E-health is another of those container terms we use for a whole range of applications of information and communication technologies (ICT). To keep seeing the wood for the trees, it is useful to classify all these diverse applications in a generalizing way into three categories of application areas:
• e-care: applications that are being used within the specific care situation and in the treatment of patients : telemedecine, telemonitoring, intelligent housing …
• e-care support: applications oriented towards the logistic and organizational support of policymakers, medical services and health insurances, care providers and patients, e.g. financial management systems, data exchange between care providers, administrative proceedings, electronic patients’ records.
• e-public health care: a very broad category which on the one hand refers to applications aiming at giving citizens or patients access to health-related information (e.g. portal sites) and on the other hand at the gathering of policy-supporting information such as minimal clinical data, public health information, consumption patterns for patients …).
The project will focus on a number of issues, discussions and challenges when policy decisions are being made, based upon e-technology applications in medical care. Some of the questions are summarized in the following sections.
Social and care-related questions and issues
E-health-related issues necessarily refer to a public good (health and well-being). The distribution mechanisms in the public space take another shape and obey different conditions than on the traditional markets. Moreover, developments in health care and public welfare will always be a typical matter for social debate. Taking into account these side conditions, a number of issues in the debate on e-health deserve our specific attention :
A needs-driven technology policy :
The health care and public welfare sector call for a well-considered technology policy that takes as its foundation the basic question : Which kind of applications deserve to be given priority ? “Bottom-up” initiatives can be interesting in a pilot stage but at some time, the question will have to be answered how everything can be integrated appropriately in order to support the needs of the target groups. That kind of policy must be shaped through social debate. An e-health policy directed towards the specific needs of the sector and its target groups deserves more attention. An organized platform where technology developers and potential users can meet and exchange information is highly desirable. Technological questions that will have to be dealt with encompass hardware and software standards (on a regional, national and international scale). In the near future we need clear developing efforts and a debate on the integration of broadband technology applications, nanotechnology and the opportunities of “ubiquitous computing” and “ambient intelligent technologies”.
Actual and efficient applications
One of the essential questions in health care and public welfare is to find out whether and how technological innovations contribute to the improvement of the state of public health. A lot of applications have been introduced without knowing if they actually contribute in a significant way to the realization of the health care objectives. Whenever public funds are being invested, the question will explicitly have to arise if these resources are used efficiently.
Privacy and (giving) access tot health-related data
Privacy is a difficult issue. Not only from a technical point of view but also from a social and conceptual perspective : Which information can be collected ? How will the information flow be managed ? Who will have access to which (kind of) data ? And how can the security and the protection of the data be organized and technically accomplished ? This is a debate on the functions of the users of the information, their identification and authorization and the storage of information.
E-health offers a range of possibilities to put the “knowledge” which is needed to function in the health care sector more easily at the disposal of citizens, clients or patients. One of the challenges resides in the question how useable, correct and useful information can be put at hand in an accessible way. On a local level, this kind of exercise is not always self-evident, given a medium (the internet) that assures a worldwide access tot all kinds of information, coming from different sources. More discussion and (action) research into the ways for “information” to be effectively tailored to the individual, social and cultural characteristics of the target groups will make the efficiency of e-health applications increase.
Access to technology
A fundamental societal issue concerns the accessibility of e-health applications. The accessibility question has to do with physical, spatial, logistic, financial, as well as social and cultural circumstances. There is a real danger that e-health will widen the gap between the “haves” and the “have-nots” and the risk for a digital gap to divide different types of users. A public good asks for a debate and solutions to be put forward and discussed.