A rose, by any other name. . .

A rose, by any other name. . .

I attended the Healthcare Information and Management Systems Society (HIMSS) Telehealth 2000 conference this month and came away with one overwhelming impression: e-health is the bastard child of telemedicine.

Consider the definitions. Telemedicine-or, in its current linguistic iteration, telehealth-is generally defined as the use of telecommunications and information technologies to deliver clinical care, health education, and administrative services at a distance. While e-health is a much more recent addition to our vernacular, it is already generally defined as the electronic capture and delivery of healthcare information and services. Given that e-health is primarily associated with the Internet, "at a distance" is a given, I think.

There are a number of other similarities. One e-health vendor I know (a dot-com) refers to its products as "collaborative medical networks." Sounds like telemedicine to me. And what about "store and forward"? Isn't it really just e-mail, with attachments?

The real difference between telehealth and e-health is economic at heart. Simply put, telehealth in its most traditional form is characterized by federally funded programs and projects that are seldom able to sustain themselves once the grant money runs out. They are predominantly rural in nature, and they are supported and operated by some of the most altruistic healthcare professionals I have ever met. They use real hardware and network backbones ranging from POTS to T1 to provide medical services to people in need, and they are making a fundamental difference in these people's lives as a result.

e-health, by contrast, is so far characterized primarily by the phenomenal IPOs that spawned its first commercial progeny. It is consumer- and investor- (versus patient-) oriented, and the products and services (such as they are) are almost exclusively Internet-based in both structure and delivery. Sustainability is a problem here, too, but it is often couched in terms of cash and traffic flow. The vendors (most of them dot-coms) seem to come and go like ambulances to the ER, creating an air of anxiety and uncertainty about their future in the hearts of the very customers they are trying to entice.

e-health, then, can be seen as the commodification of telemedicine and telehealth. The problem with the commercialization of almost anything is that its inherent value-the very thing that made it most attractive in the first place-is often lost, or at least overshadowed, in the process.

At the HIMSS meeting I asked Dena Puskin, director of the federal Office for the Advancement of Telehealth, how she distinguishes telehealth from e-health, and why. Her response was very clear and equally succinct: "I don't like e-health. I think it's a fad." Unfortunately, I think this perception is shared by more people than not these days, particularly in the medical community.

And there's the conundrum. Telehealth and telemedicine have long suffered from a lack of public recognition of their value. e-health, in contrast, has made a strong and seemingly lasting impression on the public consciousness, although it is no longer a particularly favorable one. But e-health has managed to quickly get, and lodge, its foot in the very door telemedicine and telehealth have been knocking on for some time.

So I ask you: rather than quibble over monikers and funding, why can't we all just get along? Or, as one longtime telemedicine activist noted recently, "I don't care what you call it-just learn how to make it work."

Comments/questions: kkincade@cmp.com

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