'E-health' offers a wealth of options for improving care—but we're not there yet

As medical technologies and research advance in the digital age, clinicians are faced with the field of “e-health,” a growing and shifting subset of the healthcare industry that’s opened a wealth of opportunities to create more streamlined practices. Though the development of such a field has been positive in more ways than one, experts still believe e-health is far from reaching its potential.

In an article published this month in the Journal of the American College of Cardiology, JACC editor-in-chief Valentin Fuster, MD, PhD, and a group of researchers reviewed the role of the U.S. in global health development on behalf of the Committee on Global Health and the Future of the United States. The U.S. could be a leader in the e-health era, Fuster et al. wrote, but the field is still nascent and needs guidance.

E-health is about an ideological shift as much as it’s about the physical transmission of the medical landscape into digital platforms, Gunther Eysenbach, MD, wrote in a 2001 paper published in the Journal of Medical Internet Research. E-health is a growing field that encompasses modern technology, integration techniques and data transactions. It’s a subset of the medical world that’s becoming increasingly important in this millennium.

According to Fuster and colleagues, new media has contributed to several positive practices already, one of which is increased adherence to chronic disease management by patients. With digital connections to medical professionals, electrocardiographs that fit in the palm of your hand and smartphones that can transmit data to doctors instantly, disease awareness and management has soared.

Still, the authors wrote, e-health struggles in efficiency.

“Many programs have suffered from a short-term approach and narrow program perspective, which facilitates faster and easier results, but is insufficient to prevent unnecessary duplication and inefficiencies and to address broad health system heeds,” Fuster and co-authors wrote.

Medical professionals may shy from the high upfront costs of establishing a long-term digital platform, they said, but committing time and money to that initial project will ultimately slash future costs and improve program efficiencies.

Fuster et al. focused on three application areas for digital systems in the U.S. market: data system creation, healthcare service optimization and research efficiency. The biggest suggestion the committee had, according to the paper, was merging the three initiatives into a common digital health platform, which would create interoperability across systems while retaining flexibility for individual users.

“Although digital tools have provided solutions to healthcare services, a common platform could also maximize this capacity and expand the scope of a health workforce to match the demand for more integrated health services,” the authors wrote. “In terms of research efficiency, a common platform can improve on efficiencies already gained through data-sharing among investigators, potentially allowing for novel research inquiry with low added costs.”

Achieving this could also enable more targeted studies and facilitated recruitment, they said.

In the rush to take advantage of new tech, though, Fuster and colleagues said many countries have created a series of databases that suffer from redundancy and confusing digital systems—another reason to create a universal platform. In 2012, they wrote, Uganda had to issue a moratorium on digital health pilots because its health systems were oversaturated with redundant applications.

Though the U.S. isn’t on board yet, several national governments have commissioned their own country-level e-health systems, including Ghana, Nigeria and Tanzania. The World Health Organization also has a Global Digital Health Index in the works, Fuster and co-authors wrote, which will aim to track, monitor and evaluate digital technology solutions for countries’ health needs.

“With these advances in country ownership for e-health and growing connectivity rates, the United States has an opportunity to better integrate digital health efforts in countries to reduce fragmentation and improve coordination and efficiency,” they said.