Dawn of the e-health era

24 October 2012

Pascal Garel, Chief Executive of the European Hospital and Healthcare Federation, charts the opportunities and difficulties in implementing telemedicine services across Europe…

Healthcare services are facing numerous challenges; the financial and economic crisis adding new worries to the existing ones. In this context, information and communication technologies are creating high expectations. Can they really contribute significantly to keeping the quality of healthcare at its present level or even further improving it?

Telemedicine is one of those concepts becoming increas­ingly broadly-defined as it encompasses an ever-widening range of activities, including: telemonitoring, telecon­sultation, teleradiology, teleophtalmology, telesurgery or teledermatology. It more generally covers the provision of healthcare services through the use of ICT in situations where the health professional and the patient, or several health professionals, are not in the same location.

There are clear signs that e-health technologies are effective in specific areas. It seems to improve access to care for patients living in remote or sparsely populated areas affected by shortages of specialised healthcare professionals.

Telemonitoring is said to improve the quality of life of chronically ill patients through self-management solutions and remote monitoring from home, reducing hospitalisation costs and saving on unnecessary emergency visits. Teleradiology and teleconsultation are supposed to help shorten waiting times and optimise the use of available resources.

Nevertheless, the use of telemedicine in everyday practice is still relatively low. Why is this? The notion that e-health is merely about technological intervention has certainly contributed to scepticism. Design of device-based applications, of stand-alone devices, limited education and training, and ignorance of the complexity of ward reality are said to be among the main reasons for failure, together with the lack of incentives in reimbursement and patient engagement.

Regardless, the European Commission considers telemedicine a potential major contributor to the European economy. Indeed the global market for e-health is estimated to have a potential value of €60bn, of which Europe represents one-third. e-Health is considered the third largest health industry, after pharmaceuticals and medical devices. The combined global value of the telehome and telehospital markets in 2011 was estimated at around €9bn, which should climb to €20bn in 2016, according to a BCC Research study of March 2012.

It's no surprise, therefore, that a Digital Agenda for Europe has set out as a priority the widespread deployment of telemedicine services by 2020, with a notable foe to overcome having been easily identified – the lack of legal clarity.

Since member states are primarily responsible for the organisation, financing and delivery of healthcare, the European Commission has had to navigate the fragmented legal rules across these countries in order to make the treaty, directives and regulations governing the provision of telemedicine services throughout Europe more universal. The most significant way that the Commission has been able to achieve this is in Directive 2011/24/EU on the application of patients' rights in cross-border healthcare, due to enter into force by 25th October 2013, codifying the European Court of Justice jurisprudence on EU patients' rights to be reimbursed for medical treatment in other EU member states, including through telemedicine.

However, whatever the level – national or European – little attention has been paid to ways to engage with professionals before and during the implementation of e-health services. e-Health affects professionals' current responsibilities and innovation threatens conventional roles and power structures. Lacking comprehensive and rigorous empirical evidence of measurable social and economic benefits, e-health services would benefit from more transparency on the impact of daily clinical practice and interactions.

An additional challenge is scalability. Pilot projects have generally been successful. In many cases, however, they resulted in costly and inefficient programmes when taken to scale. Will there be sufficient sustainable financing and business models that can help attract the necessary capital for scaling-up projects?