What e-Health can offer.

a world rich with resources and knowledge, closing the gap between unnecessary human suffering and the potential for good health is one of the foremost health challenges of our times. This quote from the Rockefeller Foundation's Equity Initiative captures the spirit behind the increasing attention paid to reducing the chasm between what is known and what we do in health, the so-called gap. How do we go about bridging this gulf, and what can e-Health do to help? E-Health is an all-encompassing term for the combined use in the health sector of electronic information and communication technology (ICT) for clinical, educational, research and administrative purposes, both at the local site and at a distance (1). It lies at the intersection of medical informatics, public health and business. Some definitions associate e-Health strictly with the Internet, focusing on the growing importance of this medium in health transactions. There are over 100 000 web sites worldwide, proffering health information of varying quality, that are used by both professionals and laypersons. In 2001, 86% of all adults in the United States with access to the Internet had consulted it for health-related information, and 55% of primary care physicians in Germany and 90% in the United States had made use of it (2). ICT can also make significant contributions to public health, as demonstrated by the role of telemetry data in onchocerciasis control in West Africa and the use of the Internet in the control of the SARS outbreak. But what can e-Health offer in the specific context of the know-do gap? ICT has become indispensable to health workers, as the volume and complexity of knowledge and information have outstripped the ability of health professionals to function optimally without the support of information management tools. In the area of health research, for example, the volume of new information is enough to stretch even ICT-assisted decisionmaking systems: on an average day, there are 55 new clinical trials taking place, 1260 articles indexed in MEDLINE, and 5000 papers published in the biomedical sciences. In 2002, the world produced five exabytes (a) of new information, 90% of it on magnetic media, and the annual growth rate is 30% (3). There is an urgent need for ICT tools that can aggregate information from multiple sources, to give an overall understanding of the healthy human or to provide a clearer picture at the systems level. The know-do bridge E-Health systems can improve access to information, thus increasing awareness of what is known in the health sciences, while selective dissemination by electronic means can facilitate targeting of information on those who either request it or are most likely to use it. The most effective way of building the know-do bridge, however, is to provide just-in-time, high quality, relevant information to health professionals and, increasingly, to laypersons. At the level of individual practice, ICT systems can support the mind's limited capacity to sift through large quantities of health facts and identify those items that bear directly on a given situation. Doing the right thing, in the right place, at the right time, the right way--as LEE Jong-Wook, Director-General of WHO, exhorted the staff when taking office--can be greatly facilitated through e-Health. All decision-making in health would be supported by an ICT-mediated system that builds on Weed's vision (4) and ensures that all relevant options known to the health sciences are available for consideration. Specific features of the situation at hand that help discriminate between these options would be taken into account; appropriate associations would be made between the specific features of the situation and the various options; and the right technology would be deployed and local capacity developed to permit access to the knowledge. The late James Grant declared that 80% of the children who died in Africa during his term as Executive Director of UNICEF could have been saved because the knowledge to save them existed. …