In the report on "Needs and options for future research in Information Society applications for health care", a separate chapter has been dedicated to the various obstacles that prevent a smooth integration of innovative information technologies (IT) in the European health care landscape. The report has recently been drawn up by the Strategic Requirements Board of the European Commission, DG XIII, in order to prepare the Fifth Framework Programme. Unlike in other information intensive domains, like the banking, insurance and airline sectors, the electronic data transmission via interconnected systems has not properly been launched in the health care environment. Responsible experts have analysed the situation and detected the deeper causes of this withdrawal.
The defensive attitude towards IT implementation in European health care is largely inspired by fear and negligence. The Board has distinguished five major thresholds, forming an obstacle to introduce a modern information health care society. The first one is related to public policies which regard health care as a non-profit public service and therefore fail to develop a well-defined investment strategy, based on free market principles. Policy makers and managers prefer to support new services and medical technologies, rather than build efficient IT infrastructures. They are afraid of the enormous costs without paying any attention to the potential benefits, IT solutions are able to supply to the quality of care. As a result, one observes a narrow-sighted fragmentation of industrial and SME efforts which only meet the local needs with no export capacities whatsoever.
Organizational resistance and a reluctant attitude towards the use of IT constitute a second barrier. It makes no sense to introduce information and communication technologies (ICT) in hospitals if this implementation is not accompanied by changes in working procedures, in order to streamline the workflow across the whole continuum of care. However, people have to be willing to contribute to the necessary team spirit, which is not always evident because of the fundamental differences between specialised and primary care, physicians and nurses, administration and medical staff, and so on. Intensive training and education on the spot would certainly help to "de-mystify" the world of IT and telematics, thus generating a higher degree of awareness, understanding and practical use by care takers.
A third threshold is formed by technology and standardization issues. In this regard, the integrated electronic patient record which has to guarantee the continuity of care throughout the disparate information health care systems, still doesn't exist as such. Excellent standards are required for the interoperability and proliferation of heterogeneous health telematics applications. Even classification and coding schemes for clinical data structurisation have not been defined yet. On an international level, there is too little collaboration between Europe and the United States in this domain. In most cases, standardization is so slow that new technologies already have emerged by the time the old ones have finally become compatible. The European organization CEN, which is responsible for standardization matters, is simply not well matched for maintenance and marketing issues.
A fourth barrier consists of regulatory and medico-legal issues, such as privacy, security, user authentication, and liability. As long as these problems are not solved, the international application of telematic services holds great risks. Since the European Community directive on the processing of personal data is currently being adopted by the member states, this might prevent the development of a seamless health care service. In addition, there is no consensus about the legal status of the electronic health care record.
The fifth threshold relates to the general infrastructure. In the future, health telematics will primarily focus on regional information systems and wireless technology. However, many medical sites at present are not able to afford the necessary technical infrastructure. They depend on the positive changes with regard to telecommunications tariffs. Hopefully, the ever increasing competition between telecom providers will liberate the market and reduce the costs in a substantial way. Only then, the expected efficiency and cost-effectiveness in health care through the use of IT solutions can actually be proven. For more details, we refer to the report contents on the Telematics Applications Programme Web site.