DEFINITIONS: EHEALTH, MOBILE HEALTH, TELEMEDICINE, TELEHEALTH

Definitions

eHealth: The World Health Organisation (WHO) defines eHealth as the use of information and communication technologies (ICT) for health. The terms ‘eHealth’ (electronic health).

mHealth’ (mobile health): Provision of health services using the Internet and mobile devices, respectively. In 2017 there were 325,000 mobile health apps and 84,000 mHealth app publishers in the five major app stores (Google Play, Apple, Microsoft Windows Phone, Amazon, and Blackberry). Healthcare mobile app development is one of the fastest-growing areas with a tremendous 32.5% Europe accounts for 30% of the market (28% for the US). The global market is predicted to reach €38.64bn by 2020 . Europe is the fastest-growing segment in this market, with a Compound Annual Growth Rate (CAGR) of 61.6%. The number of mHealth app downloads has also dramatically risen for the past four years, from 1.7 billion in 2013 to 3.7 billion in 2017 (+2bn in absolute terms, or +118%)  The leading countries for  mHealth business are the UK and Germany with 55% and 41% (respectively). There is a strong attractiveness towards Scandinavian countries as well (Sweden 23%, Denmark 16% and Finland 15%).

Telemedicine: Telemedicine is the provision of healthcare services where traditional face-to-face patient - doctor interaction (or doctor - doctor) is replaced by over-distance interaction through use of ICT. Several other definitions of telemedicine exist e.g. the use of telecommunications technology for medical diagnostic, monitoring, and therapeutic purposes when distance separates the users. The WHO has adopted the following description:  the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities. Telemedicine covers a very wide area of products, services, procedures and techniques. In essence, it designates all aspects relating to the progressive transformation of the health sector due to the introduction of ICT, and relies on continuous investment in digital infrastructure and digital skills in the healthcare industry. As part of a set of health information technologies, telemedicine has gained more visibility amongst governments and market players in recent years; these technologies play a key role in the European Union’s digital strategy and have become one of the lead initiatives to create an innovative Europe in a dynamic, knowledge-based economy. Telemedicine technologies require not only the use of information technology (including hardware, software, telecoms and IT services), but also the leveraging of skilled human resources to enable healthcare services to be delivered from distance or a remote location. The principal telemedicine market drivers and trends during recent years have therefore been an uptake and democratisation of information technologies, which have enabled the remote transmission of information at ease, speed and marginal cost. These information technologies have progressively defined a commercial ecosystem of health information technologies, which is currently experiencing rapid growth globally. The global telemedicine market is expected to reach more than €37 billion by 2021, with a (Compound Annual Growth Rate) of 14% during that period. This dynamic sector therefore has the potential to drastically influence the delivery of efficient patient care at a lower cost for healthcare markets worldwide.

Key Players in the Global Telemedicine Market

1. Royal Philips Health Care is a leading health technology company focused on improving people's health and enabling better outcomes across the health continuum from healthy living and prevention, to diagnosis, treatment and home care. It is the leader in diagnostic imaging, imageguided therapy, patient monitoring and health informatics
2. Polycom (now a part of Plantronics) is a provider of communications and collaboration technology. More than 400,000 companies and institutions worldwide defy distance with video, voice and content solutions from Polycom. In healthcare, Polycom provides video collaboration solutions that connect healthcare professionals with each other and/or with patients. The company also provides medical education, healthcare administration.
3. OBS Medical is the global leader in the development and provision of predictive algorithms for identifying critical instability in patients that is not picked up by traditional methods. As such, the company’s main customers are healthcare professionals.
4. InTouch Health provides cloud-based network and virtual care solutions that ensure connectivity for health systems, providers, and patients at all times. Over 130 health systems are supported by the company at present. It boasts 8,600 registered network users and 1,000,000 telehealth virtual care sessions over its platform.
5. Honeywell Life Care Solutions (formerly Honeywell HomMed) offers remote patient monitoring services, remote patient management applications, as well as decision support and evidence-based disease management.
6. Cisco delivers ‘care at a distance’ solutions, connected imaging solutions, telehealth and collaboration solutions. The company has been in healthcare for more than 20 years, spanning 17,000 healthcare organisations and 118 countries around the world.
7. Medtronic is a medical device company that acquired Cardiocom in 2015. Cardiocom used to provide telemedicine solutions for daily remote patient monitoring and disease management. Used by healthcare professionals since 1998, Medtronic solutions have recorded over 5 million telehealth patient months of use, and currently service over 95,000 patients.
8. AMD Global Telemedicine is a pioneer in clinical telemedicine equipment and technology that is used to connect a patient with a remote healthcare provider. AMD solutions primarily target rural health clinics, school health centers and pharmacy clinics. To date, the company has over 8,300 patient endpoint installations set up in 98 countries.
9. Allscripts provides hospitals and other healthcare providers with practice management and EHR technology. At present, it reaches 45,000 physician practices; 180,000 physicians; 19,000 post-acute agencies; 2,500 hospitals; 100,000 electronic prescribing physicians; 40,000 in-home clinicians; and 7.2 million patients
10. GlobalMed is the worldwide leader in telemedicine enabling more than 3 million teleconsultations annually.

Telehealth: According to the WHO, telehealth involves the use of telecommunications and virtual technology to deliver health care outside of traditional health-care facilities, [for example] a virtual home health care, where patients such as the chronically ill or the elderly may receive guidance in certain procedures while remaining at home. Telehealth has also made it easier for health care workers in remote field settings to obtain guidance from professionals elsewhere in diagnosis, care and referral of patients. Another definition of telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health related education, public health, and health administration. It refers to both clinical and non-clinical applications in the way of education, administration, and research while telemedicine is often reserved for clinical, patient care applications. There is a vast amount of literature with many definitions of the terms discusses above. We can conclude that telehealth is a more generic term that refers to health-related procedures, while telemedicine refers more specifically to treating people from distance. eHealth and mHealth are terms that are as generic as telehealth in terms of health services, but specific to the technologies used in delivering these services from distance: the Internet and mobile devices respectively. To make the latter explanation clearer, in the case of telehealth, we may have patient-doctor interactions without Internet or mobile devices. Not surprisingly – Germany, France, the UK and Italy have a large proportion of telehealth market revenue given that they are among the largest EU countries, it is also interesting to note that if we aggregate the telehealth market revenues of Denmark, Sweden, Norway and Finland, Scandinavia appears to be a dynamic region in the market with revenues of over 129m euros. This is nearly 9% of total telehealth market revenues. Indeed, when the telehealth market revenues are divided by each country’s population, then the Scandinavian countries become EU leaders. Their telehealth market revenues per capita, especially in Denmark, exceed those of the United Kingdom and France. Of course, the living and medical costs in these countries are much higher to eastern and southern European countries

Teleconsultatio/ telediagnoses or 24/7 call centres: The doctor communicates remotely with the patient, using for example video conference (with dedicated software that ensures privacy), to hear the symptoms and make the diagnosis and send him/her a prescription if needed. Teleconsultation can also work well in cases of regular prescription of drugs or medical tests (e.g. blood test) or just medical advice on specific issues. However, lack of direct human interaction can be problematic for some examinations or treatments (e.g. if the doctor need to inspect the ear). In these cases, a face-to-face meeting with the doctor is a necessity. There are other occasions where an initial physical meeting is important followed by teleconsultations for monitoring the development of the illness. In essence, for diagnostic/consultative context telemedicine can be widely adopted. However, treatment may still require a physical visit the doctor in many occasions.

Telemonitoring: This type refers to digital therapeutics that can be used anywhere (with the appropriate device and application). For example, a patient in a comma can live at home and constantly monitored remotely by a hospital clinic. Telemonitoring can also be important to lonely people with dementia or cognitive decline. Mobile devises, wearables, smart homes, connected vehicles and advanced telemonitoring devices including life support devices combined with technology such as the Internet of Things, AI and Data analytics can enable remote healthcare and early preventative intervention (already very advanced in the US) at a large scale.