HOPE on the Horizon

Europe’s eHealth Innovations: An interview with Pascal Garel

EU Research interviews Pascal Garel, Chief Executive, European Hospital and Healthcare Federation (HOPE), about eHealth in Europe. HOPE’s mission is to promote health for citizens and to push for a uniformly high standard of hospital care in the European Union. Can eHealth provide healthcare solutions for a growing, ageing population? By Richard Forsyth

EU Researcher: In the broad spectrum of eHealth categories e.g. training, diagnosis, healthcare delivery etc. – where is the most promise and which do you see as the most important?

Pascal Garel: Healthcare has been slower than some other industries to feel the full force of digital technology. But from wearable sensors providing real-time data on an individual’s wellbeing, to the ability to sequence a person’s genome for a limited cost within 24 hours, it promises greater visibility over personal health and offers the possibility of earlier, more targeted treatment when people fall ill. These devices are part of a shift towards more informed patients taking greater control over their own health, accessing to some kind of digital dashboard of health data.

Certainly the first of all the most promising elements is health analytics and Big Data in health: the transformation of data for the purpose of providing insight and evidence for decision and policy-making. Big Data makes reference to a big amount of data, larger and more complex than traditional data processing can process; this requires the use of distributed systems and advanced methods of data analysis.

The second most promising elements are electronic health records (EHRs), real-time patient-centred records that provide immediate and secure information to authorised users. EHRs include typically a record of the patient’s medical history, diagnoses, treatment, medications, allergies and immunisations, as well as radiology images and laboratory results. The fact that this information is in digital format makes it easier to search, analyse and share.

With telehealth medical services, they are delivered from a distance. This encompasses remote clinical diagnosis and monitoring. Telehealth also includes a wide range of nonclinical functions encompassing prevention, promotion and curative elements of health. It also involves the use of electronics means or methods for healthcare, public health, administration and support, research and health education.

Mobile technologies start to support health information and medical practices. The main activity of mHealth is the potential to reach wide geographical areas and the use of portable forms. Mobile health is incorporated into healthcare services such as health call centres or emergency number services and also includes functions such as lifestyle and well-being apps, health promotion and wearable medical devices or sensors.

Finally, eLearning in health uses electronic technology and media for training and education that could be used to improve the quality of education and also to increase the access to learning in geographically isolated locations or those locations with insufficient training facilities. This will contribute to increase the number of trained professionals with specialised or general skills.

EUR: Which countries have well developed eHealth initiatives and systems – can you give examples and do these provide models for other countries?

Pascal Garel: HOPE organises a European conference on 16 November 2017 in Dusseldorf, precisely on this issue. But even if we have already identified good practices to be presented during

mHealth can contribute to the empowerment of patients: they could manage their health more actively, live more independently, thanks to self-assessment or remote monitoring solutions

this event, from Spain, Estonia, Denmark, etc. we must recognise that it is easier to find good practices at hospital level or at regional level than at national level. Not a single country can be found that covers all innovative and efficient use of information technology. And anyway, considering the cultural and historical roots of health and social systems, good practices are not necessarily transferable. In this regard, an interesting initiative has been taken by the European Innovation Partnership on Active and Healthy Ageing, which is to organise some kind of twinning to overcome those transferring issues.

EUR: With a growing global population and resources that are stretched in many countries – is eHealth critical to coping with the next decades?

Pascal Garel: European population is ageing. The proportion of older people in our countries is increasing, due to fewer children, as well as a longer life expectancy. Healthcare costs in Europe are increasing. These costs are, in most European countries, a growing component of GDP, in some cases still a growing part of public finances, representing up to 12% of GDP.

Another major trend is that about 40% of the European population above the age of 15, are reported to have a chronic disease. This proportion climbs to 66% of the population over 65, having at least two chronic conditions. What’s more, 70% of healthcare costs are spent on chronic diseases and this figure is expected to rise in the coming years. For this reason, EU Member States are trying to achieve an affordable, more efficient, less intrusive and more personalised care of the citizens.

The use of information and communication technologies can be of great help and eHealth is seen as a major driver to maintain quality health services in an affordable way. The eHealth solutions and technologies are expected to significantly increase in the upcoming years. Such solutions involve a broad group of activities that use electronic means to deliver healthrelated information, resources and services. These include supportive eHealth policy, legal and ethical frameworks, infrastructure development and developing the capacity of the health workforce through training.

In the world of Big Data, applications may either be prospective data monitoring or retrospective data analysis and may contribute to increasing the effectiveness and quality of treatments by: earlier disease intervention, reduced probability of adverse reactions to medicines, less medical errors, determination of causalities, understanding of co-morbidity, cross-linkage of healthcare providers and professionals, intensification of research networks, and fusion of different networks such as social networks, disease networks or medicine networks.

It provides, as well, widening possibilities for the prevention of diseases by identification of risk factors for disease at population, subpopulation, and individual levels, and by improving the effectiveness of interventions to help people achieve healthier behaviours in healthier environments. The improvement of pharmacovigilance and patient safety through the ability to make more informed medical decisions, based on directly delivered information to the patients is also significant, as well as the prediction of outcomes, e.g. containment and improvement of chronic diseases, global infectious disease surveillance through evolving risk maps and better understanding of demographic challenges and trends – and disease trans- mission pathways.

For knowledge dissemination, it can help physicians for example, to stay current with the latest evidence guiding clinical practice. Finally, it can contribute to the reduction in inefficiency and waste, with improvement in cost containment.

EUR: Can eHealthcare help with mental health?

Pascal Garel: This is clearly what has been found out in the European Commission and Member States joint action on mental health that was recently completed. The main objectives of its working group on Depression and Suicide was to include eHealth.

In taking action against depression and to prevent suicide in different target groups (adolescent, young adults, middle age and older people), the integration of e-mental health in implementing evidence-based interventions and improving sustainability of good practices, has a clear added value. For example, by promoting trans-national approaches to e-support for minority groups present in more European countries; or by integrating eHealth interventions into the package of health services and clinical practice of health professionals.

EUR: How has mHealth helped rural areas and less developed countries deliver healthcare and what can we expect in the future in this context?

Pascal Garel: Mobile health is a rapidly developing field: over 100,000 mHealth apps are currently available on the market. It has the potential to play a part in the transformation of healthcare and increase its quality and efficiency.

Indeed, mHealth can contribute to the empowerment of patients: they could manage their health more actively, live more independently, thanks to self-assessment or remote monitoring solutions. The provision of mHealth can also support healthcare professionals in treating patients more efficiently, as mobile apps can encourage adherence to a healthy lifestyle.

This is already visible in developing countries, sometimes at a faster pace than in our countries. We are not yet at the optimal level of the use of mHealth for remote areas but several pilots are in place. It may take time for them to be mainstream.

At European level, in April 2014, the European Commission launched a public consultation alongside its Green paper on mobile health to help identify the right way forward to unlock the potential of mobile health in the EU. It gathered inputs from interested stakeholders on barriers and issues related to the use of mHealth. Together with the Green Paper, the Commission also published a legal guidance on EU legislation in the field to app developers, medical device manufacturers, digital distribution platforms, etc. The Privacy Code of Conduct and the mHealth assessment guidelines and other research and Innovation in mHealth are among the results.

EUR: Will there be a day when eHealthcare like telemedicine, ePrescriptions etc is the norm and standard globally? If so – in what kind of timeframe do you predict this could happen?

Pascal Garel: Due to the diversity of resources, of cultures and of many other obstacles, this will certainly take more time than expected. In any case, health literacy and more precisely, digital literacy, is a major challenge.

Systems must be designed to meet the needs of patients and those who care for them. Many people are already undertaking some health transactions online, such as ordering repeat prescriptions, checking hospital reviews or booking hospital and other healthcare services appointments.

With increasing amounts of health information being presented online, hospital and healthcare services need to ensure that groups with lower levels of internet use, such as older people and more deprived groups, do not miss out. Digital exclusion will need to be addressed, including by catering differently for those who are accessing no, or limited amounts of information and support online.

EUR: There have been large scale eHealth disasters – take the UK’s NHS £11bn fiasco, where the system was pulled. What are the biggest challenges to large scale eHealth projects? For instance, is it mixing two very different disciplines and groups of experts - IT engineers and health professionals?

Pascal Garel: Large-scale eHealth deployment projects face a major challenge when called to select the right set of standards and tools to achieve sustainable interoperability in an ecosystem including both legacy systems and new systems reflecting technological trends and progress. There is not a single standard that would cover all needs of an eHealth project, and there is a multitude of overlapping and perhaps competing standards that can be employed to define document formats, terminology, communication protocols mirroring alternative technical approaches and schools of thought. The eHealth projects need to respond to the important question of how alternative or inconsistently implemented standards and specifications can be used to ensure practical interoperability and long-term sustainability, in large scale eHealth deployment.

In the eStandards project in which HOPE is involved, 19 European case studies reporting from R& D and large-scale eHealth deployment and policy projects have been analysed. Although this study is not exhaustive, reflecting on the concepts, standards, and tools for concurrent use and the successes, failures and lessons learned, a paper offers practical insights on how eHealth deployment projects can make the most of the available eHealth standards and tools and how standards and profile developing organisations can serve the users embracing sustainability and technical innovation.

Another key issue to mention here is cybersecurity. It must play a crucial role within the development of eHealth, to build the trust required in society for these services to flourish. The cybersecurity investment required by actors in eHealth will necessarily be comparatively higher than in other sectors, considering the direct costs derived from incidents. As an example, the overall impact of cyberattacks on the hospitals and healthcare systems is estimated to be nearly six billion per year, in terms of financial costs.

EUR: What is the most exciting eHealth project or initiative, in your opinion, out there that you know about today?

Pascal Garel: Just to name one, among the projects in which we are involved, ICT4life is a three-year project financed by Horizon 2020, the EU Framework Programme for Research and Innovation. It kicked-off in Madrid on the 19th of January 2016, with the ambition to provide new services for integrated care, employing user-friendly ICT tools, ultimately increasing quality of life and autonomy at home for patients with Parkinson’s, Alzheimer’s and other dementias and also their caregivers.

This initiative brings together nine partners representing academia, industry and users’ groups, all committed to improving patients’ lives and advancing Europe’s leadership role in personalised services for integrated care.

The partners of this well-balanced and multidisciplinary consortium are: Artica Telemedicina (Spain) which leads the project, Polytechnic University of Madrid (Spain), Madrid Parkinson Association (Spain), Netis Informatics Ltd. (Hungary), E-seniors (France), Centre for Research and Technology Hellas (Greece), Maastricht University (Netherlands), European Hospital and Healthcare Federation (Belgium) and the University of Pécs (Hungary).

The motivation behind ICT4Life comes from the need to find solutions aimed at developing the concepts of self-care, active patients and integrated care. To reach this goal, ICT4Life will conduct breakthrough research and radical innovation and will implement the ICT4Life Platform.

ICT4Life Platform will deliver services, aimed at increasing the quality of life and the autonomy of elders in their own homes, nursing homes, day care centres and hospitals. It will support health professionals and formal and informal caregivers in the provision of integrated care to people affected by cognitive impairments at an early stage. ICT4Life Platform will provide proactive and patient-centred care using robust and secure communication channels and dedicated digital interfaces and it will be tested in real operating environments, through extensive pilots.

www.hope.be