Courage to build

Jon Hoeksma

IT industry leaders have called on European politicians to demonstrate ‘courage’ and provide clear leadership to enable the creation of a single ‘interoperable’ European market for health IT. Such a move would drive down costs, improve quality and enable more patients to benefit from e-health, they say.

A panel of senior industry executives from some of the leading firms involved in European health IT, meeting at the E-Health 2006 High Level Conference in Malaga, Spain, identified key barriers to growth and wider adoption of e-health. They stressed that the European market was currently far too fragmented, lacked common standards and does not have sufficient clear political support.

Fragmentation

Dr Volker Wetekam, president of global solutions at Siemens Medical Solutions Health Services, spelt out the problem of fragmentation: “None of us are interested in developing e-health solutions for just a dedicated country. We are interested in scale effects in both qualitative and financial terms.”

Dr Weketam said that the industry was sure of the benefits of interoperability and that all of the main industry players in Germany were now voluntarily collaborating.

The point was taken up by Tim Whiston, chief executive of iSoft, who said: “Investment in e-health tools to date has been very fragmented and parochial – specific to a particular market.”

Whiston added: “Because of the fragmentation of the market there has been a focus on the richness of e-health tools. While not giving up on the functional richness of tools we have to focus on using technology for interoperability.” Only by doing this would health organisations be enabled to better “share information and schedule resources”.

Whiston also said that a trade-off has to be made between breadth and depth of clinical richness in records. “We will have to sacrifice the idea of rich deep longitudinal records available across multiple jurisdictions.” He added: “One of the things we see as key is to have experience across a range of jurisdictions.”

Building political will

Charles Scatchard, vice president Global Health Sciences, Oracle, said barriers to e-health adoption included "a lack of central political will”, “lack of continuous funding” and “a lack of consolidation and funding when it comes to procurements”.

Scatchard said one of the things industry needed to do “was help build political will”, by highlighting key international developments such as the national programme for IT in England.

He added: "Governments have an important role to play to remove regulatory and legal barriers."

Several executives highlighted the critical role that standards can play in triggering other key industries such as mobile phones, where Europe’s adoption of the GSM standard has led to huge market growth and helped European firms become global leaders.

Gottfried Dutiné, executive vice president of Royal Philips Electronics, said that the US was currently further ahead on industry standards for e-health, particularly due to IHE (Integrating the Healthcare Exchange).

Dutiné urged European politicians to act on standards. "The EU should take a fresh look at standardising electronic health records (EHRs)".

Gordon Graylish, EMEA director of communication business organisation at Intel, argued that the key to progress on standards was to "start with what we can agree on today" which he said would cover "90% of what was needed".

Is healthcare unique?

Graylish argued that while healthcare had some particular needs they were not so fundamentally different to other sectors: "Other industries absolutely have the same requirement for robustness as healthcare. Vodafone’s billing system, for instance, is essential to them. If it’s down it costs them millions and millions of dollars a minute. It’s not a life, but to the chairman of Vodafone it comes close."

Juergen Reyinger, general manager (EMEA) of GE Healthcare Information Management Technologies, said that while analogies with other industries they only go so far. "A big difference is that e-health deals with patients and patients are not machines.”

“I would like to see more discussion focus on clinical deaths and outcomes rather than costs and who has the cheapest system, it’s about clinically deep solutions.”

Philippe Houssiau, president of the healthcare business group, and a member of the board of management at Agfa-Gevaert, said the healthcare industry remained a slow adopter of IT. "Healthcare is not taking advantage of e-health, it is still very administrative in its focus."

He added that the patient was still not the focus of systems and information flows. "The capacity to deal with data generated is still not explicit at the level of individual patients." The other key challenge, said Houissea, is to "improve productivity and throughput in hospital."

The next big challenge, he added, was "at the level of integrated advice and clinical systems."

Demonstrate benefits

The panel members stressed that key to galvanising political leadership and accelerating adoption will be to clearly demonstrate the benefits of ehealth, in terms of cost efficiency and productivity and in terms of improved patient care and new models of service delivery.

Siemens’ Dr Weketam told delegates: “Our efforts should be to quantify the benefits coming out of large regional ehealth projects.” He stressed that very significant cost and quality of care benefits can be identified.

“We expect savings of €25bn to €26bn from the German national e-health project once it is fully implemented.” Dr Weketam added that the US is similarly projecting that huge cost savings can be achieved by digitising its still largely paper-based healthcare system over the next ten years.

Jeffrey Miller, world-wide vice president for health and life sciences at Hewlett Packard, drew direct comparisons between health and the banking sector, stating that “e-health is transformational as it impacts behaviours and processes”.

He added that it will be a long haul to realise the full potential of ehealth, with the actors, agencies and institutions involved moving at very different rates. Despite the world of industry beginning to move to e-procurement 20 years ago, with all the benefits it offers in cost savings, he said it was still far from ubiquitous with a lot of paper around.

Intel’s Graylish added that so far the healthcare sector had been a slow adopter of information technology, but the advent of very small, powerful, cheap and wirelessly connected computing devices promised to transform the way healthcare is delivered. The key trend he identified was towards supporting people outside hospitals "it’s about helping my mother in her home".

Cost reductions

Weketan also stressed that there was a "need to differentiate between ehealth solutions for administrative cost reductions and ehealth solutions for health improvement".

There may be cost savings on the administrative side, but on the health side the investment is to deliver improved healthcare quality and services, said Philips VP Dutiné.

The point was echoed by panel chair Frans de Bruine, director of the Information Society and Media Directorate General of the European Commission, which leads for the EU on ehealth policy, who said: "E-health must be seen as an investment".

Martin Ford, director of healthcare solutions for Pfizer, added that e-health may actually increase costs: "I don’t see this as a cost saving investment at all, as we are likely to uncover unmet healthcare need. I’d suggest that it’s not a total healthcare delivery cost saving exercise."

Ford concluded: "We’ve got to be careful that we don’t chase something that that doesn’t exist, a will-o’-the-wisp."

Weketam predicted that as the focus moves to disease management it will help to shift attention away from the cost perspective, but stressed targets on health service improvement would be vital. "It always helps to go for quantifiable targets."

Oracle’s Scachard, meanwhile, pointed out that e-health was not a monolithic entity but a series of related interactions and initiatives, "some of which will prove successful and some of which won’t, and we will need to move on to replace those that don’t."

HP’s Millar urged all involved to “expect the unexpected”, and said that while the future cannot be predicted those beginning to adopt e-health now will be bet ready to ride future waves of change. Drawing on the banking analogy he said that banks which had invested early in ATMs subsequently found they had made built the foundations needed to offer customers online banking. “No matter what you plan today your end point will be different,” said Millar.