Inside e-health from inside World of Health IT

Governments across the developed world are starting to speak a common e-health language of standards and interoperability. But should governments or industry set the standards? And where do customers and users fit? Jon Hoeksma reports from the World of Health IT conference in Copenhagen.

Governments across the industrialised world recognise that good quality IT and information are pre-requisites for the modern, personalised health services that are being demanded by their citizens and which need to be delivered by locally based, multi-disciplinary teams. 

Yet they also know there is a lot to do. A November ranking of European healthcare systems found few are making widespread use of electronic patient records or e-prescribing. Scandinavia and the UK led the way, but even they have a long way to go.

In many respects, Europe is ahead of the US, where the use of electronic records in primary care remains stubbornly low. Outside tightly integrated healthcare systems like Kaiser Permamante and the Veteran’s Association the picture is highly fragmented.

Yet the challenges that Europe and the US face are almost identical: market fragmentation, low historic levels of investment, archaic reimbursement models and laws and regulations that can act as barriers to the take-up of IM&T. 

Wonderful, wonderful WoHIT

The scale of the challenge was set out in Copenhagen earlier this month (November 2008), when e-health leaders from Europe and America met for the World of Health IT (WoHIT) conference and exhibition.

Primarily an industry event, with few users around, speakers once aain spelled out why e-health matters.  A recurring theme for the politicians was that there is no alternative. Consumer demands aside, Western healthcare systems will not be able to meet the extra demands of their ageing populations without much better use of information technology, particulaly to treat chronic conditions.

In the US, the thrust from policymakers in recent years has been towards creating standards and a legal framework that will allow a market to develop and the costs of e-health to fall. Introperability is the watchword.

In Europe, e-health is a priority for the European Commission, which sees it as future growth market that Europe can lead in. Speaking in Copenhagen, European Commissioner Vivienne Redding said: “E-health has the potential to become the third largest part of the healthcare industry after staff and drugs.”  The benefit to citizens meanwhile will be “to allow us all to lead longer and healthier lives.”

To try and realise the potential benefits, the Commission has been working to reduce market fragmentation and promote the use of telemedicine.  Over the past decade, it has invested over one billion euros in funding e-health research programmes, promoting interoperability and standards-based approaches. 

“Our first goal is to get rid of fragmentation,” said Redding, who also stressed that the Commission was focusing its efforts on standards, interoperability and enabling cross-border patient records. In other words, the US and European approaches look increasingly similar. And Redding confirmed: “International co-operation, including with the US, will continue to be expanded.”

Setting standards

This makes sense from an industry perspective. Very few healthcare organisations can afford the costs associated with a big, highly tailored IT implementation that, for a major hospital, can run into many tens of millions of pounds, euros or dollars.  

This means that shifting to common standards and promoting the use of re-usable health IT components and services are now seen as key to making e-health usage far more widespread across healthcare systems around the globe. An outstanding issue, however, is who should be setting the standards. One of the themes at WoHIT was whether supranational and national governmental efforts are likely to have more impact than industry efforts – or vice versa.

Both the European Commission and the US government are investing in initiatives to accredit and certify electronic patient record systems. Arguably, however, it is from industry that the greatest progress on the use of standards is being seen.
In particular the Continua Alliance, which aims to make devices interoperable, and the Integrating the Healthcare Enterprise, which promotes imaging, messaging and data sharing standards, are gaining momentum.    

Learning from the leaders

The WoHIT conference gave Denmark, the host country, the chance to show off its e-health credentials.  Denmark is generally recognised as Europe’s leading exponent of e-health, with its MedCom patient portal the winner of numerous accolades.

How does it feel to be Europe’s e-health leader? According to the Danish Health minister, Jacob Nielsen, pretty good.  He told delegates that Denmark had built success from the ground up, working with healthcare professionals, citizens, trade unions and councils.  Even so, the minister said: “It is a constant challenge to ensure all the players are all pointing in the same direction.”

Builing on the success of MedCom, Denmark is now working towards a national medication record and widespread introduction of telemedicine.  

So what is the secret to e-health success? According to Dr Karl Stroetman, head of research firm empirica, a few simple rules can make a huge difference.  “You should have a vision, but don’t be too rigid; be pragmatic; be prepared to fail initially.”  He also advised that clinical leadership was essential: “If you don’t have it, forget it. Don’t even start.”