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The 10 E’s in E-Health: ICT, Change and the People

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“Health care” refers broadly to medical service provision and it is seen by some as suggesting the right of people to equally receive such essential service in a civilized society.  It may be argued that people should have health care as a matter of both practical necessity and right.  As a matter of need, health care increases the welfare of the greatest number of people. (Daniels, 2001)  Healthy people are productive citizens.  As a matter of right, proper health care provision promotes equality of opportunity and is of the greatest benefit to the least advantaged members of society.  Healthy people are caring citizens in a caring society.

Now, in our global or globalizing society, the utilization and integration of information and telecommunications technology in health care provision has begun to take shapeE-health as it is referred to.  For Eysenbach (2001), this emergent system is characterized by the following principles and concerns:

  1. Efficiency – Efficiency in health care can bring down costs.
  2. Enhancing quality of care – Quality of health care could be improved.
  3. Evidence based – Interventions should be evidence-based, rigorously scientific.
  4. Empowerment of consumers and patients – opens avenues for patient-centered service.
  5. Encouragement of a new relationship between the patient and health professional.
  6. Education of physicians through online sources, and of consumers.
  7. Enabling standardized communication between health establishments.
  8. Extending the scope of health care geographically and in a “conceptual sense.”
  9. Ethics – Involves new forms of patient-physician interaction with new challenges.
  10. Equity – Making health care more equitable, but with corresponding “threats” given the “digital divide.”

These ‘E’s’ could be the propositions upon which society can shape a new or emerging geo-political health and wellness modelThis model is a new way of doing things in the health and medical sector that would breach spatial, temporal, as well as political and cultural boundaries.  Such a model must begin with a definition of e-health and some have already attempted to craft such a definition.  For instance, e-health, “an emerging field in the intersection of medical informatics, public health and business,” can be seen as encompassing more than a mere technological development for it refers to, as Eysenbach (2001) prefers, “health services and information delivered or enhanced through the Internet and related technologies.”  Hence, Eysenbach describes it broadly as “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” with the use of ICT or information and communication technologies

Hence, one could say that the function of the Internet in facilitating geographic communication is at the core of e-health development.  However, this is not a mere hardware matter as technology always has its soft side, its social or human aspect, given the need to ultimately address the needs of the human user-inventor.  Thus, there are risks involved.  A survey of the issues in cyber-space or Internet use can very well suggest what problems one can expect in e-health.  As a case in point, the access to quality health care given the so-called digital divide may not be so promising.  Then there is the issue of cyber-crimes and hence fraud and privacy concerns could be expected to crop up in the cyber-health arena.

In view of such concerns, there is a need to link the existing computing systems into an Internet-based future but with due caution. The necessary technological and information-based research and development programs must be focused on the development of user-friendly interfaces for patients of all ages, as well as for clinicians, and will involve the development of electronic clinical care protocols, whether these be delivered in real time, or by “store and forward” electronic mail, video mail, video conferencing, telephony or other methods.  Hospitals and schools can play and are playing the lead role in the integration of these computing systems. Governance support in such a reformed health system is crucial.  This pertains, among others, to dealing with issues of security with respect to health information management systems and privacy of the community of patients.  The government can address this myriad of concerns by providing incentives to the development of more pro-people and secure e-health technologies.

In sum, and following a heuristic model of appreciating ICT use and social dynamics, these “new” challenges for the health care information technology industry can be seen as affecting: (1) the capability of consumers to interact with their systems online (B2C = “business to consumer”); (2) the possibilities for institution-to-institution transmissions of knowledge (B2B = “business to business”); and, (3) related possibilities for peer-to-peer communication of consumers (C2C = “consumer to consumer”).  With these elements, one can very well further analyze the current state of things in the health sector and project possibilities for future improvements guided by the 10 E’s of e-health.  All these should only lead to ICT and related e-health technologies to become the components of a fundamentally service- and people-oriented geo-political wellness model.  Wellness, after all, is all about people and not mere techniques.


Eysenbach, G (2001).  Editorial. Journal of Medical Internet Research.  Based on the author’s speech delivered at UNESCO (Paris), June 2001, Conference of the International Council for Global Health Progress: Global health equity – Medical progress & quality if life in the XXIst century.

Daniels, N. (2001). Justice, health and healthcare. American Journal of Bioethics 1, 2, 2-16.

Bodenheimer, T. (2005). The political divide in health care: a liberal perspective, Health Affairs 24, 6, 1426.

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