Leaders: Unleashing the power of e-Health requires the right evidence base
The two leading articles in this issue of Informatics in Primary Care describe the importance of creating the right evidence base if we are to Unleash the Power of e-Health. Policy needs to promote well-thought-out developments that are evidence based, have the right theoretical underpinnings and are carefully modelled to see where and how they might fit into the (very human) process of health care delivery and most importantly affect health outcomes.
To inform this debate, we need to be clear about what we mean by e-Health and the evidence base, their origins and definitions (Boxes 1 and 2).
e-Health origins and definition
e-Health: e-Health was a term coined in 1999 out of the realisation that ‘telemedicine’ (technologies that delivered medicine at a distance) was too isolated a concept and that any use of technology had to be better integrated with other information technologies and into health systems.1 Definitions of e-Health have since then sometimes been more Internet centred; for example:
e-Health refers to the organisation and delivery of health services and information using the Internet and related technologies.2
Others take a more health management focus, for example the World Health Organisation definition:
e-Health is the transfer of health resources and health care by electronic means. It encompasses three main areas:
The delivery of health information, for health professionals and health consumers, through the Internet and telecommunications.
Using the power of IT and e-commerce to improve public health services, e.g. through the education and training of health workers.
The use of e-commerce and e-business practices in health systems management.3
e-Health combined with patient access to evidence and their records has the potential to empower patient choice.4
Evidence-based medicine origins, characteristics and grading evidence
Evidence-based medicine: Evidence-based medicine and practice requires greater emphasis on research. One of the first people to think about the importance of evidence from randomised controlled trials was Archie Cochrane, after whom the Cochrane Collaboration was named back in 1972.5 Some 20 years later, there were international calls to move to more evidence-based practice:
Evidence-based medicine de-emphasises intuition, unsystematic clinical experience and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research.
Evidence-based medicine requires new skills of the physician, including efficient literature searching and the application of formal rules of evidence evaluating the clinical literature.6
A key element of an evidence-based approach is to use the best evidence available.
The grading of recommendations assessment, development and evaluation has become a widely accepted approach to judging the strength of evidence of recommendations base on it.