Published on in Vol 7, No 1 (2005):

What Is eHealth (3): A Systematic Review of Published Definitions

What Is eHealth (3): A Systematic Review of Published Definitions

What Is eHealth (3): A Systematic Review of Published Definitions

Authors of this article:

Hans Oh ;   Carlos Rizo ;   Murray Enkin ;   Alejandro Jadad

Review

1Centre for Global eHealth Innovation, University Health Network, Toronto ON, Canada

2Department of Health Policy Management and Evaluation, University of Toronto, Toronto ON, Canada

Corresponding Author:

Alejandro Jadad, MD, DPhil

Centre for Global eHealth Innovation

University Health Network

R Fraser Elliott Building, 4th Floor

190 Elizabeth Street

Toronto, ON M5G 2C4

Canada

Phone: +1 416 340 4800 ext 6903

Fax:+1 416 340 3595

Email: ajadad@uhnres.utoronto.ca


Context: The term eHealth is widely used by many individuals, academic institutions, professional bodies, and funding organizations. It has become an accepted neologism despite the lack of an agreed-upon clear or precise definition. We believe that communication among the many individuals and organizations that use the term could be improved by comprehensive data about the range of meanings encompassed by the term.

Objective: To report the results of a systematic review of published, suggested, or proposed definitions of eHealth.

Data Sources: Using the search query string “eHealth” OR “e-Health” OR “electronic health”, we searched the following databases: Medline and Premedline (1966-June 2004), EMBASE (1980-May 2004), International Pharmaceutical Abstracts (1970-May 2004), Web of Science (all years), Information Sciences Abstracts (1966-May 2004), Library Information Sciences Abstracts (1969-May 2004), and Wilson Business Abstracts (1982-March 2004). In addition, we searched dictionaries and an Internet search engine.

Study Selection: We included any source published in either print format or on the Internet, available in English, and containing text that defines or attempts to define eHealth in explicit terms. Two of us independently reviewed titles and abstracts of citations identified in the bibliographic databases and Internet search, reaching consensus on relevance by discussion.

Data Extraction: We retrieved relevant reports, articles, references, letters, and websites containing definitions of eHealth. Two of us qualitatively analyzed the definitions and coded them for content, emerging themes, patterns, and novel ideas.

Data Synthesis: The 51 unique definitions that we retrieved showed a wide range of themes, but no clear consensus about the meaning of the term eHealth. We identified 2 universal themes (health and technology) and 6 less general (commerce, activities, stakeholders, outcomes, place, and perspectives).

Conclusions: The widespread use of the term eHealth suggests that it is an important concept, and that there is a tacit understanding of its meaning. This compendium of proposed definitions may improve communication among the many individuals and organizations that use the term.

J Med Internet Res 2005;7(1):e1

doi:10.2196/jmir.7.1.e1

Keywords



During the 1990s, as the Internet exploded into public consciousness, a number of e-terms began to appear and proliferate. The terms were useful: email brought new possibilities for people to communicate rapidly and share experiences; e-commerce proposed new ways to conduct business and financial transactions through the Internet. The introduction of eHealth represented the promise of information and communication technologies to improve health and the health care system [Alvarez RC. The promise of e-Health - a Canadian perspective. eHealth Int 2002 Sep 17;1(1):4. [Medline] [PMC] [CrossRef]1]. It too has become an indispensable term.

As with most neologisms, the precise meaning of eHealth varied with the context in which the term was used. Nevertheless, it has been fairly well understood, and is now widely used by many academic institutions, professional bodies, and funding organizations. We recognized the impossibility of finding a universally acceptable, universally applicable formal definition, yet felt that a clearer understanding of the term could be achieved by reviewing the range of proposed meanings. What is this thing called eHealth? Two previous articles in this journal have dealt with the question of how eHealth can be or should be defined [Della Mea V. What is e-health (2): the death of telemedicine? J Med Internet Res 2001 Jun 22;3(2):e22 [FREE Full text] [Medline] [CrossRef]2,Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3]. The aim of this paper is to systematically search the literature for definitions, which have been published to date, in an attempt to answer this unanswerable question and to determine the contexts or settings in which the term has been used.

To the best of our knowledge, no such search has previously been carried out or published. We believe that a better understanding of the meaning and perspectives of eHealth could improve communication among the many individuals and organizations that use the term. For this reason, we collected, examined, and qualitatively analyzed the published proposed definitions of the term eHealth.


Systematic Review

We first conducted a systematic review of the peer-reviewed literature to capture as many definitions of eHealth as possible. Our inclusion criteria required that a source be published in either print format or on the Internet, be available in English, and contain text that defines or attempts to define eHealth in explicit terms.

We searched the following electronic databases: Medline and Premedline (1966-June 2004), EMBASE (1980-May 2004), International Pharmaceutical Abstracts (1970-May 2004), Web of Science (all years), Information Sciences Abstracts (1966-May 2004), Library Information Sciences Abstracts (1969-May 2004), Wilson Business Abstracts (1982-March 2004).

For each database, we used the search query string “eHealthOR “e-Health” OR “electronic health”. In addition, we then searched dictionaries [Stedman TL. Stedman's Medical Dictionary. Baltimore, Md: Lippincott Williams & Wilkins; Jan 15, 2000.4,Soanes C, Stevenson A, editors. Oxford Dictionary of English, 2nd edition. Toronto, Ontario, Canada: Oxford University Press; Sep 1, 2004.5] and the Google web search engine (June 2004) which ranks retrieval by importance and relevance [; Google Inc. Google Technology Overview.   URL: http://www.google.com/intl/en/corporate/tech.html [accessed 2004 December 12] 6]. Because the search of Google resulted in an overwhelming number of hits, we reviewed only the first 400 results. We also refined our search by including the additional term definition and again reviewed the first 400 hits. We then conducted a further search using the search query string “what is eHealth” OR “what is e-Health”, reviewing all 358 results. We conducted our searches between February 1, 2004, and June 30, 2004. A summary of our search strategy and results is presented in Tables 1 and 2.

Two of us (HO, CR) independently reviewed titles and abstracts of citations identified in the bibliographic databases. By viewing summaries and websites of the Internet search, we reached consensus on relevance by discussion. We retrieved the relevant reports, articles, references, letters, and websites. We also manually searched the reference lists of the articles reviewed for additional relevant sources. From the hard or electronic copy of each report, we obtained the following data: author name, publication year, source, and definition (listed in Table 3). We identified and excluded duplicate definitions.

Qualitative Analysis

Upon collection, we analyzed all the definitions and coded for content, emerging themes, patterns, and novel ideas. We used the constant comparative method described by Strauss and Corbin [Strauss A, Corbin JM. Basics of Qualitative Research : Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, Calif: Sage Publications; Sep 22, 1998.7] involving open coding, axial coding, and selective coding. The constant comparative method is an iterative process of analyzing qualitative data (ie, text). Units of text (ie, words, phrases, sentences, or paragraphs) are labeled, compared, and grouped until no new categories emerge. Two of us (HO, CR) independently coded the definitions and compared results for consistency and reliability using a commercially available qualitative analytical software package (QSR NVivo v2.0).


Systematic Review

In total, we scanned 1209 abstracts and reviewed 430 citations from the bibliographic databases. From these we collected 10 different definitions for the term eHealth (Table 1). From the Google search, we reviewed 1158 sites and identified 41 additional unique definitions (Table 2).

The definitions that we found were as short as 3 words [Marcus E, Fabius R. What is E-health?.   URL: http://www.acpenet.org/Forums/Topical/Ehealth/Primer.htm [accessed 2004 June 24] 8] or as long as 74 words [; Rx2000 Institute. eHealth FAQ.   URL: http://www.rx2000.org/KnowledgeCenter/ehealth/ehfaq.htm#Whatis [accessed 2004 June 24] 9] (Table 3). We identified 2 universal themes (health and technology) and 6 less generally mentioned themes (commerce, activities, stakeholders, outcomes, place and perspectives) (Table 4).

Table 1. Summary of database searches
Database (time)CitationsArticles ReviewedUnique Definitions
MEDLINE (1966-June 2004)49315710
EMBASE (1975-2003)218730
International Pharmaceutical Abstracts1630
Information Sciences & Library Sciences Abstracts61150
Web of Science217770
Wilson Business Abstracts2041050
Total120943010
Table 2. Summary of Google searches
Search QueryCitationsSources ReviewedUnique Definitions
“eHealth” OR “e-Health” OR
“electronic health”
9600004000
“eHealth” OR “e-Health” AND definition770004009
“what is eHealth” OR “what is e-Health”35835832
Total1037358115841
Table 3. Definitions (verbatim quotations) of eHealth presented in chronological order
YearSource (M = Medline, W = Wilson Business Abstracts, G = Google)Definition
11999Mitchell [Mitchell J. From telehealth to e-health: The unstoppable rise of e-health. Canberra, Australia: Commonwealth Department of Communications, Information Technology and the Arts (DOCITA); 1999.42] (G)A new term needed to describe the combined use of electronic communication and information technology in the health sector. The use in the health sector of digital data – transmitted, stored and retrieved electronically – for clinical, educational and administrative purposes, both at the local site and at a distance.
21999Loman - First Consulting Group [Loman P. E-Health: Putting health on the Net. An FCG White Paper.   URL: http://www.fcg.com/webfiles/whitepaper/white_paper_files/wpEhealth.asp [accessed 2004 June 24] 12] (G)E-health – the application of e-commerce to healthcare and pharmaceuticals
32000JHITA [; Joint Healthcare Information Technology Alliance. e-Health.   URL: http://www.jhita.org/ehealth.htm [accessed 2004 June 26] 13] (G)Internet-related healthcare activities
42000McLendon [Mclendon K. E-commerce and HIM: ready or not, here it comes. J AHIMA 2000 Jan;71(1):22-23. [Medline]14] (M)Ehealth refers to all forms of electronic healthcare delivered over the Internet, ranging from informational, educational and commercial "products" to direct services offered by professionals, non-professionals, businesses or consumers themselves. Ehealth includes a wide variety of the clinical activities that have traditionally characterized telehealth, but delivered through the Internet. Simply stated, Ehealth is making healthcare more efficient, while allowing patients and professionals to do the previously impossible.
52000
Medical Business News [What is e-Health?.   URL: http://www.tsmi.net/april12continued.html [accessed 2004 June 24] 46] (G)E-Health is a convergence between the Internet and the health care industry to provide consumers with a wide variety of information relating to the health care field
62000GJW Government Relations [; GJW Government Relations Ltd Health Affairs. Memorandum.   URL: http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldeucom/95/95we29.htm [accessed 2004 June 26] 52](G)A wide-ranging area of social policy that uses new media technologies to deliver both new and existing health outcomes
72000Oracle Corporation [; Oracle Corporation. CEO Perspective: Health Care Information Technology.   URL: http://www.hciv.com/profiles/oracle.pdf [accessed 2004 June 26] 15] (G)Healthcare transactions, encounters, messaging, or care provision occurring electronically.
82000DeLuca, Enmark - Frontiers of Medicine [Deluca JM, Enmark R. E-health: the changing model of healthcare. Front Health Serv Manage 2000;17(1):3-15. [Medline]16] (W) (M)E-health is the embryonic convergence of wide-reaching technologies like the Internet, computer telephony/interactive voice response, wireless communications, and direct access to healthcare providers, care management, education, and wellness.
92000Pretlow [Pretlow R. eHealth International: A Cutting Edge Company For A New Age In Health Care.   URL: http://www.ehealthnurse.com/ehealthi.html [accessed 2004 June 24] 17] (G)E-health is the process of providing health care via electronic means, in particular over the Internet. It can include teaching, monitoring ( e.g. physiologic data), and interaction with health care providers, as well as interaction with other patients afflicted with the same conditions.
102001Baur, Deering and Hsu [Baur C, Deering MJ, Hsu L. ehealth: Federal Issues and Approaches. In: Rice RE, Katz JE, editors. The Internet and Health Communication. Thousand Oaks, Calif: Sage Publications; Nov 17, 2000:355-384.11] (G)The most broad term is ehealth, with refers to the use of electronic technologies in health, health care and public health. (...) The various functions of ehealth [are]: (...) reference (electronic publishing, catalogues, databases); self-help/self-care (online health information, support groups, health risk assessment, personal health records), Plan/provider convenience services (online scheduling, test and lab results, benefit summaries), Consultation and referral (doctor-patient or doctor-doctor consultation via telemedicine systems, remote readings of digital image and pathology samples), E-health commerce (sales of health related product and services) [and] Public health services (automated data collection, data warehouses, online access to population survey data and registries, advance detection and warning systems for public health threats). (...) This chapter uses the term ehealth to refer to the broadest possible range of interactive technologies applied to health and health care.
112001Orlikoff & Totten [Orlikoff JE, Totten MK. Trustee workbook 3. E-health and the board: the brave new world of governance, Part 1. Trustee 2000;53(7):4 p following 14. [Medline]18] (M)The use of the Internet and related information systems and technology in all aspects of health care.
122001Eysenbach [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3] (M)e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes 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 health care locally, regionally, and worldwide by using information and communication technology
132001Blake [Blake G. Accelerating the E-health Connectivity Imperative: Implementing Short-term Value against Long-term Goals when Building Private-sector Relationships. Electronic Healthcare 2001;1:56-59 [FREE Full text]43] (M)The combined use of electronic communication and information technology in the health sector. It is important to note that e-health is much more than business transactions. It encompasses everything from digital data transmission to purchase orders, lab reports, patient histories and insurance claims.
142001Strategic Health Innovations [; Strategic Health Innovations. FAQs.   URL: http://www.shi.ca/ourcompany/faqs.html [accessed 2004 June 26] 19] (G)The use of information technology in the delivery of health care.
152001Robert J Wood Foundation [; The Robert Wood Johnson Foundation. The eHealth Landscape.   URL: http://www.rwjf.org/ [accessed 2004 June 24] 20] (G)EHealth is the use of emerging information and communication technology, especially the Internet, to improve or enable health and health care.
162001Wysocki [Wysocki M. What is e-Health?.   URL: http://www.suite101.com/article.cfm/9670/57010 [accessed 2004 June 26] 21] (G)e-Health refers to all forms of electronic healthcare delivered over the Internet, ranging from informational, educational and commercial "products" to direct services offered by professionals, non-professionals, businesses or consumers themselves
172001JP Morgan Partners [; JP Morgan Partners. The Rise & Fall and ??? Of e-Health.   URL: http://www.upenn.edu/ldi/healthpolicyseminarjan26_Jan.%2022%20'01.ppt [accessed 2004 June 26] 45] (G)The health care industry\'s component of business over the Internet
182001Ontario Hospital eHealth Council [; Ontario Hospital eHealth Council. An eHealth Blueprint. Setting the Course For Action. An Ontario Hospital Perspective.   URL: http://www.oha.com22] (G)EHealth is a consumer-centred model of health care where stakeholders collaborate utilizing ICTs including Internet technologies to manage health, arrange, deliver, and account for care, and manage the health care system.
192001Tieman [Tieman J. On the trail of a computer cure-all ... eHealth Initiative. Mod Healthc 2001 Jun 18;31(25):36-37. [Medline]55] (M)E-health is all that\'s digital or electronic in the healthcare industry
202001DeLuca, Enmark [Deluca JM, Enmark R. The latest revolution. What solutions will technology offer? Health Forum J 2001;44(1):22-25. [Medline]61] (M)E-health is the electronic exchange of health-related data across organizations, although every health care constituent approaches e-health differently.
212001Ball – HIMSS [Ball MJ. E-Health: Empowering clinicians and consumers.   URL: http://www.himss.org/content/files/proceedings/2001/roundtab/rslides/rsl08.pdf [accessed 2004 June 26] 47] (G)Internet technologies applied to the healthcare industry
222002Health e-Technologies Initiative [; Health e-Technologies Initiative. 2002 Call for Proposals.   URL: http://www.hetinitiative.org/sub-call_for_proposals/cfp-faqs.html [accessed 2004 June 24] 23] (G)The use of emerging interactive technologies (i.e., Internet, interactive TV, interactive voice response systems, kiosks, personal digital assistants, CD-ROMs, DVD-ROMs) to enable health improvement and health care services.
232002Grantmakers in Health [; Grantmakers In Health, Washington, D.C., USA. Examining e-health. Issue brief (Grantmakers Health) 2002 Nov(14):1-28. [Medline]24] (G)Use of ICT, especially (but not only) the Internet to enable health and health care.
242002Kirshbaum [Kirshbaum D. eHealth: Past, present & future.   URL: http://www.nehimss.org/pubs/Kirshenbaum.ppt [accessed 2004 June 26] 25] (G)There are many different definitions of eHealth
  • Electronic connectivity vehicle for improving the efficiency and effectiveness of healthcare delivery
  • Enabling consumers/patients to be better informed about their healthcare
  • Enabling providers to deliver better care in more efficient ways
252002Wyatt and Liu [Wyatt JC, Liu JLY. Basic concepts in medical informatics. J Epidemiol Community Health 2002 Nov;56(11):808-812 [FREE Full text] [Medline] [CrossRef]51] (M)The use of internet technology by the public, health workers, and others to access health and lifestyle information, services and support; it encompasses telemedicine, telecare, etc.
262003Staudenmeir - Arthur Anderson [Staudenmeir S. Introduction to eHealth.   URL: http://www.healthaction.net/esnets/web_bots/slide+presentationswebot.htm [accessed 2004 June 24] 26] (G)
Any use of the Internet or related technology to improve: the health and wellness of the population; the quality of healthcare services and outcomes; efficiencies in healthcare services or administration
272003COACH [; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39] (G)
The leveraging of the information and communication technology (ICT) to connect provider and patients and governments; to educate and inform health care professionals, managers and consumers; to stimulate innovation in care delivery and health system management; and, to improve our health care system.
282003Rx2000 [; Rx2000 Institute. eHealth FAQ.   URL: http://www.rx2000.org/KnowledgeCenter/ehealth/ehfaq.htm#Whatis [accessed 2004 June 24] 9] (G)eHealth signifies a concerted effort undertaken by some leaders in healthcare and hi-tech industries to harness the benefits available through convergence of the Internet and healthcare. Access, cost, quality and portability have been concerns in the health care arena. It\'s evident from many recent surveys that both health consumers and healthcare professionals are frustrated with the maze of health care delivery. Some, therefore, are turning to the Internet for answers and cost effective solutions.
292003Beaulieu & Beinlich - First Consulting Group [Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27] (G)eHealth (ē´helth), n. 1. The application of Internet principles, techniques and technologies to improve healthcare. 2. New way of conducting the business of healthcare enabling stronger and more effective connections among patients, doctors, hospitals, employers, brokers, payers, laboratories, pharmacies, and suppliers. 3. The “customer facing” e-revolution in healthcare. [1999]
302003eEurope - eHealth2003 [; eEurope. What is eHealth.   URL: http://europa.eu.int/information_society/eeurope/ehealth/whatisehealth/index_en.htm [accessed 2004 June 26] 53] (G)The application of information and communication technologies (ICT) across the whole range of functions which one way or another, affect the health of citizens and patients.
312003Decker – HealthVision [Decker S. What is e-Health?.   URL: http://12.42.224.48/ehealthresources/what_is_ehealth.pdf [accessed 2004 June 24] 28] (G)Corporate strategy and using the power of the Internet and emerging technology to redefine the delivery of health care.
322003Miller - athealth.com [Miller JL. The Internet as Therapist and Teacher.   URL: http://www.athealth.com/Practitioner/particles/art_InternetAsTandT.html [accessed 2004 June 24] 29] (G)E-health means any form of healthcare information made available over the Internet.
332003Telehealth Victoria [; Telehealth Victoria. Telehealth Victoria FAQs.   URL: http://www.shi.ca/ourcompany/faqs.html [accessed 2004 June 26] 30] (G)Term that is used to describe most aspects of healthcare delivery or management that is enabled by information technology or communications
342003Ebrunel.com [; ebrunel.com. eHealth.   URL: http://www.ebrunel.com/ehealth.php3#ehealth [accessed 2004 June 26] 31] (G)The provision of healthcare services available through the Internet - and particularly to the rash of health related web sites.
352003Regional Office for the Eastern Mediterranean - World Health Organization [; World Health Organization - Regional Office for the Eastern Mediterranean. E-Health in the Eastern Mediterranean.   URL: http://208.48.48.190/HIS/ehealth/AboutEhealth.htm [accessed 2004 June 27] 44] (G)E-health is a new term used to describe the combined use of electronic communication and information technology in the health sector OR is the use, in the health sector, of digital data-transmitted, stored and retrieved electronically-for clinical, educational and administrative purposes, both at the local site and at a distance
362003www.avienda.co.uk [Telehealth & EHealth.   URL: http://www.avienda.co.uk/ [accessed 2004 June 24] 32] (G)
A generic field of information and communications technologies used in medicine and healthcare.
372003Brommey [Brommey M. Challenges in e-health service delivery. 2nd annual online summit.   URL: http://www.health.gov.au/healthonline/docs/summit2/brommeyer.pdf [accessed 2004 June 24] 33]The use of electronic information and communications technologies to provide and support health care wherever the participants are located
382003Southwest Medical Group [; Southwest Medical Group. Frequently Asked Questions.   URL: http://www.southwestmedicalgroup.com/faq.asp [accessed 2004 June 26] 34] (G)e-health is an emerging field focused on medical information and health care services delivered or enhanced through advanced Internet or related technologies. In a broader sense, the term extends the scope of health care beyond its conventional boundaries. Conceptually, e-health enables patients to easily obtain medical related services online from health care providers
392003HMS Europe [What is eHealth?.   URL: http://www.hmseurope.com/e_health.htm [accessed 2004 June 24] 40] (G)The practice of leveraging the Internet to connect caregivers, healthcare systems and hospitals with consumers
402003Nova Scotia Telehealth Network [; Nova Scotia Telehealth Network. Frequently Asked Questions.   URL: http://www.gov.ns.ca/health/telehealth/faq.htm [accessed 2004 June 25] 62] (G)E-health is a broad term to describe the accessing of information, products and services on "e-health" sites
412003Strengthening Support for Women with Breast Cancer [; Breastcare Victoria. Strengthening Support for Women with Breast Cancer. E-health Information Package.   URL: http://www.breastcarevic.org.au/sswbc/docs/infopak.pdf [accessed 2004 June 26] 35] (G)The use of information and communication technology (ICT) to enhance health care.
422003Vigneault [Vigneault R. First Nations and Inuit Health Information Systems.   URL: http://www.afoa.ca/conf2002/FNIHIS%20AFOA-R%20Vigneault.ppt [accessed 2004 June 24] 10] (G)The development and evolution of technical tools to support program delivery
432003Policy on ICT Security [Policy on ICT Security.   URL: http://www.qub.ac.uk/cm/gp/UG-Med-Informatics/ [accessed 2004 June 26] 50] (G)Using the Internet and other electronic channels to access and delivery health and lifestyle information and services
442003Health systems group [; Health Systems Group. eHealth - Wellness in the 21st Century.   URL: http://www.healthsystemsgroup.com/Resources/Articles/eHealth.htm [accessed 2004 June 26] 49] (G)eHealth is health promotion delivered and managed over the Internet
452003Marcus and Fabius [Marcus E, Fabius R. What is E-health?.   URL: http://www.acpenet.org/Forums/Topical/Ehealth/Primer.htm [accessed 2004 June 24] 8] (G)Ehealth is connectivity
462003Silber [Silber D. The case for eHealth.   URL: http:/​/europa.​eu.int/​information_society/​eeurope/​ehealth/​conference/​2003/​doc/​the_case_for_eHealth.​pdf [accessed 2004 June 26] 54] (G)eHealth is the application of information and communications technologies (ICT) across the whole range of functions that affect health.
472003Ehealth Technologies [; eHealth Technologies. What is eHealth?.   URL: http://www.ehealthtechnologies.com/what%20is%20ehealth.htm [accessed 2004 June 26] 36] (G)The use of emerging information and communication technology, especially the Internet, to improve or enable health and healthcare thereby enabling stronger and more effective connections among patients, doctors, hospitals, payors, laboratories, pharmacies, and suppliers
482003International Telecommunication Union [; International Telecommunication Union. Standardization in e-health.   URL: http://www.itu.int/itunews/issue/2003/06/standardization.html [accessed 2004 June 26] 41] (G)Encompasses all of the information and communication technologies (ICT) necessary to make the health system work
492003Baker [Baker B. Nursing in an e-healthy world? A vision of e-health as core to caring.   URL: http://www.hlth.qut.edu.au/nrs/inc2003/post/ppts/2 [accessed 2004 June 26] 48]
Modified from Gott (1993) (G)
The promotion and facilitation of health and well-being with individuals and families and the enhancement of professional practice by the use of information and communication technology
502004Sternberg [Sternberg DJ. The new e-health. As technology matures, more sensible approaches to online healthcare are emerging. Mark Health Serv 2004;24(1):46-48. [Medline]37] (M)New business models using technology to assist healthcare providers in caring for patients and providing services.
512004Watson [Watson R. EU wants every member to develop a "roadmap" for ehealth. BMJ 2004 May 15;328(7449):1155 [FREE Full text] [Medline] [CrossRef]38] (M)The integration of the internet into health care.
Table 4. Themes found in definitions of eHealth
YearSource(M = Medline, W = Wilson Business Abstracts, G = Google)HealthTechnologyStakeholdersActivitiesAttitudesPlaceOutcomesCommerce
11999Mitchell [Mitchell J. From telehealth to e-health: The unstoppable rise of e-health. Canberra, Australia: Commonwealth Department of Communications, Information Technology and the Arts (DOCITA); 1999.42] (G)XXXX
21999Loman - First Consulting Group [Loman P. E-Health: Putting health on the Net. An FCG White Paper.   URL: http://www.fcg.com/webfiles/whitepaper/white_paper_files/wpEhealth.asp [accessed 2004 June 24] 12] (G)XX
32000JHITA [; Joint Healthcare Information Technology Alliance. e-Health.   URL: http://www.jhita.org/ehealth.htm [accessed 2004 June 26] 13] (G)XXX
42000McLendon [Mclendon K. E-commerce and HIM: ready or not, here it comes. J AHIMA 2000 Jan;71(1):22-23. [Medline]14] (M)XXXXXX
52000
Medical Business News [What is e-Health?.   URL: http://www.tsmi.net/april12continued.html [accessed 2004 June 24] 46] (G)XXXXX
62000GJW Government Relations [; GJW Government Relations Ltd Health Affairs. Memorandum.   URL: http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldeucom/95/95we29.htm [accessed 2004 June 26] 52](G)XXXXX
72000Oracle Corporation [; Oracle Corporation. CEO Perspective: Health Care Information Technology.   URL: http://www.hciv.com/profiles/oracle.pdf [accessed 2004 June 26] 15] (G)XX
82000DeLuca, Enmark - Frontiers of Medicine [Deluca JM, Enmark R. E-health: the changing model of healthcare. Front Health Serv Manage 2000;17(1):3-15. [Medline]16] (W) (M)XXX
92000Pretlow [Pretlow R. eHealth International: A Cutting Edge Company For A New Age In Health Care.   URL: http://www.ehealthnurse.com/ehealthi.html [accessed 2004 June 24] 17] (G)XXXX
102001Baur, Deering and Hsu [Baur C, Deering MJ, Hsu L. ehealth: Federal Issues and Approaches. In: Rice RE, Katz JE, editors. The Internet and Health Communication. Thousand Oaks, Calif: Sage Publications; Nov 17, 2000:355-384.11] (G)XX
112001Orlikoff & Totten [Orlikoff JE, Totten MK. Trustee workbook 3. E-health and the board: the brave new world of governance, Part 1. Trustee 2000;53(7):4 p following 14. [Medline]18] (M)XX
122001Eysenbach [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3] (M)XXXXXXXX
132001Blake [Blake G. Accelerating the E-health Connectivity Imperative: Implementing Short-term Value against Long-term Goals when Building Private-sector Relationships. Electronic Healthcare 2001;1:56-59 [FREE Full text]43] (M)XXXX
142001Strategic Health Innovations [; Strategic Health Innovations. FAQs.   URL: http://www.shi.ca/ourcompany/faqs.html [accessed 2004 June 26] 19] (G)XXX
152001Robert J Wood Foundation [; The Robert Wood Johnson Foundation. The eHealth Landscape.   URL: http://www.rwjf.org/ [accessed 2004 June 24] 20] (G)XXX
162001Wysocki [Wysocki M. What is e-Health?.   URL: http://www.suite101.com/article.cfm/9670/57010 [accessed 2004 June 26] 21] (G)XXXXX
172001JP Morgan Partners [; JP Morgan Partners. The Rise & Fall and ??? Of e-Health.   URL: http://www.upenn.edu/ldi/healthpolicyseminarjan26_Jan.%2022%20'01.ppt [accessed 2004 June 26] 45] (G)XXX
182001Ontario Hospital eHealth Council [; Ontario Hospital eHealth Council. An eHealth Blueprint. Setting the Course For Action. An Ontario Hospital Perspective.   URL: http://www.oha.com22] (G)XXXXX
192001Tieman [Tieman J. On the trail of a computer cure-all ... eHealth Initiative. Mod Healthc 2001 Jun 18;31(25):36-37. [Medline]55] (M)XXX
202001DeLuca, Enmark [Deluca JM, Enmark R. The latest revolution. What solutions will technology offer? Health Forum J 2001;44(1):22-25. [Medline]61] (M)XXX
212001Ball – HIMSS [Ball MJ. E-Health: Empowering clinicians and consumers.   URL: http://www.himss.org/content/files/proceedings/2001/roundtab/rslides/rsl08.pdf [accessed 2004 June 26] 47] (G)XXX
222002Health e-Technologies Initiative [; Health e-Technologies Initiative. 2002 Call for Proposals.   URL: http://www.hetinitiative.org/sub-call_for_proposals/cfp-faqs.html [accessed 2004 June 24] 23] (G)XXXX
232002Grantmakers in Health [; Grantmakers In Health, Washington, D.C., USA. Examining e-health. Issue brief (Grantmakers Health) 2002 Nov(14):1-28. [Medline]24] (G)XXX
242002Kirshbaum [Kirshbaum D. eHealth: Past, present & future.   URL: http://www.nehimss.org/pubs/Kirshenbaum.ppt [accessed 2004 June 26] 25] (G)XXXX
252002Wyatt and Liu [Wyatt JC, Liu JLY. Basic concepts in medical informatics. J Epidemiol Community Health 2002 Nov;56(11):808-812 [FREE Full text] [Medline] [CrossRef]51] (M)XXXX
262003Staudenmeir - Arthur Anderson [Staudenmeir S. Introduction to eHealth.   URL: http://www.healthaction.net/esnets/web_bots/slide+presentationswebot.htm [accessed 2004 June 24] 26] (G)
XXX
272003COACH [; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39] (G)
XXXXX
282003Rx2000 [; Rx2000 Institute. eHealth FAQ.   URL: http://www.rx2000.org/KnowledgeCenter/ehealth/ehfaq.htm#Whatis [accessed 2004 June 24] 9] (G)XXXXX
292003Beaulieu & Beinlich - First Consulting Group [Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27] (G)XXXXXXX
302003eEurope - eHealth2003 [; eEurope. What is eHealth.   URL: http://europa.eu.int/information_society/eeurope/ehealth/whatisehealth/index_en.htm [accessed 2004 June 26] 53] (G)XXXX
312003Decker – HealthVision [Decker S. What is e-Health?.   URL: http://12.42.224.48/ehealthresources/what_is_ehealth.pdf [accessed 2004 June 24] 28] (G)XXXX
322003Miller - athealth.com [Miller JL. The Internet as Therapist and Teacher.   URL: http://www.athealth.com/Practitioner/particles/art_InternetAsTandT.html [accessed 2004 June 24] 29] (G)XX
332003Telehealth Victoria [; Telehealth Victoria. Telehealth Victoria FAQs.   URL: http://www.shi.ca/ourcompany/faqs.html [accessed 2004 June 26] 30] (G)XXX
342003Ebrunel.com [; ebrunel.com. eHealth.   URL: http://www.ebrunel.com/ehealth.php3#ehealth [accessed 2004 June 26] 31] (G)XXX
352003Regional Office for the Eastern Mediterranean - World Health Organization [; World Health Organization - Regional Office for the Eastern Mediterranean. E-Health in the Eastern Mediterranean.   URL: http://208.48.48.190/HIS/ehealth/AboutEhealth.htm [accessed 2004 June 27] 44] (G)XXXX
362003www.avienda.co.uk [Telehealth & EHealth.   URL: http://www.avienda.co.uk/ [accessed 2004 June 24] 32] (G)
XX
372003Brommey [Brommey M. Challenges in e-health service delivery. 2nd annual online summit.   URL: http://www.health.gov.au/healthonline/docs/summit2/brommeyer.pdf [accessed 2004 June 24] 33]XXXX
382003Southwest Medical Group [; Southwest Medical Group. Frequently Asked Questions.   URL: http://www.southwestmedicalgroup.com/faq.asp [accessed 2004 June 26] 34] (G)XXXXX
392003HMS Europe [What is eHealth?.   URL: http://www.hmseurope.com/e_health.htm [accessed 2004 June 24] 40] (G)XXX
402003Nova Scotia Telehealth Network [; Nova Scotia Telehealth Network. Frequently Asked Questions.   URL: http://www.gov.ns.ca/health/telehealth/faq.htm [accessed 2004 June 25] 62] (G)XX
412003Strengthening Support for Women with Breast Cancer [; Breastcare Victoria. Strengthening Support for Women with Breast Cancer. E-health Information Package.   URL: http://www.breastcarevic.org.au/sswbc/docs/infopak.pdf [accessed 2004 June 26] 35] (G)XXX
422003Vigneault [Vigneault R. First Nations and Inuit Health Information Systems.   URL: http://www.afoa.ca/conf2002/FNIHIS%20AFOA-R%20Vigneault.ppt [accessed 2004 June 24] 10] (G)XX
432003Policy on ICT Security [Policy on ICT Security.   URL: http://www.qub.ac.uk/cm/gp/UG-Med-Informatics/ [accessed 2004 June 26] 50] (G)XXX
442003Health systems group [; Health Systems Group. eHealth - Wellness in the 21st Century.   URL: http://www.healthsystemsgroup.com/Resources/Articles/eHealth.htm [accessed 2004 June 26] 49] (G)XXX
452003Marcus and Fabius [Marcus E, Fabius R. What is E-health?.   URL: http://www.acpenet.org/Forums/Topical/Ehealth/Primer.htm [accessed 2004 June 24] 8] (G)X
462003Silber [Silber D. The case for eHealth.   URL: http:/​/europa.​eu.int/​information_society/​eeurope/​ehealth/​conference/​2003/​doc/​the_case_for_eHealth.​pdf [accessed 2004 June 26] 54] (G)XX
472003Ehealth Technologies [; eHealth Technologies. What is eHealth?.   URL: http://www.ehealthtechnologies.com/what%20is%20ehealth.htm [accessed 2004 June 26] 36] (G)XXXXX
482003International Telecommunication Union [; International Telecommunication Union. Standardization in e-health.   URL: http://www.itu.int/itunews/issue/2003/06/standardization.html [accessed 2004 June 26] 41] (G)XX
492003Baker [Baker B. Nursing in an e-healthy world? A vision of e-health as core to caring.   URL: http://www.hlth.qut.edu.au/nrs/inc2003/post/ppts/2 [accessed 2004 June 26] 48]
Modified from Gott (1993) (G)
XXXXX
502004Sternberg [Sternberg DJ. The new e-health. As technology matures, more sensible approaches to online healthcare are emerging. Mark Health Serv 2004;24(1):46-48. [Medline]37] (M)XXXXX
512004Watson [Watson R. EU wants every member to develop a "roadmap" for ehealth. BMJ 2004 May 15;328(7449):1155 [FREE Full text] [Medline] [CrossRef]38] (M)XX

Qualitative Analysis

Not surprisingly, all the definitions included the theme of health. The word health per se was used in almost all 51 definitions collected (only two did not include it) [Marcus E, Fabius R. What is E-health?.   URL: http://www.acpenet.org/Forums/Topical/Ehealth/Primer.htm [accessed 2004 June 24] 8,Vigneault R. First Nations and Inuit Health Information Systems.   URL: http://www.afoa.ca/conf2002/FNIHIS%20AFOA-R%20Vigneault.ppt [accessed 2004 June 24] 10]. Most commonly, the word health was used in relation to health services delivery (eg, health care [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3,Baur C, Deering MJ, Hsu L. ehealth: Federal Issues and Approaches. In: Rice RE, Katz JE, editors. The Internet and Health Communication. Thousand Oaks, Calif: Sage Publications; Nov 17, 2000:355-384.11-Watson R. EU wants every member to develop a "roadmap" for ehealth. BMJ 2004 May 15;328(7449):1155 [FREE Full text] [Medline] [CrossRef]38], health system [; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39-; International Telecommunication Union. Standardization in e-health.   URL: http://www.itu.int/itunews/issue/2003/06/standardization.html [accessed 2004 June 26] 41], health sector [Deluca JM, Enmark R. E-health: the changing model of healthcare. Front Health Serv Manage 2000;17(1):3-15. [Medline]16,; Ontario Hospital eHealth Council. An eHealth Blueprint. Setting the Course For Action. An Ontario Hospital Perspective.   URL: http://www.oha.com22,Mitchell J. From telehealth to e-health: The unstoppable rise of e-health. Canberra, Australia: Commonwealth Department of Communications, Information Technology and the Arts (DOCITA); 1999.42-; World Health Organization - Regional Office for the Eastern Mediterranean. E-Health in the Eastern Mediterranean.   URL: http://208.48.48.190/HIS/ehealth/AboutEhealth.htm [accessed 2004 June 27] 44] or health industry [; Rx2000 Institute. eHealth FAQ.   URL: http://www.rx2000.org/KnowledgeCenter/ehealth/ehfaq.htm#Whatis [accessed 2004 June 24] 9,; JP Morgan Partners. The Rise & Fall and ??? Of e-Health.   URL: http://www.upenn.edu/ldi/healthpolicyseminarjan26_Jan.%2022%20'01.ppt [accessed 2004 June 26] 45-Ball MJ. E-Health: Empowering clinicians and consumers.   URL: http://www.himss.org/content/files/proceedings/2001/roundtab/rslides/rsl08.pdf [accessed 2004 June 26] 47]) which suggests that eHealth may refer more to services and systems rather than to the health of people. Wellness as a concept was used only 5 times (namely, wellness [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3], public health [Staudenmeir S. Introduction to eHealth.   URL: http://www.healthaction.net/esnets/web_bots/slide+presentationswebot.htm [accessed 2004 June 24] 26], health and wellness [Baker B. Nursing in an e-healthy world? A vision of e-health as core to caring.   URL: http://www.hlth.qut.edu.au/nrs/inc2003/post/ppts/2 [accessed 2004 June 26] 48], health and well-being [; Health Systems Group. eHealth - Wellness in the 21st Century.   URL: http://www.healthsystemsgroup.com/Resources/Articles/eHealth.htm [accessed 2004 June 26] 49], and health promotion [; Joint Healthcare Information Technology Alliance. e-Health.   URL: http://www.jhita.org/ehealth.htm [accessed 2004 June 26] 13]).

All the definitions also referred to technology, either explicitly or implicitly. The word Internet was explicitly mentioned in 27 of the 51 definitions [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3, ; Rx2000 Institute. eHealth FAQ.   URL: http://www.rx2000.org/KnowledgeCenter/ehealth/ehfaq.htm#Whatis [accessed 2004 June 24] 9, Baur C, Deering MJ, Hsu L. ehealth: Federal Issues and Approaches. In: Rice RE, Katz JE, editors. The Internet and Health Communication. Thousand Oaks, Calif: Sage Publications; Nov 17, 2000:355-384.11, ; Joint Healthcare Information Technology Alliance. e-Health.   URL: http://www.jhita.org/ehealth.htm [accessed 2004 June 26] 13, Mclendon K. E-commerce and HIM: ready or not, here it comes. J AHIMA 2000 Jan;71(1):22-23. [Medline]14, Deluca JM, Enmark R. E-health: the changing model of healthcare. Front Health Serv Manage 2000;17(1):3-15. [Medline]16-Orlikoff JE, Totten MK. Trustee workbook 3. E-health and the board: the brave new world of governance, Part 1. Trustee 2000;53(7):4 p following 14. [Medline]18, ; The Robert Wood Johnson Foundation. The eHealth Landscape.   URL: http://www.rwjf.org/ [accessed 2004 June 24] 20-; Grantmakers In Health, Washington, D.C., USA. Examining e-health. Issue brief (Grantmakers Health) 2002 Nov(14):1-28. [Medline]24, Staudenmeir S. Introduction to eHealth.   URL: http://www.healthaction.net/esnets/web_bots/slide+presentationswebot.htm [accessed 2004 June 24] 26-Miller JL. The Internet as Therapist and Teacher.   URL: http://www.athealth.com/Practitioner/particles/art_InternetAsTandT.html [accessed 2004 June 24] 29, ; ebrunel.com. eHealth.   URL: http://www.ebrunel.com/ehealth.php3#ehealth [accessed 2004 June 26] 31, ; Southwest Medical Group. Frequently Asked Questions.   URL: http://www.southwestmedicalgroup.com/faq.asp [accessed 2004 June 26] 34, Watson R. EU wants every member to develop a "roadmap" for ehealth. BMJ 2004 May 15;328(7449):1155 [FREE Full text] [Medline] [CrossRef]38, What is eHealth?.   URL: http://www.hmseurope.com/e_health.htm [accessed 2004 June 24] 40, ; JP Morgan Partners. The Rise & Fall and ??? Of e-Health.   URL: http://www.upenn.edu/ldi/healthpolicyseminarjan26_Jan.%2022%20'01.ppt [accessed 2004 June 26] 45-Ball MJ. E-Health: Empowering clinicians and consumers.   URL: http://www.himss.org/content/files/proceedings/2001/roundtab/rslides/rsl08.pdf [accessed 2004 June 26] 47, ; Health Systems Group. eHealth - Wellness in the 21st Century.   URL: http://www.healthsystemsgroup.com/Resources/Articles/eHealth.htm [accessed 2004 June 26] 49-Wyatt JC, Liu JLY. Basic concepts in medical informatics. J Epidemiol Community Health 2002 Nov;56(11):808-812 [FREE Full text] [Medline] [CrossRef]51]; 4 of them used Internet as an adjective (Internet-related [; Joint Healthcare Information Technology Alliance. e-Health.   URL: http://www.jhita.org/ehealth.htm [accessed 2004 June 26] 13], Internet technologies [Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27, Wyatt JC, Liu JLY. Basic concepts in medical informatics. J Epidemiol Community Health 2002 Nov;56(11):808-812 [FREE Full text] [Medline] [CrossRef]51], or Internet principles [Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27]) rather than as a noun. Some authors listed specific technologies such as interactive television [; Health e-Technologies Initiative. 2002 Call for Proposals.   URL: http://www.hetinitiative.org/sub-call_for_proposals/cfp-faqs.html [accessed 2004 June 24] 23], personal digital assistants [; Health e-Technologies Initiative. 2002 Call for Proposals.   URL: http://www.hetinitiative.org/sub-call_for_proposals/cfp-faqs.html [accessed 2004 June 24] 23], CD-ROMs/DVD [; Health e-Technologies Initiative. 2002 Call for Proposals.   URL: http://www.hetinitiative.org/sub-call_for_proposals/cfp-faqs.html [accessed 2004 June 24] 23] or Internet telephony [Deluca JM, Enmark R. E-health: the changing model of healthcare. Front Health Serv Manage 2000;17(1):3-15. [Medline]16]. Others referred to technology in more general terms (eg, new media [; GJW Government Relations Ltd Health Affairs. Memorandum.   URL: http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldeucom/95/95we29.htm [accessed 2004 June 26] 52], information and communication technologies [; Strategic Health Innovations. FAQs.   URL: http://www.shi.ca/ourcompany/faqs.html [accessed 2004 June 26] 19, ; The Robert Wood Johnson Foundation. The eHealth Landscape.   URL: http://www.rwjf.org/ [accessed 2004 June 24] 20, ; Ontario Hospital eHealth Council. An eHealth Blueprint. Setting the Course For Action. An Ontario Hospital Perspective.   URL: http://www.oha.com22, ; Grantmakers In Health, Washington, D.C., USA. Examining e-health. Issue brief (Grantmakers Health) 2002 Nov(14):1-28. [Medline]24, ; Telehealth Victoria. Telehealth Victoria FAQs.   URL: http://www.shi.ca/ourcompany/faqs.html [accessed 2004 June 26] 30, Telehealth & EHealth.   URL: http://www.avienda.co.uk/ [accessed 2004 June 24] 32, Brommey M. Challenges in e-health service delivery. 2nd annual online summit.   URL: http://www.health.gov.au/healthonline/docs/summit2/brommeyer.pdf [accessed 2004 June 24] 33, ; Breastcare Victoria. Strengthening Support for Women with Breast Cancer. E-health Information Package.   URL: http://www.breastcarevic.org.au/sswbc/docs/infopak.pdf [accessed 2004 June 26] 35, ; eHealth Technologies. What is eHealth?.   URL: http://www.ehealthtechnologies.com/what%20is%20ehealth.htm [accessed 2004 June 26] 36, ; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39, ; International Telecommunication Union. Standardization in e-health.   URL: http://www.itu.int/itunews/issue/2003/06/standardization.html [accessed 2004 June 26] 41-; World Health Organization - Regional Office for the Eastern Mediterranean. E-Health in the Eastern Mediterranean.   URL: http://208.48.48.190/HIS/ehealth/AboutEhealth.htm [accessed 2004 June 27] 44, Baker B. Nursing in an e-healthy world? A vision of e-health as core to caring.   URL: http://www.hlth.qut.edu.au/nrs/inc2003/post/ppts/2 [accessed 2004 June 26] 48, ; eEurope. What is eHealth.   URL: http://europa.eu.int/information_society/eeurope/ehealth/whatisehealth/index_en.htm [accessed 2004 June 26] 53, Silber D. The case for eHealth.   URL: http:/​/europa.​eu.int/​information_society/​eeurope/​ehealth/​conference/​2003/​doc/​the_case_for_eHealth.​pdf [accessed 2004 June 26] 54], and Internet-related technologies [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3,Baur C, Deering MJ, Hsu L. ehealth: Federal Issues and Approaches. In: Rice RE, Katz JE, editors. The Internet and Health Communication. Thousand Oaks, Calif: Sage Publications; Nov 17, 2000:355-384.11,Orlikoff JE, Totten MK. Trustee workbook 3. E-health and the board: the brave new world of governance, Part 1. Trustee 2000;53(7):4 p following 14. [Medline]18,Staudenmeir S. Introduction to eHealth.   URL: http://www.healthaction.net/esnets/web_bots/slide+presentationswebot.htm [accessed 2004 June 24] 26,Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27,; Southwest Medical Group. Frequently Asked Questions.   URL: http://www.southwestmedicalgroup.com/faq.asp [accessed 2004 June 26] 34]). Only 1 definition [Watson R. EU wants every member to develop a "roadmap" for ehealth. BMJ 2004 May 15;328(7449):1155 [FREE Full text] [Medline] [CrossRef]38] used the term integration.

In 11 definitions, [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3,Loman P. E-Health: Putting health on the Net. An FCG White Paper.   URL: http://www.fcg.com/webfiles/whitepaper/white_paper_files/wpEhealth.asp [accessed 2004 June 24] 12,Wysocki M. What is e-Health?.   URL: http://www.suite101.com/article.cfm/9670/57010 [accessed 2004 June 26] 21,Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27,Decker S. What is e-Health?.   URL: http://12.42.224.48/ehealthresources/what_is_ehealth.pdf [accessed 2004 June 24] 28,Sternberg DJ. The new e-health. As technology matures, more sensible approaches to online healthcare are emerging. Mark Health Serv 2004;24(1):46-48. [Medline]37,Blake G. Accelerating the E-health Connectivity Imperative: Implementing Short-term Value against Long-term Goals when Building Private-sector Relationships. Electronic Healthcare 2001;1:56-59 [FREE Full text]43,; JP Morgan Partners. The Rise & Fall and ??? Of e-Health.   URL: http://www.upenn.edu/ldi/healthpolicyseminarjan26_Jan.%2022%20'01.ppt [accessed 2004 June 26] 45-Ball MJ. E-Health: Empowering clinicians and consumers.   URL: http://www.himss.org/content/files/proceedings/2001/roundtab/rslides/rsl08.pdf [accessed 2004 June 26] 47,Tieman J. On the trail of a computer cure-all ... eHealth Initiative. Mod Healthc 2001 Jun 18;31(25):36-37. [Medline]55] eHealth was referred to in terms of commerce, suggesting that eHealth is “health care's component of business over the Internet” [; JP Morgan Partners. The Rise & Fall and ??? Of e-Health.   URL: http://www.upenn.edu/ldi/healthpolicyseminarjan26_Jan.%2022%20'01.ppt [accessed 2004 June 26] 45], the “application of e-commerce to health care and pharmaceuticals” [Loman P. E-Health: Putting health on the Net. An FCG White Paper.   URL: http://www.fcg.com/webfiles/whitepaper/white_paper_files/wpEhealth.asp [accessed 2004 June 24] 12], or as “new business models using technology” [Sternberg DJ. The new e-health. As technology matures, more sensible approaches to online healthcare are emerging. Mark Health Serv 2004;24(1):46-48. [Medline]37]. Others associated eHealth with activities such as managing [; Ontario Hospital eHealth Council. An eHealth Blueprint. Setting the Course For Action. An Ontario Hospital Perspective.   URL: http://www.oha.com22], educating [; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39], arranging [; Ontario Hospital eHealth Council. An eHealth Blueprint. Setting the Course For Action. An Ontario Hospital Perspective.   URL: http://www.oha.com22], connecting [; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39], obtaining [; Southwest Medical Group. Frequently Asked Questions.   URL: http://www.southwestmedicalgroup.com/faq.asp [accessed 2004 June 26] 34], providing [Brommey M. Challenges in e-health service delivery. 2nd annual online summit.   URL: http://www.health.gov.au/healthonline/docs/summit2/brommeyer.pdf [accessed 2004 June 24] 33], redefining [Decker S. What is e-Health?.   URL: http://12.42.224.48/ehealthresources/what_is_ehealth.pdf [accessed 2004 June 24] 28], supporting [Brommey M. Challenges in e-health service delivery. 2nd annual online summit.   URL: http://www.health.gov.au/healthonline/docs/summit2/brommeyer.pdf [accessed 2004 June 24] 33], using [Mitchell J. From telehealth to e-health: The unstoppable rise of e-health. Canberra, Australia: Commonwealth Department of Communications, Information Technology and the Arts (DOCITA); 1999.42], assisting [Sternberg DJ. The new e-health. As technology matures, more sensible approaches to online healthcare are emerging. Mark Health Serv 2004;24(1):46-48. [Medline]37] and accessing [Wyatt JC, Liu JLY. Basic concepts in medical informatics. J Epidemiol Community Health 2002 Nov;56(11):808-812 [FREE Full text] [Medline] [CrossRef]51]. The stakeholders most often mentioned were health care providers (doctors [Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27,; eHealth Technologies. What is eHealth?.   URL: http://www.ehealthtechnologies.com/what%20is%20ehealth.htm [accessed 2004 June 26] 36], health care providers [Deluca JM, Enmark R. E-health: the changing model of healthcare. Front Health Serv Manage 2000;17(1):3-15. [Medline]16,Sternberg DJ. The new e-health. As technology matures, more sensible approaches to online healthcare are emerging. Mark Health Serv 2004;24(1):46-48. [Medline]37], health care professionals [; Southwest Medical Group. Frequently Asked Questions.   URL: http://www.southwestmedicalgroup.com/faq.asp [accessed 2004 June 26] 34,; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39], health workers [Wyatt JC, Liu JLY. Basic concepts in medical informatics. J Epidemiol Community Health 2002 Nov;56(11):808-812 [FREE Full text] [Medline] [CrossRef]51], managers [; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39], and caregivers [What is eHealth?.   URL: http://www.hmseurope.com/e_health.htm [accessed 2004 June 24] 40]). The public is mentioned as public [Wyatt JC, Liu JLY. Basic concepts in medical informatics. J Epidemiol Community Health 2002 Nov;56(11):808-812 [FREE Full text] [Medline] [CrossRef]51], patients [Pretlow R. eHealth International: A Cutting Edge Company For A New Age In Health Care.   URL: http://www.ehealthnurse.com/ehealthi.html [accessed 2004 June 24] 17,Kirshbaum D. eHealth: Past, present & future.   URL: http://www.nehimss.org/pubs/Kirshenbaum.ppt [accessed 2004 June 26] 25,Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27,; Southwest Medical Group. Frequently Asked Questions.   URL: http://www.southwestmedicalgroup.com/faq.asp [accessed 2004 June 26] 34,; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39,; eEurope. What is eHealth.   URL: http://europa.eu.int/information_society/eeurope/ehealth/whatisehealth/index_en.htm [accessed 2004 June 26] 53], consumers [Mclendon K. E-commerce and HIM: ready or not, here it comes. J AHIMA 2000 Jan;71(1):22-23. [Medline]14,Wysocki M. What is e-Health?.   URL: http://www.suite101.com/article.cfm/9670/57010 [accessed 2004 June 26] 21,Kirshbaum D. eHealth: Past, present & future.   URL: http://www.nehimss.org/pubs/Kirshenbaum.ppt [accessed 2004 June 26] 25,; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39], non-professionals [Mclendon K. E-commerce and HIM: ready or not, here it comes. J AHIMA 2000 Jan;71(1):22-23. [Medline]14,Wysocki M. What is e-Health?.   URL: http://www.suite101.com/article.cfm/9670/57010 [accessed 2004 June 26] 21,What is e-Health?.   URL: http://www.tsmi.net/april12continued.html [accessed 2004 June 24] 46], and citizens [; eEurope. What is eHealth.   URL: http://europa.eu.int/information_society/eeurope/ehealth/whatisehealth/index_en.htm [accessed 2004 June 26] 53]. Governments [; Canada's Health Informatics Association (COACH). What is eHealth?.   URL: http://www.e-healthconference.com/Default.asp?id=3& [accessed 2004 June 24] 39], employers [Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27], and payers [Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27] are also listed as potentially benefiting from eHealth.

While most of the definitions concentrated on the process of care, about one quarter of them focused on the outcomes to be expected. These definitions mentioned improving and increasing the cost-effectiveness of health care [; Rx2000 Institute. eHealth FAQ.   URL: http://www.rx2000.org/KnowledgeCenter/ehealth/ehfaq.htm#Whatis [accessed 2004 June 24] 9] and making processes more efficient [Mclendon K. E-commerce and HIM: ready or not, here it comes. J AHIMA 2000 Jan;71(1):22-23. [Medline]14,Kirshbaum D. eHealth: Past, present & future.   URL: http://www.nehimss.org/pubs/Kirshenbaum.ppt [accessed 2004 June 26] 25,Staudenmeir S. Introduction to eHealth.   URL: http://www.healthaction.net/esnets/web_bots/slide+presentationswebot.htm [accessed 2004 June 24] 26]. Others suggested that eHealth could solve problems related to access to care, cost, quality, and portability of health care services [; Rx2000 Institute. eHealth FAQ.   URL: http://www.rx2000.org/KnowledgeCenter/ehealth/ehfaq.htm#Whatis [accessed 2004 June 24] 9].

While the actual word place was not used in any of the definitions, some authors referred to the concepts of distance, geography, and location. One definition describes the impact of eHealth as local, regional, and worldwide [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3]. Another describes eHealth as taking place both at the local site and at a distance [Mitchell J. From telehealth to e-health: The unstoppable rise of e-health. Canberra, Australia: Commonwealth Department of Communications, Information Technology and the Arts (DOCITA); 1999.42]. A third suggests that distance and place no longer remain barriers, as eHealth is “to provide and support health care wherever the participants are located” [Brommey M. Challenges in e-health service delivery. 2nd annual online summit.   URL: http://www.health.gov.au/healthonline/docs/summit2/brommeyer.pdf [accessed 2004 June 24] 33].

Finally, other definitions suggest that eHealth represents a new perspective on health care. One author describes eHealth as a “state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking” [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3]. Another source describes eHealth as a “consumer-centered model of health where stakeholders collaborate” [; Ontario Hospital eHealth Council. An eHealth Blueprint. Setting the Course For Action. An Ontario Hospital Perspective.   URL: http://www.oha.com22].


The term eHealth encompasses a set of disparate concepts, including health, technology, and commerce. The 51 unique published definitions that we found included these concepts with varying degrees of emphasis. All specifically mentioned health and the technology involved. Many noted the varying stakeholders, the attitudes encompassed, the role of place and distance, and the real or potential benefits to be expected from eHealth.

Health, as used in these definitions, usually referred explicitly to health care as a process, rather than to health as an outcome. This is as expected; there is no consensus on the meaning of the word health per se, the definitions of which range from a narrowly construed “converse of disease or infirmity or when disease or infirmity is absent” [The Atlas of Canada - Health.   URL: http://atlas.gc.ca/site/english/maps/health/1 [accessed 2004 December 12] 56] to the all-encompassing World Health Organization's “health is a state of complete physical, mental, and social well being and not just the absence of disease or infirmity” [Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.   URL: http://www.who.int/about/definition/en/ [accessed 2004 July 5] 57].

In the definitions of eHealth we found, technology was viewed both as a tool to enable a process/function/service and as the embodiment of eHealth itself (eg, a health website on the Internet). We were pleased to note that technology was portrayed as a means to expand, to assist, or to enhance human activities, rather than as a substitute for them. Surprisingly few of the published definitions referred explicitly to the commercial aspects of eHealth (Table 4).

The overwhelming understanding of eHealth reflects an attitude of optimism. All definitions had positive connotations and included terms such as benefits [; Rx2000 Institute. eHealth FAQ.   URL: http://www.rx2000.org/KnowledgeCenter/ehealth/ehfaq.htm#Whatis [accessed 2004 June 24] 9], improvement [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3,; The Robert Wood Johnson Foundation. The eHealth Landscape.   URL: http://www.rwjf.org/ [accessed 2004 June 24] 20,; Health e-Technologies Initiative. 2002 Call for Proposals.   URL: http://www.hetinitiative.org/sub-call_for_proposals/cfp-faqs.html [accessed 2004 June 24] 23,Staudenmeir S. Introduction to eHealth.   URL: http://www.healthaction.net/esnets/web_bots/slide+presentationswebot.htm [accessed 2004 June 24] 26,Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27], enhancing [; Southwest Medical Group. Frequently Asked Questions.   URL: http://www.southwestmedicalgroup.com/faq.asp [accessed 2004 June 26] 34,; Breastcare Victoria. Strengthening Support for Women with Breast Cancer. E-health Information Package.   URL: http://www.breastcarevic.org.au/sswbc/docs/infopak.pdf [accessed 2004 June 26] 35,Baker B. Nursing in an e-healthy world? A vision of e-health as core to caring.   URL: http://www.hlth.qut.edu.au/nrs/inc2003/post/ppts/2 [accessed 2004 June 26] 48], efficiency [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3,Kirshbaum D. eHealth: Past, present & future.   URL: http://www.nehimss.org/pubs/Kirshenbaum.ppt [accessed 2004 June 26] 25], and enabling [; The Robert Wood Johnson Foundation. The eHealth Landscape.   URL: http://www.rwjf.org/ [accessed 2004 June 24] 20,; Health e-Technologies Initiative. 2002 Call for Proposals.   URL: http://www.hetinitiative.org/sub-call_for_proposals/cfp-faqs.html [accessed 2004 June 24] 23,Kirshbaum D. eHealth: Past, present & future.   URL: http://www.nehimss.org/pubs/Kirshenbaum.ppt [accessed 2004 June 26] 25,Beaulieu D, Beinlich J. Current promises and challenges.   URL: http://www.tricare.osd.mil/conferences/2001/downloads/breakout/W801_Beaulieu.ppt [accessed 2004 June 24] 27,; eHealth Technologies. What is eHealth?.   URL: http://www.ehealthtechnologies.com/what%20is%20ehealth.htm [accessed 2004 June 26] 36]. One definition suggests that eHealth allows patients and professionals to "do the previously impossible" [Mclendon K. E-commerce and HIM: ready or not, here it comes. J AHIMA 2000 Jan;71(1):22-23. [Medline]14]. None of the published definitions suggests that eHealth may have any adverse, negative, harmful, or disadvantageous effects.

In this review, we do not report the frequency with which certain definitions were used by others, or the impact of each definition. The most commonly cited definition on the Internet is Eysenbach's [Eysenbach G. What is e-health? J Med Internet Res 2001 Jun 18;3(2):e20 [FREE Full text] [Medline] [CrossRef]3] which was adopted or referred to by at least 87 websites on the Internet. Mitchell's definition [Mitchell J. From telehealth to e-health: The unstoppable rise of e-health. Canberra, Australia: Commonwealth Department of Communications, Information Technology and the Arts (DOCITA); 1999.42] was used by a handful of others. There were many variations on the definition that characterizes eHealth as the "use of information technology in the delivery of health care" [; Strategic Health Innovations. FAQs.   URL: http://www.shi.ca/ourcompany/faqs.html [accessed 2004 June 26] 19]. Most definitions implied that theirs was “the” definition.

In a perfectly logical language, as envisioned by Ludwig Wittgenstein in his early years [Wittgenstein L, Pears DF, McGuinness B, Russell B. Tractatus Logico Philosophicus, New Ed (Routledge Classics). New York, NY: Routledge; Sep 1, 2001.58], each word would have a specific and clear meaning. The philosopher himself recognized that such an idealized language could not be achieved in real life; he concluded his classic book, Tractatus Logico-Philosophicus, with "My propositions serve as elucidations in the following way: anyone who understands me eventually recognizes them as nonsensical, when he has used them—as steps—to climb up beyond them. (He must, so to speak, throw away the ladder after he has climbed up it.)" [Wittgenstein L, Pears DF, McGuinness B, Russell B. Tractatus Logico Philosophicus, New Ed (Routledge Classics). New York, NY: Routledge; Sep 1, 2001.58]. In his later work, Philosophical Investigations [Wittgenstein L, Anscombe E, Anscombe GEM. Philosophical Investigations: The German Text, With a Revised English Translation. Cambridge, Mass: Blackwell Publishers; Jan 1, 2002.59], Wittgenstein compares words in a language to tools in a toolbox, saying that their functions are varied according to the needs of the speaker much like the tools in a toolbox are varied according to the needs of the repairman. Their functional differences are what make them practical, and in the case of words this difference is usage. The way in which a word is used is what makes it useful in the language; a particular usage of a word gives the word its special authority in that situation [Beaver ET. Wittgenstein's Meaning and Use in Philosophical Investigations, Searle's Speech Act Theory in 'What is a Speech Act?': An Exposition and Comparison.   URL: http://www3.baylor.edu/~Elijah_Beaver/witterm.htm [accessed 2004 August 25] 60]. For this reason we have not yielded to the temptation (nor do we have the chutzpah) to attempt another “better” definition of eHealth. The widespread use of the term suggests that eHealth is an important concept, and the term is a useful “tool” to express that concept. It is generally understood despite the lack of a precise definition. The variations among the proposed definitions reflect the various perspectives, settings and contexts in which eHealth is used; they round and enhance our understanding of the concept.

In this systematic review and qualitative analysis of the definitions, we have completed only a first step in research on the evolving meaning of eHealth. It is an essential first step because it tells us how the current literature defines the term. We hope, and believe, that this compilation of existing definitions can be a useful resource to facilitate communication, discussion, and stimulate further research.

Questions remain about how the differing concepts and understandings of the term eHealth affect different stakeholders. What do people expect from eHealth? Do patients want eHealth? Do health care providers want eHealth? How does eHealth change the relationships, understandings, and interactions within the health care system? Time, patience, and further research will provide at least provisional answers to these questions, and to the myriad of questions still unasked.

Acknowledgments

We would like to acknowledge Ms. Rea Devakos (Gerstein Science Information Centre, University of Toronto) for her help in refining the strategy to search the many electronic databases. The Centre for Global eHealth Innovation provided funding for photocopying and library access fees. All of the authors were supported by funds from the Rose Family Chair in Supportive Care and the Canada Research Chair in eHealth Innovation (Canadian Institutes of Health Research).

Authors' Contributions

HO and CR conducted the search, extracted the data, and analyzed the content. All the authors participated in designing the search strategy, reviewing results, and preparing the final manuscript.

Conflicts of Interest

None declared.

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Edited by G Eysenbach; submitted 30.07.04; peer-reviewed by J Powell, C Pagliari; comments to author 16.08.04; revised version received 07.02.05; accepted 14.02.05; published 24.02.05

Copyright

© Hans Oh, Carlos Rizo, Murray Enkin, Alejandro Jadad. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.2.2005. Except where otherwise noted, articles published in the Journal of Medical Internet Research are distributed under the terms of the Creative Commons Attribution License (http://www.creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, including full bibliographic details and the URL (see "please cite as" above), and this statement is included.

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