eHealth

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eHealth, one of the priorities of the EU's i2010 programme to boost innovation and jobs, aims to provide user-friendly and interoperable information systems for patients and health professionals across Europe.

Background

eHealth stands for the application of Information and Communication Technologies (ICT) across the whole range of functions that affect the health sector - from the doctor to the hospital manager and from data processing to social security administrators and the patients. The aim is to improve the quality, access and efficacy of healthcare for all.   

In the EU, eHealth plays a key role in the block's eEurope strategy since the initiative was launched in 1999 and followed up by successive Action Plans eEurope 2002eEurope 2005 and i2010

eHealth is also one of the EU's first six Lead Market Initiatives (LMI) and harmonised health information systems will be required for the smooth implementation of the cross-border healthcare directive. 

Regional health networks, electronic health records in primary care and deployment of health cards have contributed to the emergence of an 'eHealth industry', which, according to the Commission, has the potential to become the third largest industry in the health sector, after the pharmaceutical industry and the medical device and imaging industry.

Among the broader issues to be addressed in the ehealth debate is the question of data protection. One of the pillars of the Data Protection Directive  is the safe and appropriate use of data. Winning public acceptance of new health technologies will require consumer confidence. 

Issues

The first EU  eHealth Action Plan adopted in April 2004 seeks to boost the creation of national eHealth infrastructure systems, electronic health records and patient summaries and to ensure their interoperability. 

The Action Plan for the period of 2004-2010 focuses on three priority areas:  

  • addressing common challenges and creating the right framework to support eHealth, such as interoperability of health information systems and of electronic health records, patient identifiers and mobility of patients and health professionals;
  • accelerating implementation of eHealth information on for example health education and disease prevention as well as promoting the use of electronic health cards;
  • working together and monitoring, benchmarking and disseminating best practices.  

In June 2006, the Commission's ICT for Health Unit adopted a new  strategy to promote the transformation of the European healthcare landscape. It argues that in order to face the challenges of the ageing population and other healthcare challenges 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".  

Post i2010 agenda

The approach is said to build upon the eHealth Action Plan and to involve forward-looking research under the EU's Seventh Framework Programme for Science and Research (FP7). The strategy is also in line with the Commission's new policy framework i2010 to promote application of ICT to improve social inclusion, public services and quality of life. 

A  report on European countries' eHealth priorities and strategies (April 2007) states that member states have made good progress in implementing the EU's eHealth strategy but have failed to address education and socio-economic issues falling under their responsibility (see EURACTIV 12/04/2007). The Commission has also published a report on best practice in EU member states. 

Europe has also begun the process of looking past i2010 and held a public hearing in September 2009 to consider the shape of information policy post-i2010. Contributions were received from the IT industry, the health sector, media groups and NGOs. 

Lead Market Initiative

In 2008, the European Commission unveiled plans to make eHealth one of the EU's first six Lead Market Initiatives, making it a strategic priority. The size of the market and the scope for innovation were cited as reasons for its selection. Inaddition, the possibilities for SMEs tapping into the various sub-sectors of e-Health were highlighted.

The Commission published an Action Plan  for eHealth at the end of 2007 pledging to assess the possibility of adopting a legal initiative for eHealth and telemedicine. It also noted the need for common standards in eHealth and the importance of interoperability. Greater cooperation between EU member states was encouraged. 

A mid-term progress report, published in September 2009, said the eHealth Lead Market Initiative (LMI) was still at an early phase of implementation. It said the LMI can stimulate demand-side measures in EU member states but the real impact cannot be expected for another five to ten years. 

The report suggested better coordination between the LMI and other EU projects including the Joint Technology Initiatives (JTI) and the EU Economic Recovery Plan. With the new European Commission set to put innovation at the heart of its agenda, growth industries like ehealth are likely to be pushed higher up the agenda. The EU will unveil a European Innovation Act in the spring of 2010 which will go some way towards improving the conditions for high-tech industries such as health IT. Industry and civial society have been actively engaged with policymakers in discussing how to improve the environment for innovation in ehealth. Microsoft has published a White Paper urging policymakers to move away from today's fragmented system towards a connected network through which data can flow. The European Public Health Alliance (EPHA) and the European Patients Forum (EPF) have also been tracking the issue. 

Cross-border healthcare

In April 2009, the European Parliament supported a proposal on cross-border healthcare which will bring greater patient mobility in the EU. Patients will be able to travel for treatment in another EU state and be reimbursed by their home country. The directive is still being debated by health ministers, some of whom have reservations about how the directive affects health service planning. 

However, the directive also includes measures designed to improve cross-border cooperation on eHealth. Interoperable health IT systems will be required if the proposal is to be implemented smoothly and in full.      

The directive is helping to add impetus to efforts at developing harmonised standards to accelerate eHealth adoption in Europe. Industry groups have negotiated agreement on standardised messaging to link hospitals and other healthcare provides with insurance companies and national health IT systems. 

Standardisation of electronic patient record systems is central to the work of the European Patients Smart Open Services (EPSOS) group. It has been evaluating architecture in EU member states with a view to greater harmonisation and also cooperates with the US and others to work towards international standards on electronic records. 

Interoperability

One of the most pressing practical issues in ehealth is the interoperability of IT systems. In some hospitals, customised software in the operating theatre is not compatible with the systems used in the emergency room or radiology department. 

Experts have highlighted interoperability as a major barrier to maximising the potential cost savings promised by ehealth (EURACTIV 9/9/09). Sharing electronic information within and between hospitals is a challenge, but so too is the bigger issue of communicating across borders. In the context of the cross-border healthcare directive, interoperable health IT infrastructure has become a major priority. 

seminar hosted by Microsoft in Brussels, experts said a new consensus was emerging in the IT industry that cooperation - even between competitors - is essential in order to avoid the creation of systems which cannot communicate with one another. (Click here for video)

The healthcare IT landscape now includes a host of major players but also features growing numbers of innovative SMEs operating in niche areas. The lesson from the past is that developing tailor-made products for a single department in a single hospital can lead to compatibility problems. Efforts to ensure that systems can communicate will be central to the roll-out of modern health IT systems. 

Privacy and security

Protecting personal data has become a significant concern in the modern information age. This is particularly acute when it comes to private health information. Consumers are concerned that data could fall into the wrong hands or be used for the commercial gain of others. Most individuals would prefer not to share medical records with employers, insurance companies and others. 

However, critics have been quick to point out that there were similar fears when online banking was introduced. And, despite some cases of banking fraud, most consumers have now embraced online finance and are happy to conduct their affairs electronically. 

Health data is covered by the Data Protection Directive and the European Commission is currently drafting a working paper on the legal aspects of telemedicine. Existing legislation protects patient privacy while allowing the free movement of personal data. Health information collected by public bodies and private firms can only be used for the purpose agreed to by the patient. Where data is stored electronically as part of medical research projects, it is often anonymised or coded so that investigators cannot identify participants. 

Telemedicine 

The potential of telemedicine to reduce healthcare costs by treating and monitoring patients in their own homes is something cash-strapped governments have become increasingly interested in. Ambient Assisted Living (AAS) can help preserve patient autonomy and reduce demand for expensive specialist hospital care. It also has a key role in preventative medicine which is seen as another tool for keeping people healthier for longer. The European Commission adopted a Communication on telemedicine in November 2008 and follow-up with a progress report  in October 2009. 

Positions

"The European approach to eHealth should be about spending euros on patients, not on paperwork. For example, electronic medical records can help doctors diagnose illness and prescribe treatments more accurately, thus reducing medical errors. It also means cutting down paperwork to improve efficiency. Electronic patient referrals in Denmark are saving €1 million a year and could rise to €3.5 million a year, if all referrals were sent electronically," said Information Society Commissioner Viviane Reding.

"EU-US co-operation on eHealth is important as we are both large economic areas with the same characteristics [c.f. ageing population]. We need to co-ordinate the development of standards and interoperability in the this field," said the Commission's Information Society DG Director-General Fabio Colasanti. 

"It is also clear that the technology as such is not enough. It needs to be accompanied with an appropriate legal environment and education of healthcare professionals," said Frans de Bruïne, director at DG Information Society

EU Health Commissioner Androulla Vassiliiou  has warned governments to consider investments in potentially cost-saving health technology instead of simply cutting back on services. She stressed that the development of e-health solutions advanced by the Commission enables extensive increases in productivity. 

“In the crisis we should be investing in health rather than cutting budgets. But we also have to seek favourable cost solutions just as much and grant prevention and health promotion, in particular, a greater priority,” Vassiliou said.

She said technology will be central to addressing the challenges facing health systems across Europe, including the threat posed by falling public budgets and an ageing population. 

"We cannot talk about the future of our health systems without mentioning the development of health technologies. Technology, including developments in medicine, has saved lives. But at the same time, these innovations can frequently make healthcare more efficient. A good example of this is undoubtedly ehealth. And I think we should try to make ehealth a reality across Europe," the Commissioner said.  

Florin Lupescu, Director at DG Information Society and Media at the European Commission, has said telemedicine will help prevent social isolation and allow older people to stay active and healthy for longer. "To achieve these goals, we need appropriate policies that will help promote introduction of such solutions for improved quality of life for elderly people and their carers, strongly increased efficiency of our care systems while creating fantastic new global market opportunities for European industry," he said.    

Writing in Microsoft's White Paper on innovation in ehealth, John VassalloVice President for Corporate Affairs at Microsoft Europe, said health infrastructure must be flexible in order to enable many different players to be part of an innovative healthcare IT ecosystem. He stressed the importance of interoperability, security and the need for new technologies to be "scalable". 

"Technology enables us to reinvent healthcare. Such a venture deserves to be undertaken through deep partnership and broad collaboration with stakeholders. As a technology company, Microsoft shares the vision of enabling the modernisation of healthcare, focusing on better outcomes, not on technology adopter per se but rather on its usability," he said. 

"eHealth should no longer be a subject of special conferences but simply the normal way we do healthcare," said Petra Wilson, director for the public sector healthcare at the Cisco Internet Business Solutions Group. "We need to give doctors hard-cash incentives, such as paying more per visit, to encourage them to adopt and use technology." 

Peter Langkafel from SAP agrees that incentivation of doctors is important but said that it is not enough: "You need to show value and a business case for eHealth - improved quality care and patient safety and improved use of resources in healthcare (human resources, processes). The business case can be shown by cost-benefit studies." 

"Why shouldn't patients have the same type of service possibility in healthcare as they do for instance in banking? There's a need to educate the patient about what can be achieved. The patients should turn to their healthcare providers and start putting pressure on them to use more technology," said Baldur Johnsen, director of healthcare- market development at Hewlett Packard

"Healthcare is the fastest-growing sector of our company. This is serious business," said Charles Scatchard, vice-president of health sciences at Oracle. "We also know that all new health technology takes 17 years to be finally usable." 

COCIR, the umbrella group for the radiological, electromedical and healthcare IT industry, has submitted a detailed position paper to the OECD on international comparisons of health ICT adoption and use. It advocates developing a common set of indicators on adoption of information technology by national health systems. This would allow easy comparison at the international level. However, it also acknowledged the need for flexibility so that individual countries can develop specific indicators to measure their own progress. 

The industry group wants to see more cooperation and harmonisation between the OECD, the WHO and the European Commission. 

A study by Warwick Business School on the use of eHealth in the EU claims that better governance and stronger political leadership are needed if the member states are to reap the rewards of enabling technologies (ETs) in the coming years.

The research, commissioned by US software giant Microsoft, says that ETs such as electronic health cards, telemedicine and patient portals could significantly boost healthcare delivery in Europe but that some countries are better prepared than others.

The study believes that technology can help improve the cost-effectiveness of European healthcare systems and that it is needed to meet the changing needs of doctors and patients. But this can only be fully achieved by integrating eHealth into public health policies and fostering more public-private partnerships, cross-border initiatives and new business models, the authors argue.

GE has launched a new eHealth business unit focused on healthcare IT. The company is stressing the need to connect healthcare systems and overcome national barriers. 

Brandon Savagechief medical officer of GE Healthcare IT  said there is wide variations in clinical terminology, patient identification methods and systems architecture, making the integration of health information "exceptionally difficult". "Turning that information into value for the care provider is a second, even more challenging hurdle, requiring deep understanding of care provider requirements and clinical workflows," he said.

Advances in ehealth and telemedicine will have major implications for national health systems and private insurance companies. The  Association Internationale de la Mutualité (AIM) has said the technology for telemedicine has existed for two decades but has yet to become commonplace. It said technical issues like infrastructure and interoperability will have to be addressed for IT to make a real difference to healthcare. It is calling on the European Commmission to develop evidence-based tools to help assess the value and impact of new technologies in the health arena. 

The Standing Committee of European Doctors (CPME) believes that "all patients, irrespective of background and the nature of their problem, should be able to seek medical assistance being confident that their sensitive personal data can only be accessed by health care personnel who need this information to provide appropriate care. The patient should be contacted to give explicit consent to extended use of the data." 

"E-health allows regions to overcome distance barriers when organising and delivering health services, and is therefore an important tool both for rural and urban areas. Developing such innovative technologies also contributes to a region’s overall economic development, by attracting companies specialised in this field and creating new employment opportunities," said Agneta Granström, County Councillor of Norrbotten, speaking at an Assembly of European Regions conference.

"We have to start by strengthening the co-operation between hospitals and between health care providers all over Europe. We don't need a single system, the same for everyone; we need different interoperable systems. Both universities and industry should fully appreciate the enormous potential e-health offers and together with the regions they should commit themselves to the development of e-health tools," she added. 

The Pharmacists Group of the EU (PGEU) calls upon the national and European authorities to help pharmacists, together with other healthcare providers, to develop the advantages and opportunities that the increased use of the Internet and the development of e-health applications offer. PGEU adds that "the development of European standards and the mutually recognised certification of P2P applications, including the necessary standards for transmission of electronic prescriptions and related health data, should help all stakeholders to extend their existing services and health provision gradually and safely to Internet applications. It is essential that pharmacies have access to all relevant information."

Timeline

  • 2006-2009: member states and the Commission have committed to promote interoperability and encourage efforts for increased standardisation. They have set the objective of establishing the basis of a European e-health service, for both clinical and administrative tasks by end 2009. 
  • May 2007: EU-US eHealth workshop.
  • 20 Dec. 2007: eHealth Taskforce issued a report in view of the the Lead Market Initiative.
  • 21 Dec. 2007: The Commission adopted a Communication on the lead market initiative for Europe, with eHealth as one of the first six markets. An action plan annexed to the Communication details action for the coming years. 
  • 6-7 May: EU eHealth conference adopted a Portorož Declaration.
  • 7 Jan. 2008: E-health named as one of the first six Lead Market Initiatives
  • 2 July 2008: The Commission adopted a Recommendation on cross-border interoperability of electronic health record systems.
  • 2 July 2008: A large scale EU pilot project (S.O.S.) on interoperable EHR and ePrescriptions launched. 
  • 23-24 Oct. 2008: ICT BIO 2008 conference.
  • 4-6 Nov. 2008: The World of Health IT'08 conference.
  • 25-27 Noc. 2008: Commission's ICT 2008 conference.
  • 4 Nov. 2008: The Commission adopted a Communication on Telemedicine for the Benefit of Patients, Healthcare Systems and Society.
  • February 2009: EU publishes eHealth in Action - Good Practice in European Countries
  • 9 Sept. 2009: Mid-term report on eHealth Lead Market Initiative 
  • 1 Oct. 2009: Commission published follow-up report on 10-point telemedicine action plan
  • 12 Oct. 2009: Commission announces plans for e-Health Week 2010 to coincide with The World of IT Conference and Exhibition in Barcelona in March 2010.
  • 24 Nov. 2009: EU to launch €63 million research projects as part of FP7, aimed at creating 'virtual physiological human'. 
  • 1 Dec. 2009: EU health ministers publish conclusions on ehealth, calling for action on building "an ehealth area for European citizens". 
  • 15 Mar. 2010: EU health ministers sign declaration on ehealth at the 8th ministerial ehealth conference in Barcelona
  • 31 May: European Commission study sets out role of EU in coordinating development of e-health

Further Reading

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