The Commission's Recommendation on interoperability is a hot talking point amongst health care professionals. For now, eHealth development is weakened by a lack of harmonised standards and by legal uncertainties. The Commission's Recommendation will certainly support interoperability, but it is not clear to what degree.
Health First Europe is a firm believer in the merits of eHealth, having participated in the Slovenian Presidency's conference on the subject in May 2008. eHealth and workforce development are both critical issues for the association and its membership.
The European Commission meanwhile issued its recommendation on the cross-border interoperability of electronic health record (EHR) systems, targeting fully integrated European Union-wide e-health interoperability by the end of 2015.
This is the first European Commission document to formally address the steps that Member States should take and underlines the importance of the EU-27 as principal decision-makers in respect of regulatory and financial matters. It places responsibilities on Member States that include research, inter-country dialogue, analysis of risks, provision of resources, implementation and more. It also calls for mutually recognisable conformity testing procedures for EHRs across the European Union.
To mark the launch, the Commissioner for Information Society and Media, Viviane Reding, stated: "Travelling around the European Union is taken for granted until something goes wrong, which is why the European Union's initiatives on e-health intend to remove linguistic, administrative and technical barriers, by making it easier for people to receive treatment even when they are away from their home country. I expect our recommendation to make an important contribution to saving patients' lives in emergencies."
Ilias Iakovidis, Viviane Reding's Deputy Head of ICT for Health, an expert in eHealth Europe-wide, added: "The benefits of interoperability are clear. First, the individual patient benefits from better care due to the ability of health care providers to access information. Second, society benefits through having better public health and improved cost efficiency. Thirdly, industry will benefit from having a level-playing field across Europe."
Ilias Iakovidis, who will be addressing industry and other stakeholders on behalf of the Commission at the World of Health IT Conference and Exhibition in Copenhagen later this year, also had a clear message for industry, saying: "There will not be, and should not be, any monopolies within e-health - there are too many players. Industry needs to deal with interoperability as soon as possible."
EHR systems clearly need to be able to interoperate, so that any "foreign" doctor can quickly and easily access a patient's vital information in a usable format and in his or her own language, direct from the database of the patient's own doctor.
In its recommendation, the Commission has set out guidelines with a view to creating a minimum level of steps to ensure that EHR can cross-border effectively within the European Union. These cover emergency data and patient summaries; the sharing of data among different European Union health care systems based on a limited range of applications already in use, and; the building of networks that fulfill required legal, operational and educational aims.
A second initiative launched by the European Commission to improve the safety and quality of care to people who require medical assistance while travelling or living abroad is the Smart Open Services (SOS) project. The SOS project, co-funded by the European Commission, is supported by 12 Member States and their industry players, to demonstrate the benefits of cross-border interoperability. It will enable health professionals to access specific medical data such as current medications of patients from other European Union countries. In an emergency, sharing of medical information could save many patients' lives.
The SOS project will receive over 22 million euro in funding in the next three years, 11 million euro of which is covered by the European Commission's Competitiveness and Innovation Programme (CIP). The project is a first step in addressing problems faced by doctors with patients who seek health treatment when abroad. These problems include resupplying essential medication that a patient has lost, communicating medical situations to foreign-language doctors, diagnosing illness and prescribing proper medication with little knowledge of patient history. While several Member States have already developed electronic health records, many such (national) systems cannot communicate with each other.
The new project will strive to ensure compatibility of electronic medical information regardless of language or sophistication of technology, without having to establish a common system throughout Europe. This will allow health professionals to electronically access the data of a patient from another country, in their own language, using different technologies and systems. It will also make it possible for pharmacies to electronically process prescriptions from other Member States, so that patients travelling within the European Union can obtain the correct essential medicine.
The SOS project builds on national initiatives with the direct participation of Austria, Czech Republic, Germany, Denmark, France, Greece, Italy, The Netherlands, Spain, Slovakia, Sweden and the United Kingdom. Electronic records will be purely voluntary, and created only at the citizen's request, respecting his/her right to privacy. The information contained in these health records has yet to be agreed upon, but it will include a summary of essential information such as blood group, known allergies, medical conditions and details of medication the patient may be taking.
The SOS project is classified as a Large Scale Pilot (LSP): driven by participating countries it focuses on enabling the cross-border provision of ICT-based services that are already operational at national, regional or local level. LSPs build on these services to find common specifications which can then be further developed to gain wider agreement. This will enable different national systems to communicate and interact with each other so that citizens and businesses can enjoy the full benefits of the single market.
The results of this e-Health LSP will be disseminated to the wider European health care community via the CALLIOPE network - Call for Interoperable eHealth services in Europe - so that other Member States can participate.
eHealth has become a major topic on the European Union health agenda with decision-makers trying to develop patient-centred health care while making best use of resources. eHealth, in this context, appears to be a promising tool to empower patients while at the same time freeing up scarce resources. Indeed, with home-based monitoring alone, hospital admission rates have been reduced by 21 percent and mortality by 20 percent. Although these figures do not represent the only indicators of health, they do give a good idea of what eHealth can bring.
Patients already use eHealth on a regular basis for their interaction with health professionals. Some e-procedures definitely make things easier for patients and health professionals, amongst others, since the use of such procedures reduces the administrative burden for instance. eHealth can indeed help free up additional time for health care professionals to dedicate to the important face to face interactions that are so highly appreciated by patients. But eHealth can also help reducing the number of hospital visits needed to monitor a patient's condition.
"I have used e-procedures for follow up and monitoring by a specialist who knows my condition well in France for several years. This means I do not need to take up consulting time and it helps me to self-manage my condition", Judy Birch, Health First Europe Advisory Committee Member and United Kingdom patient stated.
Telemonitoring and telenursing make the monitoring of the treatment of patients easier, giving patients more flexibility and autonomy while safeguarding quality health care. However, as the European Commission highlights, eHealth is a tool, it represents part of the solution, but it is not the panacea.
eHealth indeed needs to be seen as an element of a global health strategy along with the essential role of health care professionals, hospital managers, the medical technology industry and other stakeholders. The development of quality health care in Europe can only be achieved by co-ordinating everyone's efforts and with health care professionals working hand-in-hand with new modes of health care.
eHealth offers promising perspectives for both patients and health care professionals but it cannot develop without further investment in health care professionals themselves. They will always remain the most important element in the provision of health care services, which include the diagnosis, care and treatment of patients. eHealth is there to facilitate their job, to improve overall efficiency of health care systems. In order to gain the full benefits of eHealth, it is therefore necessary to train health care professionals in the use of the relevant eHealth tools and increase patients' acceptance of these new modes of health care.
"eHealth - and Telemedicine or TeleHealth services have to be considered as part of eHealth - is key to the necessary transformation of the health care systems in Europe", stated the European Health Telematics Association (EHTEL), Member of Health First Europe. "By being integrated into the health care delivery process, these services can benefit patients, health care professionals and citizens; they can indeed improve quality of life and well being and contribute to the sustainability of the health care systems. It is vital that barriers such as legal uncertainties, market fragmentation and lack of interoperability are removed - this is key to making Europe the global leader in eHealth."
Established in 2004, Health First Europe is a not-for-profit, non-commercial alliance of patients, health care workers, academics, health care experts and the medical technology industry. Its primary aim is to ensure that health care is regarded as a vital investment in the future of Europe and that every European citizen should benefit from the best medical treatments available.
As part of a series of awareness-raising activities, Health First Europe organises events and issues publications with the aim of communicating the following core messages to European Union decision-makers and opinion leaders:
- There are weaknesses in European health care systems; a re-think is required in order to meet current and future health challenges;
- Patients and clinicians should have equitable access to modern, innovative and reliable medical technology;
- The development of new and flexible modes of health care delivery will benefit both patients and health care providers;
- "Health equals wealth". Health is a productive economic factor in terms of employment, innovation and economic growth.