'Homecare' refers to a wide range of health and social services delivered at home. The ageing population is rapidly leading to an increase in the number of Europeans dependent on care and a modification of disease patterns, making chronic-degenerative diseases more prevalent. This, combined with shrinking health care and nursing workforces, has led experts and policymakers to consider homecare as a long-term solution.
Technology, particularly active devices such as dialysis systems, wrist-worn monitoring devices and biomedical clothes, can add to the quality of homecare. However, several barriers to the take-up of such technology exist. These include financial, organisational and legal issues as well as privacy concerns, data protection and interoperability.
The European Homecare Conference, which took place on 4 December 2007, gathered policymakers, industry representatives and patient groups to discuss the organisation and financing of homecare, the need for integrated homecare services, the impact of healthy technology and the health policy challenges for decision-makers.
In the session on the impact of health technology on homecare, the medical device industry urged for existing technologies to be taken up more quickly, whereas the Commission and a regional representative emphasised the need to put in place health information and communication networks first.
"Even though the technology is there, its uptake in the homecare sector is too slow because of the financial hurdles and the rigid organisation of health care", stated Rosanna Tarricone, director of Eucomed economic affairs. "Reimbursement schemes disincentivise providers from adopting innovative technologies as the benefits do not fall in the investors' purse, but to patients and their carers", she added, emphasising the need to change the way health care is financed and organised from the vertical approach of the 1970s to a more horizontal one, in which "the regulatory framework should not be a barrier".
Gérard Comyn from the Commission's ICT for health unit emphasised the need to put in place secure health information networks to connect the points of care for personal health systems. "Networks in telemedicine are by definition the key", he stated.
In this regard, Gérard Comyn also underlined the importance of interoperability in allowing 'mobile health' such as wireless body sensors. "Interoperability is the only technical problem in telehealth. The other challenges are not technical", he stated, instead listing legal obstacles, financial issues such as patient reimbursement and practical issues such as certification and accreditation, as well as data protection and privacy.
"Expensive, fancy, limited experiments may represent interesting tests but we need to consider solutions capable of addressing a large portion of the population", stated Giuseppe Paruolo, deputy mayor for health and communication in the city of Bologna. "The cost of devices as well as the organisational and other connected costs need to be considered from the beginning."
For example, Giuseppe Paruolo argued that public authorities are reluctant to pay 1000 euro for a medical device, such as a small wrist-worn sensor, if its real cost is around 10 euro, just because the industry adds interconnectivity and other communication costs to each device.
"I want a solution where I'm putting in place a global communication infrastructure once and for all and that reaches all houses. Then I can add to this network devices that will communicate with my infrastructure. I'm not going to pay for communication infrastructure for each device for different companies", he stated.
Giuseppe Paruolo added: "We need to put in place a public infrastructure and open tenders for devices that can be integrated into that infrastructure. For example, in this case I can pay the industry 15 euro for each device, but not 1000 euro." He also stated that European level harmonisation of standards and a sort of health care "unbundling" to separate its different parts - such as communication infrastructure and sensors - are necessary.
"In the long run, investing in technology will now be cheaper. We're facing a huge problem and we need to move much faster on this than we are currently doing", stated François Décaillet from the World Health Organisation (WHO) regional office for Europe.
In May 2008 the WHO will publish a report on homecare in Europe and in October 2008 the European Commission will publish a communication on telemedicine and innovative technologies for chronic disease management.