Les soins de santé personnalisés[en] 

As European society grows older, dealing with chronic illnesses that require long-term attention is expected to put increasing pressure on healthcare systems. While more patients are expected to suffer from long-term conditions which do not require permanent hospitalisation, homes are expected to join or even replace hospitals as primary healthcare locations, a trend that should also help answer the challenge of a declining healthcare workforce. 

The Commission has been supporting research and development activities for the application of Information and Communication Technologies (ICT) in health since the 1990s. Over the last decade, it has promoted person-centric healthcare systems - so-called 'Personal Health Systems' (PHS ) - the aim of which is not to replace but rather support health professionals via monitoring and diagnostic data which can help them to make accurate decisions.

PHS is a relatively new concept. It is centred on the use by patients of wearable or implantable systems, such as body sensors that measure physiological information like heart or respiratory rate as people do their normal activities. The systems process the information automatically and send it to health centres where physicians can remotely evaluate the individual's health status. 

According to the Commission, the aim of  these personalised systems is "to help health professionals and individuals monitor more efficiently chronic conditions like diabetes and heart failure outside the ordinary hospital environment". 

After the 2004 e-Health Action Plan , the Commission adopted a new 'ICT for Health' strategy  in 2006. 

The new approach consists of promoting the transformation of the European healthcare landscape. The Commission argues that in order to face the challenges of ageing populations, Europe needs a "new healthcare delivery model, based on preventive and person-centred health systems, which can only be achieved through proper use of ICT". The strategy is also in line with the Commission's new policy framework i2010 , which promotes the application of ICT to improve social inclusion, public services and quality of life.

The EU is currently supporting research into  Personal Health Systems under its Seventh Research Framework Programme. It is seeking to improve the productivity of healthcare systems, ensure continuous and more personalised care solutions and contribute to the prediction and prevention of disease as well as improve patient safety and the industrial leadership of the eHealth industry.

The specific areas for action include: 

• Personalised (health status) preventive monitoring for people at risk and for chronic disease management. Expected R&D outcomes include wearable or portable/mobile ICT systems, remote monitoring and care, interoperability with electronic medical records, avoiding hospitalisation, promoting doctor-patient interaction, facilitating personalised guidance and prompting earlier medical intervention. 
• Point-of-care diagnostics to, for example, identify predisposition to disease, aid treatment and create an interface with hospital and laboratory information systems and electronic medical records.

In addition, the Commission and 14 EU member states established, in 2007, a joint programme called Ambient Assisted Living ( AAL ) (€1billion 2008-2013). This programme is a so-called 'Article 169 initiative ', which enables the Community to participate in research programmes undertaken jointly by several member states, including participation in structures created for the execution of national programmes. 

The AAL programme supports research which mainly seeks to enhance the quality of life and support the maintenance of the health and functional capability of the elderly  by supporting carers, families and care organisations through the use of ICT. It also seeks to promote a better and healthier lifestyle for individuals at risk, lower future social security costs and increase the efficiency and productivity of the resources used by ageing societies. 

Although the vision to take healthcare out of the hospital, bring it to the home and embed it into people's lives through Personal Health Systems is clear, "little deployment has happened so far. The barriers to deployment originate at different levels and are associated with a multitude of technological, cultural, legal, political and market-related factors," argues a recent stakeholder conference report .

The same report states that the successful introduction and deployment of Personal Health Systems requires "profound changes at system level". It also stresses the increasing importance of factors like organisational change, economical viability, reimbursement, legal framework, liability, data security and privacy as well as cross-border availability and the provision of services. 

Industry would like to foster the spread of eHealth systems through open standards and interoperability, as these are important to make sure that single companies do not dominate sub-sectors of the eHealth market, which could potentially spoil the whole sector's growth potential. In particular SMEs depend on open standards to integrate with bigger companies' infrastructure. Furthermore, industry stresses the importance of certification, a friendly regulatory environment  and awareness-raising with the public and policymakers.

As for long-term R&D and the path towards more personalised, computational medicine, the Commission supports initiatives regarding the  Virtual Physiological Human (VPH)  as part of the EU's Seventh Research Framework Programme funding for ICT. The aim is to develop patient-specific computer models for personalised and predictive healthcare and ICT-based tools for modelling and simulating human physiology and disease-related processes. Future applications would include a medical simulation environment for surgery, the prediction of disease, early diagnosis and assessment of the efficacy and safety of drugs without patent trials.

The Commission's Lead Market Initiative (LMI) adopted in December 2007 identified eHealth as one of the areas in which high-growth potential markets for research and innovation-rich goods and services could be created, with the public sector driving the demand. The annexed action plan  details how legislation on the area, including personal health systems, home care and chronic disease management services, will be improved and how public procurement, standardisation, labelling and certification will be encouraged.

Industry is showing an increasing interest in the field of personalised health systems and awaits the creation of a market for innovative solutions. 

The Continua Health Alliance, an industry alliance founded in 2006, brings together ICT companies, health devices and fitness and pharma companies to promote interoperable personal telehealth solutions. The Alliance envisages a system of networked devices (blood pressure meters, scales, pill dosers and various kinds of sensors) throughout the household working together smoothly with adapted appliances in a doctor or caretaker's cabinet - an "extension of healthcare systems into the home," as Continua Chairman David Whitlinger said. 

For this vision to become a reality, the Alliance believes the following questions must still be answered: 

• Financing. Monitoring chronically ill people electronically would considerably reduce costs compared with current face-to-face monitoring and it could thus be justified that such a shift be funded by social security systems. Preventive monitoring would however have to be paid for by the patients themselves.
• Accessibility and inclusion. Not everyone is computer-literate enough to deal with even the simple interfaces required by eHealth appliances. What's more, internet access remains quite unevenly distributed throughout Europe. Dealing with the digital divide and e-inclusion are therefore essential for bringing the full benefits of such a system to all citizens.
• Privacy. As personal health data is among the most sensitive around, secure encryption at all levels is thus required in eHealth systems.
• Outsourcing. Some of the monitoring activities could technically be outsourced to lower-wage countries. But this would make it difficult to respect European regulatory standards and could put pressure on wages in the healthcare sector. 

According to the European medical technology industry association (Eucomed) "Personal Health Systems and Homecare" is the fastest growing sector in healthcare, with a 19% share of the European market compared with 5-6% for the medical devices industry. In addition, the global market for telehealth was $7.7 billion in 2006, which represent a 241% increase from 2003's figure of $3.2 billion.

According to the European Health Telematics Association (EHTEL), the wider use of telemedicine services is currently being held back for the following reasons, among others: long testing phases for telemedicine pilot projects, the lack of a global vision of the role of eHealth in the healthcare transformation process and poorly documented and unproven returns on investment models. EHTEL also cites the unclear and restrictive legal environment and the lack of reimbursement schemes for telemedicine by statutory as well as private health insurance schemes. 

The association calls for the establishment of a culture of interdisciplinary and cross-sectoral collaboration between different specialised medical fields and the formulation of explicit national strategies, scenarios and business models for sustainable telemedicine. It believes that "a new type of health service industry, composed mainly of public and private sector SMEs, is emerging in Europe" with new innovative and entrepreneurial health service professionals seeking to combine high medical quality with sound business understanding. 

According to EHTEL President Martin D. Denz, this will alleviate pressure on national health systems and boost the European economy "by creating possibly millions of new jobs" and contributing to the EU's Lead Market Initiative on creating innovative solutions for public services.

The Institut national de recherche en informatique et en automatique (INRIA), the French national institute for research in computer science and control, stated that one of the major scientific challenges of our time is to improve the understanding of the complex systems surrounding us. This can, according to INRIA, be done through scientific investigation in modelling the human cell and brain as well as epidemiology. 

Modelling in life sciences is, according to INRIA, about creating a virtual general model of a heart. A patient's personal heart data can then be added to this general model, allowing surgeons to simulate surgery in advance to predict the results of potential surgery in advance as well as to determine the best location for a pacemaker, thus optimising health outcomes. Other fields of research include molecular dynamics, the metabolic system, interactions between genes, cancerology, the biomechanics of living tissue and neurosciences, as well as biochemistry to predict the effects of the drugs.

The Standing Committee of European Doctors (CPME) welcomes the Commission's initiative to involve all stakeholders in debate and reflection on new initiatives such as Telemedicine. CPME Secretary General Lisette Tiddens-Engwirda said: "With regard to telemedicine deployment, apart from technical, organisational and regulatory aspects, we would like to highlight the need to address a whole range of ethical issues. As the trust between the patient and the doctor is always at the centre of medical treatment, the use of telemedicine must preserve dignity and the right to self-determination of both the patient and the doctor. Prior consent should given to the doctor before data is stored, made accessible or exchanged, and responsibility for recording should be well defined. Guidelines and protocols would also prove useful tools to addressed these aspects. Finally, inequality regarding patients' access to technology and their know-how should also be considered as a very important matter."