e-Health innovation: time for engagement with the cardiology community

Abstract

e-Health is a broad term addressing the use of information and communication technologies in the support of health and health-related fields including healthcare provision, health surveillance, and education.1 e-Health can be divided into four areas: Related terms also include m-health (‘mobile health’) building on the concept of mobile devices delivering health information such as drug and treatment options, screening patients, monitoring vital signs, providing direct care and patient education, and p-health (‘personalized health’) used to describe wearable micro- and nano-technologies with sensors, actuators, and ‘smart’ fibres to help facilitate personalized health and social care decision making and delivery.2 In 2010, COCIR, the European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry, established a dictionary of telemedicine terms to reduce the uncertainty surrounding the overlapping terms and concepts.3 telemedicine and telecare (including disease management services, remote patient monitoring, teleconsultation, homecare); clinical information systems (electronic health records and decision support); integrated regional and national information networks and associated e-referrals; and cardiology registries and other non-clinical systems used for education, public health, and healthcare management. e-Health can provide innovative solutions addressing problems in ageing societies with increasing numbers of citizens living with chronic conditions, limited healthcare funding, and personnel. It can support the strong political drive to move care closer to patients' homes and away from specialist centres. Technological innovation has brought e-health services that enable co-operation, information sharing, and decision support based on good practices and emerging evidence-based guidelines. However, social and technological issues hinder healthcare systems from reaping the benefits of wide adoption. Too often e-health services are technology-driven and health professionals have been resistant to their deployment and mainstream adoption, considering them ‘solutions seeking a problem’. Concern is raised about the risk of medicine becoming depersonalized, rather than e-health being considered as an aid to improve daily working practices, the allocation of resources, and ultimately to optimize patient outcome. Cardiology has always been at the forefront of what is now termed ‘e-health’ technology: in 1906, Einthoven4 investigated electrocardiogram (ECG) transmission over telephone lines; radio transmissions were used to link physicians to patients on ships for medical emergencies; and even as early as 1924 remote telecare was described as a possibility.5 Following decades of bold experimental research that set the foundations of biomedical engineering, in 1974 Jerome R. Cox, an engineer, AMIA fellow and Paul Hugenholtz, past European Society of Cardiology (ESC) president (1984–1988), established the annual Computers in Cardiology conference (now Computing in Cardiology—CinC). For 40+ years CinC alternates in Europe and in the USA6 serving as a forum for scientists and professionals in medicine, physics, engineering, and computer science to discuss their current research in topics pertaining to computing in clinical cardiology and cardiovascular physiology including e-health.7 Trans-telephonic monitoring of pacemakers was introduced in the 1970s,8 and of implantable cardioverter defibrillators in the early 1990s. At about the same time, ECG diagnosis of evolving myocardial infarction in the ambulance was piloted in the Netherlands.9 Food and Drug Administration approval and CE mark were first awarded for digital telemonitoring of cardiac implantable electronic devices (CIEDs) in 2002. All major vendors of such technology now support this capability, and early standards for remote monitoring have been set by professional bodies.10 In many countries, the legal framework and reimbursement policies are currently being established, and allow remote device monitoring to partly replace the hassle and costs of regular in-person visits to the hospital, while tapping the potential of early response to alarms for better patient outcomes. Remote monitoring of chronic conditions, such as heart failure, has been subject to increasing attention.11 Meta-analysis of a number of small-scale studies of stand-alone systems suggested considerable clinical benefit when compared with the usual care provided at that time,12 but few data were available on the costs of such an approach, the nature of the interventions triggered by remote monitoring, or the re-education required to support healthcare professionals, patients, and their informal care givers in taking up their new roles. More recent and larger randomized trials, such as TIM-HF in Germany13 and Tele-HF in the USA,14 suggest that the specific type of technology used is crucial, as are the characteristics of the patients, to ensure that the