The rhetoric and reality of e-health: a critical assessment of the benefits of e-health in primary health care

We are delighted to have been invited to guest edit this special issue of the Australian Journal of Primary Health and to bring you 13 papers looking at aspects of the rhetoric and reality of e-health in relation to primary health. We were pleased to see the enthusiastic reaction from authors to the call for papers and have thoroughly enjoyed reading the submitted papers and guiding them through the reviewing and revision processes. In developing the special issue, several things have been foremost in our mind. First, what exactly is e-health, and is it different from telehealth, information and communication technologies (ICT) for health, online health and other terms? The World Health Organization (WHO) defines e-health as the use of information and communication technologies for health, with e-health innovations including electronic health records, computer-assisted prescription systems and clinical databases, ICT-supported clinical care, online health information for the general public and scientific information for professionals, platforms for publishing and disseminating health alerts and supporting administrative functions (World Health Organization 2006). The papers in this special issue reflect awide understanding of e-health and cover topics including health professional training to use online health systems, issues around access and equity for consumers, and electronic records and management. The papers cover areas such as maternity care, dentistry, general practice, mental health, cancer care, chronic disease, nursing and community health. Second, we were keen to develop this special issue in light of the techno-optimism that we feel prevails within some parts of government and of the health professions in Australia in relation to e-health, and which is not always balanced by a critical perspective of who actually benefits, or of unintended consequences of its introduction or expansion. Australia’s national E-Health Strategy (Australian Health Ministers Advisory Council 2008) envisages ‘a safer and more sustainable health system that is equipped to respond to emerging health sector cost and demand pressures’, and it sees this being achieved by changing the way information is accessed and shared across the health system. This means that interactions with the health system by consumers, care providers and healthcare managers will increasingly be through electronic means. In particular, the Strategy notes the ‘potentially important role e-healthmayplay in deliveringAustralians a higher quality, safer, more equitable and more efficient health system’ and that ‘e-health should be considered a means to potentially address the ever-increasing costs of Australian health care’ (Australian Health Ministers Advisory Council 2008, p. 23). Australia’s national E-Health Strategy has substantial goals, including that by 2018 (i.e. in just 5 years from now) up to 20% of consultations will be by electronic consultation or telehealth capability, and over 90%of care providerswill be using standards compliant systems for patient, clinical and practice management that support e-health priority solutions such as the electronic transfer of prescriptions, test orders/results, referrals and event summaries. It also envisions that by 2018, 50% of consumers will be actively accessing and using a personal Electronic Health Record tomanage their health and interact with the health system. The Strategy sees ‘latent capacity in the system represented by consumers themselves playing a more active role in the protection and management of their personal health outcomes’ (Australian Health Ministers Advisory Council 2008, p. 1), although it does not detail how all consumers will be up-skilled and resourced to be able to this. Similarly, Australia’s E-Mental Health Strategy (Department of Health and Ageing 2012) focuses on mainstreaming the provision of online health information and online support services for consumers and carers, seeing these as widely accessible (but with little acknowledgement of the inequities in technical Internet access by geography and socioeconomic status across Australia, or of how social/cultural and educational barriers to successful Internet use can be overcome to provide e-mental health that is truly accessible by all). The Strategy also outlines the need for training of the mental health workforce to provide services in these ways. TheNational E-health Strategy sees the approach as threefold: (1) to improve the quality and safety of the Australian health system(and thereby reduce avoidabledemand forhealth-care services) through improved data and monitoring, access to decision support tools for care providers and up-to-date consumer information and knowledge sources at the point of care; access to better quality datasets of treatment effectiveness; automatic monitoring of individual care; and access to timely and comprehensive data for more effective health surveillance and management.