eHealth Research, Theory and Development
Chapter 1 – Introducing eHealth
After completing this chaptoer you will be able to:
explain the relationship between technology, psychology and health, and connect them to
this book’s vision of eHealth.
state several areas of application of eHealth and provide accompanying examples.
name several benefits and barriers of eHealth in development, implementation, evaluation
and use in practice.
explain what a holistic vision of eHealth entails and why it is required to overcome the
barriers and achieve the benefits.
name and explain the importance of the five pillars of holistic eHealth development.
eHealth = the use of technology to improve health, well-being and healthcare.
Advantages: cost-effectiveness, process optimization, an increased reach and impact, improving
quality of care, higher satisfaction of patients.
However, not all technologies are used as much or in the way as was intended, intended goals are
not achieved of problems with financing.
Why eHealth?
Essence of healthcare: provide the best care possible that meets the needs of patients and
caregivers.
However, an ageing population implies an increase in chronic diseases that need to be self-managed.
Also, fewer working-age adults are available the healthcare system is in great need of innovation.
Today, in contrast with the traditional model patients and their ‘informal caregivers’ are more in
lead of their own healthcare.
Cooperative model of healthcare encourages and expects active involvement of patients, caregivers
and healthcare professionals participatory health.
Future options of innovative ways of support: de-hospitalization, organizing healthcare into regional
networks, adequate homecare, and concentration of highly specialized, complex care in one location.
Role of technology is emphasized in such solutions!
eHealth as instrument for communication between patients and caregivers and for providing health-
related information.
Different ways of looking at eHealth: Categorizing eHealth technologies according to …
• their place in the healthcare continuum: describing services to support care delivery, to
manage care or to promote prevention and education as part of public health self-
management programmes
• the characteristics of the technology: describing capacities of devices and systems (e.g.
wearable devices, virtual reality, web-based applications)
• their influence on the healthcare system: describing the infrastructure for healthcare,
emphasizing the possibilities of technologies to innovate or disrupt healthcare.
eHealth has impacted the healthcare infrastructure, for example, by providing care that is affordable
and accessible everywhere and anytime, and by sharing knowledge to everyone who has access to
the Internet.
“eHealth is not only a technical development, but also a state-of-mind, a way of thinking, an attitude,
and a commitment for networked, global thinking, to improve healthcare by using information and
communication technology.” ~ Eysenbach statement
,eHealth terminology
eHealth The use of technology to support health, well-being and healthcare.
eHealth technology The actual technological instrument via which health, well-being and
healthcare are supported, often information or communication
technology.
eHealth intervention An eHealth technology specifically focused on intervening in an existing
context by changing behaviour and/or cognitions.
Health informatics The interdisciplinary study of the design, development, adoption and
application of IT-based innovations in healthcare services delivery,
management and planning. Also called ‘medical informatics’.
Behaviour change Behavioural change interventions are interventions designed to affect the
interventions actions that individuals take with regard to their health.
eHealth: technology
well-functioning technology is necessary for good eHealth interventions. A good design that appeals
to users is beneficial as well. The role of technology within eHealth is often overlooked.
eHealth became interactive, it became possible to communicate with its users. Also, communicate
with each other became a possibility Humanizing technology.
Ethical concerns: how reliable should the feedback of technology be? Who is the owner of all the
collected data?
Another issue: following the newest trends and innovations (might have unknown effects) or using
well-researched (but less state-of-the-art) technologies?
A technology should fit with the user and context. This match is important for concepts like user
engagement, adherence, trust and involvement. To achieve this, a good development process is
essential.
Technology is essential for eHealth, and developers should always make sure that there is a good fit
between the technology, the user and the context.
eHealth: psychology
Theories and approaches from psychology should be used to create technologies that can enable
behaviour change.
Persuasive technology aims to persuade users in a positive way to make better choices for their
health and well-being.
Also, it is important to require knowledge of how people think and behave to make a good design for
your target group. In this way, it will fit their perspective. For this, psychological theories and
methods can be used.
Integrating psychology and technology
Technology can influence our cognitions, and our cognitions influence the way we view and use
technology.
Content and technology are often developed independently, which causes the perspectives of the
user and stakeholder to be forgotten along the way. To prevent this, collaboration is the key.
Benefits of eHealth
ACCES TO CARE
Via eHealth, healthcare can become available independent of time and place, because people can
access it whenever and wherever they need it (e.g. online consultations).
It can also create a lower threshold to access healthcare, which entails that more people have a
possibility to access healthcare more equally distributed improvement in healthcare equity.
However, people will need online access and a amount of (computer) skills.
It can also remove thresholds to healthcare like stigmatization.
, EMPOWERMENT
Technology may empower people by giving them the opportunity to take more control of their own
healthcare. People can choose when and where they want to access healthcare. In this way, they are
more in control of their own health and care process. It also increases people’s knowledge about
their own health. The information people collect can make it easier for them to make their own
informed health decision or have more equal discussions with their doctors.
Care professionals can be empowered as well. Technology can provide tailored support on medical
decision making, among other things, via data-driven diagnosis support and artificial intelligence.
INNOVATION
The possibilities that eHealth offers can be seen as a catalyst for innovation in healthcare. Technology
stimulates all involved stakeholders to critically think about how they deliver or receive care. It opens
up new ways of thinking, which can in turn stimulate innovation.
QUALITY OF CARE
eHealth technologies can incorporate medical guidelines and quality standards for healthcare. This
makes following guidelines or standards independent of individual care providers’ skills and
knowledge and an integral part of the regular process.
Effectiveness can be improved by using the possibilities of technology to improve traditional
interventions and treatments. Collected data can be used to provide tailored advice.
Efficiency: eHealth can require fewer resources to achieve the same quality of care and effects on
health and well-being.
eHealth: in practice
SELF-CARE AND PREVENTION
The patient or health consumer is in lead: technology can be used to foster self-management.
Sometimes a healthcare professional can be involved, e.g. when they answer a question.
To provide information on health and well-being.
E.g. decision aids, discussion forums, e-consultations, self-help course, websites/apps, (self)-
monitoring, online (self-help) treatments.
Online interventions are often used in combination with face-to-face therapies = blended care.
SUPPORTIVE CARE
More involvement of the healthcare professionals. The healthcare professionals and patients work
together. The care process is often more complex than in self-care and prevention.
eHealth can improve the information exchange as well as provide online self-management support
and monitor the performance.
E.g. telemedicine (to support care decision making), personal health records (PHRs)
SOCIETAL HEALTH
Both patient and healthcare professionals are involved, focuses on broad health-related issues that
might affect individuals. Societal health issues demand that governments play a vital role in creating
policies and regulations (prevention, spread and control of diseases and infections, or access to
healthcare for everyone)
eHealth can influence the attitude or awareness of individuals about societal health issues.
eHealth can be used to support behaviour that is compliant with guidelines that are required to
manage broad health-related issues.
eHealth can support communication between health professionals about societal health issues.
Chapter 1 – Introducing eHealth
After completing this chaptoer you will be able to:
explain the relationship between technology, psychology and health, and connect them to
this book’s vision of eHealth.
state several areas of application of eHealth and provide accompanying examples.
name several benefits and barriers of eHealth in development, implementation, evaluation
and use in practice.
explain what a holistic vision of eHealth entails and why it is required to overcome the
barriers and achieve the benefits.
name and explain the importance of the five pillars of holistic eHealth development.
eHealth = the use of technology to improve health, well-being and healthcare.
Advantages: cost-effectiveness, process optimization, an increased reach and impact, improving
quality of care, higher satisfaction of patients.
However, not all technologies are used as much or in the way as was intended, intended goals are
not achieved of problems with financing.
Why eHealth?
Essence of healthcare: provide the best care possible that meets the needs of patients and
caregivers.
However, an ageing population implies an increase in chronic diseases that need to be self-managed.
Also, fewer working-age adults are available the healthcare system is in great need of innovation.
Today, in contrast with the traditional model patients and their ‘informal caregivers’ are more in
lead of their own healthcare.
Cooperative model of healthcare encourages and expects active involvement of patients, caregivers
and healthcare professionals participatory health.
Future options of innovative ways of support: de-hospitalization, organizing healthcare into regional
networks, adequate homecare, and concentration of highly specialized, complex care in one location.
Role of technology is emphasized in such solutions!
eHealth as instrument for communication between patients and caregivers and for providing health-
related information.
Different ways of looking at eHealth: Categorizing eHealth technologies according to …
• their place in the healthcare continuum: describing services to support care delivery, to
manage care or to promote prevention and education as part of public health self-
management programmes
• the characteristics of the technology: describing capacities of devices and systems (e.g.
wearable devices, virtual reality, web-based applications)
• their influence on the healthcare system: describing the infrastructure for healthcare,
emphasizing the possibilities of technologies to innovate or disrupt healthcare.
eHealth has impacted the healthcare infrastructure, for example, by providing care that is affordable
and accessible everywhere and anytime, and by sharing knowledge to everyone who has access to
the Internet.
“eHealth is not only a technical development, but also a state-of-mind, a way of thinking, an attitude,
and a commitment for networked, global thinking, to improve healthcare by using information and
communication technology.” ~ Eysenbach statement
,eHealth terminology
eHealth The use of technology to support health, well-being and healthcare.
eHealth technology The actual technological instrument via which health, well-being and
healthcare are supported, often information or communication
technology.
eHealth intervention An eHealth technology specifically focused on intervening in an existing
context by changing behaviour and/or cognitions.
Health informatics The interdisciplinary study of the design, development, adoption and
application of IT-based innovations in healthcare services delivery,
management and planning. Also called ‘medical informatics’.
Behaviour change Behavioural change interventions are interventions designed to affect the
interventions actions that individuals take with regard to their health.
eHealth: technology
well-functioning technology is necessary for good eHealth interventions. A good design that appeals
to users is beneficial as well. The role of technology within eHealth is often overlooked.
eHealth became interactive, it became possible to communicate with its users. Also, communicate
with each other became a possibility Humanizing technology.
Ethical concerns: how reliable should the feedback of technology be? Who is the owner of all the
collected data?
Another issue: following the newest trends and innovations (might have unknown effects) or using
well-researched (but less state-of-the-art) technologies?
A technology should fit with the user and context. This match is important for concepts like user
engagement, adherence, trust and involvement. To achieve this, a good development process is
essential.
Technology is essential for eHealth, and developers should always make sure that there is a good fit
between the technology, the user and the context.
eHealth: psychology
Theories and approaches from psychology should be used to create technologies that can enable
behaviour change.
Persuasive technology aims to persuade users in a positive way to make better choices for their
health and well-being.
Also, it is important to require knowledge of how people think and behave to make a good design for
your target group. In this way, it will fit their perspective. For this, psychological theories and
methods can be used.
Integrating psychology and technology
Technology can influence our cognitions, and our cognitions influence the way we view and use
technology.
Content and technology are often developed independently, which causes the perspectives of the
user and stakeholder to be forgotten along the way. To prevent this, collaboration is the key.
Benefits of eHealth
ACCES TO CARE
Via eHealth, healthcare can become available independent of time and place, because people can
access it whenever and wherever they need it (e.g. online consultations).
It can also create a lower threshold to access healthcare, which entails that more people have a
possibility to access healthcare more equally distributed improvement in healthcare equity.
However, people will need online access and a amount of (computer) skills.
It can also remove thresholds to healthcare like stigmatization.
, EMPOWERMENT
Technology may empower people by giving them the opportunity to take more control of their own
healthcare. People can choose when and where they want to access healthcare. In this way, they are
more in control of their own health and care process. It also increases people’s knowledge about
their own health. The information people collect can make it easier for them to make their own
informed health decision or have more equal discussions with their doctors.
Care professionals can be empowered as well. Technology can provide tailored support on medical
decision making, among other things, via data-driven diagnosis support and artificial intelligence.
INNOVATION
The possibilities that eHealth offers can be seen as a catalyst for innovation in healthcare. Technology
stimulates all involved stakeholders to critically think about how they deliver or receive care. It opens
up new ways of thinking, which can in turn stimulate innovation.
QUALITY OF CARE
eHealth technologies can incorporate medical guidelines and quality standards for healthcare. This
makes following guidelines or standards independent of individual care providers’ skills and
knowledge and an integral part of the regular process.
Effectiveness can be improved by using the possibilities of technology to improve traditional
interventions and treatments. Collected data can be used to provide tailored advice.
Efficiency: eHealth can require fewer resources to achieve the same quality of care and effects on
health and well-being.
eHealth: in practice
SELF-CARE AND PREVENTION
The patient or health consumer is in lead: technology can be used to foster self-management.
Sometimes a healthcare professional can be involved, e.g. when they answer a question.
To provide information on health and well-being.
E.g. decision aids, discussion forums, e-consultations, self-help course, websites/apps, (self)-
monitoring, online (self-help) treatments.
Online interventions are often used in combination with face-to-face therapies = blended care.
SUPPORTIVE CARE
More involvement of the healthcare professionals. The healthcare professionals and patients work
together. The care process is often more complex than in self-care and prevention.
eHealth can improve the information exchange as well as provide online self-management support
and monitor the performance.
E.g. telemedicine (to support care decision making), personal health records (PHRs)
SOCIETAL HEALTH
Both patient and healthcare professionals are involved, focuses on broad health-related issues that
might affect individuals. Societal health issues demand that governments play a vital role in creating
policies and regulations (prevention, spread and control of diseases and infections, or access to
healthcare for everyone)
eHealth can influence the attitude or awareness of individuals about societal health issues.
eHealth can be used to support behaviour that is compliant with guidelines that are required to
manage broad health-related issues.
eHealth can support communication between health professionals about societal health issues.
