OECD countries need ehealth to reform

The vision of eHealth records being accessible in different European Union countries and beyond is now being looked at by many different countries, according to the OECD’s Martine Durand.

Speaking at the recent Berlin E-health conference she said "All OECD countries are facing challenges meeting the pressures in their healthcare systems. They are all struggling with questions of affordability, sustainability and efficiency."

She illustrated the point but citing the growth in healthcare expenditure in the G7 countries from 5% of GDP in the 1970s to 9% today, and even higher in the US.

Rising costs are in part coming from ageing populations and the rapid rise in chronic conditions – such as asthma, diabetes and coronary heart disease – which now account for the majority of healthcare expenditure, she said.

Durand said a 2005 study on the health status of people over 55 found that two thirds had one or more chronic diseases requiring long-term care. While a Canadian study had found 67% of healthcare costs could be attributed to chronic conditions.

These pressures on demand and costs were forcing reform of healthcare systems. She said that healthcare was an industry that needed to change and overcome their current high degree of fragmentation. "OECD healthcare systems remain, to an unbelieveable extent, cottage industries."

The other huge driver to ehealth across OECD countries was patient safety, Durand pointed out that it was five years since the US Institute of Medicine’s landmark study had been published which found there were 44,000-90,000 deaths in the US each year resulting from medical errors.

Durand said that government’s look for ways to improve the performance and value of money of healthcare systems they must create policies, laws and conditions that support ehealth. This was particularly important in European countries where the government often was the major funder and sometimes provider of healthcare.

She said the rise of the connected information society, with over 2bn people globally having internet connections in 2005 helped create an unstoppable momentum. "This means that eHealth has become inevitable due to the build up of capacity in the ICT industry over the past 30 years."

Crucially, she said that the ICT sector continued to be one of the engines of growth of the international economy, growing at 6% in 2006.

"We must ensure that today’s efforts are supported and nurtured," said Durand. "The take up of ehealth is still limited compared to other industries and services in OECD countries."

She said that the questions policy makers struggled with were "how do we implement it?" and "how best to do it". Fortunately Durand said the answers were now emerging due to the efforts of pioneer healthcare systems.

"There is a real world laboratory out there today – national strategies are emerging and being implemented. The UK launched the NHS National Programme for IT in 2002. In Canada Health Infoway was launched in 2001. And Australia has launched a national eHealth Transitional Authority."

Durand said that although the pace of uptake varied the transition to eHealth was already happening.

She said though that ehealth represented a set of tools that policy makers, industry and healthcare professionals needed to prioritise and use carefully. "IT is not a magic bullet to solve of the problems of a healthcare system." She said it must be combined with other changes and policies such as funding and clinician reimbursement policies"

The OECD executive said that as funders, governments can have enormous leverage. "They can strongly influence how healthcare professionals provide healthcare services."

In particular she highlighted the introduction of the Quality and Outcomes Framework (QoF) in the UK and Pay for Performance in the US as examples of payment policies introduced by governments that can help spur the collection and use of electronic systems and data.

One of the challenges about developing and implanting an ehealth strategy Durand said was how to measure success. "What sort of metrics should be developed to measure benefits? Should they be about cost savings or quality impact?"

She added: "What role should government’s play to ensure lessons to ensure lessons learned are shared?" One of the key roles they must play she argued is to ensure co-ordination, interoperability and set clear standards for electronic health record issues.

"Information systems must be able to exchange information across different settings. Linkages remain a serious problem," said Durand. Part of the problem she said was that the benefits of interoperability "are highly dispersed."

The OECD exec said the drive to interoperability must come from within healthcare systems themselves, "suppliers will deliver what customers want but will not get too far ahead of them."

To help member governments co-ordinate policy and share best practice on ehealth the OECD has now established a dedicated work programme.