Online Health, E-Health, E-Medicine,Tele-Medicine, Tele-Health, Tele-Rehabilitation

Once the age of computers arrived it was a foregone conclusion that its applications would soon incorporate online health services.
E-Health was introduced  as a further development of the idea of telemedicine.  It began to be used by many academic 
institutions, professional bodies, and funding organizations . The prefix ‘tele’ derives from the Greek for ‘at a distance’. Nowadays, eHealth is understood as the “use of information and communication technologies locally and at a distance” that combines and integrates health information and communication technologies.  Telemedicine is a new interdisciplinary approach to practice medicine with enormous potential and new perspectives for development. Ethical and medicolegal concerns, human and cultural factors, and reimburstment for 
services are still  issues of telemedicine that need to be fine tuned. 

During the last decade of the 20th century, e-commerce exploded giving new ways to conduct business and financial transactions through the Internet. Various e-terms began to appear and proliferate in combination to Internet development.  E-Health was introduced as a 
consequence of e-applications, and as a further development of the idea of telemedicine. What do those terms mean? Many previous articles have dealt with the question of how telemedicine and eHealth can  or should be defined. The aim of this article is to discuss the understanding of  telemedicine and eHealth definitions already developed in the literature, which have been published to date, and compare them to clinically oriented definitions already established. 
 There is  hope that a better understanding of the meaning and perspectives of telemedicine and eHealth will improve communication and 
cooperation of many medicine and technology specialists. 


The definition of eHealth is based on a wide variety of meanings combining informatics technology 
and health and wellness, where the concept of wellness refers to public health and health promotion. It also relates to health services delivery (e.g., health care,  health industry products). E-Health represents a new concept of health care. Technology is incorporated into the definition. Additionally, internet and internet related technologies belong to that technology. Finally, eHealth combines and integrates health, information and communication technologies. 
The idea of eHealth presents a unique opportunity for the development of public health. The World Health Organization and other subsidiaries of the United Nations have drawn up strategies for eHealth that include the use of it for public-health purposes and health-care delivery. The main ideas of the strategy focus on “eHealth for all by 2015 ”. 

 The term eHealth is currently used by many medical professionals, academic institutions, and representatives of technology in medicine. Despite the lack of a clear and precise definition it has become a widely accepted neologism. The widespread use of this term suggests the need of electronic health among the many individuals and organizations. 

Telemedicine has worldwide implications. The target of eHealth is wide and concentrates on improving and increasing the cost-effectiveness of  health care at large and to solve problems related to access, care, cost, quality, and portability of health care services locally, regionally, and worldwide . Telemedicine seems to focus on the 
same target, but is restricted to relations between patient and physician . The ultimate benefits of implemented telemedicine go directly or indirectly to a patient. The term eHealth encompasses a set of disparate concepts, including health, technology, and commerce. It has raised the promise that information and communication technologies will improve medicine and the health care system. 
The term telehealth was developed to substitute for the term telemedicine . In the early years of the twenty first century more fashionable terms such as “online health” and “e-health” appeared due to internet expansion. Some authors suggest new terms as approximate synonyms. 
 It is reported that “telemedicine encompasses all of the health care, education, information and administrative services that can be transmitted over distances by telecommunications technologies”. 

Nowadays, eHealth is understood as the “use of information and communication technologies locally and at a distance”. The technology is viewed both as a tool to embodiment of eHealth itself to expand, or to enhance human activities, but not substitute for them. 

One of the benefits of telemedicine can be that it allows the patient to receive more immediate care.  That may be expressed by utilizing digitalized products and systems. The impact on health systems may become more efficient by improving access to care, especially in remote areas, for people with disabilities and for the elderly. That creates new opportunities for faster and more comprehensive epidemiological surveillance and for better patient care. A global approach to handling data flows should be able to promote standardization and low-cost services. That opens the new platform for international participation and collaboration on information and communication technologies with other providers which can in turn 
remove barriers for health data flow. 
The main lines of the strategy for the telemedicine societies are to integrate eHealth applications into health systems and develop norms, standards, guidelines, information and training materials. 
National centers and networks of excellence will mobilize collaboration for determining evidence based eHealth. 

E-Health for citizens, patients and health professionals should meet quality, safety and ethical standards. The value of eHealth is to improve the quality and the economy of the present  health systems. However, many eHealth and telemedicine applications  are currently unregulated   or insufficiently regulated.

Any adverse, negative, harmful, or disadvantageous effects are rarely mentioned while describing eHealth or telemedicine .

 

The whole range of medical activities including diagnosis, treatment and prevention of disease, continuing education of health-care providers and consumers, and 
research  and evaluation is encompassed. Grigsby and Sanders  pointed out that   telemedicine is defined as “the use of electronic information and communications technologies to provide and support health care when distance separates the participants” or the specialty which “encompasses all of the health care, education, information and administrative services that can be transmitted over distances by telecommunications technologies. 

Telemedicine subjects include the interaction between the medical service receiver and the expert 
(i.e. real-time or prerecorded). Neither health care provider nor medical service receiver is moved, but only information is transmitted (e.g. text, audio, video). 

Telemedicine practice is now performed in industrialized countries, but there is an increasing interest in the use of telemedicine in developing countries. 

One of the most promising aspects of all the ehealth applications is telerehabilitation. This is manifested through the use of the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been in use now for several years in some of the leading rehabilitation facilities in the U.S. and Europe. These physical therapy products provide intensive exercise programs with augmented feedback for patients who have had a stroke, Parkinson’s disease, brain or spinal cord injuries, CP, MS, Brachial Plexus injuries and other upper and lower surgeries that have affected the movement of various limbs. When the patient is discharged from acute care or lives too far from a rehabilitation facility he can access this physical therapy solution right in his home through the use of telerehabilitation. The physical or occupational therapist at the other end will evaluate and quantify the patient’s impairments and customize an exercise program for him. Certified by the FDA and CE the TUTOR system is appropriate for adults as well as children from the age of 4 or 5. See WWW.MEDITOUCH.CO.IL for more information.

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