21.08.2017 | Brussels Background eHealth –A real opportunity for our healthcare systems or a hopeless vision?

Although healthcare systems across Europe are increasingly struggling with many challenges, reforming the system has never been a game changer in any election campaign. EHealth seems to be a buzzword that may solve many existing challenges and therefore is seen in many election manifestos. Both candidates during the French elections, for instance promoted eHealth as a decisive tool to improve the health of elderly people. Not only in France, but also in Germany and the rest of the EU the concept of eHealth is constantly in the news, lately very popularly during last Month´s eHealth week in Malta organised under the Maltese Council presidency. Many things are happening around eHealth even at EU level. Since its first Action Plan in 2004 that was followed by a new Action Plan 2012-2020, the European Commission marked the importance of eHealth as a major tool for improving EU citizens’ health and well-being. In its newly released mid-term review of the Digital Single Market, the Commission, once again, emphasised the importance of fostering eHealth strategies in the near future. But why? Is eHealth really the solution to all our problems or do we simply overestimate its benefits?

We do face plenty of issues when it comes to ensuring that the health care system we have today will still be a working system tomorrow. Shortages of healthcare professionals, efficiency concerns and an ageing society are a couple of the big challenges to which eHealth seems to be a good solution.

Especially, the ageing society is a major challenge. Although the quantity of our life span has gone up, apparently the quality of our life hasn’t which means that we face longer but not necessarily healthier lives (more information here). Further to this, chronic diseases and multimorbidity increased as well. All of these factors contribute to increasing costs for all health care systems across the EU. For policy makers and politicians eHealth is the praised solution. But how much have they done to facilitate access to eHealth tools and provide opportunities for research & development as well as increase investment in promising initiatives?  

One example for a promising eHealth related project is developing the possibility of cross-border usable electronic health records. Since it is one of the “four freedoms” to choose your country of residence within the European Union, it should be a given that if you live in another Member State, you should also be able to receive medical treatment as easily as possible. A first step in the right direction was definitely Directive 2011/24/EU which aims at promoting patients’ rights in cross-border healthcare. The directive also has its own article on eHealth and sets up a voluntary eHealth network which is supposed to support Member States in achieving their eHealth goals. What have been the great achievements of this work so far? The goal was a functioning cross border informational system by 2020. Three years before the end of the deadline this seems all but very likely. Interoperability problems between and within countries do persist and don´t seem to be solved any time soon. Problem solving for questions of data privacy and security is only developing slowly with no practical solutions in sight.

The European Union has recognised the general problems and does show the will to improve the area of eHealth. However, there is more that needs to be done. We want more passion, effort and determination to build a solid and predictable legal framework, both on European and national level. After all, healthcare systems are subject to the competence of Member States. So what about Germany?

Germany had some ideas at least: Back in January 2004, articles 291 a, b were added to the German Social Code (SGB V) and with this the idea of the electronic health insurance card (elektronische Gesundheitskarte) was born. These articles mainly function as a roadmap for the implementation of the new electronic health insurance card and for the infrastructure (gematik) hosting it. The principle of the electronic card is genius – it could save all patient relevant data, from a medication plan to electronic health records that could be transferred from one healthcare professional treating the patient to another, facilitating the lives of millions of patients and healthcare professionals at the same time. But then again, all of this was planned to be fully achieved and implemented in January of 2006. This is just one example where the potential of a good idea has not been seized to the fullest. Health related data needs an adequate and clear protection framework. Policy makers and politicians in Germany as well as in Europe could do a lot more on that end, if they want eHealth and electronic patient records to be fit for purpose in the future. In the case of Germany there is however a silver lining: In January 2016 the so-called eHealth-law entered into force, which establishes concrete deliverables and deadlines as e.g. the mandatory introduction of electronic health records until the 31st December 2018. 15 years to realise a small part of this project by then – up to you to decide whether this was fast or not.

Even for the pharmaceutical industry and its changing business models, e-Health provides opportunities for growth. It would allow transcending from manufacturing pharmaceuticals to provide tailored services to patients from one single provider. Especially, in niche categories of diseases, pharmaceutical companies could provide electronic medication plans and an online platform of patients in addition to its life-saving treatment. But also for chronic conditions, such as diabetes, eHealth holds opportunities e.g. paired devices that are capable of measuring blood glucose levels regularly and administer insulin when it is needed. Both the pharmaceutical industry and medtech companies are exploring the collaboration opportunities with IT-players actively to provide the best, personalised treatment for patients. These developments should not be slowed down by political discussions and a lack of courage to tackle the big questions around use and storage of health related data while sufficiently protecting patient’s privacy.

We will see what the future holds. Whether all the visons will be realised fully in a few years from now or there are more delays to be expected. But one thing is clear: we need to work hard to seize the benefits that eHealth has to offer or otherwise it will always stay a cute vision for the future but nothing more.