Inside e-health on a life without borders
The European Union is creating a single market in healthcare. The impact will be uncertain and the IT challenges immense, says Jon Hoeksma.
Microsoft’s UK healthcare team held its annual chief information officers’ summit at its headquarters in Thames Valley Park last week. One of the speakers was Chris Evennett from NHS South Central, who mused on some of the challenges that would be facing his strategic health authority over the next few years.
As he said himself, most of these challenges will be familiar; how to cope with a lower financial settlement while delivering on the last of the government’s waiting time business; how to improve health as well as healthcare; and how to make patients partners in that endeavour.
Another of his challenges will be less familiar to many people in the NHS; how to prepare for the new world (or at least the new Europe) in which patients can travel quite freely across European Union borders for support and treatment. “Patients will be able to opt to be treated in any member state if the treatment they are seeking is allowed in their own state.”
The single market comes to healthcare
The issue of cross-border care has fallen off many people’s agendas. There was a lot of interest in the subject a few years ago, when the European Court of Justice made a number of rulings establishing that patients could travel for treatment – and claim back the cost – if they faced unreasonable delays in their own healthcare systems.
Since then, however, the European Commission has put forward proposals that would effectively create a single market in healthcare. Although it expects member states to remain the main providers for their citizens, patients will be able to opt to be treated in any member state if the treatment they are seeking is allowed in their own state. Patients will be expected to pay up front and then claim back the cost.
Portals and patient records
The Commission has put forward proposals for “a directive on the application of patients’ rights to cross border care” – in other words, a set of rules to make it clearer what these are and how they will apply. Among other things, this proposes that member states should set up “national contact points” to explain the system.
In a recent response to the proposals for a directive, the British Medical Association argued that this would be too much of a burden, and that the Commission itself should set up a single information portal for patients. Meanwhile, the doctor’s body is concerned that clinicians are going to lead a lot more information, and IT support, if the new rules are going to work safely and effectively.
The Commission has grand plans in this area. In July, it announced a smart open services (SOS) project involving 12 member states that is intended to pave the way for a pan-European, multi-agency emergency patient record that will link into national pharmacy systems. Eventually, it wants member states to create inter-operable electronic health systems.
However, neither will happen quickly. In the meantime, the BMA wants a system of hand-over notes put in place and for more attention to be given to issues such as standardised coding, so clinicians have a better chance of understanding what is in any notes they get.
“Cross-border healthcare could be another of those ‘disruptive technologies’ with the potential to have a big impact on the NHS.”
Disruptive potential
In itself, the EU’s action will have some interesting effects. Governments may be forced to say what is and is not provided by their healthcare systems – and the cost of treatments in the different baskets may become much more transparent.
What is not known, yet, is how much use patients will make of their new rights. Although it is relatively easy to see that patients in Luxembourg or Belgium might want to travel across their land borders for healthcare, it is harder to imagine a mad rush of English patients heading over the English Channel for operations.
Still, it could happen; particularly if, say, French hospitals have a compelling story to tell on cleanliness or quality (and they want the extra work). Meanwhile, as Mr Evennett recognised, there is no reason at all for some of the new, web-based advice and monitoring services to be used only by the residents of one country.
In principle, therefore, cross-border healthcare could be another of those “disruptive technologies” with the potential to have a big impact on the NHS. However, IT is going to be essential for that impact to be realised. And sorting out the IT is not going to be easy.
In its response to the directive proposals, the BMA also points out that many issues that have proved difficult for individual states to deal with – such as how to structure records and to record and code information – “could be magnified when applied to this scale.” That is putting things mildly.
Jon Hoeksma is a journalist specialising in healthcare and IT. He is co-founder and editor of the E-Health Insider website and also runs its sister portal, E-Health Europe.