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Clayton Hamilton, e-Health and Innovation unit leader at the World Health Organization’s Regional Office for Europe, considers the potential of e-health and its impact in the WHO European Region

As a domain, e-health has been steadily growing in importance for the WHO Regional Office for Europe as well as its Member States over the past five years. The impact of e-health has become increasingly significant to policy makers in terms of universal health coverage, democratising knowledge for professionals and patients, overcoming barriers, be they geographical or financial – the list is long. Having reached this point, collaborators in public health and policy makers were looking to WHO for guidance on the best way forward. It was time to take stock, and so the e-health team at the Regional Office in Copenhagen, Denmark, embarked upon producing the most comprehensive report to date on measuring the public health impact of e-health in the 53 countries that make up the WHO European Region, culminating in the report ‘From Innovation to Implementation: eHealth in the WHO European Region’, which was released in March 2016.

Based on the WHO Global eHealth Survey conducted in 2015, the focus of the survey and the regional report was to measure the impact that e-health is having in terms of achieving ‘universal health coverage’ – a fundamental public health mechanism to which, in 2005, all WHO Member States committed to achieving for the improvement of health, wellbeing, and for promoting human development.

Universal health coverage is the expression of the belief that all people should have access to the health services they need without risk of financial ruin or impoverishment and is usually depicted in three dimensions: the scope of national health services offered to individuals; the population groups covered by such services; and the proportion of direct costs paid in order to receive these services (out-of-pocket expenses). By examining health in this way, we are able to better quantify and measure the impact of the tools available to policy makers to influence the health of populations. This powerful concept also forms the heart of the WHO European policy framework, Health 2020, which aims to improve the health and wellbeing of populations, reduce health inequalities, strengthen public health, and ensure people-centred health systems are universal, equitable, sustainable and of high quality. It is no surprise that e-health, in this context, is now seen as a key driver of innovation in enabling effective health service delivery and health information accessibility by widening the population base capable of accessing the available health services and fostering innovation and efficiency gains in the provision of healthcare.

Key findings of the report

Firstly, there is a notable transition of e-health at the national level to a subject of strategic importance for health policy makers. In the same way that health data is beginning to be viewed as an asset class in its own right, the survey data revealed that e-health has become a recognised asset for governments to extend the scope, transparency and accessibility of health services to citizens. This is quite a significant shift in understanding and recognition of the value of applying technology to the health sector, and one that is very much welcome. There is also acknowledgement that e-health has a key catalytic function in reforming the national health information landscape, which in many countries is plagued with inefficiency and legacy approaches to information management. This has particular relevance to Europe where there has been significant investments by the European Commission over a long period for developing cross-border interoperability of health information – essentially enabling European Union citizens to receive the same level of services and access to their personal health information in any EU country just as they would in their own.

Maturity

Secondly, countries are becoming better equipped to deal with the degree of change that is required to ensure successful adoption of e-health and, most importantly, that it requires far more than technology acquisition alone. Better understanding of the holistic and integrated requirements of change to organisational processes and structures, roles, standards, legislation as well as considerations for human resources, education, literacy, reimbursement, and cultural contexts of health is being seen.

Significant lessons have been learnt by countries from past technology implementations that have failed to address one or several of these factors. ‘Throwing good technology at bad processes in healthcare can only result in bad healthcare’ is the mantra frequently heard within the international e-health community. There is also a maturing approach to risk management in national e-health projects that has not been seen in the past which is, again, evidence of the value of lessons being learnt – often the hard way. While this picture of maturity obviously differs widely between European countries, in composition and according to national priorities, it is becoming more homogenous as a set of factors for health policy makers to address.

Thirdly, it is being more widely acknowledged that creating effective healthcare on a national scale involves taking an intersectoral approach to delivery. That is, significant and sustainable progress in creating integrated, people-centric health systems, enabled by e-health, is best achieved when health permeates, and is embraced across, the portfolio of both government and society.

Funding

Finally, funding, over any other aspect, is now reported across all surveyed areas of e-health as the biggest barrier to adoption. This change is likely to be indicative of the tail-end effect of the global financial crisis on health systems but also indicates maturity within national e-health implementations in that countries have made efforts to address legislation, privacy and security concerns.

While there is still some way to go in having supportive legal frameworks for health information technology that both protect the individual and enable innovation, these barriers are reported as less important in impeding national progress in e-health adoption than issues of obtaining the necessary investment capital and ongoing financial sustainability.

The ultimate beneficiary in each of these scenarios is of course the individual who is increasingly empowered with a choice of options for managing their own health and through increased accessibility to their own health information.

Education

With the increasing range of possibilities for individuals to manage their own health, there is an undeniable need for an increased focus by governments on digital and health literacy. To leverage these possibilities, individuals need to understand both the methods and techniques of accessing and applying information related to their health and the language that underpins it.

Consumers need to be sufficiently educated to understand where they are sourcing their health information and be confident as to its reliability, its applicability, and the risks and impacts involved in acting on that information. We are only beginning to see some structured efforts for improving literacy; however, given the pace at which health systems are transforming, if governments and civil society fail to act, we risk increasing the equity divide and marginalising the digitally illiterate.

Promising aspects and potential growth areas

The report highlights that telehealth has undeniably become one of the largest areas of growth in healthcare delivery in the WHO European Region, though more evaluation and evidence on economic benefits and cost-effectiveness are still needed. That said, there are already many successful examples of telehealth operating in the European Region with teleradiology, remote care and remote patient monitoring being the most prolific services implemented to date. Telepsychiatry too has shown a significant increase in the rate of adoption in the recent past. As life expectancy in Europe is increasing, empowering individuals through telehealth to maintain their lifestyle of choice, to manage acute and chronic illness, and to promote active and healthy ageing will be a crucial factor in ensuring the sustainability of health systems.

Mobile health (m-health) is another major growth area in Europe. Advances in mobile technologies and a maturing market of health-related apps and wearable technologies are contributing to an increase in m-health use and its integration into other e-health services. M-health is viewed as a key conduit to facilitating patients’ engagement in their own healthcare in addition to being a key enabler for the provision of remote care services and health promotion activities. Perhaps surprisingly, given the rapid growth and business potential for m-health, very few countries in Europe have an entity that is responsible for the regulatory oversight of m-health apps for quality, safety and reliability, and only a fraction report any formal evaluation of government-sponsored m-health programmes.

We are also likely to see continued growth in the use of health analytics and Big Data in healthcare in the coming years as these areas mature and the skills required to leverage them become more widespread. The role of analytics in defining evidence-based health policy is a particularly exciting area, as it has the potential to drive badly needed reform in national health information systems and provide policy makers with a solid body of evidence from which to define more discrete and targeted interventions.

What’s next?

In the European Region, WHO is firmly committed to achieving the objectives set out by Health 2020 for strengthening people-centred health systems and building capacity for an evidence-based approach to policy making. We are seeing e-health unite services and information in ways that are revolutionising our understanding of the role of public health and the WHO’s strategic position in supporting Member States. This will mean that we have to be increasingly agile, not only in facilitating the transition to modern and adaptive health systems but also in understanding how to best implement technology within health on a large scale, with all of the risks and benefits that such change can bring.

We must never lose site of the goal of enabling the individual to actively participate in the management of his or her own health and wellbeing, and the way in which countries view the changing role of health information in this respect will be pivotal.

WHO is resolute in the ability of e-health to support the transformation of European health – and health information systems – and will continue to tirelessly pursue its mandate of assisting Member States to deliver more equitable, accessible and affordable healthcare for all.

Clayton Hamilton

Unit Leader, E-health and Innovation

WHO Regional Office for Europe

http://www.euro.who.int/en/health-topics/Health-systems/e-health

This article first appeared in issue 19 of Pan European Networks: Science and Technology.