Figure 1 presents a graphic model of the digital practice milieu that will soon surround both the provider (aka the "supply" side) and the consumer (aka the "demand" side) of advanced health care systems like those in Israel, the United States, and other high income nations. This conceptual model acknowledges that in most modern health care systems the provider is no longer just a single physician or doctor group, but usually a multi-disciplinary team that is either physically or virtually integrated into an organized, structured delivery system (such as an Israeli sickness fund/health plan or an American integrated delivery system/accountable care organization). On the demand side, the model acknowledges that the "patient" (aka the consumer) is part of a family or other social network; something especially relevant where caregivers support young, old, or otherwise dependent patients. It is also critical to acknowledge that the family fits into a broader community, population, or societal context. This graphic gives emphasis to the special nature of the doctor/patient relationship as the figure builds upon a concentric ring model developed by the U.S. Institute of Medicine to help define an idealized role for primary care physicians [17].
Surrounding the provider and consumer concentric rings, Figure 1 lays out the many distinct (though often intertwined) types of e-health/HIT tools that currently, or in the near future, will likely be present to support and mediate information and communication flow in the health care systems of most developed nations.
Starting at bottom center of the chart (and front and center in the Peleg and Nazarenko paper) is the core of information/communication technology; telephone and broadband Internet networks. Specifically, this would include wired and wireless telephones and smart-phones and wireless and wired broadband. This is the platform on which a wide range of consumer-based Internet health applications are built, including social network support groups. It is also the platform for mobile phone (aka "m-health)-based apps that can be independent or "tethered" (i.e., linked) to a specific provider organization. ICT is also the backbone for conventional e-mail or secure messaging systems (which can be bi- or uni-directional between the provider and the consumer).
At the top center of the graphic model is the provider-controlled electronic health record, the consumer-controlled personal health record, and the so-called "web portal"; so termed because it is the web-based entry point for patients wishing to access their provider's EHR system. At its core, the EHR is the key repository and interactive source of medical information for the clinician and all other providers (and often the consumer). In advanced systems, the EHR serves as the hub for other key provider-based HIT components on the left side of the figure.
In evolved delivery systems the EHR goes beyond serving as just the "paperless" medical record. In such settings, the EHR serves as the core for most clinical and administrative processes through its linkage to the other provider-side HIT modules noted on the graph, including: clinical decision support (CDS) tools that help the doctor and other clinicians make evidence-based diagnosis and treatment decisions (e.g., tests needed to make a differential diagnosis, or how to choose the best drug); the "provider order entry" (POE) system that electronically implements clinical actions (e.g., e-prescribing, test ordering, or obtaining a specialist consult); and administrative/management information systems that support organizational and care management functions (e.g., patient outreach, quality improvement, patient scheduling, financial management or billing, and staffing).
Just as the EHR serves as the hub for clinicians, though not yet as widespread, the patient health record can serve as the hub for some of the consumer/community e-health functions summarized on the right side of the figure [18]. While this commentary and the featured paper focus on provider/patient interactions, it is important to remember that the locus where consumers manage most of their health needs is not within the provider organization. Rather, they address their health concerns within their family, workplace, school, and community settings. Therefore, thinking about health communication in this broader context is essential if the goal of individual and population wellbeing is to be achieved. Population/community centric delivery systems can help to achieve this goal by integrating their "medical care" e-health networks with home-based biometric/tele-medicine monitoring systems, personal health and wellness management m-health tools, and public and human services support systems. Integrating e-health solutions with this latter category of community-focused IT systems (often run by government agencies) is essential to address environmental, housing, food, and socio-economic needs and challenges. These "safety net" services must be part of the e-health equation, especially for those consumers at greatest risk.