**1. Introduction**

Access to healthcare means having "the timely use of personal health services to achieve the best health outcomes. It consists of four components:

• Coverage: facilitates entry into the healthcare system. Uninsured people are less likely to receive medical care and more likely to have poor health status.


In 2001 Gulliford, et al. [2] provided a description of access to health services in which they said "Facilitating access is concerned with helping people to command appropriate healthcare resources in order to preserve or improve their health. There are at least four aspects, they said:


The Institute of Medicine (IOM) defined access to healthcare "as having timely use of personal health services to achieve the best possible health outcome [3]. According to The Agency for Healthcare Research and Quality's (AHRQ ) [4] "access requires gaining entry into the health-care system, getting access to sites of care where patients can receive needed services, and finding providers who meet the needs of patients and with whom patients can develop a relationship based on mutual communication and trust". The National Academies of Sciences, Engineering, and Medicine [5] suggested that "People use healthcare services to diagnose, cure, or ameliorate disease or injury; to improve or maintain function; or to obtain information about their health status and prognosis". Anderson and Newman [6] presented a framework (4th phase) of health-care utilization that includes predisposing factors, enabling factors, and magnitude of illness. The framework suggests that an individual's access to and use of health services is considered to be a function of three characteristics:

	- a.Social Structure: Education, occupation, ethnicity, social networks, social interactions, and culture
	- b.Health Beliefs: Attitudes, values, and knowledge that people have concerning and towards the healthcare system
	- c.Demographic: Age and Gender

*Improving Healthcare Access through Digital Health: The Use of Information… DOI: http://dx.doi.org/10.5772/intechopen.99607*

d.Enabling Factors: The logistical aspects of obtaining care:

	- a."Perceived" need will better help to understand care-seeking and adherence to a medical regimen,
	- b."Evaluated" need will be more closely related to the kind and amount of treatment that will be provided after a patient has presented to a medical care provider.

People go, or more important they do not go to healthcare services for different reasons. Three overarching categories of reasons emerged based on the necessity, availability, and desirability of care-seeking [7]:


Some of these reasons relate to the human nature of the people while others relate to the health facilities themselves. People go to these services to seek methods of prevention, protection, diagnosis, treatment, palliative care, education, research and a multiple of other reasons. Healthcare services may be provided in different ways and locations including hospitals in tertiary services, clinical and other professional services, dental services, home healthcare services which are at the increase as more patients move from hospital care to home care, nursing care services at the hospital or at home], pharmaceutical and medication dispensing services in addition to other over the counter medicines.

eHealth is one of the enablers of "access to healthcare services" along with a number of other factors. Social determinants of health represent a collection of factors that interplay in their influence of the health of people and therefore their ability to access health services using digital health technologies. It has become imperative to design and deploy such technologies in the communities to reduce inequity and improve ability to access health services. eHealth has been described as the "… use of information and communications technologies (ICT) in support of health and health-related fields, including healthcare services, health surveillance, health literature, and health education, knowledge and research" [8]. eHealth includes the ICT-enabled components of health informatics, healthcare informatics, medical informatics, biomedical informatics, mobile health (mHealth), and telehealth

and telemedicine, as well as the human and non-electronic components which are essential for these systems to function. Digital health has been extensively used to mean all concepts included in eHealth plus the use of digital devices to capture, monitor and report health data images, and vital signs: body temperature, pulse rate, respiration rate and blood pressure) from individuals and the relevant signs from the environment. The World Health Assembly (WHA) adopted a resolution in 2017 [9] and then a global digital health strategy in 2020. The description provided by the two documents of digital health extensively referred to eHealth as the core component in national eHealth planning, integration of eHealth in health systems, application development, monitoring and evaluation. In a review of definitions of eHealth in 2005, [10] the reviewers found that technology was viewed both as a tool to enable a process/function/service and as the embodiment of eHealth itself. They expressed pleasure to note that technology was portrayed as a means to expand, to assist, or to enhance human activities, rather than as a substitute for them.

A diversified range of areas in which eHealth can be used as many studies indicate [11–13]. Some of these are directed to service providers while others are directly linked to patients. In all cases the ultimate benefit goes to the citizen.

This range of areas may include:


*Improving Healthcare Access through Digital Health: The Use of Information… DOI: http://dx.doi.org/10.5772/intechopen.99607*


In a review of definitions of digital health [14], the findings showed that digital health, as has been used in the literature, is more concerned about the provision of healthcare rather than the use of technology. The reviewers added that "Wellbeing of people, both at population and individual levels, have been more emphasized than the care of patients suffering from diseases. Also, the use of data and information for the care of patients was highlighted. A dominant concept in digital health appeared to be mobile health (mHealth), which is related to other concepts such as telehealth, eHealth, and artificial intelligence in healthcare". Improving access to healthcare services: especially in rural and deprived areas with low (or no) availability of healthcare services, eHealth tools can enable remote consultations, therapies and rehabilitation [15].

eHealth and digital health will be used in this chapter interchangeably to mean the "use of information and communication technology in health". They are considered true interdisciplinary sectors that bring knowledge and practices from the fields of computer and information sciences, telecommunications, social sciences, health sciences (medicine, public health, pharmaceutical, dentistry, health management], health services research, communication, law and engineering. Success of eHealth depends on the extent and ability to integrate and function as an interdisciplinary system. Elements and applications of digital health have become an integral part of health services and information delivery. One cannot imagine a health service without the use of one or more of a digital health device or an eHealth application. eHealth is contributing to achieving Universal Health Coverage (UHC) and the Sustainable Development Goals [16]. eHealth has shown to enable national health system that use ICT to ensure that the people are aware of the availability of and accessibility to health services, that people are happy (satisfied) with the services they receive and that a monitoring and evaluation system is in place [17–20].

WHO (2013) [21] describes the goal of UHC as to ensure that all people obtain the health services they need- prevention, promotion, treatment, rehabilitation and palliation without risk of financial ruin or impoverishment, now and in the future. eHealth empowers patients and make services and providers more transparent and providers are become more efficient when they use eHealth technologies to manage or deliver healthcare services.

WHO (2016) [22] confirmed that "It has become increasingly clear that UHC cannot be achieved without the support of eHealth." The results of the Global eHealth Survey conducted by WHO in 2015 in which a total of 125 countries participated provided some key findings based on the themes that were covered in the Survey. These included:


evaluations of government-sponsored mHealth programmes, thereby limiting knowledge of what works well and what mistakes to avoid.


As healthcare itself is data and information intensive sector it simply means that for this sector to achieve its objectives, it has to collect, exchange and utilize high quality data. Health data has a number of characteristics including:


The above has led to potential misuse, no use or underuse of health data. Digital health strategies have become integral parts of the overall public health and healthcare delivery system in many parts of the world as health and digital technology

*Improving Healthcare Access through Digital Health: The Use of Information… DOI: http://dx.doi.org/10.5772/intechopen.99607*

seamlessly integrate. Planning, monitoring and evaluation of digital health have become essential to the health systems strengthening process. These have become part of the health system's resilience and learning. A country cannot afford to have a resilient health system that is responsive to current and future demands without using digital health technology to predict, protect, diagnose, educate and treat. Adopting digital health strategies carries the promise to improve the quality of health services, reduce costs, improve equity of access, and empower citizens in a person-centered healthcare system [23]. Evidence, to prove that all these are attainable at the same time, is still being built. Digital health technologies vary in form and utilization, but have a number of commonalties:


Digital health has adopted a number of other "new" technologies that were not originally designed for the health sector. This has shown that this sector is in a real need for such technologies to enable safe, secure, affordable, timely and equitable access to health services.
