Defining e-health - where are we?
E-health is health's version of e-commerce: that is, conducting health business electronically. E-health is the combined use of electronic communication and IT in the health sector, both at the local site and at a distance for clinical, educational and administrative purposes (Unstoppable rise of e-health, 1999).
E-health is a broad, encompassing term that envelops information technologies and telecommunication technologies. Telehealth, the provision of health at a distance using telecommunications, is subsumed by e-health.
Unfortunately there is a lot of confusion about this new field and some vendors are getting onto the hype bandwagon by adding "e-" to old solutions. Many new initiatives remain unproven, and, like modern art, time will tell which shall endure.
Users' strategic goals and end users' needs should drive solutions and not the vendors or suppliers’ business models. However, sometimes the users' needs are latent and thus it may be very difficult for us to identify sustainable competitive advantage in e-health. We will present some ideas on an approach that we hope will help you create sustainable competitive advantage.
There is much activity in Australia in the e-health area, and we have had some success, in areas such as call centres, radiology, pathology, psychiatry, pharmaceuticals, smart cards and staff development, in particular. We are now moving beyond the stage of telemedicine trials and telehealth networks. There's a new commercial focus on electronic health records and supply chain management.
The increasing Commonwealth activity with initiatives such as HealthConnect and similar State/Territory initiatives are creating the environment for e-health to develop. Steadily business and political imperatives are emerging .
Information Exchange Standards
Telecom infrastructure supplies the medium for information exchange. We also require standards for information exchange. These are beginning to emerge, but there still remains much work to be done.
There is much talk about XML (eXtensible Markup Language) as standard for exchanging data elements, yet this requires defining the medical meta-data set so everyone can agree how to label health care data entities. Certainly there is considerable consciousness about XML in South Africa. HL7 is also being used. I am aware of its use by two large healthcare informediaries (claims handing agents), both of whom claim that HL7 still required some "customisation" for their purposes.
Other important information exchange standards include e-mail protocols, and the older electronic data interchange standards such as EDIFACT. We require standard ways of accessing databases such as SQL and MIQUEST, a healthcare data query language being used in the UK to access clinical data from practice management systems. The Electronic Health Record too, may be viewed at this level as a "standard" for storing and retrieving clinical episode and encounter data, as distinct from a particular software application or database server infrastructure.
On the whole the progress in this vital area is good and is improving all the time.
Some general thoughts are:
• Buyers: e-health has the potential to improve the value proposition for healthcare consumers. This means affecting one or more of the criteria of Time, Quality, and Cost. Healthcare is a very high involvement product. Customers are very concerned about their own health. E-health is an ideal medium for shifting from a transaction-based to relationship-based product. I will shortly describe a patient intervention product where we did just this.
• Rivals: Differentiate yourself from the competition by emphasising your brand or reputation. As a communication medium e-health creates opportunity to do this. E-Health is also an ideal medium to reduce inefficiencies and reduce costs enabling you to achieve competitive advantage through cost reduction.
• New Entrants and Substitutes: Your power against substitutes and new entrants may come from adopting a pioneering and innovative culture, retaining the best staff, and emphasising your reputation.
• Suppliers: E-health can give competitive advantage through supplier integration, with resulting cost efficiencies.