Doctor (Physician) or patient? Who will drive eHealth & mHealth?

By Joseph Aghatise | 06 Dec, 2012

Who do you think should get all the attention in 2013 and beyond? Your contributions would help us (developing nations) focus more on best practices for eHealth & mHealth deployment.



Joaquin Blaya, PhD Moderator Replied at 1:01 PM, 6 Dec 2012

Hi Joseph,
I think you'll have to explain a bit more what you mean by this, give us
more context as to what you're thinking. And also, I think asking who
should get ALL of the attention is not a valid question, since there will
be reasons to have both physician and patients involved, and the country
context and other factors will be a factor as to who drives the process.

Gerente de Desarrollo, eHealth Systems <>
Research Fellow, Escuela de Medicina de Harvard <>
Moderador, <>

Rakesh Biswas MD Replied at 2:01 AM, 7 Dec 2012

The user drives the process, be it the physician or the patient user.



International Journal of User Driven Health-care IJUDH, US
BMJ Case Reports, UK
Journal of Evaluation of Clinical Practice, UK

Usman Raza Moderator Emeritus Replied at 2:18 AM, 7 Dec 2012

Then I guess a more appropriate question would be: Who is the user (really)
of mHealth/eHealth products?

Usman Raza <>

Ali Habib Replied at 3:53 AM, 7 Dec 2012

I'd say who the user is (and consequently who drives the process) depends
on the technology in question. I don't think "eHealth" or "mHealth" can be
treated as single entities. eHealth and mHealth technologies have been
used by health workers, doctors, program staff, patients - in different
settings for different things. They all have different needs and all those
needs drive the development and/or implementation of technology. In the end
of course, the idea is to benefit patients (through prevention of disease,
improved treatment outcomes, more efficient programmatic management, better
palliative care, whatever the case is). But the users vary.

Ali Habib
Director, Informatics
Interactive Research and Development
Ph: +92-21-34327697

Rakesh Biswas MD Replied at 4:38 AM, 7 Dec 2012

The user is any human being who uses the system through a user name. Given
the right user driven learning environment (more here:
both patient and health-professional 'users' can positively drive health
care information to achieve better health care outcomes.(more here:



Blerim Berisha Replied at 5:32 AM, 7 Dec 2012

Hi all,

Interesting discussion! I believe that the users of eHealth and mHeath are going to be both physicians and patients. There are already and there probably be a lot more applications that are dedicated to physicians and other that are dedicated to patients. I believe that eHealth and mHealth is going to be driven by patients and not very much by health community.

I base this idea in the fact that although the information technology has advanced so much, health system is lacking behind in implementing all the capabilities that the new technology offers and this is mainly due to the very closed and conservative way of function in the health community. For example although the technology in our time is so advanced physicians are still using stethoscopes and other ancient equipments that could be replaced with much more powerful new equipments that offer much more qualitative and quantitative informations.

Blerim Berisha
Telemedicine Centre of Kosova

Usman Raza Moderator Emeritus Replied at 5:41 AM, 7 Dec 2012

This can vary in different contexts I believe. Here in Pakistan, I see
these the health care providers as the primary users of these technologies
at the moment, for a number of reasons (including other than simply
improving their quality of care). However this may change with time.

Usman Raza <>

Nuria Gil-Fournier Replied at 2:46 PM, 7 Dec 2012

Although I still trust too much on my sthetoscope, my hands, my eyes, my
ears..., I really believe in eHealth and mHealth as a complementary tool to
be more efficient on health care, offering the best affordable quality of
care but optimazing resources. How? facilitating communication between
physician-patient and between physician-physitian physitian-nurses-health
community workers... depending on enviroment...

I think can be a great tool to integrate and facilitate a patient-centered
approach, very important in Non Communicable Diseases management...

But I am not expertise in anything! it is just a thought; In my opinion
they might be used to integrate relationships between all partners involved
directly in health care: patients, physicians, nurses or communitty

Nice to read all your comments,

Best regards,


[image: Archivo adjunto]
Nuria Gil-Fournier Esquerra
Endocrinología. Diabetes. Nutrición.
@nigsp <>

Joseph Aghatise Replied at 2:55 AM, 10 Dec 2012

Thanks everyone for adding your comments. I may be wrong, but from my experience implementing eHealth projects, I have observed that Physicians are so used to their traditional approach of pen & paper, most of them have phobia for technology while others don't even bother about the quality of care they give to their patients (they just want to prescribe and go over to the next patient in queue).

A/Prof. Terry HANNAN Moderator Replied at 4:43 AM, 10 Dec 2012

Dear Joseph, this topic is so large it almost requires a PhD thesis to highlight the issues. Despite the limitations of space I would like to add more comments in the hope that they add positive value to what has been written before on this site,
Physicians must change. They will be forced to change as shown by W. Stead in his 2008 document (Stead and Starmer 2008).
The current outcomes of care as documented in several studies have shown we are not making significant progress in terms of costs, quality and outcomes. (Jha and Classen ; Wennberg 2004; Leape and Berwick 2005)
SO what has been the patient population response to this with the availability of Web 3.0 and m-Health technologies? They have taken the initiatives for their own well-being.
SO we now have the interesting findings from the “Wisdom of Crowds” where it appears that in some instances the overall health of members of the crowd based on the sharing of information is better than under the current widget/appointment-based model of care in many institutions.
Of you look at the Californians Health Care Foundation site and the documents on Care without the Doctor and others there is much interesting information.[]
Two other recent publications worthwhile reading are;
Medicine In Denial L. Weed, L. Weed and The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care Eric Topol M.D.

Therefore patients are driving the change. Unless physicians adapt and realise the doctor-centred care is no longer a sensible option then change will be even harder to manage.
Jha, A. K. and D. C. Classen "Getting moving on patient safety--harnessing electronic data for safer care." N Engl J Med 365(19): 1756-1758.

Leape, L. L. and D. M. Berwick (2005). "Five years after To Err Is Human: what have we learned?" JAMA 293(19): 2384-2390.

Stead, W. W. and J. M. Starmer (2008). "Beyond Expert-based Practice. Institute of Medicine (IOM) 2008. Evidence-Based Medicine and the Changing Nature of Health Care: ." 2007 Annual Meeting Summary, Washington, DC: The National Academies Press, pp. 94-105.

Wennberg, J. (2004). "Wrestling with variation: an interview with Jack Wennberg [interviewed by Fitzhugh Mullan]." Health Aff (Millwood) Suppl Variation: VAR73-80.

Joseph Aghatise Replied at 6:32 AM, 10 Dec 2012

Prof. Terry, I totally agree with you. The discussion is becoming more interesting and new points coming out.

Usman Raza Moderator Emeritus Replied at 10:55 AM, 10 Dec 2012

Agree with Prof. Terry and still want to say that the change we see as
necessary and inevitable, is hardly seen the same way by the average
physician in some of the developing countries. One question is, what is the
easiest and most appropriate point in the health care system at which this
change could be initiated. It's important to realize though, that 'easiest'
may not be the same as 'most appropriate'. To me it seems the easiest is to
aim at undergraduate medical education. However, trainees eventually tend
to absorb not what is taught but what they observe in the standard
apprentice-ship model i.e. the practice model of physicians has to change
at the same time. This is where other larger contextual factors come into
play and situation in a well developed health system and that of a
developing country becomes incomparable. Countries with high out-of-pocket
health expenditures, low literacy rates and specifically low health
literacy, lack of a collective awareness of the poor quality of care and
other barriers to mass adoption of such technologies may face tremendous
challenges in developing meaningful, inter-operable e-health systems.

Usman Raza <>