eHealth action plan 2012-2020

11 December 2012
by eub2 -- last modified 11 December 2012

The European Commission has unveiled an Action Plan to address barriers to the full use of digital solutions in Europe's healthcare systems. The goal is to improve healthcare for the benefit of patients, give patients more control of their care and bring down costs. While patients and health professionals are enthusiastically using telehealth solutions and millions of Europeans have downloaded smartphone apps to keep track of their health and wellbeing, digital healthcare has yet to reap its great potential to improve healthcare and generate efficiency savings.

What is eHealth?

eHealth means using digital tools and services for 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. Examples include health information networks, electronic health records, telemedicine services, wearable and portable personal health systems and many other information and communication technology (ICT)-based tools assisting disease prevention, diagnosis, treatment and follow up.

What are the benefits?

Using ICT based tools and systems gives patients more information, and more involvement in their healthcare, they improve access to health advice and treatment and can make national healthcare systems more efficient.

For example, the Danish Health Data Network provides fast and efficient communication between patients, general practitioners and social care professionals. These streamlined services for patients and healthcare workers have led to cumulative savings of $120 million a year. The Danish information system is cited by several studies to be the most efficient in the world, saving doctors on average 50 minutes per day usually spent on administrative work.

In Italy, overall savings from the introduction of ICTs in the Health Sector are estimated to be around 11.7% of national health expenditure (i.e. € 12.4 billion). Savings from digital prescriptions alone are estimated to be around € 2 billion.

A recent study across The Netherlands, UK and Germany showed that introducing home telemonitoring systems could improve survival rates by 15%, bring a 26% reduction in hospital days per patient and make 10% overall cost savings through nurse telephone support.

In Estonia, since 2009, citizens have online access to their medical data via an Electronic Health Record System (EHR). Citizens can access their own data and browse their health record, download documents, submit consents, update demographic data, get an overview of prescribed and dispensed medication, and review their health record use logs. The Estonian EHR system is already used by 47% of citizens and 95% of doctors while over 80% of prescriptions are electronic, meaning less errors and less paperwork.

How widely used is eHeath?

Hospitals, doctors and patients throughout the EU are using eHealth tools, with proven benefits. However use varies from region to region, and many people still lack the infrastructure, skills and confidence to use them.

A 2010 survey of public, private and university hospitals in Europe showed that 81% have one or more electronic patient records systems in place, but only 4% grant patients online access to their health information.

71% use online eBooking systems for patients' appointments with medical staff but only 8% offer patients the opportunity to book their own hospital appointment online.

43% of hospitals surveyed exchange radiology reports electronically. However, only 30% use ePrescription for medicines, 8% telemonitor patients at home, 5% have some form of electronic exchange of clinical care information with healthcare providers in other EU countries.

What did the 2004-2012 eHealth action plan achieve?

The action plan increased awareness among Member States of the importance of making eHealth an integral part of their health systems. Today, every EU Member State has an eHealth strategy in place and is working to achieve this. In addition, it:

    focused attention on the importance of cross-border, interoperable healthcare. This led to 23 countries working together to achieve interoperable patient summaries and ePrescription services through the large scale pilot epSOS.

    Led to the funding of EU projects such as Renewing Health which are increasing the evidence of the benefits of telemedicine solutions and better disseminating best practice, meaning that providers can benefit from economies of scale and do not need to reinvent the wheel.

    Led to industry backing for technical solutions that will allow systems to join up and "communicate" with each other.

    Created an EU wide telemedicine market that has reached a level of maturity whereby practitioners are willing to provide services across borders and now need the legal reassurance on how they can do this. This is why the eHealth action plan is accompanied by a staff working paper on this specific issue.

    Focused international attention on the importance of interoperability to achieve a global market in eHealth and the need for a skilled workforce in this area. This led to the signing of a Memorandum of Understanding with the United States on these subjects.

Why is it time for a new one?

Market and behavioural trends have evolved since 2004. Now, more than ever, people are monitoring their health and wellbeing online or through devices such as smartphones. The action plan reflects this shift in behaviour and aims to enhance user confidence in these digital tools and apps, while ensuring that the market conditions encourage continued innovation.

Over the past decade, a strong base of evidence has emerged on the effectiveness of eHealth solutions and it is now time to focus on their widespread deployment. This requires the commitment of member states to implementing organisational changes which make patient-centric eHealth solutions an integral part of their healthcare systems.

At a time of economic crisis and austerity, there is more reason than ever to invest in long term cost-effective solutions which can also provide opportunities for market development in Europe, particularly among SMEs who are innovating in this growing area.

What is the role of the eHealth network?

The eHealth network was set up under Article 14 of Directive 2011/24 on the application of patients' rights in cross-border healthcare. The network brings together the national authorities responsible for eHealth from all the Member States on a voluntary basis to work on common orientations for eHealth. The aim is to ensure EU wide interoperability of electronic health systems and to ensure safety and continuity of cross-border healthcare.

The network is mandated to produce EU guidelines on eHealth, including a set of patients' data to be exchanged across borders, identification and authentication measures used in healthcare, and interoperability of e-prescriptions.

Given the nature of the network and its structure, the eHealth network plays a strategic role in the governance of interoperable cross-border eHealth services and infrastructure. The network will be consulted and fully involved in the activities foreseen in the eHealth action plan.

What will the 2012-2020 plan mean for healthcare workers and patients?

For healthcare workers, the plan will mean more opportunities to develop and enhance their digital skills in an area of increasing demand. This would increase their confidence in working with digital health tools, and lead to wider acceptance and use of eHealth technologies.

For doctors in particular, this means more meaningful time with their patients and less unnecessary appointments, for example, thanks to the use of ePrescription and telemonitoring.

For patients, this means spending less time, effort and money on unnecessary hospital or GP visits. For example, in the UK, currently 80% of visits to GPs are from patients requesting repeat prescriptions, but from April 2013 patients will start to use online prescribing and appointments. This is expected to decrease substantially unnecessary visits to GPs and will allow patients to take a more pro-active role in the management of their health.

What is in the eHealth action plan for small and medium-sized businesses?

The action plan supports entrepreneurs and SMEs who want to enter the eHealth market. An important way of doing this will be through "law incubators". These are pro-bono legal clinics where law students (under the supervision of their Professors) provide legal advice to ICT start-ups and entrepreneurs who are grappling with complex legal issues.

The EU's proposed research and innovation funding programme Horizon 2020 includes more than €8 billion in support of research and deployment in the area of health, demographic change and wellbeing. Over the period 2014-2020 this will mean opportunities for businesses, big and small, to get involved in areas as diverse as personalised medicine, advanced analytics and mobile technologies and apps.

Why provide legal guidance on cross border telemedicine?

There is no single piece of EU legislation specifically covering cross-border telemedicine. Due to its diverse nature and characteristics covering issues such as health data, reimbursement and licensing, cross-border telemedicine falls within the scope of several EU legal instruments. For this reason, the Commission staff working paper provides an overview of the relevant body of EU legislation that is applicable to cross-border telemedicine services provided in the EU and in particular:

    clarifies patients' rights and reimbursement conditions for telemedicine services received from another Member State;

    outlines that qualified healthcare professionals performing cross-border telemedicine services do not need to seek additional registration/licensing in the Member State of the patient;

    explains the strict legal conditions for processing health data.

eHealth Action Plan: chronological overview of the actions

Date	Action	Who ?	Area covered?
From 2012 onwards	The Commission will support the eHealth network in producing guidelines on a dataset for patient summary records to be exchanged across borders, common measures for interoperable electronic identification and authentication in eHealth and will enhance security of health information and eHealth services and interoperability of databases for medicinal products.	European Commission	Achieve wider interoperability in eHealth Services
From 2012	The Commission encourages Member States involvement in the EIP AHA to help them develop and share their national (including regional) eHealth strategies, taking into account international recommendations, and deploying promising solutions for active and healthy ageing on a larger scale.	European Commission & Member States	Supporting research, development, innovation and competitiveness in eHealth
In 2013	Launch a study under the Health Programme 2014-2020 to examine Member States' laws on electronic health records in order to make recommendations to the eHealth network on legal aspects of interoperability	European Commission	Achieve wider interoperability in eHealth Services
By the end of 2013	Prepare the governance for the large scale deployment of interoperable eHealth services under the CEF 2014 – 2020, taking into account the recommendations of the eHealth network.	European Commission	Facilitating uptake and ensuring wider deployment of eHealth
From 2013	Support concrete steps towards greater integration of processes for cross-border eHealth. The Commission will make proposals on organisational issues with the aim of facilitating cooperation in the EU.	European Commission	Achieve wider interoperability in eHealth Services

From 2013	Starting with the Competitiveness and Innovation Programme and continuing under Horizon 2020, the Commission will support activities aiming at increasing citizens' digital health literacy. For professionals (health and scientific communities) the focus will be on developing evidence-based clinical practice guidelines for telemedicine services with particular emphasis on nursing and social care workers.	European Commission	Facilitating uptake and ensuring wider deployment of eHealth
From 2013	Enhance work on data collection and benchmarking activities in health care with relevant national and international bodies to include more specific eHealth indicators and assess the impact and economic value of eHealth implementation.	European Commission	Promoting policy dialogue and international cooperation on eHealth at global level
From 2013	Promote policy discussions on eHealth at global level to foster interoperability, the use of international standards, develop ICT skills, compare evidence of the effectiveness of eHealth, and promote ecosystems of innovation in eHealth.	European Commission	Promoting policy dialogue and international cooperation on eHealth at global level
During the period 2013-2016	The Commission will assess cost benefits, productivity gains and business models, notably through Health Technology Asessment (HTA)	European Commission	Facilitating uptake and ensuring wider deployment of eHealth
Between 2013 and 2020	Support actions to improve the market conditions for entrepreneurs developing products and services in the fields of eHealth and ICT for wellbeing	European Commission	Supporting research, development, innovation and competitiveness in eHealth
During the period 2013-2020	Leverage the CEF and the ERDF for the large scale deployment of innovative tools, the replicability of good practices and services for health, ageing and wellbeing, with a particular attention to improving equal access to services.	European Commission	Facilitating uptake and ensuring wider deployment of eHealth

By 2014	Green Paper on mHealth and health and wellbeing applications	European Commission in response to the recommendations of the eHealth Task Force	Achieve wider interoperability in eHealth Services
From 2014	Sets of common indicators will be made available to measure the added value and benefit of eHealth solutions, based on work funded by the Commission in partnership with stakeholders.	European Commission, Stakeholders	Facilitating uptake and ensuring wider deployment of eHealth
2014-2020	Support research and innovation "Health, demographic change and wellbeing" of Horizon 2020, in the areas of: an ICT and computational science and engineering framework for digital, personalised, and predictive medicine, including advanced modelling and simulation; innovative instruments, tools and methods for unlocking the value of data and for advanced analytics, diagnostics and decision making; new digital media, web and mobile technologies and applications, as well as digital instruments that integrate healthcare and social care systems and support health promotion and prevention; eHealth systems and services with strong user involvement, focusing on interoperability and the integration of emerging patient-centric technologies for cost-effective healthcare.	European Commission	Supporting research, development, innovation and competitiveness in eHealth

By 2015	Establish the semantic and technical cross-border interoperability specifications and assets necessary for the eHealth Interoperability Framework; Propose an EU interoperability testing, quality labelling and certification framework for eHealth systems. Assets, such as vocabularies, will be taken from past projects or ongoing projects developed under CIP, FP7, the ISA work program and in the future Horizon 2020 and be used and maintained under the proposed Connecting Europe Facility	European Commission, with the endorsement of the eHealth Network	Achieve wider interoperability in eHealth Services
By 2015	Propose an eHealth Interoperability Framework based on the results of studies, pilots and research projects.	European Commission, with the endorsement of the eHealth Network	Achieve wider interoperability in eHealth Service

eHealth Action Plan and Staff Working document, Staff Working Paper on Telemedicine

Source: European Commission