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Eysenbach G (2001) Journal of Medical Internet Research Impact Factor (2018): 4.945 - ranked #1 medical informatics journal by Impact Factor Volume 3 (2001), Issue 2 ISSN: 1438-8871 Editor in Chief: Gunther Eysenbach, MD, MPH Contents Editorials What is e-health? (e20) G Eysenbach. 3 What is e-Health (2): The death of telemedicine? (e22) Vincenzo Della Mea. 5 Original Papers A Web-Based Distance Education Course in Nutrition in Public Health: Case study (e16) Dirce Sigulem, Tania Morais, Lilian Cuppari, Sylvia Franceschini, Silvia Priore, Kátia Camargo, Reinaldo Gimenez, Viviane Bernardo, Daniel Sigulem. 7 A Framework for an Institutional High Level Security Policy for the Processing of Medical Data and their Transmission through the Internet (e14) Christos Ilioudis, George Pangalos. 20 Comparing Web and Touch Screen Transaction Log Files (e18) David Nicholas, Paul Huntington, Peter Williams. 27 Virtual Sonography Through the Internet: Volume Compression Issues (e21) Olga Ferrer-Roca, Joseba Vilarchao-Cavia, Juan-Mario Troyano-Luque, Matilde Clavijo. 38 Review Ethical Challenges of Medicine and Health on the Internet: A Review (e23) Kirsti Dyer. 55 Short Paper Factors Associated with Intended Use of a Web Site Among Family Practice Patients (e17) Peggy Smith-Barbaro, John Licciardone, Howard Clarke, Samuel Coleridge. 71 Journal of Medical Internet Research 2001 | vol. 3 | iss. 2 | p.1 XSL·FO RenderX Viewpoints Evidence-based Patient Choice and Consumer health informatics in the Internet age (e19) Gunther Eysenbach, Alejandro Jadad. 77 The Patient-Physician Relationship in the Internet Age: Future Prospects and the Research Agenda (e15) Ben Gerber, Arnold Eiser. 88 Journal of Medical Internet Research 2001 | vol. 3 | iss. 2 | p.2 XSL·FO RenderX JOURNAL OF MEDICAL INTERNET RESEARCH Eysenbach Editorial What is e-health? G Eysenbach (J Med Internet Res 2001;3(2):e20) doi:10.2196/jmir.3.2.e20 characterizes not only a technical development, but Introduction also a state-of-mind, a way of thinking, an attitude, Everybody talks about e-health these days, but few people have and a commitment for networked, global thinking, to come up with a clear definition of this comparatively new term. improve health care locally, regionally, and Barely in use before 1999, this term now seems to serve as a worldwide by using information and communication general "buzzword," used to characterize not only "Internet technology. medicine", but also virtually everything related to computers This definition hopefully is broad enough to apply to a dynamic and medicine. The term was apparently first used by industry environment such as the Internet and at the same time leaders and marketing people rather than academics. They acknowledges that e-health encompasses more than just "Internet created and used this term in line with other "e-words" such as and Medicine". e-commerce, e-business, e-solutions, and so on, in an attempt As such, the "e" in e-health does not only stand for "electronic," to convey the promises, principles, excitement (and hype) but implies a number of other "e©s," which together perhaps best around e-commerce (electronic commerce) to the health arena, characterize what e-health is all about (or what it should be). and to give an account of the new possibilities the Internet is Last, but not least, all of these have been (or will be) issues opening up to the area of health care. Intel, for example, referred addressed in articles published in the Journal of Medical Internet to e-health as "a concerted effort undertaken by leaders in health Research. care and hi-tech industries to fully harness the benefits available through convergence of the Internet and health care." Because The 10 e©s in "e-health" the Internet created new opportunities and challenges to the traditional health care information technology industry, the use 1. Efficiency - one of the promises of e-health is to increase of a new term to address these issues seemed appropriate. These efficiency in health care, thereby decreasing costs. One "new" challenges for the health care information technology possible way of decreasing costs would be by avoiding industry were mainly (1) the capability of consumers to interact duplicative or unnecessary diagnostic or therapeutic with their systems online (B2C = "business to consumer"); (2) interventions, through enhanced communication possibilities improved possibilities for institution-to-institution transmissions between health care establishments, and through patient of data (B2B = "business to business"); (3) new possibilities for involvement. peer-to-peer communication of consumers (C2C = "consumer 2. Enhancing quality of care - increasing efficiency involves to consumer"). not only reducing costs, but at the same time improving So, how can we define e-health in the academic environment? quality. E-health may enhance the quality of health care for One JMIR Editorial Board member feels that the term should example by allowing comparisons between different remain in the realm of the business and marketing sector and providers, involving consumers as additional power for should be avoided in scientific medical literature and discourse. quality assurance, and directing patient streams to the best However, the term has already entered the scientific literature quality providers. (today, 76 Medline-indexed articles contain the term "e-health" 3. Evidence based - e-health interventions should be in the title or abstract). What remains to be done is - in good evidence-based in a sense that their effectiveness and scholarly tradition - to define as well as possible what we are efficiency should not be assumed but proven by rigorous talking about. However, as another member of the Editorial scientific evaluation. Much work still has to be done in this Board noted, "stamping a definition on something like e-health area. is somewhat like stamping a definition on ©the Internet©: It is 4. Empowerment of consumers and patients - by making the defined how it is used - the definition cannot be pinned down, knowledge bases of medicine and personal electronic as it is a dynamic environment, constantly moving." records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and It seems quite clear that e-health encompasses more than a mere enables evidence-based patient choice. technological development. I would define the term and concept 5. Encouragement of a new relationship between the patient as follows: and health professional, towards a true partnership, where e-health is an emerging field in the intersection of decisions are made in a shared manner. medical informatics, public health and business, 6. Education of physicians through online sources (continuing referring to health services and information delivered medical education) and consumers (health education, or enhanced through the Internet and related tailored preventive information for consumers) technologies. In a broader sense, the term http://www.jmir.org/2001/2/e20/ J Med Internet Res 2001 | vol. 3 | iss. 2 | e20 | p.3 (page number not for citation purposes) XSL·FO RenderX JOURNAL OF MEDICAL INTERNET RESEARCH Eysenbach 7. Enabling information exchange and communication in a likely to benefit from advances in information technology, standardized way between health care establishments. unless political measures ensure equitable access for all. 8. Extending the scope of health care beyond its conventional The digital divide currently runs between rural vs. urban boundaries. This is meant in both a geographical sense as populations, rich vs. poor, young vs. old, male vs. female well as in a conceptual sense. e-health enables consumers people, and between neglected/rare vs. common diseases. to easily obtain health services online from global providers. In addition to these 10 essential e©s, e-health should also be These services can range from simple advice to more complex interventions or products such a pharmaceuticals. • easy-to-use, 9. Ethics - e-health involves new forms of patient-physician • entertaining (no-one will use something that is boring!) and interaction and poses new challenges and threats to ethical • exciting issues such as online professional practice, informed - and it should definitely exist! consent, privacy and equity issues. 10. Equity - to make health care more equitable is one of the We invite other views on the definition of e-health and hope promises of e-health, but at the same time there is a that over time the journal will be filled with articles which considerable threat that e-health may deepen the gap together elucidate the realm of e-health. between the "haves" and "have-nots". People, who do not Gunther Eysenbach have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, Editor, these patient populations (which would actually benefit the Journal of Medical Internet Research most from health information) are those who are the least Acknowledgments 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. The article was partly stimulated by the question "what is ehealth?" asked by A. Risk on various mailing lists and in Health Informatics Europe http://hi-europe.co.uk/files/2001/9996.htm. Conflicts of Interest None declared. Submitted 22.12.00; this is a non±peer-reviewed article;accepted 18.06.01; published
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