Managing eHealth

From Vision to Reality

M. Rosenmöller, D. Whitehouse, P. Wilson, M. Rosenmöller, D. Whitehouse, P. Wilson

• Publisher: Palgrave Macmillan
• Year: 2014
• ISBN:
  9781137379443
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This book constitutes an excellent source of information for gaining a better understanding of information technologies in healthcare; for reviewing how healthcare will change as a consequence; and how to manage these changes in order to realise eHealth's full potential in creating value for patients, professionals and the system as a whole.

1

Introducing eHealth: Past, Present and Future

Diane Whitehouse, Petra Wilson and Magda Rosenmöller

Overview

As seen in the Preface, this book is intended as a tribute to the work of our friend and colleague, Professor Jean-Claude Healy. Jean-Claude Healy was at the origin of many of the early ideas in the 1990s and the first part of this decade, which formed the foundations of eHealth in Europe. Stimulating and building eHealth in Europe was one of his key objectives – indeed, a decade ago, “eHealth matters” were the opening words of the European eHealth Action Plan that stemmed directly from the work of Jean-Claude and his team (European Commission, 2004). Jean-Claude’s heritage, his vision, and the initial building blocks put in place through his and his colleagues’ work, is still manifest in Europe today, where eHealth continues to establish itself as a key enabler of safe and efficient health and care.

Yet today, there is still a lot to do to make eHealth a complete reality. Current European studies, as well as the European policy position, emphasise that the promise offered by information and communication technologies (ICT) in healthcare remains largely unfulfilled (European Commission, 2012). Policy planning is focused on identifying, addressing and overcoming such limitations as deployment, digital skills and literacy, international cooperation, interoperability, and research and development. Both here, and in terms of future challenges, the shift is very much towards the co-design and co-production of innovative initiatives (Goodwin, 2013; Loeffler et al., 2013). Technologies that remain challenges for the fields of health and care include big data, genetic developments, mobile health, and many more. The issues surrounding these topics are being looked at by the experts who write in this volume.

What is eHealth?

eHealth is an attractive, concise and easy-to-remember term for a very large, yet not always clear-cut, concept. Some see the term as occasionally ambiguous, and others as an evolving definition. These shifts in terminology have been explored from the early years of the 21st century onwards (see, for example, Whitehouse and Duquenoy, 2009; 2010; George et al., 2012). Overall, the definition of eHealth moved first from an encyclopaedic listing of applications (European Commission, 2004) to a concentration on “the relationship and connections between the data shared among institutions and users” (European Commission, 2007, p. 10). In 2010 – as seen in the 2010–2011 policy work of the European Commission – it transitioned to an even more all-encompassing description, which focused largely on the challenges of healthcare supported by ICT rather than on eHealth itself (European Commission, 2011a, p. 3):

eHealth is the use of ICT in health products, services and processes combined with organisational change in healthcare systems and new skills, in order to improve health of citizens, efficiency and productivity in healthcare delivery, and the economic and social value of health. eHealth covers the interaction between patients and health-service providers, institution-to-institution transmission of data, or peer-to-peer communication between patients and/or health professionals.

The notion of eHealth comprises three separate elements. They are the three market-related notions of products, services and processes; the two organisational aspects of change management and personnel/user expertise; and the trio of expected outcomes – improved individual health status, healthcare delivery and the economic and social value of health.

For academics, discussion around the precise meaning of eHealth remains a matter of keen debate. This is occurring even at the very moment in time that increasing numbers of people are arguing that it is time to drop the “e” in eHealth (EHTEL, 2009; Ebels, 2012; Roberts, this volume). The trend is to concentrate on important challenges related to the two domains of both health and care. Indeed, as is evident in European policy documents, the focus is now on innovative healthcare for the 21st century, and personalising health and care in a wide variety of applied and scientific developments (European Commission, 2011a).

As co-editors, we decided to maintain the concept of eHealth for the scope, title and orientation of this volume. This was indeed the idea and the name that was adopted when much of the work described here began in the late 1990s. The notion of eHealth represents the book’s point of departure (see, for example, the two chapters by Rossing and Iakovidis). It is, however, a moot point that eHealth – as a concept – may be disappearing rapidly from people’s psyche and vocabularies. Indeed, the demise of the term may be considered to be an indicator that eHealth’s ambitions have been achieved. It is now a term that is well embedded in people’s consciousness. In the same way, the term eCommerce is no longer in use because nearly all commercial enterprises – as part of their mode of doing business – use some element of that former expression.

eHealth has been regarded as encompassing many different forms of technology (European Commission, 2004; 2011a). In this book, several authors base their work around the term eHealth and its progress over time (examples include the chapters by Joan Dzenowagis; Ilias Iakovidis; Zoi Kolitsi and Michèle Thonnet; Niels Rossing; and Birgit Beger and Michael Wilks). Contemporarily, technologies supporting new forms of care such as integrated care and person-centred care are tackled by Nick Goodwin and Albert Alonso, and Dipak Kalra and his colleagues. Electronic health records are the core subject of Don Dettmer’s chapter, but the implication for personal or individual records is also taken up in the papers by Mats Sundgren and Vanessa Díaz-Zuccarini and colleagues, as well as from the hospital viewpoint (Geissbühler and colleagues). Other authors are more oriented towards particular technologies – the Internet, web, social media and social networks are all evident in the chapters by Celia Boyer and also Denise Silber, whereas mobile health (mHealth) is covered by Patricia Mechael and her co-authors. Two specific domains in the field of informatics are handled here: medical informatics by Niels Rossing, and nursing informatics by Nick Hardiker.

Scope, aims and goals

The scope of this book is threefold. It aims to capture the current policy debates by putting them in their historical context, review the ways in which all the appropriate actors are involved in using ICT to ensure access to high-quality yet economic healthcare provision, and cover actual practice through a range of inputs, case studies and examples. It also considers patients’ empowerment and participation. The book offers useful insights into how to tackle the challenges facing the healthcare systems of many regions and countries throughout the globe, even if its primary focus is on the European Union. Together, these approaches provide a rounded context for the environment in which eHealth is being developed and implemented. In this sense, the volume is an “umbrella” book, one which – although it stays with the big picture and offers a holistic overview of ICT use in healthcare systems – also mines in depth many important, and more detailed, topics.

The book brings together a series of chapters written by more than 30 leading experts in their respective eHealth fields. Among the authors are eminent health policy and eHealth leaders at international, European and national levels; leading business school faculty; corporate executives; well-known hospital executives and researchers; healthcare professional leaders; and prominent individuals in non-governmental organisations and civic society.

The book has three main messages. First, it enables readers to gain a better understanding of the uptake of ICT in healthcare. It uses examples that show how patients, physicians and healthcare providers all collaborate better in an improved and more efficient healthcare system as a result of using eHealth. It therefore covers a considerable number of good eHealth practices while it does not forget by any means the challenges that remain to the use of technologies in healthcare. Second, the book reflects its contemporary position between a great deal of work having been achieved while substantial work on transformation still needs to be done. The book’s historical overview shows how healthcare has changed due to the introduction of ICT. It also indicates how healthcare will change in the future, and how these alterations can be managed to assure high value for patients, professionals and the system as a whole. It particularly points to what can be learned positively from the experiences of others. Third, the book illustrates how the work of healthcare professionals may change, and how its readers, as diverse stakeholders, might involve themselves pro-actively in that transition process by contributing to the developments that are about to happen.

Healthcare systems, and the ways in which they can be supported by state-of-the-art and future technologies, are very much on a journey of transition. Indeed, the transition will be ongoing: as one cycle of deployment and implementation reaches maturity, the next is forthcoming. Electronic health records – once considered revolutionary in their implications – are moving into far more common use, combined with the availability of mobile telephony (mHealth); the exploration of genetic data to predict and prevent disease and hereditary health conditions is becoming increasingly usual; and the notion of human beings wearing “chips in the[ir] head[s]” – to cite one of Jean-Claude Healy’s favourite examples – is an organic continuation of the contemporary growth in the use of sensors, radio-frequency identifiers and networks (http://futuremed2020.com) (eHealth Task Force, 2011).

This book does not pretend, by any means, to cover the complete width and variety of practices in the field of eHealth that are present and upcoming. eHealth is such a comprehensive field that it would be impossible to cover all its aspects in such a modest volume. For example, to name but three, the challenges posed by interoperability, medical devices and procurement have not been examined here in any great detail. For this reason, this volume has a simple structure, which reflects its main themes: policies, people and practices. The logic behind each of these sections is outlined here by the three contributing editors.

Politics: Policies and Institutions

Examining critical success factors for the transformation of any key issues in society requires the right political climate, institutions and leaders who can help formulate and make policy. Policies provide both the framework and the drivers for progress in combination with the work of the people on the ground, who put the policies into practice. Healthcare supported by ICT is no exception to this general rule. eHealth has been driven forward by energetic people possessing insight and vision, by solid policy positions and documents, and by people who have committed to actions that have coalesced around these political directions.

Five chapters form the core of this first section of the book. The first chapter in this section is written by Niels Rossing, who has evoked his personal memories of the early years of what became eHealth in Europe, and specifically in the European Commission. Niels was the first individual tasked with heading up this domain, and he was also the direct predecessor of Jean-Claude Healy. Niels highlights the way in which a number of substantial elements in the health field have not changed dramatically over the past 25 years. Today, as in 1988, it is still anticipated that eHealth will improve and facilitate healthcare, and develop sustainable products and services through a close collaboration between academia and industry. Yet, in 2013, in addition to policy-makers, it is very much the citizens and patients themselves who are getting engaged and realising this potential!

Ilias Iakovidis, who was also an early colleague of Jean-Claude Healy, takes up the story of eHealth in Europe as from 1990. Over the last quarter century, the European Commission has contributed to the emergence of several generations of technologies in diverse domains of healthcare. Much of this work has been accompanied by the development of relevant policy instruments (from research programmes on diverse areas of eHealth research and innovation) and by noteworthy deployments in products, goods and services. This progress puts a number of European regions and Member States at the leading edge of societal and technological innovation. Many healthcare benefits are already, and will likely continue to be, the result.

From governments to governance: Joan Dzenowagis explores how this paradigm has shaped eHealth, and charts some of its key aspects worldwide. She traces the history of the path taken by eHealth inside the World Health Organization, through its various committees, task forces and assemblies: such was the organisation’s determination to facilitate the use of technologies to improve healthcare standards worldwide. The expected results continue to be greater access to healthcare and improvements in its quality, effectiveness and efficiency. Jean-Claude Healy made a unique contribution to this initiative. Joan’s is a very personal view of someone who worked closely and intensely with Jean-Claude Healy. Its wording shows the degree of passion and commitment to eHealth that this very unusual individual generated in his colleagues and the surrounding community. This willingness to take bold steps forward lays out an inspiring message for many other groups of stakeholders working in contemporary health-related fields.

Governance in eHealth has previously been a considerable challenge, argue Zoi Kolitsi and Michèle Thonnet. Yet, in recent times, there is a growing clarity about how to govern this field. Built over the course of years, increased cooperative work on ICT related to healthcare is taking place among the European Member States and eHealth stakeholders. New proposals for eHealth for the 2013–2020 timeframe are now on the agenda: new institutions have been created to service and support these next stages in eHealth policy development and deployment. More are on the agenda. Like many other authors in the book, these two women take both a historical and a future-oriented view of eHealth.

Shaping eHealth through legal actions is the concern of Petra Wilson. Her expertise in the legal aspects of eHealth dates from the late 1990s, when she worked in the European Commission to advance a sound policy understanding of the ethical and legal aspects of eHealth. Her chapter offers an overview of the way in which various court cases, that have alternatively challenged or supported the use of the Internet for health purposes, have had an influence in Europe. Eventually there has been a shift towards a Directive, which supports cross-border access of patients to healthcare throughout the Union (European Commission, 2011b). Petra explores the ways in which legal frameworks could facilitate a more expansive framework for healthcare-enhancing technologies.

The politics and institutions portrayed in this section of the volume are among the most influential in the healthcare field both globally and in terms of the European continent. They include the World Health Organization, the European Commission, the Council and Parliament and the relevant ministries of a set of the European Member States. Also included is an overview of legislation at levels that cover the European continent and, in many cases – most relevantly for the health sector – the individual nations. It is these countries that, ultimately, possess the mandate for tackling healthcare. They do not, however, always carry the responsibility for policy-making in the many other areas of legislation – such as data protection; security; mobile telephony and medical equipment – that affect directly the technologies used to provide and support healthcare.

Many of the policies described in this first section of the book – entitled Politics: Policies and Institutions – are directly derived from the era in which Jean-Claude Healy started to work so energetically in the field of eHealth. Many of the authors who write about European and world politics and policies knew him directly and worked with him closely. For this reason, in several of the chapters there are reminiscences of times past and the important role that Jean-Claude played in several major historical events. Overall, however, the texts in this section of the book bring us up-to-date while also covering the historical context and, at the same time, they indicate exciting potential directions for the broader future.

Last but not least, this section of the book provides a story about personal and professional collaboration, not simply institutional development. It involves deep insights into people and the way in which they work together. It highlights the point that the potential of eHealth, and real value in healthcare, can be created with enthusiastic and motivated people, a concept Jean-Claude instilled in everyone he met. By bringing groups of individuals into the foreground of policy-making, it serves as a prelude to the next section of the book, with its more targeted focus on People: Professionals, Patients and Consumers.

People: Pro...

Table of contents

• Cover
• Title
• 1  Introducing eHealth: Past, Present and Future
• Part I  Politics – Policy and Institutions
• Part II  People – Professionals, Patients and Consumers
• Part III  Practice – New Ways of Working and Other Challenges
• Index