Information and communication technology in healthcare has its enthusiasts and its critics. In Europe, as eHealth moves towards the mainstream of healthcare, we have already witnessed both successes and failures in this domain. The reasons behind failures are complex and will no doubt be debated for many years to come. When it comes to success, however, an important pre-requisite is the support, confidence and empowerment of two groups of people: patients and healthcare workers.
Technology and Patients – taking care of preventive health and providing support
There is a body of evidence which shows us how patients are increasingly ready and willing to embrace eHealth. Every day, millions of people pro-actively search for health data online. In Europe, it is estimated that up to one-half of adults may have searched online for health information.
In the UK, the popularity of online information services such as NHS Choices and NHS Direct demonstrates how turning to technology for health advice has become a natural reflex for many people. According to the Department of Health, winter visits to the health information website NHS Choices now average just under 11 million a month compared to 6.8 million at the same time last year. In 2010, 5.6 million patients used NHS Direct's range of online health and symptom checkers
Recent indications also suggest that turning to technology is not only a reactive impulse when we already feel ill, but increasingly a pro-active choice: over the period of a year, NHS Choices has seen downloads of its quit smoking iPhone application increase by 13%. More generally, the surge in popularity of these kinds of medical apps - by August 2012 it is estimated that there will be more than 13,000 iPhone health apps available for consumers - demonstrates how people can feel empowered to take control over their healthcare by engaging with technology. The convenience of being able to test whatever aspect of our health, whenever and wherever we like is clearly contagious.
According to a recent survey by Edelman, 68% of those using digital tools, devices and apps for tracking their health said that using these technologies had helped to improve their health. The figure among 18-30 year olds was 74%. Whether this is simply a fad or an emerging market of health-empowered young adults is yet to be seen, however, the trend is certainly promising.
As well as personal empowerment, we are also seeing an evolution of the Health 2.0 phenomenon whereby citizens are increasingly willing to share information and experiences among a "community". This can range from rating one's GP, submitting healthcare-related data to gain knowledge about one's "health profile", or chatting with other patients who have had similar experiences of a certain illness or condition. Whereas initially these types of sites grew from grass roots movements of patients with common concerns or were the brain-child of web entrepreneurs, we are now seeing elements of them being installed within governmental structures.
The USA is particularly developed in this regard. Websites such as data.medicare.gov from the Department of Health and Human Services incorporate a significant element of public data about hospitals and care centres including results from surveys of patients' hospital experiences and a discussion feed where visitors to the site can comment. As the UK government moves forward on its commitment to open up public sector data, could this be a trend that we see crossing the Atlantic?
All this evidence would seem to suggest the beginning of a shift in behaviour. Rather than simply being passive consumers, an increasing number of "prosumers" (progressive producer-consumers who use new media tools to inform their decisions) are emerging. When it comes to healthcare, increased pro-activity and empowerment can mean better health and less unnecessary health visits.
Looking at the bigger picture, however, we must acknowledge that this group currently remains relatively small. A more fundamental challenge is to reach the 30% of the EU population that has never been online through initiatives on digital literacy while improving infrastructure through more widespread roll out of broadband.
For this reason, the European Commission has set ambitious targets to stimulate investment in broadband. Most recently, in October 2011 it proposed to spend almost €9.2 billion from 2014 to 2020 on pan-European projects to give EU citizens and businesses access to high-speed broadband networks and the services that run on them.
In the area of digital literacy, the European Commission has set out a series of actions to ensure that digital skills are promoted across all EU Member States, and that groups such as the disabled are also able to access information online and are not excluded from the digital revolution.
While Rome was not built in a day, there are nevertheless some inspiring examples we can draw from, such as Estonia which enjoys free wifi practically everywhere; where a digital literacy programme rolled out in the 1990s means that non-digital Estonians are a rare occurrence and where the President, Toomas Hendrik Ilves who chairs the European Commission's eHealth Task Force, considers access to internet to be a human right.
Technology and Healthcare Workers – providing efficiency, effectiveness, safety and quality
A second group of people whose active support is essential for the success of eHealth are healthcare workers.
In general terms, the healthcare sector as a whole has embraced technology – CAT scans, pre-natal scans, blood pressure monitors, and the like are today "normal" features of any European hospital and workers interact with such technology without hesitation on a daily basis. Recent industry statistics also confirm a continued investment by hospitals in ICT, showing that the European market for health ICTs in hospitals totalled €2.5 billion in 2010 and is estimated to grow to €2.8 billion by 2015 .
With this in mind, one may be tempted to think that gaining the support of this group would be an easy win. Scratch beneath the surface, however, and we see a more complicated picture.
Some healthcare workers are so convinced of the benefits of eHealth that they are already using the latest devices as part of their daily work. This is leading to a "Bring Your Own Device" phenomenon whereby "digital natives" are working faster than hospital ICT management, bringing forward challenges such as security of data and the risk that information is not backed up, as well as technical compatibility issues such as the possibilities of accessing shared resources like file-sharing systems and printers.
Conversely, resistance from doctors (particularly those over 50) is a regularly cited reason for slow uptake of eHealth solutions. For some this may be an unwillingness to change their methods of working; for others it is scepticism of the improvements in efficiency, effectiveness, safety and quality that can be brought by eHealth.
For the first group, there may be no convincing them to change, however, the experience in some countries has shown that linking eHealth uptake with faster payments to GPs was incentive enough to trigger widespread uptake. As concerns the second group, large-scale evidence on the effectiveness of eHealth is gradually emerging. Later this year, a pan-European project "Renewing Health" is expected to provide evidence of the effectiveness of telemedicine services across nine regions of the EU. Its focus will be on three chronic conditions: diabetes, cardio-vascular diseases (CVD) and chronic obstructive pulmonary disease (COPD).
The results of the project should be watched closely by health authorities across Europe, especially as we consider the social and economic impact of these three diseases: CVDs are the largest cause of death in the EU and account for approximately 40% of deaths or 2 million deaths per year. According to the WHO, deaths in Europe from COPD are expected to rise by about 20%, from 248 000 in 2008 to more than 300 000 in 2030; deaths directly attributable to diabetes are predicted to rise from about 166 000 in 2009 to over 209 000 in 2030.
Also of interest to follow will be a new telemedicine project launched in Denmark in December 2011, which marks a first step towards establishing a common national infrastructure for telemedicine. Focusing on COPD (emphysema), diabetes, inflammatory bowel diseases and pregnant women with and without complications, it provides an opportunity to scale up successful local experiences across the country.
In parallel, the new "3 million lives" telehealth campaign which has been recently launched in the UK and builds on the success of the Whole System Demonstrator integrated health and social care project, which was piloted across sites in Cornwall, Kent and Newham, will also be an important project to follow.
All of these projects require the engagement of patients and healthcare workers. It is satisfying to see such bottom up initiatives providing inspiration and blossoming into national projects. Unfortunately, all too often it has been the less successful eHealth projects such as the large and ambitious National Programme for IT in England that have made the headlines, while the smaller successes have gone largely unnoticed.
In times of austerity, sharing and spreading this sort of best practice through partnerships can open up benefits for patients, health systems and the economy. This can mean better healthcare outcomes even when there is less money to go around.
Partnerships and platforms: the keys to success
The many practical examples of eHealth in action that we are seeing across Europe (telemedicine in Denmark, Whole System Demonstrator in the UK, Renewing Health across Europe and the explosion of health apps virtually everywhere) demonstrate that there is a high level of innovation being developed across the EU. There is a thirst among patients and healthcare workers for safe, quality, efficient and effective interactive healthcare solutions. There is also a craving among businesses for market growth in tough economic times, and among governments for efficient and economical solutions that will provide high quality and sustainable universal healthcare.
The current economic climate, where individual actors have less to invest, makes partnerships an even more attractive prospect. This combination of needs and wants provides the "perfect storm" for a partnership approach.
Partnerships are essentially an evidence-based tool for circumventing some of the resilient obstacles to innovation. Be they inside or outside the health sector, they can bring huge collateral benefits beyond their original intended target. They don't need to be large to be effective but the knock-on effect of sharing small scale successes with different partners who have different perspectives can be far reaching.
Just as the business environment relies on the constant development of new growth platforms to stay relevant and competitive in a changing world, so the sharing of data and ideas can provide high potential for windfall gains in terms of breakthroughs on unrelated problems facing the same community.
It is with this mindset that the European Commission has launched its pilot European Innovation Partnership (EIP) on Active and Healthy Ageing (see facts below).
In practical terms, the EIP approach means that we can look at and learn from actions taken at local level to solve a local problem. For example, in Scotland telehealth solutions are being utilised successfully to reach out to people living in remote areas. The same formula can be applied to other regions which have a small population scattered over a large geographic area. The beauty of partnership is that instead of direct replication, different combinations of people can provide tailored solutions which can in turn provide further and often unexpected benefits and inspiration elsewhere. These "networked partnerships" can then become a platform for solutions that are a constant source of innovation.
The marriage of ICT and health provides huge scope in this regard. ICT has proven itself to be a breeding ground for fast-moving innovation and partnership. A good example is "triple play", bringing together Internet, TV and telephone technologies, which has become a practical and economical reality for citizens across the EU. Already we can see the same logic of partnering technologies being used and applied to integrated care - some telehealth technologies, for example, function via digital TV. The benefits that this sort of technology can bring to those 30% of citizens in Europe who have not yet gone on line are inspiring. Going forward, there are clear opportunities for further platforms to be built, taking technology to places that we can only dream of.
As well as being able to act locally, the EU – by merit of its size and reach - is also able to take large-scale action. The epSOS (European Patients Smart Open Services) project is a good example of how governments can come together in partnership to overcome the technical, administrative and linguistic barriers to cross border healthcare. epSOS has developed the technical capabilities to improve the medical treatment of EU citizens while abroad by providing health professionals with the necessary patient data in their own language. A political commitment to interoperable eHealth along with the economic and practical benefits of sharing expertise has led to the participation of 23 countries in the project. Benefits for citizens include the convenience of being able to receive medication (ePrescriptions) when in another country. For the health professional, having access to the relevant, translated clinical information – with the explicit consent of the patient - ensures that the safest, most appropriate medication can be prescribed.
Whether on a pan-European or local scale, people, partnerships and platforms are bringing together the necessary checks, balances and expertise that can help achieve universal, sustainable healthcare in the digital age.
EU Member States have some great successes to build on. The European Commission is ready and committed to deploy the tools and network the teams that can take these successes to another level.
Robert Madelin, Director General, European Commission Directorate - General Information Society and Media
The views presented are those of the author and do not necessarily represent the official view of the European Commission on the subject.
FOOTNOTES
Facts: European Innovation Partnerships
European Innovation Partnerships (EIPs) are part of the EU's Innovation Union strategy to enhance European competitiveness and tackle societal challenges through research and innovation. They are designed to address weaknesses in the European research and innovation system (notably, under-investment, conditions which are not sufficiently innovation-friendly, and fragmentation and duplication), which in many cases prevent the take up of innovations in the market.
The pilot EIP on Active and Healthy Ageing aims to turn the challenge of the ageing population into an opportunity: enabling citizens to live independently for longer and in good health; making the cost of care more sustainable; and growing the market of innovative products to increase the EU's global competitiveness. The overarching target of this pilot partnership will be to increase the average healthy lifespan by two years by 2020.
It is a stakeholder driven platform for engagement, linking up the people who are willing to commit their contribution but still need support from others for joint success in Europe. The Strategic Implementation Plan, developed by the EIP's Steering Group (composed of representatives from Member States, regions, industry, health and social care professionals, elderly and patient organisations and other interest groups),launched a first set of specific actions in 2012.
Invitations for commitment have been launched on 3rd April in the following areas: Innovative ways to ensure patients follow their prescriptions – a concerted action in at least 30 European regions; Innovative solutions to prevent falls and support early diagnosis for older people; Co-operation to help prevent functional decline and frailty, with a particular focus on malnutrition; Spread and promote successful, innovative models for integrated care for chronic diseases amongst older patients, such as through remote monitoring; Improve the uptake of interoperable ICT independent living solutions through global standards to help older people stay independent, mobile and active for longer.