A look at progress in the developmentof eHealth in the European RegionResults and recommendations from the 2016report “From Innovation to Implementation:eHealth in the WHO European Region”
Clayton Hamilton, eHealth and Innovation
WHO Regional Office for Europe
eHealth Development in Ukraine workshop
27 April, 2016
Geography of the WHO European Region
53 Member States
900 million population
WHO Regional Office for Europe
Copenhagen, Denmark
The 2016 report oneHealth in theWHO EuropeanRegion
The 2015 WHO Global eHealth Survey and report methodology
•Global survey sent to all WHO Member States (health responsible ministries) underthe theme of eHealth in support of universal health coverage.
•European Region response rate to the survey was 89% (47 of 53 Member Statesresponded, results for 46 presented in the report).
•Report responses were “taken at face value” and don’t include input from otherstakeholders (patients, communities, healthcare providers and industry). Oneresponse per country.
•Not all countries responded to all questions. Percentages, where given, are based onnon-blank responses to each question.
•Selected case examples from national implementations are included in the report.
Overall report findings
•A notable transition of eHealth to a subject of strategic importance forpolicy makers. eHealth has become a key enabler of effective healthservice delivery and for health information accessibility.
•Countries are actively building upon their national eHealth foundationsto deliver public health and health services in a more integrated, cross-sectoral manner.
•Successful investment in eHealth requires far more than technologyacquisition. Better understanding the holistic picture of changesrequired to org. processes & structures, roles, standards, legislation aswell as considerations for Human Resources, education, literacy,reimbursement and cultural contexts of health.
•Funding, over any other aspect, is now the biggest barrier to adoption.
Thematic chapters of the report
•eHealth Foundations
•Electronic Health Records
•Telehealth
•mHealth
•eLearning in health
•Social media in health
•Health analytics and big data
•Legislative frameworks for eHealth
•84% (38 countries) have a national universal healthcoverage policy or strategy, of which 74% (28countries) report a specific reference to eHealth or ICTin support of universal health coverage.
•70% (30 countries) report having a national eHealthpolicy or strategy.
•69% (31 countries) report having financial supportavailable for the implementation of their nationaleHealth strategy or policy.
•89% (40 countries) have universities or technicalcolleges providing students with training on how to useICT and eHealth. 82% (37 countries) provide training tohealth professionals on how to use ICT and eHealth.
eHealth Foundations - main findings
•Public funding is the most available type is the regionwith 93% (42 countries) reporting that public funding isavailable for eHealth programmes, followed by donor ornon-public development funding (53%, 24 countries).
•35% (16 countries) report having a policy or strategy onmultilingualism applicable to health.
•76% (34 countries) report government-sponsoredhealth websites provide information in multiplelanguages.
eHealth Foundations - main findings
eHealth Foundations – funding types by subregion
•59% (27 countries) report the existence of a nationalEHR (according to the definition provided)
•69% (18 countries) have legislation governing use ofEHRs.
•50% (22 countries) report that funding is the mostimportant barrier to EHR adoption.
Electronic Health Records – main findings
Electronic Health Records – legislation and use
EHR ancillary systems and ICT-assisted functions
EHR - barriers
•27% (12 countries) have a dedicated policy or strategyfor telehealth.
•Teleradiology is the most prevalent telehealthprogramme in the WHO European Region (83%, 38countries) followed by Remote Patient Monitoring(72%, 33 countries) and Telepathology (63%, 29countries).
•71% (30 countries) report a lack of funding to developand support telehealth programmes as the mostsignificant barrier.
Telehealth – main findings
Telehealth – growth in key initiatives
Telehealth – barriers
•49% (22 countries) report having government-sponsoredmHealth programmes.
•73% (33 countries) do not have an entity responsible forthe regulatory oversight of the quality, safety and reliabilityof mHealth applications.
•Only 11 countries (26%) report that health authoritiesregulate mobile devices and software for quality, safetyand reliability.
•Few Member States (7%) report evaluations ofgovernment-sponsored mHealth programmes.
mHealth – main findings
mHealth – guiding policies and the role of health authorities
mHealth – barriers
•71% of countries use eLearning to train healthprofessionals and 66% use it to educate students of healthsciences.
•96% of countries report the main reason for use ofeLearning for students is to improve access to educationalcontent and to experts (the same applies to training ofhealth professionals in 94% of countries).
eLearning – main findings
eLearning – barriers
•Only 7 countries (16%) have a national strategy/policy onthe use of social media by government organizations
•Only 6 countries (14%) have a national policy governingthe use of social media in health professions.
•However, almost all countries (91%, 40 countries) reportthat individuals and communities are using social media tolearn about health issues.
•Social media is most often used by national entities for thepromotion of health messages and/or campaigns.
Social Media – main findings
Social Media – use
Social Media – training for health professionals
•6 countries (13%) reported having a nationalpolicy/strategy regulating the use of big data in the healthsector.
•Only 4 countries (9%) have a national policy/strategyregulating the use of big data by private companies.
Health analytics and big data – main findings
Health analytics and big data – barriers
•60% of Member States (27 countries) have legislation onsharing data through EHRs within their own country.
•61% of Member States (27 countries) have legislationallowing the sharing of personal and health data betweenresearch entities.
•38% of Member States (17 countries) have legislationgoverning the sharing of EHR data between countries.
Legal frameworks – main findings
Legal frameworks – legislation on patient access and control
So is the news all good?Does the data reported by countries support what we observe?
•Low presence of Telehealth policies doesn’t support (or is in contradiction to)the actual growth that is being observed.
•Data doesn’t represent the strength of Health Insurance funds in many nationalsettings, nor does it give a true representation of the discontinuity and divisionin many national health information systems.
•Doesn’t illustrate the lack of cross-sectoral engagement for health in manycountries, nor highlight this as a barrier.
So is the news all good?Does the data reported by countries support what we observe?
•Does reflect the efforts made by those countries moving towards a patient-centric care model.
•Does show that legislation and privacy are still key issues that threatenuptake of solutions.
•Does show that digital and health literacy are emerging issues that, if notsufficiently addressed, will have the potential to increase the equity gap inaccess to healthcare.
So what are the key recommendations?
1.Explicit political commitment for eHealth by governments backed by sustainablefunding for implementation and innovation activities is needed.
2.Dedicated national eHealth strategies that link to the achievement of tangiblehealth goals are recommended – BUT - such strategies need to be “alive” in termsof an action plan and M&E framework.
3.Legislation on the use of Electronic Health Records needs to be strengthened,clarifying in particular, data ownership and the right of the patient to access andmanage data.
4.Targeted, intersectoral strategies and policies for telehealth are encouraged.
So what are the key recommendations?
5.A systematic approach to the adoption of standards is paramount. Following theEU Refined eHealth European Interoperability Framework (ReEIF) + a qualitymanagement system for interoperability testing, a set of appropriate testing tools,and a quality label and certification process.
6.Establish national entities responsible for regulatory oversight of mHealth and tocarry out evaluations on the impact and benefits of mHealth applications.
7.Digital and Health literacy among health professionals and the public shouldbecome an area of strategic focus.
8.eLearning in health for both students and healthcare professionals needs to beinstitutionalized and formally evaluated.
So what are the key recommendations?
9.National policies and strategies on regulating the use of big data in the healthsector need to be addressed by national health and ICT entities and should includea clear position on the use of big data by private companies.
10.National policies governing the use of social media in health professions need tobe put in place.
THANK YOU!Clayton Hamiltonhamiltonc@who.intTwitter: @ClaytonHamiltonhttp://www.euro.who.int/en/health-topics/Health-systems/e-healthhttp://www.euro.who.int#eHealthUkraine #е-здоров’я