Takes a Stand: e/m-Health and Telemedicine

Critical Anthropology for Global Health (CAGH)

Takes a Stand: e/m-Health and Telemedicine

 

 

Statement drafted by

 

Tanja Ahlin (University of Amsterdam)

Mark Nichter (University of Arizona)

 

November 14, 2015

 

 

In November 2013, several members of the Critical Anthropology for Global Health (CAGH) special interest group launched a Takes a Stand (TAS) initiative on e/m-health and telemedicine. At the core of this decision was the recognition that e/m-health and telemedicine may have a significant impact on understanding, practicing and organizing healthcare globally as well as locally. E/m-health and telemedicine are innovative practices that are still in the making; the shifts in healthcare they stimulate are gradual, but profound. The stakes are high especially for the final users and practitioners of e/m-health and telemedicine, as there is a strong commercial aspect to these technologically enhanced health practices; questions have also been raised about power distribution of various actors involved. At the same time, there is indication that e/m-health and telemedicine have a lot of potential to improve healthcare, especially for chronic patients, elderly and those living in remote areas. With the help of several CAGH members, we have drafted a statement to encourage anthropologists to study e/m-health and telemedicine in more depth. Below, we briefly describe what e/m-health and telemedicine are. We then explain why we believe this is an important topic for anthropologists to address. Finally, we propose 12 areas of research, with suggestions for particular research questions. While studies of these relatively new phenomena have been made in other disciplines, few anthropologists have touched the topic so far. We urge anthropologists to become involved, as their training in ethnography makes them particularly suited to provide a more nuanced picture, and thus a more productive view, of e/m-health and telemedicine. We also invite anthropologists already familiar with or conducting research on this topic around the world to shed light on literature that has been published in languages other than English.

 

 

What are e/m-health and telemedicine?

 

A number of innovative health care and health monitoring practices have been encompassed by the terms e-health, m-health, telemedicine, and telecare. Definitions of these terms are diffuse. A systematic review of literature produced 51 unique definitions of e-health alone (Oh et al., 2005). For the purposes of this review we will adopt the World Health Organization (WHO, 2011a) definition of e-health as “the transfer of health resources and health care by electronic means,” which primarily entails “the delivery of health information, for health professionals and health consumers, through the Internet and telecommunications.” E-health includes the transfer of health-related information in all possible directions. As a part of e-health, telemedicine focuses more specifically on “the use of telecommunications to diagnose and treat disease and ill-health” (WHO, 2011a) primarily by medical professionals (Allen, 2000). A growing component of e-health is m-health, or mobile health, which refers to medical and public health practice supported by hand held mobile devices (WHO, 2011b) such as mobile phones and other wireless devices. E-health also encompasses the use of electronic health records, consumer health informatics, health knowledge management, virtual health care teams, population health management and health care information systems (Wrighton, 2011).

E-health in its broadest sense, that is as the use of information and communication technologies (ICT) for health, has been recognized as one of the most rapidly growing fields in health (WHO, 2013). This is hardly surprising, given the rate at which Internet and mobile phone use are spreading around the globe. The number of mobile cellular subscriptions worldwide has grown from less than 1 billion in 2000 to more than 7 billion in 2015. Globally, 3.2 billion people are currently using mobile devices, of which 2 billion live in developing countries (International Telecommunication Union (ITU), 2015).

Internet, also accessed through mobile phones, is increasingly being used to seek information about 1) the possible diagnosis, cause, severity, or trajectory of a health condition; 2) health care seeking options and treatment alternatives; 3) medication use, effectiveness, and side effects; 4) clinical trials; 5) patient groups willing to share experiences; 6) population based data on the distribution of health problems, risk factors, and genetic predispositions; 7) preventive and promotive health advice; and so on. In the United States, 59% of adults report having looked online for health information and 35% of them say they have used the Internet specifically with the intention to determine the medical condition for themselves or someone else (Fox and Duggan, 2012, 2013). Many access the Internet after seeing a practitioner to gain more information about the health problem, learn if additional treatment options exist, or research what the practitioner has advised. Family and friends use the Internet to gather information about another’s health condition as an idiom of concern as well as to participate in health care decision making.

 

 

Why are e/m-health and telemedicine important research topics for anthropologists?

 

The recent proliferation of information technologies is critically reconfiguring health-related practices, whether at bodily, institutional, or population levels. The rise in flows of information makes the study of biocommunicability (i.e., power relations within mediated information) and biosociality vital health social science concerns.[1] The use of e/m-health may grow spontaneously with individuals’ becoming more and more accustomed to information seeking and posting information about lessons learned from their health care experience. A growing number of websites and online health forums are accommodating exchange of health-related information (e.g., Oh, 2012; Neumark et al., 2013; Rutten et al., 2012). It is also worth noting that information seeking and sharing is in step with neoliberal ideas related to taking greater responsibility for one’s health practices. This is being encouraged by both private and public organizations. For example, ICT in health care has been strategically promoted by the European Commission (EC) as a part of its digital agenda through action plans for e-health (2007–2013, 2013–2020; EC, 2007, 2012), which among other things envisaged e-health as an important solution to dealing with population aging (Community Research and Development Communication Service, 2013).

In 2005, WHO adopted a resolution on e-health as a means to promote the strengthening of health systems in countries through e-health, build public-private partnerships in ICT development and deployment for health, support capacity building for the application of e-health in WHO member states, and develop and adopt standards (WHO, 2013). Based on the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health (CoIA), 75 target countries, including the world’s poorest 49 nations, should have integrated the use of ICT in their national health information systems and health infrastructure by 2015 (WHO, 2013). In the global South, strategic collaborations have been forged between India and Africa in order to establish the Pan-African e-Network (PAeN) for Telemedicine and Tele-education across 53 African nations (African Union Commission, 2004; Duclos, 2012, 2014). In India, a telemedicine platform is being established by the Apollo Hospitals, a private health service provider that established a non-profit subsidiary, Apollo Telemedicine Enterprise Limited, as early as in 1999 to carry out research on development and implementation of telemedicine in rural and remote areas (Bowonder, Bansal and Giridhar, 2005).

E/m-health is being promoted as a means to address some of the most pressing issues in health care organization and delivery. These issues include, among others, inefficient management of medical records; poor access to care due to lack of health care practitioners, especially in rural areas; a rising number of people in need of health monitoring, such as the elderly and chronically ill; inefficiencies in scheduling, triage, and payment of health care professionals; poor quality of care due to gaps in history and continuity of care; lack of patient empowerment/participation; and rising health care costs, leading to the need to reduce and maximize the number of visits to health care facilities as well as reduce costly delays and errors in the process of administration and treatment. Rather than stand-alone solutions, e/m-health strategies promoted to address these and other issues “should be viewed as integrable systems that should fit into existing health system functions and complement the health system goals” (Labrique et al., 2013: 160-161).

Despite the enthusiastic response of international organizations, industry, and national governments, challenges to implementation of e/m-health and telemedicine persist (Tomlinson et al., 2013). In some cases the proposed e/m-health solutions were not well accepted by their intended users (López and Domènech, 2008). The failure to introduce ICT in health beyond pilot projects has been attributed to differences between how e-health designers and end-users engage with their local worlds. For this reason, the International Society for Telemedicine and eHealth (ISTeH) added the consideration of end users and civil society to its previous framework for e-health, which had been based on the triad of academia, government, and industry (Kwankam, 2012).

 

 

How can anthropologists contribute?

 

The ethnographic studies of e/m-health published to date tend to come from the fields of science and technology studies (STS) and sociology (e.g., Pols, 2012; Lupton, 2014a), but anthropologists have been little involved. Ethnography has played a considerable role in studying e/m-health and telemedicine projects, but often it was used only instrumentally, as one tool among others for need specifications, design, and evaluations. As a research method, ethnography has thus not been granted its full potential in revealing the complexities of various practices and situations. Anthropologists could also emphasize the importance of studying e/m-health and telemedicine practices as embedded in a wide variety of local contexts. We suggest that anthropologists should amend this, and thereby add significantly to the understanding, assessment, and improvement of e/m-health interventions. This would include formative research on both receptivity to using different forms of technology for particular purposes by different stakeholders and user response to programs initiated as well as local innovations using similar technology in fields outside health. Innovations such as e/m-health and telemedicine entail more than just the introduction of new technologies; they result in new relationships, expectations, and responsibilities (Pols, 2012, cf. Duclos, 2015).

In what follows we identify several issues for formative research and ethnographies of the social life of e/m-health and telemedicine. We call for 1) analytical research of e/m-health and telemedicine as temporarily and locally situated practices embedded in global economic and political developments, and 2) research pertaining to understanding and contributing to various applications of e/m-health and telemedicine.

 

  1. History and contextualization of e/m-health and telemedicine

 

How was e-technology for the delivery of health care envisioned to interface with medicine? What interest groups were behind this vision and why? How were these visions transformed over time based on shifts in motives, progress in technologies, and the reactions of all stakeholders (e.g., Park et al., 2012; Braitberg 2002; Cartwright, 2000; Bareiss, 2001)? Researchers have already called attention to a series of market-based issues related to the commercialization and commodification of health care that require further research (Lupton, 2014b, 2014c, 2014d, 2015; Brijnath, 2012; Cartwright, 2000; Sinha, 2000; Cleland, 2002; Orizio and Gelatti, 2010; Duclos, 2014). For example, how are power structures of patients, practitioners, and heath care organizations changing in this context? Research on these topics would provide data on lessons learned which, in turn, could influence future problem solving in the implementation and practice of e/m-health and telemedicine.

 

  1. Digitalization of health records and data storage

 

Beyond making access to patient records easier, m-health has enabled health workers to electronically register their services and submit point-of-care test results through ICT systems, so that patient histories may be updated from the field (Labrique et al., 2013). How does the introduction of e/m-health into the management of health records influence health care practices within and outside health care institutions, including their impact on patient-practitioner communication?

Moreover, what is the role of corporations as information collectors and gatekeepers? Through practices such as telemonitoring and personal self-tracking devices and applications, data about people’s everyday health condition is collected, stored and managed remotely (Lupton, 2013, 2014d, 2015; Sarrafzadeh and Sykes, 2012; Bin-Sabbar and Al-Rodhaan; 2013; Leffingwell et al., 2013). Issues of trust would be important to explore related to who has access to a patient or citizen’s health data. What data is being shared, how is it being used, for what purposes and by whom, and are people aware of data collection practices (e.g. Pine, 2011; Fischer and Monahan, 2008; Lupton, 2012, 2015)? The encroachment of corporations into the realm of e/m-health and telemedicine needs to be monitored (Monahan and Fisher, 2011; Baba 2013; Lupton, 2014a, 2014c).

 

  1. Health care organization

 

Health care teams are affected by the use of ICT, as a review by Geraldine Fitzpatrick and Gunnar Ellingsen (2013) shows. Several studies so far have addressed how ICTs influence working relations and team dynamics, how they change care routines, and what impact they have on quality of health care (e.g., Oudshoorn, 2011; Gagnon et al., 2012; May et al., 2003; Pols, 2010a, 2010b, 2010c, 2012; Finch et al., 2003, 2005; Vedder, 2013; Hendy, Chrysanthaki and Barlow, 2014). Other studies have shown how the social relations of care (e.g., for the elderly or chronic patients) are being re-shaped by the possibilities offered by e/m-health (e.g., Roberts and Mort, 2009; Pols and Moser, 2009; Miller, Roberts and Mort, 2011; Pols, 2012). Some questions remain for anthropologists to unpack, e.g., how do new ways of auditing care practices in the name of efficiency and cost effectiveness influence how workers function in health care organizations? What is the impact of electronic health records on health care organization and administrative practices in hospitals (Baba 2013)? Finally, how does ICT change the practice of diagnosis, which can now be done at a distance (e.g., Oudshoorn 2008; Andersen et al. 2011)?

 

  1. E/m-health and patient-practitioner relationship

 

Anthropologists need to address the questions of the impact of ICT on patient-practitioner relationship and clinical practice, where challenges include confidentiality, professional boundaries, effective and competent practice, and unanticipated contact (Fantus and Mishna, 2013; Fujioka and Stewart, 2013). Hitherto, some studies have argued that the increasingly available health-related information online may contribute to democratization of medical knowledge and increase patient confidence and empowerment, making the doctor–patient relationship less hierarchical and more oriented towards an equal partnership and collaboration (for an overview, see Ahlin 2011; Marcinkiewicz and Mahboobi, 2009; McMullan, 2006). Others have contested such views and questioned the motives behind the promotion of digital health technologies as a way to encourage patients in self-management and self-responsibility (Henwood et al., 2003; Lupton, 2013, 2015).

There is a need to investigate online health forums and support groups and to assess health information available online (e.g. Barker 2008). Anthropologists would need to address the production and presentation of health related (dis)information published online and the factors that influence what people access and in what sequences (e.g., Dobransky and Hargittai, 2012; Lupton, 2014b), from what sites appear first during information searches to where people are later redirected. What kind of health-related information is shared online, by whom, and for which audience? People use the Internet to interpret, produce, and circulate knowledge, for example in relation to genetic conditions (Schaffer, Kuczynski and Skinner 2008). How is the information found online consumed, but also contested, and how does it impact the interaction between patients and their relatives and health care practitioners and personnel? Also, how is the role of the healthcare practitioners changing as they increasingly prescribe websites as sites of information and serve as filters for reliable sources of information? This raises questions about the criteria on the basis of which practitioners and healthcare organizations choose the sources of information they recommend. How do people, both practitioners and patients, filter information in or out, how do they decide which assemblages of information are trustworthy and which not, and whom do they trust as filters?

Moreover, how are the roles of both patients and health care staff changing due to the influence of ICT (e.g. Finch et al. 2008; Nielsen 2015a, 2015b; Dedding et al. 2011)? Who is the “expert” on a particular health condition, the practitioner, the patient, or the technology (e.g., Pols 2014)? Consequently, who bears the responsibility for decisions made? In relation to electronic health records, would patients have access to these files to see what is charted, and perhaps to edit information? Taking patients and practitioners in their new role as the users of e/m-health and telemedicine technologies, studies in STS have looked into the misuse and/or disuse of telecare devices and the patients’ interpretations of this kind of services (e.g., López and Domènech, 2008). Further investigations in this direction are called for to better understand the circumstances in which certain ICTs are adopted by their users or not (cf. Akrich 1992; Oudshoorn and Pinch 2003).

 

  1. Tele-training and education of health care professionals

 

There has been some evidence that in countries where travelling long distances is affected by poor infrastructure and there are great socio-economic and demographic disparities between rural and urban areas, tele-education of health care professionals is seen as an important strategy to increase the number of highly trained health care staff (e.g., Fernández and Ovaido, 2011; Mahadevan et al., 2012; Mars, 2013) or even to provide training to areas in violent conflicts (Ghanem et al., 2012). Anthropologists could investigate in detail who is developing what kind of tele-training programs for health care and toward what ends, as well as the coordination and contestation of such programs. The impact of such training should be evaluated through ethnographic study, particularly in terms of governance, democratization of health, certification, and the creation of health care professionals’ communities that arise as a consequence of tele-education. Where and how is the training of health care professionals to practice e/m-health and telemedicine provided, and what challenges does this entail (Vaccaro and Lambie, 2007)?

 

  1. Public health interventions

 

In some countries, the potential of mobile phones for health has been recognized by particular public health institutions. For example, text messages have been used to influence behaviour change (Hingle et al., 2013) and manage disease in cases of chronic illnesses (Cole-Lewis and Kershaw, 2010). In Peru, mobile phones have been proved to be a highly efficient and cost-effective tool in preventive health care, especially among the poorest households and households in areas with the highest incidence of dengue (Dammert, Galdo and Galdo, 2012). How and to what extent can mobile phones improve the timeliness and effectiveness of public health interventions? In what ways may they be used, if at all, to reduce non-adherence and delay in health care seeking?

 

  1. Monitoring treatment, self-care and self-tracking at a distance

 

E/m-health and telecare are used to monitor and care for patients with chronic illness, taking medication and needing to manage home treatment for diseases like chronic lung disease (Pols 2012), diabetes (Paré et al. 2010), or Buruli ulcer. How are these monitoring projects conceived and implemented in different contexts around the world? What is their impact on patients’ adherence to treatment regiments, and how do they influence identification of serious complications that require immediate clinic visits? The practice of monitoring also influences patients’ families as they become involved in tracking the progress of treatment. How does increased family presence influence communication and trust between patients, health care centers, and the community at large?

Monitoring is not necessarily carried out between the patient and the health practitioner; people who are not necessarily patients may be using various tracking devices and applications for self-care and self-monitoring (e.g. Lupton 2014d). How are practices related to health prevention programs, or how could they be?

 

  1. Epidemiological monitoring of diseases

 

ICT may be used in epidemiological monitoring and surveillance of illness episodes, medicine use, and other health related issues through real time data mining of Internet use and mobile traffic as well as through proactive local reporting through electronic means (e.g., Dugas et al. 2013, Lazer et al. 2014). For example, mobile phones may be tracked to model the travelling of the malaria-causing parasite (Buckee et al., 2013), and in Madagascar, a short message service has been used in a sentinel surveillance system for influenza-like illness (ILI) based on data collected from general practitioners (Rajatonirina, 2010). In Mexico, text messages and online search queries have been tracked in order to follow and survey the spread of the H1N1 flu pandemic (Krisberg, 2010). How does such reliance on ICT change the practice of epidemiology, data collection, and consequent public health decision-making?

 

  1. Online health communities

 

Through the lens of biosociality, anthropologists could research how patients and their family members proactively use ICT to secure health care for themselves and their family, friends, and so on. Inquiry into this topic could range from the practice of consulting health practitioners at a distance to the use of ICT to mobilize support networks in which people share concerns and experiences, as well as critically assess the available health care options. How does ICT, for example online support forums and webcam-supported patient communities, encourage sharing of practical solutions that the “expert patients” (Edgar, 2005) create through their practice of living with a chronic illness (Pols 2013b)? How are online groups and chat rooms that are created by those sharing an illness used and what are they useful for? They may, for example, be used to share feelings of connectedness rather than only for sharing information, or to bolster the illness identity. Professional and lay patient organizations could particularly benefit from such engaged academic research.

On the practitioner side, knowledge may be transferred through online communities among practitioners of different kinds (Stewart and Abidi, 2012). Research is needed to explore this emergent practice, which includes provider-to-provider sharing of information and experience. Moreover, how are health-related online forums a place of negotiation of power and identity, for example when they are used by activist groups for a particular health condition, such as autism, or public health practices, such as vaccination?

 

 

  1. Perceptions and expectations of (potential) users towards e/m-health

 

The ways in which people perceive health-related technologies and what they expect from them is related to how these technologies are represented in general discourses and the media, including the Internet. What is the image of various e/m-health devices and practices in different local contexts, how does it come about, and what are the influences of these images (i.e., hype or suspicion) on the uses of e/m-health?

 

  1. Legislation and ethics

 

Anthropologists should carry out an evaluation of guidelines and (lack of) legislature regarding e/m-health and telemedicine in countries around the world (e.g., Leenes and Kosta, 2013). While the use of ICT is potentially highly transformative and useful, anthropologists should investigate how such technologies might be used to constrain the scope and practice of what constitutes citizenship (cf. Akrich 1992). For example, how does the encouragement of e/m-health and telemedicine practices interact with the notion of a self-reliant, independent patient-citizen, and how is responsibility distributed among various stakeholders (e.g., Lupton 2013)?

 

  1. E/m-health and telemedicine in global health

 

Questions about e/m-health and telemedicine differ according to local contexts. How does the implementation and use of these practices differ in contexts with different levels of access to healthcare services? What local, national, international, and global power structures are involved, and how are they impacted and influenced by e/m-health?

 

 

How can you contribute to the initiative?

 

E/m-health and telemedicine are global phenomena that have an increasing impact on people’s understanding of health care needs as well as health practices that effect their lives. The members of this SIG initiative have been active in organizing panels and presenting papers on e/m-health and telemedicine since the AAA meetings in 2012. We welcome all contributions on this topic, be they in the form of research reports, suggested references and links, or comments on the statement and proposals for future AAA meeting panels. We invite all anthropologists working on e/m-health and telemedicine in any part of the world to write short briefs (up to 1000 words) about their research to be published on the CAGH website. We particularly encourage anthropologists working in non-English contexts to join this initiative.

 

 

 

 

Working Bibliography

 

African Union Commission (2004). Pan African e-Network (PAeN) for Tele-medicine and Tele-education, http://pages.au.int/infosoc/pages/pan-african-e-network-paen-tele-medicine-and-tele-education, accessed September 26, 2013.

 

Ahlin, T. (2011). Technology and Cultural (R) evolution: Can E-Health and Telemedicine Give Power to the Patients? Curare, 34(3), 165-172.

 

Akrich, M. (1992). The de-scription of technical objects. Shaping technology/building society, 205-224.

 

Andersen, T., Bjørn, P., Kensing, F., & Moll, J. (2011). Designing for collaborative interpretation in telemonitoring: Re-introducing patients as diagnostic agents. International journal of medical informatics, 80(8), e112-e126.

 

American Telemedicine Association (ATA, 2013). Who is ATA? http://www.americantelemed.org/about-ata/who-is-ata, accessed September 26, 2013.

 

Allen, A. (2000). Morphing Telemedicine – Telecare – Telehealth – eHealth. Telemed Today, Special Issue: 2000 Buyer’s Guide and Directory, 1: 43.

 

Baba, M. L. (2013). Electronic Health Records and Big Data: Emerging Issues in the Anthropology of Policy. Anthropology News, 54(9): e1-e13.

 

Barker, K. K. (2008). Electronic support groups, patient-consumers, and medicalization: The case of contested illness. Journal of Health and Social Behavior, 49(1), 20-36.

 

Bareiss, W. (2001). Telemedicine in South Dakota: A Cultural Studies Approach. New Media Society 3(3): 327-355.

 

Barry, N., Reid, M., Ibbotson, T., and Bower, D. J. (2000). Telemedicine diffusion in Scotland: training and technical support issues. Journal of Health Care Computing, 17(5): 20-23.

 

Bin-Sabbar, M. S., & Al-Rodhaan, M. A. (2013). Diabetes Monitoring System Using Mobile Computing Technologies. Diabetes, 4(2).

 

Bowonder, B., Bansal, M. and Sharnitha Giridhar, A. (2005). A telemedicine platform: a case study of Apollo hospitals telemedicine project. IJSTM 6(3/4/5):449-466.

 

Braitberg, V. (2002). Liberators, Innovators, and Experts: Struggle for the Telemedical Future in the Shadow of the Neoliberal Reform. PhD dissertation, submitted to University of North Carolina at Chapel Hill.

 

Briggs, C. L., & Hallin, D. C. (2007). The Neoliberal Subject and its contradictions in news coverage of health issues. Social Text 93, 25(4): 43-66.

 

Briggs, C. L., & Nichter, M. (2009). Biocommunicability and the biopolitics of pandemic threats. Medical anthropology, 28(3), 189-198.

 

Brijnath, B. (2012). Pills, pluralism, risk and citizenship: Theorising e-pharmacies. BioSocieties, 7(3), 294-307.

 

Buckee, C. O., Wesolowski, A., Eagle, N. N., Hansen, E., & Snow, R. W. (2013). Mobile phones and malaria: Modeling human and parasite travel. Travel medicine and infectious disease, 11(1): 15-22.

 

Cartwright, L. (2000). Reach out and heal someone: telemedicine and the globalization of health care. Health:, 4(3), 347-377.

 

Cole-Lewis, H., & Kershaw, T. (2010). Text messaging as a tool for behavior change in disease prevention and management. Epidemiologic reviews, 32(1), 56-69.

 

Community Research and Development Communication Service (2013). ICT Challenge 5: ICT for Health, Ageing Well, Inclusion and Governance, http://cordis.europa.eu/fp7/ict/programme/challenge5_en.html, accessed September 26, 2013.

 

Cutchin, M. P. (2002). Virtual medical geographies: conceptualizing telemedicine and regionalization. Progress in Human Geography, 26(1), 19-39.

 

Dammert, A., J. Galdo, and V. Galdo (2012). “Preventing Dengue through Mobile Phones:Evidence from a Field Experiment in Peru”, http://http-server.carleton.ca/~adammert/dengue_2012.pdf, accessed September 26, 2013.

 

Dedding, C., van Doorn, R., Winkler, L., & Reis, R. (2011). How will e-health affect patient participation in the clinic? A review of e-health studies and the current evidence for changes in the relationship between medical professionals and patients. Social science & medicine, 72(1), 49-53.

 

Dobransky, K., & Hargittai, E. (2012). Inquiring minds acquiring wellness: Uses of online and offline sources for health information. Health communication, 27(4), 331-343.

 

Duclos, V. (2012). Building Capacities: The Resurgence of Indo-African Technoeconomic Cooperation. India Review, 11(4), 209-225.

 

Duclos, V. (2014). Of Doctors and Wires ICTs, Health care, and India’s Telemedicine Venture into Africa. Journal of Critical Southern Studies, 1(1), 7-34.

 

Duclos, V. (2015). Designing spaces of care in the era of global connectivity. Medicine Anthropology Theory 2(1): 154-164. http://medanthrotheory.org/site/assets/files/4925/tp-duclos-ehealth.pdf

 

Dugas A. F., Jalalpour M., Gel Y., Levin S., Torcaso F., Igusa T., et al. (2013). Influenza Forecasting with Google Flu Trends. PLoS ONE 8(2): e56176.

 

Edgar, A. (2005). The expert patient: Illness as practice. Medicine, Health Care and Philosophy, 8(2), 165-171.

 

Ellis, I. (2004). Guest Editorial-Is telehealth the right tool for remote communities? Improving health status in rural Australia. Contemporary nurse, 16(3), 163-168.

 

European Commission (EC) (2007). A Lead Market Initiative for Europe: Action Plan for eHealth, http://ec.europa.eu/enterprise/policies/innovation/files/lead-market-initiative/action_plan_ehealth_en.pdf, accessed September 26, 2013.
European Commission (EC) (2012). eHealth Action Plan 2012-2020: Frequently Asked Questions, http://europa.eu/rapid/press-release_MEMO-12-959_en.htm, accessed September 26, 2013.

 

Fantus, S., & Mishna, F. (2013). The Ethical and Clinical Implications of Utilizing Cybercommunication in Face-to-Face Therapy. Smith College Studies in Social Work, 83(4), 466-480.

 

Fernández, A., and Ovaido, E. (Eds.) (2011). E-health in Latin America and the Caribbean: Progress and Challenges. Santiago: United Nations.

 

Finch, T., May, C., Mair, F., Mort, M., & Gask, L. (2003). Integrating Service Development with Evaluation in Telehealth care: An Ethnographic Study. Bmj, 327(7425), 1205-1209.

 

Finch, T., Mort, M., May, C., & Mair, F. (2005). Telecare: Perspectives on the Changing Role of Patients and Citizens. Journal of telemedicine and telecare, 11(suppl 1), 51-53.

 

Finch, T. L., Mort, M., Mair, F. S., & May, C. R. (2008). Future patients? Telehealth care, Roles and Responsibilities. Health & Social Care in the Community, 16(1), 86-95.

 

Fisher, J. A., & Monahan, T. (2008). Tracking the social dimensions of RFID systems in hospitals. International journal of medical informatics, 77(3), 176-183.

 

Fitzpatrick, G., & Ellingsen, G. (2013). A review of 25 years of CSCW research in healthcare: contributions, challenges and future agendas. Computer Supported Cooperative Work (CSCW), 22(4-6), 609-665.

 

Fox, S., and Duggan, M. (2013). Health Online 2013. Pew Internet & American Life Project, November 8, http://www.pewinternet.org/Reports/2012/Mobile-Health/Key-Findings.aspx, accessed September 23, 2013.

 

Fox, S., and Duggan, M. (2013). Health Online 2013. Pew Internet & American Life Project, January 15, http://www.pewinternet.org/Reports/2013/Health-online/Summary-of-Findings.aspx, accessed September 23, 2013.

 

Fujioka, Y., & Stewart, E. (2013). How Do Physicians Discuss e-Health with Patients? The Relationship of Physicians’ e-Health Beliefs to Physician Mediation Styles. Health Communication, 28(4), 317-328.

Gagnon, M. P., Desmartis, M., Labrecque, M., Car, J., Pagliari, C., Pluye, P., … & Légaré, F. (2012). Systematic review of factors influencing the adoption of information and communication technologies by health care professionals. Journal of medical systems, 36(1), 241-277.

Ghanem, A. M., Zaben, M., Shaban, N. A., Green, C., Abu-Sitta, G., & Myers, S. (2012). Tele-education for teaching of evidence-based medicine and burn care in the occupied Palestinian territory: a pilot study. The Lancet, 380, S28-S29.

Hendy, J., Chrysanthaki, T., & Barlow, J. (2014). Managers’ Identification with and Adoption of Telehealth care. Societies, 4(3), 428-445.

Hingle, M., Nichter, M., Medeiros, M., & Grace, S. (2013). Texting for health: the use of participatory methods to develop healthy lifestyle messages for teens. Journal of nutrition education and behavior, 45(1), 12-19.

HIMSS Media (2013). mHealth Summit: Technology, Business, Research, Policy – Overview, http://www.mhealthsummit.org/about-summit/overview, accessed on September 23, 2013.

International Telecommunications Union (ITU). (2015). ICT Facts & Figures: The World in 2015. http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2015.pdf

ISfTeH (2013). About the ISfTeH, http://www.isfteh.org/about/about_the_isfteh, accessed on September 23, 2013.

Krisberg, K. (2010). Public Health Workers Using New Means to Track, Predict Flu: Staying Ahead of Influenza Outbreaks. Nations Health 20(8).

Kwankam, S. Y. (2012). Succesful Partnerships for International Collaboration in e-Health: The Need for Organized National Infrastructures. Bulletinn of World Health Organization, 90: 395-397.

Labrique, A. B., Vasudevan, L., Kochi, E., Fabricant, R., & Mehl, G. (2013). mHealth innovations as health system strengthening tools: 12 common applications and a visual framework. Global Health: Science and Practice, 1(2), 160-171.

Lazer, D., Kennedy, R., King, G., and A. Vespignani. (2014). The Parable of Google Flu: Traps in Big Data Analysis. Science 343: 1203-1205.

 

Lillehoj, P. B., Huang, M. C., Truong, N., & Ho, C. M. (2013). Rapid electrochemical detection on a mobile phone. Lab Chip.

 

Leffingwell, T. R., Cooney, N. J., Murphy, J. G., Luczak, S., Rosen, G., Dougherty, D. M., & Barnett, N. P. (2013). Continuous Objective Monitoring of Alcohol Use: Twenty‐First Century Measurement Using Transdermal Sensors. Alcoholism: Clinical and Experimental Research, 37(1), 16-22.

Leenes, R., & Kosta, E. (Eds.) (2013). Bridging Distances in Technology and Regulation. Oisterwijk: Wolf Legal Publishers.

Lupton, D. (2012). M-health and health promotion: The digital cyborg and surveillance society. Social Theory & Health, 10(3), 229-244.

Lupton, D. (2013). Digitized health promotion: personal responsibility for health in the Web 2.0 era.

Lupton, D. (2014a). Beyond techno-utopia: critical approaches to digital health technologies. Societies, 4(4), 706-711.

Lupton, D. (2014b). The commodification of patient opinion: the digital patient experience economy in the age of big data. Sociology of health & illness, 36(6), 856-869.

Lupton, D. (2014c). Critical perspectives on digital health technologies. Sociology Compass, 8(12), 1344-1359.

Lupton, D. (2014d). Apps as artefacts: towards a critical perspective on mobile health and medical apps. Societies, 4(4), 606-622.

Lupton, D. (2015). Health promotion in the digital era: A critical commentary. Health promotion international, 30(1), 174-183.

Marcinkiewicz, M., & Mahboobi, H. (2009). The Impact of the internet on the Doctor-Patient Relationship. Australasian Medical Journal, 1.

Mahadevan, S., Muralidhar, K., & Shetty, D. (2012). Tele-Education Service Using Telemedicine Network in Health care Industry. Telemedicine and e-Health, 18(9), 699-702.

Mars, M. (2013). Telemedicine and Advances in Urban and Rural Health care Delivery in Africa. Progress in Cardiovascular Diseases.

May, C., Mort, M., Williams, T., Mair, F., & Gask, L. (2003). Health Technology Assessment in its Local Contexts: Studies of Telehealth care. Social science & medicine, 57(4), 697-710.

McMullan, M. (2006). Patients using the Internet to obtain health information: how this affects the patient–health professional relationship. Patient education and counseling, 63(1), 24-28.

Milligan, C., Roberts, C., & Mort, M. (2011). Telecare and older people: who cares where?. Social Science & Medicine, 72(3), 347-354.

 

Monahan, T., & Fisher, J. A. (2011). Surveillance impediments: recognizing obduracy with the deployment of hospital information systems. Surveillance & Society, 9(1/2), 1-16.

 

Mol, A. (2006). Proving or improving: on health care research as a form of self-reflection. Qualitative health research, 16(3), 405-414.

 

Mol, A. (2008). The logic of care: Health and the problem of patient choice. Routledge.

 

Nielsen, K. D. (2015a). Invited to Participate? An Ethnography of Patient Involving E-health in Heart Care (Doctoral dissertation, Københavns UniversitetKøbenhavns Universitet, Det Sundhedsvidenskabelige FakultetFaculty of Health and Medical Sciences, Institut for FolkesundhedsvidenskabDepartment of Public Health, Afdeling for SundhedstjenesteforskningSection of Health Services Research).

Nielsen, K. D. (2015b). Involving Patients with E-health: The Dialogic Dynamics of Information Filtration Work. Science & Technology Studies 28(2): 29-52.

Neumark ,Y., Lopez-Quintero, C., Feldman, B. S., Hirsch Allen, A. J., & Shtarkshall, R. (2013). Online Health Information Seeking Among Jewish and Arab Adolescents in Israel: Results From a National School Survey. Journal of Health Communication: International Perspectives, 18(9):1097-1115.

Oh H., C. Rizo, M. Enkin & A. Jadad (2005) ‘What Is eHealth (3): A Systematic Review of Published Definitions.’ Journal of Medical Internet Research 7(1): e1.

Oh, S. (2012). The characteristics and motivations of health answerers for sharing information, knowledge, and experiences in online environments. Journal of the American Society for Information Science and Technology, 63(3): 543-557.

Oudshoorn, N. (2008). Diagnosis at a distance: the invisible work of patients and healthcare professionals in cardiac telemonitoring technology. Sociology of Health & Illness, 30(2), 272-288.

 

Oudshoorn, N. (2011). Telecare technologies and the transformation of health care. London: Palgrave Macmillan.

 

Oudshoorn, N., & Pinch, T. (2003). How users matter: the co-construction of users and technology (inside technology). MIT Press.

 

Orizio, G., & Gelatti, U. (2010). Public eHealth and new scenarios in terms of risks and opportunities: a specific focus on cyberpharmacies. Social Semiotics, 20(1), 29-41.

 

Pambazuka News (2009, 24 April). Africa: Pan African e- Network: a model of “South- South cooperation,” http://www.pambazuka.org/en/category/media/55920, accessed on October 20, 2013.

 

Paré G, Moqadem K, Pineau G, St-Hilaire C: Clinical Effects of Home Telemonitoring in the Context of Diabetes, Asthma, Heart Failure and Hypertension: A Systematic Review. Journal of Medical Internet Research, 12(2): e21.

 

Park, D. K., Jung, E. Y., & Moon, B. C. (2012, October). The evolution of telemedicine and nano-technology. In Global Congress on Nano-Medicine: Nano-Bio-Info Convergence (pp. 85482M-85482M). International Society for Optics and Photonics.

 

Pine, A. (2011). From Healing to Witchcraft: On Ritual Speech and Roboticization in the Hospital. Culture, Medicine, and Psychiatry, 35(2), 262-284.

 

Pols, J. (2010a). Wonderful webcams: about active gazes and invisible technologies. Science, Technology & Human Values.

 

Pols, J. (2010b). The heart of the matter. About good nursing and telecare. Health Care Analysis, 18(4), 374-388.

 

Pols, J. (2010c). Telecare: What patients care about. Care in practice. Bielefeld: Transcript Verlag.

 

Pols, J. (2012). Care at a Distance: On the Closeness of Technology. Amsterdam: Amsterdam University Press.

 

Pols, J. (2013a). The Patient 2.Many: About Diseases that Remain and the Different Forms of Knowledge to Live with Them. Science & Technology Studies, 26(2): 80-97.

 

Pols, J. (2013b). Knowing patients: Turning patient knowledge into science. Science, Technology & Human Values, 00(0): 1-25.

 

Pols, J. (2014). Knowing patients: turning patient knowledge into science. Science, Technology & Human Values, 39(1): 73-97.

 

Pols, J., & Moser, I. (2009). Cold technologies versus warm care? On affective and social relations with and through care technologies. ALTER-European Journal of Disability Research/Revue Européenne de Recherche sur le Handicap, 3(2), 159-178.

 

Rajatonirina, S., Heraud, J. M., Randrianasolo, L., Orelle, A., Razanajatovo, N. H., Raoelina, Y. N., … & Richard, V. (2012). Short message service sentinel surveillance of influenza-like illness in Madagascar, 2008-2012. Bulletin of the World Health Organization, 90(5), 385-389.

 

Roberts, C., & Mort, M. (2009). Reshaping what counts as care: Older people, work and new technologies. ALTER-European Journal of Disability Research/Revue Européenne de Recherche sur le Handicap, 3(2), 138-158.

 

Rutten, L. J. F., Hesse, B. W., Moser, R. P., Martinez, A. P. O., Kornfeld, J., Vanderpool, R. C., … & Luna, G. T. (2012). Socioeconomic and Geographic Disparities in Health Information Seeking and Internet Use in Puerto Rico. Journal of Medical Internet Research, 14(4).

 

Sarrafzadeh, M., & Sykes, R. (2012). WANDA: an end-to-end solution for tele-monitoring of chronic conditions. International Journal of Integrated Care, 12(Suppl1).

 

Schaffer, R., Kuczynski, K., & Skinner, D. (2008). Producing genetic knowledge and citizenship through the Internet: mothers, pediatric genetics, and cybermedicine. Sociology of Health & Illness, 30(1), 145-159.

 

Scott, R., Maurice Mars, M. B., & Hebert, M. (2012). How Global Is ‘e-Health’and ‘Knowledge Translation’?. In Technology Enabled Knowledge Translation for eHealth (pp. 339-357). Springer New York.

 

Sinclair-Jones, J. (2000). E-medicine and e-work: the new international division of medical labour? Health Sociology Review, 10(1):19-30.

 

Sinha, A. (2000). An Overview of Telemedicine: The Virtual Gaze of Health Care in the Next Century. Medical Anthropology Quarterly 14(3): 291-309.

 

Stewart, S. A., & Abidi, S. S. R. (2012). Applying social network analysis to understand the knowledge sharing behaviour of practitioners in a clinical online discussion forum. Journal of medical Internet research, 14(6), e170.

 

Tomlinson, M., Rotheram-Borus, M. J., Swartz, L., & Tsai, A. C. (2013). Scaling Up mHealth: Where Is the Evidence?. PLoS medicine, 10(2), e1001382.

 

Vaccaro, N., & Lambie, G. W. (2007). Computer‐Based Counselor‐in‐Training Supervision: Ethical and Practical Implications for Counselor Educators and Supervisors. Counselor Education and Supervision, 47(1), 46-57.

 

Vedder, A. (2013). Will technology innovation save the health system? In: R. Leenes & E. Kosta (Eds.), Bridging Distances in Technology and Regulation, pp. 165-172.

 

Watters, E. (2010). Crazy Like Us: The Globalization of the American Psyche. New York: Free Press, 2010.

 

WHO (2011a). Trade, Foreign Policy, Diplomacy and Health: E-health, http://www.who.int/trade/glossary/story021/en/, accessed September 23, 2013.

 

WHO (2011b). mHealth: New Horizons for Health through Mobile Technologies. Global Observatory for eHealth Series – Volume 3, http://www.who.int/goe/publications/goe_mhealth_web.pdf, accessed September 23, 2013.

 

WHO (2013). Global Observatory for e-Health, http://www.who.int/goe/en/, accessed September 23, 2013.

 

Wrighton, B. (2011). An Overview of eHealth Initiatives – Strategies and Lessons from Around the World. Presentation at Greater China eHealth Forum, October 7.

 

 

 

Links

 

American Telemedicine Association

 

International Society for Telemedicine and eHealth (ISfTeH)

 

mHealth Summit

 

European Commission – Enterprise and Industry – eHealth

 

WHO Global Observatory for eHealth

 

 

 

Initiative Members

 

Tanja Ahlin, University of Amsterdam

Mark Nichter, Univeristy of Arizona

Victor Braitberg, University of Arizona

Nora J. Kenworthy, Columbia University

Vincent Duclos, University of Monteral

Karen Dam Nielsen, University of Copenhagen

 

[1] Biocommunicability (Briggs and Hallin 2007; Briggs and Nichter 2009) is an analytic for examining how different discourses circulate and interact, and how individuals and groups involved in their circulation interpret and make use of these discourses in different ways. It may be used to ask questions about what social imaginaries are being used, by whom, and in what circumstances, and what normative assumptions are embedded within the way information is flowing.