The future of e-health,including telemedicine and telecare,in the European Union: from stakeholders' views to evidence based decisions

The European Commission has long been convinced of the benefits of e-health and there are significant research projects and pilot studies taking place. However, technology does not yet allow most Europeans to manage their health. With health costs and demands from patients increasing, and the number of care workers decreasing, a failure to radically improve our use of technology will have serious consequences for Europe and its citizens. Furthermore, in a period of fiscal austerity, investment in e-health could help contribute to a successful recovery. However, success is only likely if the investment is evidence based.

The European Commission has been supporting e-health research for over 20 years. At present an average of € 100 million a year is spent on research in e-health. Healthcare facilitated by information and communication technology (ICT) has developed from a niche sector into a mainstream activity. However, supporting research and deployment in e-health is not enough, and technology alone is not the solution. A more comprehensive strategy is needed to enable European citizens, healthcare systems and the market to benefit from the opportunities that ICT – and in particular e-health – can offer. We need a strategy which foresees a continued support for research and deployment but which is also accompanied by measures to facilitate organizational change, enhance user acceptance and accelerate technological developments.

E-health alone cannot solve all the new challenges at once. A wider deployment of telemedicine and telecare may help, but only if supported by appropriate leadership and implemented in a coordinated way. If this is done, telemedicine and telecare can improve people's quality of life, raise productivity in the health sector and contribute to the sustainability of national health systems.

In this context, the European Commission is planning to adopt a new e-health Action Plan (eHAP), a policy document outlining the strategy and the necessary actions to realise the opportunities offered by e-health. The new eHAP will reflect the objectives of the 2020 European Strategy ¹ and the Digital Agenda for Europe (DAE). ² In particular the DAE aims to empower patients through the use of electronic health records, facilitate the widespread deployment of telemedicine services by 2020, and improve the interoperability framework in Europe. The eHAP should also support the social challenges of an ageing population. The European Innovation Partnership on active and healthy ageing provides a detailed strategy for implementing telecare and telehealth in Europe. The Innovation Parternship provides a vision of a more efficient global health care system from prevention to “care and cure”, and support for independent living. An integrated vision of telecare, telehealth and innovative services will help to ensure that the new health care model is both sustainable and effective.

Since the adoption of the first eHAP in 2004, significant progress has been achieved. For example political awareness of e-health has risen significantly, leading to many European Member States, regions and healthcare providers committing to widespread deployment of e-health applications, enhancing legal certainty and improving technical guidance. While all the planned actions defined in the eHAP have been undertaken and progress has been made, ³ challenges still remain. The Commission is in the process of elaborating a new eHAP for the next few years, and is basing it on evidence and experience gained so far, as well as the views of the relevant stakeholders. The overall policy objectives of this new initiative will be: to continue to support Member States and healthcare providers so that they can benefit from ICT in the best interest of patients, healthcare systems and society; to help enable an innovation friendly environment and to make best use of innovation in health. To achieve these policy objectives, the Commission plans to: (1) increase awareness of the benefits and opportunities of e-health, and empower citizens, patients and healthcare professionals; (2) address current impediments to e-health interoperability; (3) improve legal certainty for e-health; (4) support innovation and research in e-health and development of a competitive European and global market.

To inform the process, a public consultation process was launched in March 2011, giving interested parties the opportunity to express their views on the proposed policy objectives. A draft questionnaire was discussed and validated by representatives of Member States, as well as by e-health stakeholders such as professionals, patients and healthcare managers.

The questionnaire ⁴ forms part of the European Commission's official public consultation process, which seeks to ensure that the proposed initiative reflects the needs of those who will be affected by them. The results have been published. ⁵ The consultation, which involved 239 stakeholders including NGOs, academic institutions, businesses, health and social care providers and public authorities from many Member States, aimed to validate four proposed objectives and to explore possible actions to be undertaken in the future. More than 90% of the stakeholders agreed with the four main objectives of the eHAP and concluded that the main benefits of e-health solutions are to improve the quality, the efficiency and the sustainability of the available healthcare services.

The majority of respondents believed that the main method to increase patients' awareness and trust in e-health (including telemedicine) should be through information campaigns. Improving healthcare professionals' awareness and acceptance should be addressed through the inclusion of e-health in the medical curriculum and training in the workplace; organizing information campaigns and supporting the dissemination of good practices and results at professional conferences both at national and international level. It is equally important to provide policy input based on evidence and research and by doing so encouraging the dissemination of the benefits of e-health. According to 71% of respondents, the European Commission should support the deployment of ICT systems for clinical use (e.g. decision support systems, e-health records, e-prescription, radiology information systems, telemedicine applications).

Removing borders to interoperability is regarded as an important area that needs to be tackled. According to respondents, this should include taking steps to accelerate technical advancement, further strengthening European cooperation in standards, particularly in taking up existing standards, and developing common profiles and technical specifications.

On the subject of legal issues, most participants thought that the EC should encourage professional associations, scientific societies and civil society representatives to promote best practice through the development of clinical guidelines and/or codes of conduct for telemedicine services. Data protection and liability have also been identified as key areas to focus on. Stakeholders considered that to achieve increased e-health deployment, it is important to provide funding for the scaling up of innovative e-health solutions, for example by facilitating deployment of research results and providing more flexible financing mechanisms to support research and innovation. More emphasis should be put on international cooperation to promote benchmarking and evaluation projects provide evidence to support the deployment of telemedicine solutions and to support new innovative solutions in areas such as Virtual Human Physiology, Personal Health Systems and ICT for Public Health.

The next step will be to support the opinions of stakeholders and experts with scientific evidence, and provide realistic, rational and appropriate e-health actions in accordance with the EU's cultural and economic differences. The new eHAP should be adopted before the end of 2012 and its actions will aim to ensure that e-health – and specifically telemedicine and telecare – become a reality by 2020 in the best interests of patients, healthcare systems and society as a whole.