eHealth

The provision of Health Care requires, and generates, a wide variety of data and information, which need to be collected, processed, distributed, accessed and used - securely and respectful of strict ethical and legislative rules. This is particularly vital for the Clinical and Managerial information. Other types of information are the Epidemiological, Literature and Knowledge.

The sources of these types of data and information are within and outside the Health Care infra-structure and located at varying distances from their respective users. In practice, users require and generate a mix of these types of information and at differing stages of their respective functions, e.g. a physician may consult a knowledge base, whilst examining a patient and would make a relevant entry onto the patient's record, which may be used for billing purposes.

The Health Care encounters and transactions are multi-faceted. They occur, for example, between a patient and a physician; between two physicians; between a physician and an expert consultant; a patient and a health institution such as a test laboratory, a pharmacy or a rehabilitation centre. And, such encounters may occur in one's own community, in another part of the country or abroad. All such encounters require data and information prior to the actual start of the encounter, and generate the same during the encounter or soon thereafter. Such data and information could be in differing volumes, at differing times and in differing forms such as voice, numbers, text, graphics and static or dynamic images, and are often a judicious mix of these.

The sources and repositories of such data and information could spread over differing locations and would take differing forms, for example, complete patients records; hand-written prescriptions; reports by a physician, a consultant or a laboratory

Traditionally, all such encounters were face to face, and the spoken and the written word were the main modes of communications and medical record-keeping, whilst transport was mainly by road, rail or air, public and private services. As the telephone services network grew, it became the communication network of the health professionals and institutions, nationally and internationally, until the advent and growth of modern tools of Health Telematics.

The uses of technology in the clinical/medical aspects of the Health Care services steadily grew and included instrumentation and equipment, particularly sensing and measuring equipment, laboratory services, static and dynamic imaging. With the growth of the uses of such technologies and of the variety and sophistication of these, it was inevitable that many of such technological services became separated from the mainstream Health Care institutions - separated in distance and more significantly in management. So, the communications between such technology-based services and the mainstream Health Care services, became an important consideration in the efficacy and economy of such services.

The popular use of Information and Communications Technologies by the health sector, started over 25-years ago with simple electronic messaging (E-mail) carrying purely alpha-numeric notes and reports. Just as voice communications was the main motive for the installation of telephones in physicians cabinets and Health Care institutions, E-mail was the main initial justification for the installation of modern telecommunication links. And, as E-mail services grew, so did the demands on their performance and geographic coverage: more locations at more speed and with more bandwidth to cater for the growing attachments to the E-mail messages. The past ten years have witnessed an exponential growth in the uses of E-mail in the health sector, within and between countries, even in the poorest countries, particularly over the INTERNET. For example, e-Transactions are taking over those functions that do not really require face-to-face encounters, such as preparing and sending

prescriptions and reports, fixing appointments and scheduling services, referring patients and, where the telecommunications services performance permit, also transmitting medical images and their associated expert readings, either written or oral.

Another level of sophistication of the uses of Information and Communications Technologies is TeleMedicine, which is "the provision of medical care using audio, visual and data communications", including the actual diagnosis, examination and even care of a patient who is remotely located. TeleMedicine is an important and growing field and is expected to change many of the traditional approaches in Health Care, indeed it is the start of a new paradigm in medical care.

Another area, that is relatively speaking not recent but will usefully expand with the spread of telematics support, is the access to and uses of knowledge-based systems. These systems, which are also known as expert systems and decision support systems, are systems that provide expert advice and guidance on medico-scientific issues and procedures. For example, given a patient's coordinates and symptoms, it could provide diagnostic support, suggest additional tests or propose a treatment.

All the above cited developments are also having a major impact on the relevant Management Information Systems needed for and used in the health sector, e.g. Hospital MIS. These are no more systems for the administrative management of hospital care to patients, from admission to discharge/transfer, but include a multitude of intelligent, medical-staff-friendly interfaces to, for example, clinical decision support systems, TeleMedicine links, Website portals, etc…

Two other recognised realities of Health Care staff and patients should also be cited: their mobility and their need for having their hands free and thus dedicated to the medical care itself. The mobility feature means that they can get to the medical information required, e.g. an Electronic Patient Record, or to a tool or instrument, from any remote location and whenever necessary subject to their verification, within a building or a town, but within whole countries and between countries. And, the hands free feature means that solutions have to be found for identification and authorisation that do not engage the medical worker in a manual intervention, e.g. to open a door or to key onto a computer keyboard.

Thus, Health Care is a profoundly information-intensive sector, in which the collection, flow, processing, presentation and distribution of health, and health-related, data and information, are key to the efficacy, efficiency and economy of the operations and development of the Health Care services, within a country and between countries.

A crucial requirement is that all such flow must be fulfilled securely and confidentially, and in strict adherence to ethical and legal rules and regulations.

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