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Introduction

Many observers believe that the use of emerging interactive health information technologies, often referred to as eHealth,1 can help to improve the quality, capacity, and efficiency of the health care system. eHealth has the potential to improve access to the health care system for traditionally underserved populations and to increase the capacity to provide tailoring and customization for individual patients and consumers (Ahern et al., 2006). eHealth systems can also improve clinical decision making and adherence to clinical guidelines; provide reminder systems for patients and clinicians, thereby improving compliance with preventive service protocols; provide more immediate access to laboratory and radiology results; and, when integrated with clinical decision support systems, help to prevent many errors and adverse events (IOM, 2003).

While eHealth has many potential benefits, some observers have expressed concern that these systems could increase health care disparities by helping mainly those individuals and communities with greater resources. Recent reports show that health care disparities do exist between advantaged and underserved populations (IOM, 2002). Underserved populations generally include ethnic minorities, people in lower

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It should be noted that throughout the report, speakers use different definitions of the term eHealth in their presentations. This is not surprising since there is no agreed upon definition for the term. In fact, Oh and colleagues (2005) found 51 different definitions for the term eHealth. Since a workshop summary must accurately represent the concepts and ideas of each speaker, no attempt can be made to ensure consistency of definitions across presentations.



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1 Introduction Many observers believe that the use of emerging interactive health information technologies, often referred to as eHealth,1 can help to improve the quality, capacity, and efficiency of the health care system. eHealth has the potential to improve access to the health care system for traditionally underserved populations and to increase the capacity to pro- vide tailoring and customization for individual patients and consumers (Ahern et al., 2006). eHealth systems can also improve clinical decision making and adherence to clinical guidelines; provide reminder systems for patients and clinicians, thereby improving compliance with preven- tive service protocols; provide more immediate access to laboratory and radiology results; and, when integrated with clinical decision support systems, help to prevent many errors and adverse events (IOM, 2003). While eHealth has many potential benefits, some observers have expressed concern that these systems could increase health care dispari- ties by helping mainly those individuals and communities with greater resources. Recent reports show that health care disparities do exist between advantaged and underserved populations (IOM, 2002). Under- served populations generally include ethnic minorities, people in lower 1 It should be noted that throughout the report, speakers use different definitions of the term eHealth in their presentations. This is not surprising since there is no agreed upon definition for the term. In fact, Oh and colleagues (2005) found 51 different definitions for the term eHealth. Since a workshop summary must accurately represent the concepts and ideas of each speaker, no attempt can be made to ensure consistency of definitions across presentations. 

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 HeALtH LiteRACY, eHeALtH, AnD CoMMUniCAtion socioeconomic groups, and people with lower educational and reading levels. These populations also tend to have limited access to computer technology (Eng et al., 1998). Furthermore, even if it were possible to ensure equal access to tech- nology, some user groups find it extremely difficult to take advantage of such technology. The average U.S. adult reads on just an eighth-grade level, for example, while most websites are designed for people whose reading level is much higher (Berland et al., 2001). In particular it is the elderly and those with limited literacy and number skills who are most likely to have low health literacy and thus be least able to take advantage of new health technologies. The Institute of Medicine Roundtable on Health Literacy serves to educate the public, press, and policy makers regarding issues of health literacy. Given the importance of health literacy issues in eHealth, the Roundtable decided to hold a workshop to explore and discuss strategies for improving the ways in which information and communication tech- nologies address the needs of those with low health literacy and language barriers. A planning group designed a workshop to answer the following questions: • hat is the current status of communications technology, particu- W larly electronic records systems? • hat are the challenges of communication technology used for W populations with low health literacy? • hat are the strategies for increasing the benefit of these technolo- W gies for populations with low health literacy? The workshop was moderated by George Isham. As the presentations in this workshop demonstrate, tremendous resources are being directed toward the development of health information technologies. While the vast majority of these resources are being devoted to systems that focus on physicians and health institutions, some notable efforts, such as those presented in this workshop, have been made to extend the use of these new technologies to patients. The first panel provided an overview of the issues, including a broad examination of eHealth, skills essential for eHealth, and a discussion of communication inequalities. The next two panels used specific examples to explore the challenges and outcomes of different strategies for addressing health literacy issues in eHealth. The final panel discussed the use of emerging tools in developing eHealth systems. The following workshop summary is organized according to the panel presentations.