E-health hampered by interoperability glitches
Potential cost-savings from e-health are being jeopardised because computer systems cannot talk to one another, according to experts. Healthcare IT specialists also warn of resistance from healthcare workers and patients amid ongoing concerns over data protection.
Ilia Fortunov, architect and technology strategist at Microsoft, said the IT industry had "learned the hard way" that interoperability must be built into e-health products from the outset.
He said a new ethos was emerging in industry, even between competing players, which would see a greater deal of cooperation in the interests of avoiding the paralysis that can result from creating systems which cannot communicate with each other.
"It's no longer a case of 'my stuff' and 'your stuff', but rather we are talking about 'our stuff' – new products have to work together for the benefit of all," Fortunov told e-health experts from the public and private sectors gathered in Brussels at an event hosted by Microsoft.
He added that the days of a single dominant player providing all the answers to the problems posed by e-health are long gone. There are now, he said, many vendors and platforms, a situation which requires industry to change its mindset.
International cooperation required
"One of the big challenges is to move from expensive acute care towards preventative management of conditions – which is cheaper," he added.
This view was broadly echoed by Charles Parisot of GE Healthcare, who said interoperability would be central to future innovation in the e-health industry.
However, he warned that throwing money at the problem had proven ineffective in the past and global cooperation is required in order to make a genuine breakthrough. "Money cannot buy interoperability – many projects have failed because of a lack of understanding of the complexity of the problem."
E-health as a cost-cutting agent?
The prospect of making major health gains by deploying technology remains a matter for debate, although policymakers generally view e-health as a solution to Europe's looming demographic crisis. An ageing population means greater pressure will be put on health budgets over the coming decades and fewer healthcare workers will be available to care for a growing number of patients.
Benoit Abelos of the European Commission's information society directorate said e-health will increase quality and efficiency of health services and contribute to major cost savings. He said market fragmentation and interoperability have been identified in Europe's 'lead markets' initiative as a major barrier to e-health market development.
The political and business culture in Europe may also be a barrier to the healthcare revolution required to save money using ICT. Silviu Braga, a general practitioner and R&D director at medical IT consultancy Medicognos, warned that doctors often find investing time and money in technology does not deliver major gains.
He said the equivalent in annual health IT spending for deploying large scale or national ehealth projects is around €30 per person on a ten-year investment cycle.
Pointing to the examples of the UK and Germany, Braga said GPs also had to be offered financial incentives to encourage them to embrace information technology and IT-supported quality improvement behaviours. As a result, governments could need to spend up to 2.5% of national health budgets on technology and the incentives for providers.
However, he says the experience of companies in the United States shows that under the right circumstances, quality and cost benefits can result from e-health investment. Private healthcare provider Kaiser Permeante in California invested an extra 7.7% in healthcare ICT, but achieved a 30% increase in some key quality indicators with 30% less spending per member than the average costs in California.
To do this in Europe, Braga believes a culture change and a dramatic increase in the number of doctors specialising in IT is required. "Only a few of the 11,000 GPs in Belgium are trained to master's degree level in information technology. We need something like one in 300, to be able to deploy and maintain an acceptable, usable and efficient healthcare IT environment," he said.
Winning over doctors and patients
Getting healthcare workers on board remains a major barrier to the widespread adoption of e-health. Luc Maes, e-health programme manager for the Belgian government, acknowledges that younger doctors are quicker to embrace technology than those trained decades ago.
"When I studied medicine twenty years ago, health informatics was not on the agenda but it is now. So there's an age gap. But there are also geographical differences. In northern Belgium, around 80% of doctors work with a computer. In the south of the country, it's 50% but ever growing," he said.
Maes said doctors must be incentivised to encourage them to adapt to new technologies and that governments and industry must demonstrate how ICT can make their lives easier. "We have to go for some quick wins so that people see the benefit," he said.
Michal Danilak, executive director of Lynx, which advised Slovakia on its e-health strategy, said doctors were quick to change their behaviour when Slovak health insurers insisted that doctors apply for reimbursement electronically. "Within two years every doctor had a computer because it was necessary for payment."
Data protection paramount
Luc Maes said added that Belgium is working to create a legally safe environment in which doctors, hospitals and companies can use health data.
Privacy is also major concern for the EU executive which is currently drafting a working paper on the legal aspects of telemedicine. Catalina Dima from the European Commission's information society directorate said existing legislation protects patient privacy while allowing the free movement of personal data.
She said information collected by governments and companies should only be used for the purpose agreed to by the patient and, in clinical trials, data should be anonymised or coded where possible.
Applying advances in information and communications technology (ICT) to healthcare is touted as a revolutionary means of improving health outcomes and cutting costs. The healthcare sector has been relatively slow to embrace technology, but governments and industry are making a concerted effort to use e-health to achieve efficiencies.
The term 'e-health' can cover electronic patient records, telemedicine, and the use of ICT to assess quality standards and reduce medication errors. It represents a multi-billion euro industry with thousands of innovative SMEs producing niche products alongside major technology players which seek to integrate software programmes.
E-health has developed sporadically and in an often uncoordinated fashion over the past decade. As a result, computer systems in neighbouring countries are often incompatible. In some cases, individual hospitals have departments using custom-made software in their radiology departments which cannot communicate with the programmes used the hospital's emergency or surgical departments.