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equality of eHealth

From Primary Health Care to Universal Health Coverage

According to the WHO, Primary Health Care (PHC) addresses the majority of a person’s health needs throughout their lifetime. Some examples of primary health care are dentistry, physiotherapy and psychiatry. We believe that everyone has the right to improve and maintain their health. Unfortunately, there are health inequities and inequalities around the globe which make some people unable to access healthcare1.

Therefore, improving universal health coverage globally remains essential in the forthcoming future. In order to achieve this goal, we will need to work hard on providing affordable and quality health services to the communities. Telemedicine plays pivotal role in this trend, it helps to overcome the physical distance barriers with much lower costs and lesser travelling time. With the technology of telemedicine, now we can reach the communities located in remote and poverty-stricken areas. For enhancing the global universal health coverage, it requires countries collaboratively to exchange eHealth information, policies and legislations across borders for learning from each other and enhancing better interoperability2.

Personalised healthcare

In this era, it’s all about personalisation and people-centred in nearly all industries. Simply providing the general health service is no longer enough as the conditions of each patient would be different. At the same time, if we want to improve the entire healthcare ecosystem, we will need to focus more on people-centred health system and care. The people-centred health system is an approach consciously adopts perspectives from individuals, carers, families and communities to establish trusted health systems that responds to their meets and preferences in humane and holistic way. This system empowers patients to have more controls in the health system and engage actively in medical decision-making process and own care when compared to the traditional healthcare system. For this system to work, the public need to be educated with more medical knowledges like signs and symptoms of the diseases, consequences and side-effects of different treatments, so that they can actively engage in decision-making process with healthcare professionals. Therefore, the government and healthcare experts should emphasise on promoting and delivering medical and health information to the public.

On the other hand, we need to highlight the “trust” in this personalised healthcare system because nearly 75% of patients would use telemedicine to see a physician with whom they have a relationship and 40% would choosing their physicians by referrals or great positive reviews3. It showed that customer relationship management (CRM) would be another important future focus for enhancing the customer loyalty and trust.

Electronic Health Record Based (EHR-Based) Telehealth

Expansion and developing of telemedicine over the globe are growing dramatically due to the COVID-19 pandemic, so the EHR-based Telehealth is taking a critical position here. Electronic health record (EHR) is a digital version of patients’ paper chart which is real-time patient-centred records carrying tremendous sensitive personal data including patients’ medical history, diagnoses, medications and treatments plans. The eHealth records need to be available instantly and securely sent to the authorised users in order to shorten the whole process time of telemedicine. This is not hard to see some future focuses here: (1) Enhancing the ability of generating and delivering data in much shorter time; (2) Improving the cloud technology for storing and analysing big data; and (3) developing more advanced technologies for data protection to avoid catastrophic data leak.

Internet-of-Medical-Things (IoMT)

Sometimes, patients might not be honest about their compliance of doctors’ instructions. Or, they might not even know how to express their own feelings and conditions to the doctors verbally and systematically. It might affect the medical assessments, follow-up checkup and recover progress tracking. Subsequently, patients could be suffering from much slower recovery process, or even cause more damages in the worse cases. IoMT is an ecosystem of telemedicine. In the other words, it is a connected infrastructure of medical devices, software applications, health systems and devices. It involves anything in telemedicine process. For instance, surgical instruments, MRI scanners, and wearables. The medical data is generated, collected, analysed and transmitted by those devices to create the Internet-of-Medical-Things4.

mHealth hardwares

Wearable devices like smart watches paired with smartphone applications, has contributed significantly to the IoMT. The health data collected can be sent to the healthcare professional in real time. For example, data generated by Fitbit activities trackers allowed healthcare professionals to evaluate patients more accurately with ischemic heart disease by recording their heart rate and accelerometer data simultaneously5. Also, people nowadays have higher awareness of health and want to keep fit always. The technology of wearable devices allow people to view their own health-related data easily and conveniently for self health management. Apple Inc. has matched with the market trend by adding new features like blood oxygen saturation monitoring, sleep-tracking and faster electrocardiogram sensor to its Apple’s Series 6 Watch6. It is predictable that people would want more health tracking features on their wearables matching with more advanced and user-friendly smartphone fitness applications.

mHealth softwares

Both mobile health hardwares and softwares need to be synchronised because they are highly intertwined and interoperable. The number of consumer mHealth applications available for download was doubled up to 318,000 within two years since 2015. Data also showed that mHealth helped people in changing health behaviours and behaviour-related outcomes such as weight loss, consuming healthy diet and smoking cessation7. However, many mobile health applications with great potential were eliminated soon after their launches. From the study done by Sahr, Karim and Catherine about electronic health application (2018)8, mobile health application developers should focus more on the end-user experiences and significant improving health outcomes rather than just showcasing the innovation designs and technologies themselves. Moreover, adding more incentives into the applications would definitely enhance end-user engagement. One thing to bear in mind at the same time is, considering the public does not sufficient medical knowledges to understand all jargons. So we should avoid overwhelming the public with too much professional terms.

Hybrid model

We should take advantages of the telemedicine technology in order to develop a comprehensive hybrid model of healthcare, so both patients and healthcare professionals can be beneficial from it. We can look at some examples in the America. Orlando Health has deployed mobile devices to allow video visits between family members and Atrium Health has launched its virtual hospital program in March 2020. The virtual program allows patients to attend observation care and acute via Telehealth, even offering 24-hour remote vital signs monitoring9. Those programs have greatly assisted the patients with severe diseases and might not be able to travel back and forth, especially during the pandemic.


The pandemic has pushed telemedicine to move much forward, however, how should we make it sustainable even after pandemic? It would involve health innovation and eHealth standardisation. We should think outside the box. For example, in America, telemedicine kiosks are invented to enlarging accessibility to healthcare professionals because it can be easily installed in any shopping malls and commercial building. In the old days, we might not think that we could actually “see doctors” via a machine.

For eHealth standardisation, it means a series of regulations, guidelines and legislations should be established in order to protect the rights and benefits of patients and healthcare professionals. We need to keep monitoring and improving those elements with the changing environments and challenges, only then we can improve the sustainability of telemedicine in long run.

Moreover, governments take important role in promoting eHealth in their own countries as well. For instance, they can launch government-owned eHealth mobile application which can link the whole medical network and exchange personal eHealth records within the platform. So it requests the governments to invest in related technologies and fund the telemedicine industry in order to create more user-friendly applications and delightful experiences. With the support of the governments, the public would be reassured and have more trust in telemedicine.

Finally, yet importantly, on-going education and promotion of telemedicine and eHealth would be needed for keeping the public updated about the latest technology and medical information. Only then, the whole healthcare ecosystem would be reinforced and keep running for the long haul.

  1. What Does a Hybrid Telehealth Care Model Look Like?“, by Nathan Eddy on 22 Jan 2021
  2. From innovation to implementation – eHealth in the WHO European Region, by Carrie Beth Peterson, Clayton Hamilton and Per Erlend Hasvold in March 2016
  3. Four new statistics that prove that telemedicine isn’t just a pandemic fad“, by Andrei Zimiles on 9 Jul 2020
  4. Medtech and the Internet of Medical Things How connected medical devices are transforming healthcare“, on Deloitte
  5. How the Internet of Medical Things is impacting healthcare“, by Andrew Steger on 16 Jan 2020
  6. How the Internet of Medical Things is impacting healthcare“, by Andrew Steger on 16 Jan 2020
  7. An evaluation of mHealth adoption and health self-management in emerging adulthood“, by Connor Drake, Meagan Cannady, Kathryn Howley, Christopher Shea and Ralph Snyderman on 4 Mar 2020
  8. Moving towards Sustainable Electronic Health Applications“, by Sahr Wali, Karim Keshavjee and Catherine Demers on 1 Aug 2018
  9. An evaluation of mHealth adoption and health self-management in emerging adulthood“, by Connor Drake, Meagan Cannady, Kathryn Howley, Christopher Shea and Ralph Snyderman on 4 Mar 2020