Defining and Characterising the Landscape of eHealth

Introduction

The need for reforming the delivery of healthcare services to accommodate the needs of modern societies is being experienced on a global scale. Government expenditure for the healthcare domain is increasing on a yearly basis (Bergamo, 2015). Population figures are growing with a reported increase of one billion people within the next 15 years, reaching 8.5 billion in 2030 (UN, 2015). Such a rapid increase in population is placing pressure on existing resources for healthcare (Keehan et al., 2015), thereby stressing the need for healthcare services to be reformed. Within the rapid rates of population growth, the fastest growing segment in the European population is the over 65 age group (Coale and Hoover, 2015), a group which utilises three to five times more healthcare services than their younger counterparts. Additionally, disease growth is on the increase as population rates incline. Despite the major progress in reducing death rates from various diseases, dramatic changes in global diseases have occurred whereby diseases have shifted to more lifestyle-related diseases (e.g. obesity, chronic obstructive pulmonary disease, type 2 diabetes and heart disease). Issues such as expenditure, population and disease growth enhance the need to reform the delivery of healthcare services. It is recognised that Information Systems (IS) is a critical success factor in the achievement of health care reform goals (Heeks, 2006) as the general use of IS globally is a powerful driver for change across the healthcare industry. Advantages of successfully implementing IS within the healthcare domain are reported in literature. These include reduced time to diagnosis, improved access for patients to care, quality of life and patient satisfaction, enhanced healthcare provider decision making, increased accuracy in medical treatment and cost-savings (Bergamo, 2015).

Hospital Information Systems (HIS) were the main and earliest use of IS in healthcare (Reichertz, 1975). Prior to 1960, electronic computers were not in general use in hospitals (Austin and Greene, 1978). From these early days HIS were defined as systems for “transmitting data among various personnel in different support units of the hospital” which ultimately seeks to “integrate all elements of information processing related to patient care into one system with a shared database” (Barnett and Zielstorff, 1974, p. 158). This definition of HIS has been used as a guide to defining the various eHealth technologies which subsequently emerged. However, since the 1970s HIS have evolved by incorporating other types of eHealth technologies, e.g. electronic medical records or electronic health records (EHR), electronic clinical decision support systems (CDSS), which has resulted in the varying definitions we observe in literature today.

Building from this, the objective of this paper is to define and characterise the landscape of eHealth technologies from an Information Systems (IS) perspective. The next section defines and characterises the concept of electronic Health (eHealth). In doing so, various features and functionalities of eHealth technologies are reported. It is argued that the evolving nature of technological artefacts influence how the term eHealth is defined. In light of this, the concepts of eHealth integration and ontologies are subsequently discussed. Concluding this chapter is an overview of both academic and practitioner-orientated contributions and future eHealth research directions.