COVID-19 and eHealth: A Promise or Peril Paradox?


It would be difficult to conceive of anyone not knowing about or not having been impacted by (directly or indirectly) the COVID-19 pandemic. There will be profound and long-lasting personal and societal effects of this global event. It also seems destined to dramatically change the future of eHealth (or digital health1).

The scientific literature and social media are already replete with papers, news pieces, and opinion pieces providing examples of eHealth being applied to counter, circumvent, or combat some aspect of COVID-19’s impact. Such uses include mobile apps to assess signs and symptoms, to provide information about testing, and to allow automated Artificial Intelligence enabled contact tracing. Varying applications of teleconsultation have been applied to reduce the need for public transit and physical presence for diagnosis of this variably infectious and (particularly for some demographics) deadly virus. eHealth solutions have also been noted to be of particular value in addressing mental health issues, exacerbated by ‘lock downs’ imposed to counter COVID-19. The utility of biosurveillance and big data analysis has come to the fore, as have more mundane applications for rapid access to information including, regrettably, mis- and dis-information expedited by social media.2

Many of these publications have advised, inspired, implored, recommended, or urged the application of eHealth long after resolution of the COVID-19 pandemic.3-7 The collective sigh “At last …….” has been almost palpable, as many eHealth proponents have exhaled loudly throughout the world after decades of exasperated effort to implement and integrate scaled and sustained eHealth solutions.

But is this ‘promise’ of rapidly expanded adoption, even integration, of eHealth into the fabric of health systems globally something to be hailed. Or is it a ‘peril’ about which we must be astute enough to view with caution?  Certainly it is a paradox.

There will be a temptation to simply let the flood gates open, beckoning forth every eHealth solution imaginable like a Pandora’s Box. We have already seen the innate introduction and adoption of ‘spontaneous’ telemedicine, where healthcare providers themselves saw the value of an eHealth solution and implemented it independently and without traditional steps or approval.8 But is such blind faith in ‘kismet’ advisable when it comes to the widespread adoption and integration of eHealth – a known opportunity cost! There has been a somewhat step-wise (and time consuming) approach to introduction of successful solutions in the past;8 will time be made for these steps in the urgency to implement eHealth?

What of the evidence-base for many applications of eHealth, which may be promising but which is not absolute? Cost-benefit analysis of eHealth in low and middle income countries has been said to be ‘lacking’,9 the evidence-base for telemedicine has been described as ‘equivocal’,10 and for telehealth it has been stated “The available evidence cannot promise that telehealth will solve the complex problems the healthcare system faces”.11 What of the varying capability of health systems (particularly in developing countries) to appropriately absorb, utilise, sustain, and maintain country-wide eHealth implementations and associated info- and infra-structure – let alone to be able to afford them? Health systems of limited resource-settings struggled prior to the pandemic; is the expectation they will not only recover from the added strain of a pandemic response and continue to absorb local and / or migrational population growth, but also sustainably adopt and integrate eHealth solutions! Implementation of e-health on a national basis is a complex undertaking.12,13 Who will exercise the requisite caution to ensure only fitting evidence-based and needs-based eHealth solutions are selected for implementation in any specific setting? Profit motivated vendors? Pressed politicians? ‘Dark side’ eHealth proponents turned lobbyists?

Pressure to implement eHealth comes in many forms. Vendors are naturally excited by the anticipation of a growing global digital health market, in particular the mhealth market. It is projected to grow six-fold (at a CAGR of 28.5%) to over $600 billion dollars (USD) by 2026.14 Politics govern socio-political, economic, and health aspects of each country, and a conducive political setting is essential for digital development which it is believed will be one driver of the post-pandemic recovery,15 and this will include eHealth. Continued pressure also comes from the World Health Organization (WHO) which continues to urge member states to adopt eHealth / digital health. There are no published reports yet of eHealth proponents / advocates / champions pressuring policy- and decision-makers to adopt specific eHealth solutions, but inevitably this will occur. Reliance on such individuals will see variation in perspective and foresight, influenced by their experience, and by their breadth and depth of understanding of what constitutes eHealth / digital health. Each of these forms of pressure will provide significant stimulus to all ‘users’ – patients, providers, policy-makers, and vendors – to adopt eHealth. 

The dawning of a greater global understanding of the ‘potential’ of eHealth is encouraging. But society collectively, and the eHealth / digital health community specifically, must rise to the occasion. Enthusiasm must be tempered with thoughtful guidance regarding technologically appropriate, culturally attentive, environmentally sensitive, economically fitting, politically palatable, setting specific, health needs-based, and evidence-informed eHealth adoption, thereby reining in possible future misadventures. Given the anticipated post-pandemic opportunities, this approach may seem counter-intuitive - even counter-productive - but it is the responsible thing to do …….


Richard E Scott

Maurice Mars



  1. Scott R, Mars M. Here we go again - 'Digital Health'. J Int Soc Telemed eHealth 2019;7:e1-1. DOI: 10.29086/JISfTeH.7.e1.
  2. Scott RE, Mars M. Behaviour change and ehealth - looking broadly: A scoping narrative review. Stud Health Technol Inform 2020;268:123-138. DOI: 10.3233/shti200011.   
  3. Ohannessian R, Duong TA, Odone A. Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: a call to action. JMIR Public Health Surveill 2020;6(2):e18810. DOI: 10.2196/18810.
  4. Smith AC, Thomas E, Snoswell CL, et al.  Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). DOI: 10.1177/1357633X20916567.
  5. Zhou X, Snoswell CL, Harding LE, et al.  The role of telehealth in reducing the mental health burden from COVID-19. Telemed J eHealth 20201;26(4):377-379. DOI: 10.1089/tmj.2020.0068.
  6. Wind TR, Rijkeboer M, Andersson G, Riper H. The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for ehealth. Internet Interv 2020;20:100317. DOI: 10.1016/j.invent.2020.100317.
  7. Bashshur R, Doarn CR, Frenk JM, Kvedar JC, Woolliscroft JO. Telemedicine and the COVID-19 pandemic, lessons for the future. Telemed J eHealth 2020;26(5):571-573. DOI: 10.1089/tmj.2020.29040.rb.
  8. Mars M, Scott RE. Being spontaneous: The future of telehealth implementation? Telemed J eHealth 2017;23(9):766-772. DOI: 10.1089/tmj.2016.0155.
  9. Fritz F, Kebede M, Tilahun B. The need for cost-benefit analyses of eHealth in low and middle-income countries. Stud Health Technol Inform 2015;216:981. DOI: 10.3233/978-1-61499-564-7-981.
  10. Freed J, Lowe C, Flodgren G, et al. J Innov Health Inform 2018;25(1):14-18. DOI: 10.14236/jhi.v25i1.957
  11. Totten AM, McDonagh MS, Wagner JH. The Evidence Base for Telehealth: Reassurance in the Face of Rapid Expansion During the COVID-19 Pandemic. Rockville (MD): Agency for Healthcare Research and Quality (US); May 2020. PMID: 32479040.
  12. Asthana S, Jones R, Sheaff R. Why does the NHS struggle to adopt eHealth innovations? A review of macro, meso and micro factors. BMC Health Serv Res 2019;19(1):1-7. DOI:  10.1186/s12913-019-4790-x.
  13. Pieterse M, Kip H, Cruz-Martinez RR. The complexity of ehealth implementation: a theoretical and practical perspective. In: van Gemert-Pijnen L, Kelders SK, Kip H, Sandermans R, editors. eHealth Research, Theory and Development: A Multi-Disciplinary Approach. Abingdon, UK: Routledge; 2018. p. 247-270.
  14. Fior Markets. (2020). Global digital health market is expected to reach USD 623.20 billion by 2027. Available at: https://www.globenewswire.com/news-release/2020/09/16/2094218/0/en/Global-Digital-Health-Market-Is-Expected-to-Reach-USD-623-20-Billion-by-2027-Fior-Markets.html  accessed 28 December 2020.
  15. Fu X. Digital transformation of global value chains and sustainable post-pandemic recovery. Transnatl Corp 2020;27(2):157-166. DOI: 10.18356/d30d9088-en.

Scott RE, Mars M. Editorial, J Int Soc Telemed eHealth 2021;9:e1
DOI: https:doi.org/10.29086/JISfTeH.9.e1
Copyright:© The Authors 2021
Open access, published under Creative Commons Attribution 4.0 BY International Licence