21st Nov 2018


Hurdles confront e-health across Europe

  • E-health offers great savings but data protection concerns remain (Photo: European Parliament)

Information technology applied to healthcare – broadly termed e-health – is set to revolutionise patient care and how healthcare systems can be structured and managed. However, different obstacles are standing in the way for Europe to truly embrace the digital reform of its healthcare systems.

Europe's aging population and increase in chronic lifestyle illnesses pose serious challenges and strains to the sustainability of governments' national health and social care systems, which are mostly based on public financing.

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Health expenditure in the European Union is therefore expected to increase from nine percent of the EU gross domestic product at present to around 16 percent by 2020, according to Healthcast 2020.

"The health sector is, however, very information intensive, so advanced information and communication technologies can make healthcare systems more cost-effective, allowing more funds to be spent on healthcare, and less on administering it," states the European Commission.

A recent report by the former Swedish EU presidency estimated that annually 9 million bed-days could be freed up in Europe through the help of computer-based patient records alone, corresponding to a value of nearly €3,7 billion.

Examples of how the application of a broad range of information technologies to healthcare delivery can range from a doctor sending a prescription directly to the pharmacy, speeding up the patients process of obtaining medicine; to a hospital accessing the electronic health record of a new patient from another country; an elderly person sitting in his or her own living room while having a consultation with a doctor via a web-cam; or even a government setting up an information website for the prevention of child obesity.

Barriers to implementing e-health

However, despite the many advances in technology over the last couple of decades, deployment has lagged behind, facing obstacles at different levels in order to fully reach its potential. Legal, political, cultural and market-related factors are in many cases a hurdle for e-health development while, more technically, there is a lack of interoperability between the systems developed for e-health use.

Privacy concerns related to e-health is another barrier for European countries where the protection of privacy is quintessential. Last month, Germany decided to put the roll-out of Germany's national e-health smart card on hold due to concerns of security and confidentiality.

The German smart card project is one of the largest in Europe and intends to eventually provide every German citizen with an electronic card carrying their health data, medical history, prescriptions, and insurance status.

Public attitudes towards e-health can also be a blocking factor, argues the European Health Telematics Association (EHTEL). "We are close to having the technology we need, including interoperability of information and the systems that share it, but we are not yet there in terms of cultural change of mentality, nor the flexibility to collaborate and share among actors."

The association recommends that innovation in the sector should be encouraged and rewarded in order for e-health to become a much more common community care model over the next decade.

Risk management expert Barbara Daskala from the European Network and Information Security Agency (ENISA), has pointed out though that that there is a benefit in e-health being deployed slowly across Europe. Slow progress would allow for alerts about possible risks and concern, such as privacy and data protection.

"E-health services have a lot to offer of important benefits for citizens and society in general, there is no doubt about that. However, it is still a controversial area in the sense that it may also pose many important risks that need to be addressed, preferably before its massive deployment."

"We wouldn't want as a society to solve some problems, while at the same time creating others, perhaps of equal importance and gravity," Ms Daskala said last year.

EU health ministers meeting last December called on member states to boost initiatives enabling the deployment and use of e-health services as the central means to enhance quality, access and safety in healthcare. Member states must "build confidence in and acceptance of eHealth services..., bring legal clarity and ensure the protection of the data..., solve technical issues and facilitate the market development."

The ministers also called on the European Commission to update the European Action Plan on e-health, as well as strengthen and increase e-health activities across the 27-member bloc.

Healthcare is national politics

Under the EU's subsidiarity principle, health and healthcare systems remain the responsibility of member state governments. However, the European Commission has an indirect impact, as it is involved with the market growing activities connected to e-health.

"As leaders in developing e-health, European enterprises are in a strong position in the world marketplace, and the European Union aims to encourage them to build on their efforts," argues the European Commission.

The EU has in total contributed more than €500 million of research funding to the development of e-health tools and systems since the early 1990s. EU-supported projects have helped place Europe in a world-leading position in the use of regional health networks, electronic health records in primary care and deployment of smart cards, in particular, according to the European Commission.

The e-health market is currently around two percent of total healthcare spending in Europe, but has the potential to more than the double of that almost meeting the market for medical devices or half of the pharmaceutical market.

According to the World Health Organisation (WHO), e-health is one of the most rapidly growing areas in the health sector at the moment and the UN organisation argues that e-health should be an essential component of any plans and strategies for health system reform in the 21st century.

Financial troubles

Despite the economic strains on EU governments at the moment, due to the world financial crisis, some argue that e-health is one of many opportunities out of financial troubles and can help accelerate the reaching of a European knowledge-based economy.

US President Barack Obama's administration has promised to spend billions of dollars on getting electronic medical records to US patients within five years, firstly as part of the Obama's battle to reform US healthcare and secondly as part of the north American country's economic recovery plan.

"With similar commitment in Europe and ongoing support from stakeholders, e-health can deliver growth and jobs in a European Health Market based on ICT and bring the quality and safety of healthcare that patients and medical practitioners want to experience," stated former commissioner for information society Viviane Reding last year.

"The recent financial crisis has not made the challenge of sustainable healthcare any less significant. On the contrary, the long-term economic benefits that e-health can provide have been brought into sharper focus," she continued.

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