Hans van den Heuvel

INTRODUCTION: E-HEALTH: A NEW OPPORTUNITY? Health care is facing the emergence of a new range of systems, services and applications using electronic communication. E-health is the network of technology applications regarding health issues, including e.g. web-based informative programs, remote monitoring, teleconsultation and mobile device supported care. 1 As the health care costs in developed countries continue to increase, policies for cost reduction without concessions to the quality of care are being imposed. Unrestricted by time and place, e-health applications also provide solutions for patient empowerment and value based health care. 2 Patient empowerment is assumed to improve patient participation in medical decision-making, commitment to treatment and thus health outcomes. 3-5 The boost in patient engagement can be an important factor for the improvement of quality of care and patient safety. 6 Young women in their reproductive years are frequent users of Internet, social media and smartphone apps. 7 The Internet is ever more utilized for the search of health information on prenatal, perinatal and postnatal topics. 8 Furthermore, the web is also used as a forum for the exchange of experiences and peer support. 9 Figure 1 shows multiple domains of perinatal care in which e-health is already being used by patients and health care providers. Protocols of professionals’ associations and institutions contain little communication regarding e-health. No statements are made regarding e-health in guidelines from the British Royal College of Obstetricians and Gynaecologists (RCOG), the National Institute for Health and Care Excellence (NICE) and the American College of Obstetrics and Gynecology (ACOG). The Dutch Association of Obstetrics and Gynecology notes that “developments in e-health should be actively implemented in obstetric healthcare” to “induce the shift of scheduled care to the home setting” and thus lower the in-hospital care burden. 10 E-health has the potential to fulfil a key role in the transformation of the healthcare system for both patients and care givers. However, questions are raised if e-health can deliver the quality of care that is required to remain or even improve health outcomes. It is evident that there is a need for guidance and management of quality standards. Issues of costs and reimbursement, safety of data collection and storage, privacy and reliability of information on websites and in apps should also be taken into account. Our aim is to provide a comprehensive and contemporary overview of the literature on e-health in perinatal care and assess the applicability, advantages, limitations and future of this new generation of pregnancy care. CHAPTER 2 20