An overview of the issues surrounding the implementations e-health globally.

1. eHealth: Meanings, Scope, Scale &
Successes
Adesina Iluyemi
Fellow, Royal Society of Medicine
adesina.iluyemi@port.ac.uk
University of Portsmouth
@
Innogen, The Open University
Milton Keynes, UK
13/06/2012

2. Meanings
• Multiple, Contested & Divergent Meanings (Pagliari et. al.
2005)
– Reflects National & Regional Preferences
– Reflects academic & clinical professional inclinations
– Reflects the inherent complexity in practice
– Most are Functional & Techno-centric
– Most neglects social & organizational elements

3. Broad Definition
• “eHealth is an emerging field in the intersection of medical
informatics, public health and business, referring to health
services and information delivered or enhanced through the
Internet and related technologies. In a broader sense, the
term characterizes not only a technical development, but
also a state-of-mind, a way of thinking, an attitude, and a
commitment for networked, global thinking, to improve health
care locally, regionally, and worldwide by using information
and communication technology” (Eysenbach 2001)

4. Understanding Scope & Scale

5. Scope: Services & Applications
• Telemedicine
• Telehealth/Telemonitoring
• mHealth
• Telecare/ Home Telehealth
• Electronic Health Record
• Electronic Prescribing
• Health Management Information System
• mHealth
• E-Learning
• Laboratory Information System
• Health Information Technology

6. Scope: Technologies
• Telecommunication
– Connectivity- Fixed & Wireless
• Computing
– Desktop & Mobiles
– Videoconferencing
– Sensors
– Networks
• Medical
– Imaging
– Diagnostic
– Therapeutic

7. Scales
• Current global explosion of:
– Implementations
– Innovations
• Rapidly evolving Landscapes
– Changing Demography
– Shifting Epidemiology
– Health System Constraints
– Disruptive Technologies
– Global Techno-economic changes
– Industrial Drivers
– Proactive National Government Policies
– Enabling International Cooperation

8. Small Scales: Uncertainty
• Pilots & Operation Globally in:
– Hospitals
– Clinics
– Homes
• Scalability is a challenge
– Especially in Developing Countries
• Socio-technological constraints
– Technological Incompatibility
– Usability
– Affordability
– Maintainability
– Sustainability

9. Large-Scale: Types
• Explosion of National Programmes
– UK, US, Australia, Canada, Denmark, Norway, South Korea,
Malaysia, South Africa et. cetera
• Formulation of National eHealth Policies
– Uganda, Kenya, South Africa and EU countries
• Continental
– Pan-African Telemedicine Network
– EU-wide EHR System

10. Large-Scale: Complexity
• Boundary Spanners
– Ambitious
– Big
– Political
– Managerial
– Inter-organisational
– Territorial
– Technology-intensive
– Socio-technological
– Expensive
– Contentious
– Transformative?

11. Policy Debates: Successes
• Success is contested & ambiguous
– Multiple stakeholders
– Inherent complexity
– Clinical Expectations
– Political mandates
– Economic benefits
– Multiple Technologies
– Health System/service inertia
• Measuring success is challenging!
– Divergent & plural expectations

12. Impact Measurements: Incoherence
• Process or Outcomes?
– Clinical Outcomes (Patients)
– Health Workers Acceptability & Utilisation
– Financial Inputs
– Innovation/Industrial Outputs/Inputs
– Societal Benefits/Risks
– Economic Benefits/Risks
– Commercial/Business Inputs/Outputs
• Uncertain & Contested Outcomes
• Policy Challenge
– How to and what to measure?

13. Policy Implications
• Scope
– Single or Multiple Services or Technologies?
– Localised or Networked Systems?
– Circumscribed or Distributed Implementations?
• Scale
– Incremental or Big bang?
– Service or Engineering project?
– Short-term or Long-term?
• Success
– ??????????

14. Conferences
• SIHI 2012, September, CHMI, University of
Portsmouth
• Telemed & eHealth 2012, Royal Society of
Medicine, November, London