medical errors, and data collection and dissemination, can be widely adopted, consumers and providers need to be confident that data will not be shared or sold To address some of these issues, a number of professional and consumer groups have developed guidelines, codes of ethics, and seals of approval for e-health sites that require security measures and allow users to access and change any data they have submitted. Other measures include digital credentials to provide authentication for secure Internet transactions and encryption software to protect e-mail messages.

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