Table 1.

Potential eHealth Benefits And Problems

Potential benefits2,17,23,26:

▪ Increases reach to vulnerable, geographically dispersed, rural, underserved patients with less access to care, lower health literacy, single parents, less educated, minorities, immigrants.

▪ Enhances health equity.

▪ Extends clinical care to everyday world and natural environment: an expanded interface between HCT and patients.

▪ Can provide immediate, real-time, useable management feedback.

▪ Guides patient management and decision making.

▪ Assists in management problem solving.

▪ Provides information to enhance HCT and user decision support.

▪ Some potential to lower costs for health systems, patients, or both, or to provide for a good clinical return for investment.

▪ Provides real-world data to both HCTs and patients so that in-office visits can be focused.

▪ Provides more opportunities for panel management, with linkages to other health systems and resources.

Potential problems4,20,23,27,61:

▪ High attrition: high refusal to participate and high subsequent program drop-out rate.

▪ Low adherence: many users remain in the program but engage infrequently.

▪ Problems with data security and privacy, with a potential for eHealth interfaces with EHRs to open up access to hackers.

▪ Too much data collected in forms not easily obtainable and useable by HCTs and patients.

▪ Problems with both HCT and patient usability and user-friendliness: technologically complex, with too many whistles and bells.

▪ Best results require customization and ongoing adaptation for both HCTs and patients: user literacy, numeracy, culture, education, age, gender, and technological savvy of end-users are rarely considered.

▪ Variable accuracy of measurement tools: the validity of the tools used to provide feedback to users (carb estimators, physical activity trackers) display poor validity or accuracy compared with gold standard assessment tools.

▪ Lack of clarity of specific short- and long-term clinical objectives, including both proximal and distal clinical outcomes.

▪ Often do not include needed end-user training for both health system and patients.

▪ Lack of user input on the multiple perspectives needed for meaningful program development.

▪ Although the best outcomes occur when the program utilizes multiple media, this often increases cost and complexity.

▪ Variations in eHealth programs use can unintentionally increase health inequities.

▪ eHealth interventions often are unsustainable within health systems because of a lack of clear planning, targeting and integration within health systems operations.

▪ Health systems can become overly dependent upon external, proprietary systems such that the costs incurred in switching or modifying the program become prohibitive.

▪ Difficulty in integrating eHealth data with other data management systems, for example, EHR, public health.

EHR, electronic health record; HCT, health care team.