E-health in practice
What is e-health?
E-health is a broad concept, defined as the use of electronic means to deliver information, resources and services related to health. Many terms are included in e-health, such as:
- electronic health records;
- mobile health, or m-health (e.g. apps, wearable technologies, medical devices);
- telehealth or telemedicine (whereby a patient can consult a health care worker on the computer, a tablet or a phone, for example);
- health-related e-learning (use of technology and media for training and educating both a broader audience and the health workforce);
- social media for health (informal, social online communication channels); and
- health data analysis and "big data" (transformation of data to provide insights and evidence for decision- and policy-making)
From medical monitoring of nomadic reindeer herders, to education and training with multilingual, virtual, simulated patients, technology is increasingly being used to deliver and advance health services in the WHO European Region. A new report provides an overview of the developments and benefits of using e-health, with 29 cases from across the Region.
The following examples illustrate different uses of e-health.
Improving appointment systems in the former Yugoslav Republic of Macedonia
Before 2011, patients in Skopje experienced long waiting times to see doctors and have diagnostic tests. The MojTermin (My Time) system made it possible to book appointments online and receive text message reminders and for decision-makers to access a live dashboard to see referrals, prescriptions and requests in real time. MojTermin also integrates electronic health records and health cards. The system was so successful in reducing waiting times that it rapidly expanded from a pilot project to become a key part of public and private health care in the former Yugoslav Republic of Macedonia.
Supporting patients with rare conditions
RareConnect is an online patient community that connects patients with rare conditions, their families and those involved in their care. It is also a peer support platform, allowing professionals who treat rare diseases to exchange information and experience on treatment, prognosis, symptoms and coping strategies, thus promoting research and building relationships among health care professionals in different countries. A member survey showed that 76% of patients considered that they understood their condition better, 72% felt that were better able to cope with their problems, 41% of members with HIV infection reported that they had reduced risky behaviour, and 22% with mood disorders found that they needed less inpatient care after using the site.
First nationwide electronic health record system
Estonia launched its electronic record system in 2008, becoming the first country in the world to fully implement such a system nationwide, with records covering an individual's medical history from birth to death. In 2009, Estonia used health information exchange to upload all medical documents into the system. This use of e-health is supported by legislation: Estonia's Health Information System Act (2007) and the Government Regulatory Act of Health Information Exchange (2008). Information on the health of 1.35 million people (98% of the population) is now in the system, and e-prescriptions account for 98% of all prescriptions issued. The electronic record system forms part of the broader eEstonia electronic public services, which, in addition to e-health, include e-taxes, e-schools, e-commercial registries and e-elections.
Training medical students in using a multilingual, virtual, simulated patient
A project for use of multilingual, virtual, simulated patients in medical education across Europe is providing greater flexibility in learning. The initiative, which includes 11 countries in the Region, involves creation of a multilingual, virtual, simulated "patient" that responds and behaves in the same way as a real patient being seen in a primary care setting. It can be used by medical students in different countries with different languages. The system simulates a clinical interview with a virtual patient presenting with symptoms of one or a combination of illnesses. During the interview, it can express moods, which can be adapted to both the virtual simulated patient's illness and the student's behaviour. Such role-play scenarios not only help students to detect illnesses but also add to teaching of communication skills and reduce reliance on actors, the use of whom can be time-consuming and costly.
Extending services through e-health in the Russian Federation
Telemedicine is already well established in the Russian Federation; however, the challenges include continuing professional development and establishing a legal framework for distance health services. Collaboration was instituted between the Norwegian Centre for Integrated Care and Telemedicine and the Nenets Autonomous Okrug to improve health care for remote and nomadic populations, including use of telemedicine for health promotion and also for prevention and early detection of illness, for example by arranging medical appointments for nomadic reindeer herders when they stay in villages. Other initiatives included encouraging health workers to use technology and educating, recruiting and involving new employees. The project also addressed the use of technology for monitoring the health of pregnant women and infants in the first year of life, thus reducing long journeys to clinics.