Tuesday

12th Nov 2019

Focus

Trust remains key barrier to eHealth

In the not-too-distant future, you may be able to access your own medical records, make an appointment with your doctor, re-order a prescription, track your blood pressure, check test results or receive actual care all electronically.

It's called e-health and EU policy-makers like the idea very much.

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  • The European Commission wants citizens to have online access to their medical health data by 2015 (Photo: surroundsound500)

They say electronic medical records will save time, and help reduce diagnostic or other medical errors. Routine monitoring could be carried out at home while those with rare diseases would not have to travel to be seen by specialists in other regions.

"E-health applications can make it possible that your medical data travels with you or is only one mouse click away from the operating theatre in case of emergency," says EU health commissioner John Dalli.

Pilot e-health programmes within member states are already under way. One in Paris, for example, has linked up a geriatric centre with a university hospital, allowing specialists to interact directly with patients. This means dermatologists can check ailments such as bedsores via videolink while cardiologists can check ECG tests remotely.

In Hull, in the north of England, a tele-health service for heart patients sees them set up with electronic equipment at home once they are discharged from hospital. This allows them to record their weight, blood pressure and pulse as well as any other usual symptoms. The data are then sent via a secure server to a tele-health nurse.

E-health roll-out is happening steadily across all member states. In Sweden, more than 85 percent of all prescriptions are transferred from doctor to pharmacy electronically while in Belgium, plans are underway to use the electronic ID card for all health service and insurance-related identification.

More prosaically, e-health is expected to save money in the long run while helping Europe deal with the societal pressures of an ageing population, requiring frequent healthcare interventions, but not necessarily hospital stays.

"Health systems are under pressure from ageing population, the rising costs of new technology and medicines, heightened patient expectations and global economic challenges. Everybody is looking for solutions," says Dean Westcott, deputy president of ACCA, an accountants association that has been involved in projects evaluating e-health solutions.

We firmly believe eHealth has an important role to play in delivering efficient and effective health care," he said at a recent conference on the issue.

E-health is part of a broader Digital Agenda for the EU. The European Commission wants citizens to have online access to their medical health data by 2015 and is pushing for widespread telemedicine (health and medical care via interactive media) by 2020.

But while e-health is being strongly promoted by Brussels, many questions remain unanswered.

Where is my data?

Among the most important concerns data storage and privacy. If all medical records are available electronically, it raises the question of how secure they are, who has access to them and how a patient gives consent for this access. It is also not clear where or what entity should store the information.

"This [personal] information is highly sensitive," Ophelie Spanneut from the European consumers association, BEUC, says. "What happens if someone has HIV and the employer or insurance company finds out?"

A recent study in the Netherlands indicates the potential problems. It found that 75 percent of hospitals were lax regarding internet security rules.

"In all countries, trust in e-health systems by both citizens and professionals has been identified as one of if not the key challenge. Privacy is recognised as the most sensitive aspect of electronic health record systems," says a report on e-health strategies published in January by the European Commission.

One of the most controversial questions is whether patients should actively give their consent to their e-health records being created or the eHealth records are created automatically unless a patient expressly says otherwise. In Belgium, France, Italy and Spain, patients have to 'opt-in' before their health data may be stored electronically. But in Estonia, Poland, Slovakia and Sweden, the records are created automatically.

There is also the question of whether the data is stored in a centralised system (such as in the Czech Republic and Finland) or decentralised (Belgium and the Netherlands). France, meanwhile, has chosen a third way. It allows patients to choose a data host for their health records.

A hi-tech future for health could also mean a new division in healthcare – with those with technological know-how and access getting better treatment than those without.

"What happens when you're not literate? What happens when you are not able to access the system and access the self-management of care that certain e-health solutions demand of you," asks Monika Kosinska, Secretary General of the European Public Health Alliance.

Patient associations, meanwhile, worry that too much emphasis on technology will mean losing sight of the importance of human contact in healthcare.

Making systems work with one another

The single biggest practical problem is the fact that member states systems are not compatible with one another – they vary not only from member state to member state but also within national borders. In Brussels, for example, it is not possible to electronically transfer patient information from a hospital in the Ixelles part of the city to the Edith Cavell hospital, some 20 minutes away.

Language is a big issue for the electronic exchange of information. In Europe alone, this implies compatibility over 20 languages and three alphabets.

Making systems interoperable also requires both financial investment and a change in culture – from introducing technological solutions and thinking in hospitals to getting them to co-operate with other points in the system such as heath care centres and social services.

The bottom line is money. The potential long term financial benefits of eHealth will need to be offset by investment now – a time of squeezed public financing.

Fabian Zuleeg, chief economist at the European Policy Centre, asks where this investment will come, noting that future funding of health systems is likely to stem much more from the private sector while patients will increasingly be expected to put their hands in their pockets as the line between what is medical intervention, what is a health intervention and what is a lifestyle issue grows increasingly blurred.

"We are already seeing that for certain medical technologies – monitoring technologies for example – it is actually the patient who are purchasing them or paying significant amounts of money for them," he says.

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