Ilias Iakovidis
Deputy Head
ICT for Health European
Commission
DG Information Society and Media
The marriage of ICT to healthcare has led to many offspring in the form of eHealth systems and services, although most of these are still in the project and pilot phase. There are, however, an increasing number of initiatives that have reached adulthood – fully functioning solutions that are used in daily routines. These include: regional health information networks, diagnostic tools, decision support systems, management tools, and homecare systems that support patients at the point of need.
Many of the solutions that have been deployed are not only working, but are also delivering scientifically proven benefits such as improved access to quality of care and productivity.(1) However, these benefits do not come easily and are the result of a combination of factors such as organisational changes, skills, legal certainty, user-friendly technologies and evidence of clear user incentives.
The health sector as a whole employs almost 10% of Europe’s active workforce and accounts for almost 9% of the EU’s GDP. Yet, despite many successes, eHealth is still the “new kid on the block”, and viewed with a certain amount of distrust. For many people, eHealth symbolises merely an electronic health portal. To a majority of busy physicians, it means cumbersome devices where data input and output take far too much time. To many health authorities, it is a luxury expense that can afford to wait. Major efforts are still needed to communicate the scope of eHealth, its potential and benefits.
The eHealth industry is achieving fast growth as a subsector of both the ICT and healthcare sectors, and is becoming the third-largest industry in the health sector (following the pharmaceutical and medical devices industries) with a turnover of around €20 billion a year.
Investing in eHealth
The European Commission (EC) has been working for the last 18 years to show that eHealth matters. The EC was one of the first international funding agencies to support research and development (R&D) in eHealth (in areas such as medical informatics, health telematics and biomedical informatics), and has invested over €650 million in eHealth research projects alone. The goal that has underpinned the EC’s R&D policy in eHealth has been the development of tools for continuity of care. These have included electronic health record systems, regional health information networks that connect all the points of care (ie, hospitals, primary care, labs, pharmacies and homes), and support to all stages of prevention, diagnosis, treatment and follow-up.
Currently, the emphasis of the EC’s eHealth R&D programme is on personal health systems that transform each patient into a “node” in these kinds of regional health information networks. Continuous health status management, disease prevention and patient education are enhanced and enabled. The importance of eHealth and its achievements have been appropriately recognised. As a result, the EC’s budget for eHealth R&D has been doubled over the next two-year period to €100 million a year.
Other research topics include ICT for patient safety and support to predictive medicine. Patient-specific models are being developed to assist in safer medical operations, alongside the development of personalised treatments and safer drugs. Predictive medicine brings together the medical and bioinformatics communities to collaborate on molecular medicine, where the disease and physiology are integrated from the level of molecule and cell to the levels of organs and systems.(2)
Since 2004, the EC has taken a lead in coordinating eHealth deployment by adopting a European eHealth Action Plan.(3) This advocates the development of interoperability standards for patient identifiers, medical data messaging and electronic health records. The ultimate goal is to enable secure access to a patient’s electronic health record and emergency data from anywhere in Europe, whenever it is required and agreed to by the patient. Interoperability will also have a profound impact on the eHealth industry. The majority of companies are small- to medium-sized businesses whose survival depends on the creation of interoperable solutions. The activities under the eHealth Action Plan are expected to:
- Support Member States in developing deployment roadmaps and investment in eHealth.
- Stimulate investment and beneficial deployment of eHealth solutions.
- Accelerate the development of interoperable solutions.
- Facilitate labelling, certification and accreditation of eHealth systems.
- Provide more legal certainty in using and managing eHealth systems and services.
- Facilitate the growth and transparency of the eHealth market.
- Address the fragmentation of the eHealth landscape across Europe.
Moving the eHealth agenda forward
If the problems relating to the large-scale deployment of eHealth had to be prioritised, it is the organisational and legal issues relating to privacy that would probably be the most pressing. The management of change is particularly challenging in the eHealth domain due to a lack of clear hierarchical structures and legal certainty. User acceptance is one of the underestimated critical factors for successful implementation. Users and, in particular, opinion leaders are not sufficiently involved, incentives are often weak, and the required effort to “change the way of working” is underestimated.
Fortunately this situation has changed. More and more physicians are aware of the potential, demand better systems and are attending eHealth events. They are becoming more involved and committed. This is a very crucial change: it means shifting from an engineer’s view to a physician’s insight.
The interoperability of electronic systems and existing solutions, together with persisting technological inadequacies, would come a close second on the list of priority issues. Despite a popular belief to the contrary, the technology is still not there. The speed of interaction, relative lack of user-friendliness and unreliability leaves much to be desired. Together with partners in European countries, the EC is drawing up guidelines to ensure the interoperability of future eHealth systems. This is no mere theoretical exercise. The Netherlands, Belgium, the UK, various Scandinavian and other EU countries are worldwide leaders in various areas of eHealth. Each of these countries already has its own masterplan for eHealth, and each has already achieved a lot in implementing these plans.
But, what does the remainder of the European agenda look like? 2005 was the year of national masterplans. On 10 May 2006, European Ministers discussed these at the international eHealth 2006 conference in Malaga. The discussion between providers and users took place on 10–13 October 2006 at the World of Health IT conference and exhibition in Geneva, Switzerland (www.worldofhealthit.org).
Furthermore, the interoperability, identification and authentication systems for both patients and health professionals, and the certification of eHealth systems, will be the centre of attention in 2007. The plan is to propose guidelines for interoperability and certification of electronic health records in 2007. This proposal does not necessarily concern the whole health record – the possibility of exchanging the summaries of these records in Europe would already be quite an achievement. Interoperability is also about shared care. In this respect, we are only at the very start of the exchange of information between general practitioners, hospitals, homecare organisations and other institutions. We are getting more and more accustomed to the idea that hospitals are no longer the only locations that must have direct access to the right information. Ideas, in this respect, are changing.
Investing in eHealth costs a lot of money. It is comparable to the budget of any Ministry of Defence, except the healthcare sector does not have that amount of money. Other resources beyond healthcare budgets should be deployed to set up the eHealth infrastructure and services, but the expenses for keeping them running will have to come from the healthcare institutions and their budgets. Will there be an adequate return on such investments? Yes, but in a different way from the one we are used to seeing today. Cuts within each health-related organisation cannot be achieved. The benefits have to be seen at a regional level. So, let us look beyond the limits of our own countries’ healthcare organisations.
Europe should be proud of its eHealth developments. It is a perfect breeding ground for innovation in eHealth, which has recently been recognised as a market leader in which Europe should invest.(4) We should therefore stop being overly concerned by imperfections. Instead, we should open up to and embrace real technological innovation. Industry, health authorities and users should endeavour to sit around the table together. Each party surely wishes to be a partner in an innovative eHealth partnership. Let’s therefore take that step to move forward together.
The views developed in this article ar those of the author and do not necessarily reflect the position of the European Commission
References
- Iakovidis I, Wilson P, Healy JC. e-Health: Current situation and examples of implemented and beneficial e-Health applications.Amsterdam: IOS Press; 2004.
- Martin-Sanchez F, Iakovidis I, Nørager S, et al. Synergy between medical informatics and bioinformatics: facilitating genomic medicine for future health care. J Biomed Inform 2004;37:30-42.
- Communication on “eHealth – making healthcare better for European citizens: an action plan for a European eHealth Area”. Available from: http://europaeu.int/information_society/activities/health/policy_action_…
- Aho Group Report. “Creating an Innovative Europe”. Available from: http://ec.europa.eu/invest-in-research/action/2006_ahogroup_en.htm
