Two weeks ago I attended the eHealth 2012 conference in Copenhagen, along with 2 500 other delegates, policy makers, providers, industry and many others. Coming out of there, my strongest take-away is the amazing opportunities innovation in technology can bring -for patient empowerment, improved health and more efficient provision of care – and the frustratingly slow pace at which it is being adopted in the health care system. The new, exciting opportunities in mobile health and eHealth are mind blowing, and I’m glad to be working in this field right now. But how far have we got when it comes to transforming this opportunity into reality? In one of the conference sessions, Bill Crounse of Microsoft Worldwide Health rhetorically asked whether markets, consumers, clinicians and technology are ready to realize the potential of eHealth. He showed compelling examples illustrating that consumers, clinicians and technology are indeed ready for eHealth, but that markets are still largely resisting. In another session, a show of hands showed only half of attendees thought eHealth was actually “taking off” today.
How can this be? eHealth has been talked about for at least 15 years and probably much longer too, how can it be possible it is still discussed as a separate topic? eHealth is part of a much bigger discussion – it’s not so much about the “e” itself, but about the general modernization of the health care system.
Some years ago, I attended a session with Harvard Economics professor David Cutler where he used US productivity statistics to demonstrate how technology- and process innovation driven productivity gains seen in virtually every other sector of society are yet to arrive in health care. True, health care is not manufacturing, but that does not mean some learnings from other sectors cannot be transferred into health care.
The increased patient empowerment, productivity and efficiency in the health care sector which eHealth can deliver is not a nice to have, it is a need to have to deal with the challenge of an aging population and constrained economic resources. It is a need to have for patients, caregivers and for the competitiveness of the European Union. This is why the EU Innovation partnership for Active and Healthy Aging is right to focus its effort on moving “from pilot to full scale deployment”, looking at innovation in not only products but also processes and services, and looking at reducing the time to market for innovative solutions.
eHealth is no more, but also no less than the modernization of the health care system, and modernization needs to go beyond projects into business as usual and into standard of care. Sure, before large scale deployment, it is legitimate to ask for data on the value of eHealth and telecare, but in many ways that evidence exists now. The Whole Systems Demonstrator (WSD) study in the UK is one example, finding that telehealth can reduce mortality, need for hospital admissions and days spent in hospital. The WSD was a large randomized control trial, and as such represents a high level of evidence on the value of telehealth. We know what the benefits from modern health care management and from technology innovation are, and they are already available, but too few patients are getting access, in essence being denied those benefits and a more healthy and productive life.
Some of the barriers hindering the progress are institutional; reimbursement systems that don’t recognize care provided through telecare solutions and budgeting silos which do not enable funds to flow with the patient to optimize patient pathways. This is where governments and health care authorities need to get going on adapting the institutions to the new technological reality. Encouragingly, we are seeing examples of that happening, for example in the Netherlands. Other barriers are behavioral. Changing work processes, changing habits, adapting to new care delivery models – it all requires successful change management. And in my view, this is where the technology industry can do more in the health care sector. We need to dedicate as much commitment to the science and practice of successful implementation of technology as we do to the research and development of technology itself. In health care, technology often achieves little on its own, it is skilled and motivated health care professionals and patients who delivers the value through the use of technology. Diagnostics and disease management is the classic example; it’s not information in itself which improves health and wellbeing, it is the actions taken based on that information. This is why the increasing efforts by the Medtech sector on a user-focused implementation of technology – understanding current pathways, processes and needs – is a key to success. Only when we approach technology from the users perspective, as an integrated, natural and normal part of health and health care, will the full promise of eHealth be realized
Eucomed eHealth taskforce and CRM Telemonitoring working group member
Health economics and reimbursement manager Cardiac Rhythm Disease Management Medtronic Europe