ICMCC

eHealth without Frontiers

This week was eHealth without Frontiers in Slovenia, a yearly event (”a key date in the eHealth annual policy awareness-raising agenda”), its organisation mostly linked to the country that has the Presidency over the EU. I was not there, my health condition does not allow that yet.
But HealthTech Wire kept us informed with the most important information, some of which you can find on our news page.

What caught the eye was the 2008 Conference Declaration:

“Based on these yearly commitments, the Member States have achieved a great deal of progress. Their successes include eHealth roadmaps in all 27 of the Member States, in-depth involvement in the large-scale pilot on eHealth, and considerable penetration in many different countries of the use of electronic health records, much of this based on direct implementation of the eHealth Action Plan for a European eHealth Area.”

It took some digging to find these roadmaps. You can find them here. They are called factsheets, however. Some of these documents are amazingly short. Denmark is all 3 (three!!) pages of text. Some of them do have a paragraph titled roadmap, most of those do not even reach the length of an A4 page.

Back to the Conference Declaration. What followed after this promising introduction is a series of promises:

• Commitment is needed to ensure that roadmaps are updated and distributed regularly
• A consortium of Member States and industrial stakeholders has committed to developing, designing, prototyping, and validating in a pilot context European Union electronic health services
• The Commission plans to issue a recommendation on cross-border interoperability of electronic health record systems
• Participation of industry in the planned large-scale pilot on cross-border use of patient summaries and medication data is particularly welcome
• The Communication included specific actions for Member States to contribute to accelerating the development of the market, including support for further pilot actions under the Competitiveness and Innovation Programme and a coordinated action that will relate to possible developments in the legal framework, standardisation, certification and procurement activities
• Three key initiatives must now begin to operate harmoniously alongside each other in order to overcome the major health challenges that lie ahead over the next ten-year period
• The Member States and the European Commission commit to support together the deployment of high-capacity infrastructure and infostructure for health and social care information networks and services such as telemedicine (teleradiology, teleconsultation, telemonitoring, telecare), ePrescription and eReferral

The European Commission announced in Portoroz that the contract for the SOS project will be signed before the summer break. This “SOS large-scale pilot project” is all about the cross-border interoperability of eHealth infrastructures. In 12 EU countries, that is. As Dr. Gérard Comyn, head of the European Commission’s “ICT for health” unit, says it:

The goal is to make national health-IT infrastructures in the different EU Member States interoperable. We need access to medical information all over Europe. It is a bottom-up approach, which means that we want to take what is already there in the different EU Member States and establish a level of interoperability on top of it.

Unfortunately the Commission can only try to act bottom-up. Mike Palmer, member of Dr. Comyn’s unit, states it very clearly:

The European Commission does not interfere directly with the national health systems of the Member States due to the principle of subsidiarity.

In other words, health is a national issue and does not fall under the competence of the European Commission, in my view one of the biggest mistakes of the 2000 Lisbon agreements.
You can make up your own mind on how effective the Commission can and will be on these matters.

Since we are dealing with the conference in Slovenia I wanted to touch another subject.
Much noise has been made in the press about the recent Benchmarking ICT use among General Practitioners in Europe. This report was officially presented at the conference. The absolute highlight of the survey is:

87% of European general practitioners (GPs) use a computer, 69% are connected to the Internet

I have no reason to doubt the outcome of the interviews. However, I do have a small remark on the subjects of those interviews; 6,789 GPs throughout Europe were interviewed; 29 countries. The authors of the survey claim that:

The universe consisted of all General Practitioners in the respective countries. From the universe a random sample of practices / institutions with a quota on region and — where possible — private practice / institution was drawn. (p.14)

However, in the Netherlands 258 GPs were interviewed, in Germany 253, in the UK 257, in Portugal 284, just to give a random example. How are these numbers in relationship to the total number of GPs in a country? I would have expected that kind of background information, but I can’t find it. However,

After the fieldwork, weighting coefficients were computed giving each country a weight according to its population size in the respective group of countries: EU27+2 (for all 29 countries surveyed), EU27 (all EU Member States).(p.14)

Two things, the report does not mentioned specifics of these weighting coefficients (in my view crucial to the interpretation of the outcome) and it is a weighting according to the population size, whereas, I repeat, a weighting on the total numbers of GP practices in a country should have been included as well.
So in my view it is quite bold to state that 100% of the GPs in Hungary use computers to store patient data (p.7), to mention just one conclusion.

Lodewijk Bos