Over to EU

Mike Palmer

Mike Palmer, a project officer in the ICT for Health Unit of the Commission’s Information Society and Media Directorate-General in Brussels, will be speaking at E-Health Insider Live ’09.

He tells Lyn Whitfield that this is not the moment for Europe’s hard pressed economies to stop investing in e-health and outlines the role that the EU can play in promoting it.

The major economies of Europe have been badly affected by the financial crisis and subsequent recession. Germany saw its GDP fall by 2.1% in the last quarter of 2008 alone, while the UK’s economy contracted by 1.5% and France’s by 1.2%.

Smaller economies have been even worse hit, with some announcing plans for immediate reductions in public spending in response. Yet the European Commission is arguing that this is precisely the wrong moment to stop investment in e-health and other measures to tackle the impact of the continent’s rapidly ageing population.

“We are saying that the crisis does not change the challenge of creating sustainable healthcare,” says Mike Palmer, a project officer in the ICT for Health Unit of the Commission’s Information Society and Media Directorate-General in Brussels.

“We still need to reap the benefits of e-health. In fact, in some ways, the crisis underlines that we need the efficiency and economic benefits that e-health can deliver.”

Palmer points out that in the recession of the early 1990s, Finland developed a mobile phone network that made Nokia a world leader. With a huge ‘silver market’ of over 65s now being created, “e-health could be our next big thing.”

Patience is a virtue in e-health

Palmer is responsible for innovation policy within the ICT for Health Unit, for e-health market issues and for co-coordinating the activities of EU member state e-health representatives. This means he spends his time dealing with the EU’s complex politics, structures and resulting acronyms.

Yet he identifies some ‘big picture’ issues that will need to be addressed if Europe is to create a beneficial market in e-health systems. For a start, he says, more clinicians and patients need to be involved to create support and demand. And there needs to be a much more visible evidence base.

“Ministers sometimes have a short life-span,” Palmer points out. “We did a study called ‘eHealth is worth it’, which showed that e-health does have benefits, but it takes patience to achieve them. Understandably, many ministers don’t have that patience at the moment.”

‘eHealth is worth it’ focused on ten European sites, starting with NHS Direct in England and a Belgian vaccination service, and eventually covering electronic medical record, e-prescribing, workflow and supply chain management projects.

On all ten sites, investment in IT improved the timeliness, efficiency and effectiveness of services. But it took from two to eight years for the economic benefits to be felt – and when they were, they were fairly evenly divided between healthcare providers and users.

Addressing pilot-itis

One result of the mismatch between the time that ministers spend in office and the time it takes to see the benefit of investment is ‘pilot-itis’ (it is always easier to start something small than to risk something big, especially if you know that your successor will gain from any benefits).

The Commission is trying to address pilot mentality through its Competitiveness and Innovation Framework Programme (CIP), which promotes innovation and provides access to funding and support for small and medium sized enterprises.

ICT is one of the CIP’s three strands, within which ‘more efficient and effective services in areas of public interest’ and ‘improving of quality of life’ are explicit aims.

As part of CIP, the Commission has also provided €11m of funding for the Smart Open Services for European Patients (epSOS) project, which is working on the implementation of electronic health records and e-prescribing across 12 member states.

“EpSOS is going through different scenarios – for example, travellers falling sick while abroad – to show how record sharing and e-prescribing could work for them,” Palmer says. “It is also working on ironing out some legal issues, for example around data sharing and clinician liability.”

A network of member state and stakeholders representatives known as Calliope is working closely with the project, to provide input on the design and deployment of services.

Making markets

Under the EU’s principle of ‘subsidiarity’, health and healthcare systems remain the responsibility of member state governments. As a result, the impact of ‘Europe’ tends to be indirect. Indeed, it is most pronounced when it is involved in market growing activities.

For example, Palmer points out that when the E-Commerce Directive came out in 2000 it had a significant impact on telemedicine; even if few clinicians think of telemedicine as a commercial activity.

Another good example is the Lead Market Initiative, which was proposed by Finland to drive growth while addressing environmental, economic and social changes well before the present crisis hit. The LMI identified six sectors in which policy was needed to create more favourable market conditions, of which e-health was one.

A two year, interim report on the LMI has just been published, which shows that most of the e-health activities that were planned are underway. For example, the Commission issued a ‘recommendation on interoperability’ last year that advises member states on how to address the interoperability of electronic health records (and also supports the EU’s proposed directive on patient rights to cross-border care).

Projects are also being run to exchange best practice between member states and to create a procurement network. EpSOS is now seen as complimentary to this work. Unfortunately, the review says it is too early to say whether the LMI has had any impact, but Palmer says it will be evaluated in 2011 and stakeholders are “pushing hard” to see it used effectively.

Over there

The Commission also has a role in promoting research and development. As part of its seventh framework programme (FP7) it is investing alongside private partners in three e-health areas: personal health systems; patient safety; and “the virtual physiological human” – a project to model organs and systems.

And, of course, the EU has an impact on member states through its legislative and leadership functions. The EU’s rotating presidency is currently held by Sweden, which is widely seen as a leader in e-health as a result of its ambitious summary care record project and other initiatives.

Palmer says the Swedes have been very active in raising awareness of the opportunities offered by e-health. The presidency presented an ‘eHealth for a Healthier Europe’ report to an informal meeting of health ministers in Jönköping on 6 and 7 July.

The report outlines how political goals for healthcare can be realised through e-health investments, and confirms the findings of EU-funded studies on eHealth IMPACT. The Swedish presidency is also proposing EU Council Conclusions on e-health, pointing to specific areas in which member state cooperation is important and requesting EC support for such cooperation.

The next EU Presidency, Spain, is also making ambitious plans to hold the largest ever European eHealth conference, in Barcelona in March 2009.

Yet the EU and its institutions remain poorly understood in the UK. And there is still a tendency for English policy makers and managers to look across the Atlantic rather than the English Channel for ideas.

President Barack Obama’s battles to reform US healthcare have received rather more attention in the English press than the EU’s attempts to open up a single healthcare market for professionals and patients.

The Obama administration is also promising to spend billions of dollars on getting electronic medical records to US patients within five years. So could Europe’s widely perceived lead on e-health pass back to the US?

Palmer sees recent developments more as an opportunity. “E-health companies in the EU are more developed than those in the US, so if the US wants to develop these systems there is an opportunity for EU companies – including US companies that have developed their products and workforces here,” he says.

“The most important thing is that change in the US can encourage the UK and the EU as a whole to accelerate its e-health programmes. Obama wants EMRs in just five years. The EU has been working on its roadmaps for longer than that. There’s a lot to learn on both sides.”

Link

ICT for Health Unit