eHealth – a driver for growth and innovation?
What can information technologies do to improve the delivery of healthcare? How should the gap between promise and practice be closed?
These questions become ever more pressing, both in Europe and beyond. The health ministers of the European Union have identified information technologies as having the potential to transform the delivery of healthcare across Europe. In the United States, the federal government’s economic stimulus package includes the allocation of $50 billion to encourage the take-up and application of IT to healthcare.
Although there is a general consensus emerging about the potential of what is known as eHealth, there is much less agreement about how to go about introducing new technology. Points of debate include which technologies should be prioritised, how to ensure interoperability between different systems, and how to ensure that eHealth technologies correspond to the needs of doctors and patients.
IT in healthcare
At a seminar on 23 February, researchers presented their work in developing a model for analysing healthcare systems that would help policymakers assess the potential effects of introducing IT. Using the examples of Germany and Spain, they showed how the model brought out different potential benefits and problems in the two countries.
The research was presented to audiences both in Brussels and Washington, DC, during the course of a transatlantic debate, supported by Microsoft and hosted by European Voice and its sister publication Roll Call. The event was moderated in Brussels by Tim King, the editor of European Voice, and in Washington by Morton Kondracke, the executive editor of Roll Call.
From IT to ET
Dan Hamilton of Johns Hopkins University in Baltimore, US, introduced the research presentation by explaining that it was part of an attempt to explore the journey from what he called “IT to ET – information technologies to emerging technologies” – across various sectors including energy and education.
Wendy Currie, a professor at Warwick Business School, UK, outlined what has been named the TEMPEST model. It takes its name from seven critical areas that can drive or enable the adoption and diffusion of eHealth technologies: technology, economic, market, political, evaluation, social and transformational change.
Fact File
Speakers
Wendy Currie, professor, Warwick Business School
Dan Hamilton, professor and director, Centre for Transatlantic Relations, Paul H. Nitze School of Advanced International Studies
John Vassallo, vice-president EU affairs, Microsoft
Zoran Stancic, deputy director-general, information society and media directorate, European Commission
Bart Gordon, US Congressman and chairman of the House of Representatives’ science and technology committee
Speakers
Tim King, editor, European Voice
Morton Kondracke, associate editor, Roll Call
Photo gallery
View pictures of the debate here.
Each of these seven categories is further sub-divided into three themes and then into four quantitative or qualitative measures. Healthcare spending would, for instance, be an indicator in the economics category; education and training policy would be assessed in the political category; and IT maturity in the health sector would fall in the market category.
Taken together, the assessment of how IT interacts with a country’s healthcare provision is made up of 84 indicators (seven categories, divided into three themes, further sub-divided into four measures).
Currie explained that these indicators have been derived from a review of more than 200 studies on information and communications technology, medical devices and imaging technologies.
The TEMPEST model was used to evaluate, in a systematic manner, the use of, for example, electronic health records, personal health records (held by the patient), electronic booking of appointments, telemedicine, the electronic transfer of prescriptions and so on.
Currie set out her contrasting assessments of Spain and Germany and made recommendations as to how eHealth might best be advanced in each country.
Germany had, she said, a strong medical technology market, but a conservative approach to the adoption of ICT. An electronic health card scheme, launched by the German government, had, she said, been undermined by resistance from medical professionals.
Need for new business models
“Pharmacists were finding that they had to spend money to adopt the systems, while physicians found it was taking more time to deal with patients,” she said. German doctors had opposed remote monitoring technology, she said, because they were paid according to the number of patients they saw, and would lose money if people did not have to come in for check-ups. “Technologies can be disruptive,” she said. “We need to move to new business models if we are going to get the benefits of new technologies,” she said.
Spain’s health sector was decentralised. Strong regional governments could seize the initiative and adopt eHealth policies without having to wait for national-level decisions. Currie said, however, that this “agility” could potentially leave Spain with an “interoperability problem”, as local schemes would not necessarily be compatible with each other.
Interoperability
The importance of interoperability between different schemes was emphasised by US Congressman Bart Gordon, who delivered the event’s opening speech. The chairman of the House of Representatives science and technology committee, said that “each one” of the 95 counties in his home state of Tennessee had set up health IT systems, but with different, incompatible, software. “There was an effort to get health IT systems out quickly,” he said, adding that it had been “crazy” for the state to roll out eHealth technologies without interoperable standards. Gordon said that €50bn had been earmarked for eHealth in the $787bn stimulus package adopted last year by the US Congress, and that this would be partly wasted unless interoperability was assured. He also flagged up concerns from both clinicians and patients about privacy and confidentiality that would have to be addressed.
Governance structure
Zoran Stančič, the European Commission’s deputy-director general for information society and media, said that the TEMPEST study “highlighted the relevance of setting up the right governance structure for eHealth”. He underlined the importance of the health ministers’ agreed conclusions on “safe and efficient healthcare through eHealth”. The conclusions commit governments to removing “barriers” hampering the deployment of eHealth services and to consider “the creation of specific financial incentive mechanisms”. Stančič said that the Commission “looked forward to strengthening co-operation with the US” on eHealth, building on a “structured discussion” that was launched in 2005.
epSOS
Erwin Bartels, an official in the German health ministry, said that the EU needed to improve its performance in turning the fruits of research and development into practical innovations. He invited other countries to join epSOS, a pilot project, funded by the EU, to develop cross-border interoperability between electronic health records. epSOS currently involves 12 member states. Bartels said that communication and co-operation were essential if Europe was to avoid developing “non-interoperable” solutions.
On the US side, Susannah Fox, associate director of the Pew Research Centre’s “internet and American life” project, warned that TEMPEST might yet be overtaken by technological and market developments. “What seems to be an important indicator this year may not be an important indicator next year,” she said, urging the researchers to “stay flexible”.
Transatlantic health passports
Participants split into groups to identify what, in their view, encouraged or inhibited the implementation of eHealth technologies. The discussion produced a list of issues that should be addressed by policymakers, including the need for eHealth training at medical school, security safeguards to protect data privacy, and some credit-winning pilot projects. Examples were needed to justify the roll-out of eHealth – and the business models had to be right. One group suggested the development of an EU-US “health passport” for tourists.
Summing up contributions from the European-side, John Vassallo, Microsoft vice-president EU affairs, said that an issue of key importance was whether proponents of eHealth could demonstrate the benefits of the technology. “Can we show savings, can we measure costs?” he said. He also stressed the benefits that eHealth could have for developing countries.
Summing up for the US side, Kondracke said that he thought “everyone is optimistic, and is hopeful” about the potential of eHealth. He said that participants had discussed why eHealth technology could not be rolled out as simply as ATM machines (cash dispensers), concluding that eHealth was more complicated and less trusted. But there was a general view that technology could address security and privacy concerns about eHealth.
Justifying eHealth
Further barriers to the roll-out of eHealth were identified during a dinner debate on the European side. Milan Cabrnoch, a Czech member of the European Parliament, said that participants should put themselves in the shoes of a rural doctor asked to start using eHealth technologies. He said that such a doctor would not be interested in “cost savings or efficiency savings”, which could cost him precious state funding, and that their patients would be suspicious of the new technologies. Policymakers had to come up with different kinds of arguments in favour of eHealth. The point was echoed by Pedro Nunes, president of the Portuguese Medical Association, who said that doctors “see eHealth as an opportunity but also as a threat”. He said that policymakers and industry should “give us tools that are suitable for our work”.
Eric Maurincomme, a board member of the European Co-ordination Committee of the Radiological, Electromedical and Healthcare IT Industry, said that each region should draw up a road-map for rolling out eHealth services. He said this would protect small businesses that offered eHealth services to the public sector from being undermined by changing government priorities.
Closing the event, Vassallo emphasised the importance of getting more involvement from the grass roots in the debate on eHealth. He said what was needed was input from “patients, doctors, nurses, chemists, everyone who is involved in the chain. And it’s a long chain”.