E-health: the challenges of the digital transformation of the healthcare system

E-health, WHO definition

E-health, or digital health as defined by the World Health Organisation (WHO), is the optimal use of information and communication technologies (ICTs) to strengthen public health objectives. This approach modernises medicine by improving the quality of care offered to patients, facilitating their access to medical services and strengthening the governance of healthcare systems.

It encompasses a range of applications, from electronic medical management and online consultations to telemedicine and mobile medical monitoring tools. Online solutions such as patient communities (like Carenity and Patientslikeme), mobile applications and connected objects open up new perspectives for patient monitoring.

The WHO stresses that e-health goes beyond technological adoption; it requires strategic integration to ensure benefits while guaranteeing data confidentiality and compliance with ethical standards. Finally, it is also important to emphasise that e-health can play a crucial role in meeting the health needs of emerging countries, which face challenges in terms of access to healthcare, as demonstrated by the initiatives of the International Telecommunication Union (ITU).

Today, e-health is still poorly understood, with 64% of French people not having a clear vision of the concept, according to the results of the EDHEC BMS IPSOS 2022 barometer.

Digital health: fields of application

E-health encompasses several areas. It is changing the way patients consult their doctors and manage their medical records.

Health or hospital information systems

The healthcare or hospital systems are one of the fundamental pillars of connected medicine. They aim to computerise and centralise medical, administrative and financial data within healthcare establishments. Thanks to these IT systems, healthcare professionals can access patients' medical records quickly and efficiently, promoting more coordinated and secure follow-up.

These platforms also enable better management of hospital resources, by facilitating appointment scheduling, bed management, electronic prescribing and treatment monitoring. In addition, by centralising information, these systems help to reduce medical errors, by ensuring better communication between the various healthcare players and by enabling data to be analysed for clinical and epidemiological research. However, it is essential to guarantee security and confidentiality by putting in place important measures to protect sensitive patient information from cyber threats and unauthorised access.

Telehealth

Telehealth is at the heart of digital medicine, offering innovative alternatives for consulting and caring for patients at a distance. It encompasses a wide range of services, from virtual medical consultations to robotic surgery and online monitoring of patients with chronic conditions.

This approach is transforming the way medicine consults patients, overcoming geographical constraints and providing equitable access to care, particularly for rural or remote populations. Telemedicine tools, such as secure mobile applications and connected devices, enable healthcare professionals to monitor vital parameters, exchange medical data and make diagnoses.

For example, pharmacists can accompany and monitor patients digitally (decree no. 2021-707 of 3 June 2021 on telehealth, order of 3 June 2021 defining telecare activities, article L. 6316-2 of the French Public Health Code), except in the case of care requiring direct face-to-face contact or specific equipment not available to the patient.

Issues and challenges

The issues and challenges facing digital health are many and complex, reflecting current socio-demographic and epidemiological developments.

Better allocation of medical resources

Changes in medical demographics pose a major challenge, with a growing shortage of healthcare professionals in certain regions and specialities. Digital health can offer solutions to overcome these shortages by enabling a virtual redistribution of medical resources and facilitating teleconsultation.

Coping with medical deserts

Territorial inequalities in access to healthcare remain a key concern, especially in rural and remote areas. Telemedicine and e-health platforms can help to reduce these disparities by offering a remote medical service and strengthening local healthcare infrastructures. 

Managing the growth of chronic illnesses

The rising prevalence of chronic diseases requires a proactive and integrated approach. Digital health can play a decisive role by enabling continuous monitoring of patients, promoting self-management of illnesses and facilitating coordination between the various healthcare players.

Responding to an ageing population

Finally, the ageing of the population and the management of dependency pose considerable challenges. The integration of digital solutions, such as connected devices, home monitoring applications and software, and shared information systems, can improve the quality of life of older people, increase their independence and support carers, while optimising available resources.

E-health: where do we stand?

France has seen significant developments in the field of e-health in recent years. Initiatives such as the shared medical record (DMP), which aims to centralise a patient's medical information, and telemedicine, which enables remote consultations (teleconsultations), have been highlighted. The health crisis linked to COVID-19 accelerated the adoption of connected solutions, with a significant increase in teleconsultations and a growing awareness of the importance of digitalisation in the French healthcare system.

For example, the SI-DEP digital platform, implemented in spring 2020, has been a major tool in Covid-19's screening strategy. Biologists and pharmacists can use it to record the results of RT-PCR and antigen tests.

However, challenges remain, particularly in terms of :

• systems interoperability,
• protection of personal data in the context of online file management,
• and training healthcare professionals in the use of digital tools.

Globally, e-health is expanding rapidly, driven by technological advances, growing healthcare needs and demographic challenges. Many countries have adopted national strategies to promote digital health, ranging from the introduction of electronic medical records to the use of artificial intelligence to diagnose and treat disease.

Regions such as the United States are at the forefront of e-health innovation, with significant investment in connected infrastructures, research and the development of technological solutions. However, disparities remain between developed and developing countries in terms of access to technologies, financing and regulation, underlining the need for a global and collaborative approach to maximise the benefits of e-health on an international scale.

Good to know: The use of teleconsultations has increased significantly during periods of intense health crisis and confinement. Outside these contexts, teleconsultations are now a regular practice for self-employed GPs, accounting for 3.7% of their activity in 2021, compared with 5.7% in 2020, according to DREES figures. As such, they have become an integral, but still limited, part of the medical pathway, positioning themselves as an alternative to traditional visits. In particular, they remain less frequent than face-to-face consultations since the restrictions of the first confinement were lifted.

In short, e-health is emerging as a fast-growing field, offering unprecedented opportunities to revolutionise the way patients are consulted. However, its deployment requires strategic thinking, appropriate regulation and interdisciplinary collaboration to maximise its benefits while guaranteeing the ethics, safety and quality of medical care. As technology continues to evolve, it is imperative to embrace e-health as a catalyst for innovation, while ensuring that it genuinely serves the well-being and health of people around the world.

Picture by K. Grabowska via pexel.com