Two reasons I worked through the eHealth MOOC I wrote about last time were to find out just how big the eHealth movement is and where it was or can be successful in making life easier providing better health outcomes for us BigD-ers.
Firstly, it’s big, very big. Most countries are setting up or designing an eHealth framework of some kind or other. They include the usual suspects, like Scandinavia, the UK, most of Europe, Hong Kong, Singapore, Australia and New Zealand, and parts of Canada and the US. Thankfully much of the rest of the world is also on the job, like Russia, Brazil, India, Pakistan, the Philippines, Mexico, Turkey, Nigeria, Israel, Iran, Saudi Arabia.
There are also at least two eHealth systems developed and run by Non-Government Organisations (NGOs):
- OpenMRS, developed as a collaborative open source project in the US, which is in use in at least 23 developing countries (mostly in Africa), and
- United Nations Relief and Work Agency (UNRWA)’s e-Health system developed in-house in 2011 to address the administrative burden of millions of patient is the Middle East region (Lebanon, Gaza and Westbank, Syria and Jordan).
These two systems are great examples because they were designed and built mostly by volunteers to meet their core need: a single, comprehensive, mobile medical record that is available wherever the patient goes.
Most eHealth frameworks are based around the World Health Organization’s National eHealth Strategy Toolkit, which is a roadmap and toolkit for developing or revitalizing a country’s eHealth. The Toolkit has three steps:
- Develop a national eHealth vision that responds to health and development goals
- Develop an implementation roadmap that reflects country priorities and the eHealth context.
- Establish a plan to monitor implementation and manage associated risks
I rather like Israeli definition of national eHealth: To achieve a universal access to health care services leaving no one behind. Short, sweet and inclusive.
That’s the theory. So what should/could the ideal national eHealth framework deliver to us BigD-ers? Well, we are high-maintenance individuals, all with similar healthcare needs. We use at least one health service at least three times a week, often more. So as an example, here some of the eHealth services I’d like:
- eDialysis: that provides dialysis performance details after each session, with opportunities for contact with dialysis clinicians for queries and support
- eResults: online access to all my test results, blood and body fluid tests, biopsies, ECGs, MRIs, and all other medical imaging, with facilities to email the associated clinician for advice/discussion or to set up an appointment (for a fee)
- eMedications: a list of all my current and past medications, with side effect details, would be useful
- ePrescriptions: prescriptions generated in the doctor’s electronic prescribing system and then transmitted through a secure network to the national e-prescription database. While only the prescribing physicians and pharmacy personnel have access to the prescription, I can then have my medication dispensed at any convenient time and pharmacy
- eReferrals: especially for renewals, simply going online and requesting a new referral, which would be emailed to my specialist. I’d be happy to pay a small fee for this rather than us both blowing precious time (and money) on a full visit
- eEmergency: An on-my-person record of personal details, next of kin, ailments, medications, prescriptions, health insurance, and emergency contacts
- eHealthInsurance: readily available, electronic proof of health insurance
- eAppointments for dialysis: being able to set up my treatment times online, to swap times and even book times in other dialysis clinics electronically
- eAppointments for other health care services: setting them up online with my nephrologist, general practitioner or family doctor, clinics/hospitals, nurse practitioner, pharmacist, physiotherapist, psychiatrist, clinical psychologists, occupational therapists, dietitian – the lot
- eVaccination: a system that tracks my vaccination history and reminds me when we need another (currently I am more likely to get a vaccination reminder for my dog!)
- eDonor: if there are any useful bits of me left when I go for the big sleep, the fact that I would donate them should be both with me (on my driver’s licence) and online somewhere
- eMyHistory: secure online access, ideally in timeline and calendar formats, to my patient records (about my hospital visits, transplants, infections, heart problems, etc), specialist visits, family doctor visits (in fact, from all the people listed in my eAppointment dream above)
- eDNA: access to my genetic profile, showing my health risks, inherited conditions, drug risks and general traits. I want to know if I have any vulnerabilities or inherited diseases. This would also be available for the transplant team to help with matching.
Most of these are already available somewhere but in isolation. I’d like these on my smart phone please, preferably as a single App.
This list (except for the eDNA; it will probably be on next year’s list) is what eHealth is aiming to deliver. Most countries are starting with the easy stuff (eAppointment and ePrescription are popular) because they can be developed relatively quickly as stand-alone projects.
Other countries (including Australia) decided on the big bang: to develop a national eHealth record system and then convince patients, clinicians, hospitals and health care services generally to use it. Without exception, this approach has been very expensive and very, very difficult, especially in countries with a mix of public and private healthcare providers; to the point that most have failed on the first try.
The Scandinavian eHealth system is the most advanced because they started earlier (a couple of decades ago) so they have the most scar tissue and the most success.
But whatever the track record, the expected benefits from eHealth keep it firmly on the agenda in every country, including yours. To find out how it is progressing, just Google: (your country) and eHealth. You may be surprised; if not now, soon.
ps: I’ve ignored the many concerns about security and potential for misuse of a centralised health record about each one of us. They certainly exist, but must wait for another day.