"Europe is a world leader in eHealth deployment in primary care and in regional health information networks. Many Member States and regions are very advanced in using eHealth. On average, over 80% of general practitioners are today online," said Iakovidis, the main co-author of the succinct, 26-page Communication that sets out the specific targets and deadlines for EU Member States to meet.
"In the US, advances have been made within hospitals. But Europe has more regional networks, which the US lacks," added the Deputy Head of Unit.
From research to deployment via six major challenges
According to Iakovidis, the Commission focused mainly on research and development for health IT until about 1999. But many research projects had difficulties to scale beyond the original partners. So as early as 1997 the European Commission office started to meet with relevant stakeholders in search of a new approach. To this end, the first EU-level eHealth ministerial conference was held in 2003 in Brussels under the Greek presidency.
Based on his experience, Iakovidis has reduced the eHealth issue down to six major deployment challenges: organisational/cultural issues; national/regional leadership; legal issues; industrial issues; user acceptance; and technology itself.
All are cited in the Communication, which also features an action plan of almost 30 separate actions. In relation to the challenge of leadership in terms of setting up an eHealth action plan in their own country, EU countries are presenting their current strategies at the fourth of the High Level eHealth Conferences in Malaga, Spain, from 10-12 May 2006.
"Member States are preparing priority lists to serve as 'roadmaps' for future eHealth deployment. In Malaga these plans will be very actively discussed and analysed," said Iakovidis. The Commission is also collecting good eHealth practices and aims to gather up to 400 examples on the website www.ehealth-impact.org. Some of these case study examples will be subjected to a cost-benefit analysis specially designed for the task.
User acceptance is a must to meet the eHealth challenge
Iakovidis' personal favorite among his six deployment challenges is 'user acceptance', as it is crucial for clinicians and other health professionals to accept eHealth technology.
"There are no business models and no clear incentives for doctors to take up eHealth, to break up existing professional interests. The existing human-computer interaction interface needs to be improved to address doctors' top priority: speed. Windows-based technologies were bad news for doctors â typing and playing with a mouse and a menu seemed for many of them to reduce the speed of their daily work."
The most popular reason, justified or not, for users to boycott health IT solutions pertains to privacy and security issues. In medicine, privacy is even more critical than in the banking sector. Information about your health that makes its way into the public domain could stigmatise you for life.
The three central eHealth challenges to be tackled in 2006/2007
Iakovidis also identified a set of three immediate challenges. The first is interoperability and connectivity. "That's our biggest priority now," he said.
At EU level, the findings of a dedicated eHealth working group that involves Europe's national health ministries will be funnelled into a Recommendation on interoperability that is due to be published by the European Commission in 2007.
The second challenge is certification/accreditation/labelling. "Today you have no clue what is good, bad or ugly," Iakovidis said.
The third current challenge is financing. Right now, the eyes of the world are focused on the UK's National Health Service (NHS). Many other countries have been cautious about investing in eHealth and spending large amounts. Many of them will never be able to reach the level of funding of the NHS. But spending as much as the NHS is "not necessary," Iakovidis added. Smaller but continuous steps are needed to achieve the priorities set out, keeping all the stakeholders committed at all times.
"We have to differentiate between the set-up and the keep-up. The set-up can be done by industry, by telecoms, or by a consortium of organisations involved in publicâprivate partnership. But the keep-up must be done by the healthcare service. There must be a commitment to keep it up." Following on from these three big priorities, legal issues are due to be tackled by 2009, according to Iakovidis.
These are themes which are currently key. So, they are being discussed both in Malaga at the High Level eHealth 2006 conference as well as during the Geneva-based World of Health IT Conference & Exhibition 2006. While the first event is centred around health authorities whether at the regional or national level, the Geneva event is an "eHealth market event." It brings eHealth users and buyers together with eHealth providers. A large industrial exhibition and user led educational sessions are its main pillars.
The time is ripe to think positively and to agree on a citizen-centered strategy
"The Commission's vision is about putting people at the centre. We fund development of ICT systems to support citizen-centred healthcare systems that puts patients in the middle of a network that includes their family doctor and hospital."
"In particular, we are trying to develop healthcare systems where patients use a mobile phone, and portable or wearable tools, to monitor their particular chronic health condition, whether it is diabetes or heart disease," said Iakovidis.
"For us, it's really important to engage patients, to give them more responsibility and reduce the number of times they must go to the hospital. The 90s were about connecting all the players via a regional health system, the next step is about creating mobile, personal health systems." Iakovidis then added, however: "A necessary condition for it to work is if authorities, industry and users agree to do it, and do it together ...A lot of money has been lost in the past decade when one of the three stakeholders did not play along with a planned proposal."
Iakovidis said it is important for policymakers to look past the next election and stop thinking short-term when it comes to eHealth, as more long-term planning is required.
The solution is to 'think positive' Iakovidis concluded: "Instead of fearing e-Health, and waiting for others, people should actually turn around, promote it, and act now. There is increasingly more scientific evidence published that eHealth saves lives, improves quality of care and productivity when combined with proper organisation and skills. People who do not use the proven tools may tomorrow find themselves responsible for not providing the benefits to patients and society in time.
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World of Health IT Conference & Exhibition 2006