Imagine a Europe where prescriptions are never confused, where a shortage of Radiographers in Norway is not a problem because the X-rays can be read in Spain. Imagine a Europe with no confusion of medical files when crossing borders because files can be automatically transferred. And all of this achieved with seamless interoperability, with consent mechanisms and all perfectly secure. This is the vision of those innovating in eHealth today.
eHealth can enable medical data to be transferred between departments, hospitals, regions and even countries, regardless of physical borders and restrictions that exist. Systems such as ’telemedicine’ could revolutionise health care and enable greater freedom as well as faster and easier access to health care, health data and physical treatments.
With novel eHealth techniques a doctor in another Member State could find your medical file, if you fell ill in that country, and determine if you had any allergies or previous surgeries that could affect their treatment. The doctor could then give you a prescription that would exist in an electronic form (e-prescription), translated into every European language and understandable to everyone across the Union. If while travelling you need a prescription from home you could order that prescription from your doctor. eHealth could enable a wide range of health benefits, from the very simple (easy booking of appointments), to the very complex (surgeries carried out over the internet).
Problems and Solutions
The systems in place today not always run perfectly, and there are still plenty of difficulties. Nevertheless, real examples can be found today, as can very real problems :
Interoperability From a purely logistical point of view, this is probably the single biggest problem with eHealth at the moment. In order for two health systems to communicate with each other effectively, they have to have software that is compatible or can at least in some way understand the information that is being sent. As healthcare is the remit of Member States, there is no harmonisation, on any level, of the software used for health care between Member States. The majority of Member States are not compatible or have ’low interoperability.’ Calliope (a project funded by the European Commission) aims to ensure interoperability throughout Europe. The results of this project and a roadmap for the interoperability of eHealth systems are expected in December 2009.
Safety Concerns about the safety of personal health data, is not helping the progression of eHealth. When citizens in Europe hear stories of criminal files being lost and identity theft on the increase, it does not instil much confidence in E-system security. So security issues need to be resolved before this technology can go mainstream, with the confidence of citizens.
How much information is available ? your entire file or just a patient summary containing essential information (previous operations, allergies etc...) ? This is a question that has been one of the main focuses of the Commission-funded, epSOS project. The epSOS project works towards the consolidation of existing and new systems to ensure that effective eHealth systems are in place such as e-prescriptions and patient summaries.
Consent Who is accessing my information ? when it is accessed abroad is it destroyed after I have left ? Have I given my consent for a health professional to access my files ? How can I ensure that only those who I gave consent to are viewing my files ? These questions are the sort of questions that patients and citizens at large, may well ask in reference to their consent.
Politically Various Member States in Europe have invested significantly in data systems and eHealth already. They will try to ensure that the eHealth systems that are being developed does not clash with their own systems. A great deal of legislation on eHealth could be managed through DG INFOSOC, however, the health impact is so considerable that Member States could consider that it could interfere with their rights to organise their own health systems.
What about the Patient ?
The aims of eHealth advocates are admirable but what of the patient ?
The competitive opportunity that eHealth offers is huge.
The potential for investment and return is huge.
The research is currently being funded by organisations that will be expecting some return on that investment.
So the question remains, where does the patient, the citizen, fit into this ? eHealth could help to speed up a health system and ensure lack of confusion if operated properly but are there any tangible health benefits to be seen from the many systems already in place ?
Legislation such as the patients rights in cross-border health care Directive lauds eHealth and recommends exploring its possible uses in cross-border activities. A communication from the Commission in July 2008 entitled : eHealth -Making Health Care Better for European Citizens : An Action Plan for a European eHealth Area again promotes further expansion and exploration of eHealth. The Commission is putting a great deal of effort into eHealth and this could yield fruitful results, but it must go down a citizen-centred path. A user-centric approach is as critical to successful delivery as interoperability or compatibility.
The other issue that is often ignored is how to maintain a personal approach to healthcare service delivery if many channels are replaced with technology ? Many patients - particularly heavy users of services, as this group is often older and in some cases less familiar or confident with technology - prefer to interact with human agents. As technology advances and improves efficiency in the healthcare sector, as we have seen in many other sectors, how to ensure that the appropriate balance between cost saving, through automation, and a sensitive patient delivery system is maintained ?
EPHA Comment and Conclusions
There are attempts by the Commission to solve the problems with eHealth, interoperability, security etc.... There is political and industrial will, but is the focus on eHealth correct ? EPHA would like to ensure that the citizens voice be heard in this debate. EPHA would like to see progress in the development of consent systems and progress in ensuring protection of citizens.
eHealth could revolutionise and improve healthcare services to citizens but Europe has to take a cautionary approach and not jump in head first. eHealth contains many risks as well as many benefits. EPHA would like to see this technology explored fully and with the citizens’ needs as the focus.
For more information
EPHA related articles
eHealth flagged as a priority sector for growth
Workshop at eHealth Conference 2008
EU pilot project to remove linguistic barriers for care abroad
