ISSUE 4, NOVEMBER 2005   

Welcome to issue 4

In this FOURTH issue of the A-BARD eNewsletter, we look at eHealth. Why eHealth?
Normally people living in isolated rural areas or small rural villages do not have fast access to advanced medical assistance.  In the best case they will have access to dispensaries or secondary hospitals.  Deployment of eHealth systems in the rural areas can offer an alternative or complement to centralised urban-based institutional care. eHealth type services are seen as important both in the context of rural health-care delivery and in the justification for rural broadband. 


In this issue we will discuss different issues regarding eHealth and give some examples of progressive eHealth initiatives from Sweden. To read the complete eHEALTH report, go to www.a-bard.org

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What is eHealth?

eHealth can be viewed as health services and health information accessed through the internet and related ICT (information and communications technologies) technologies.

It can include everything from health information based Internet resources to medical decision support systems designed to assist clinical assessment.  It involves access technologies connecting remote patients as well as interconnecting health professionals to each other and to their patients.

Why eHealth?

There is a perception that eHealth can facilitate fairer access to healthcare, responsive, appropriate and targeted healthcare delivery, and better value for money than conventional healthcare systems.  Ultimately eHealth should deliver better health for everyone.
eHealth is also seen as a means of radically reforming and improving health care provision at the Member State and sub-Member State level.
eHealth is essentially a tool or concept that supports and empowers those involved at every level of the health sector, whether patients, health care professionals or healthcare administrators. 

Importance of eHealth

To date adoption of ICT in general healthcare provision has been disappointing and lags behind developments in other sectors with similar communication and networking requirements.  Investment in eHealth solutions at the Member State level ranges from 1 to 2% of national health care budgets.  This compares to some 80% on personnel.

Private sector ICT investment in certain sectors that are heavily reliant on information processing can be as high as 15%.  Compared to other sectors such as finance and commerce the adoption of ICT in the health sector is proceeding slowly.
Because of this slow take-up of ICT in the health sector initiatives are underway at the national and international level to rectify this situation.
The Commission has called on the private and public sectors to make better use of ICT to improve healthcare and empower patients across Europe.

Overview of some eHealth Issues

Quality assurance
Generally many of the issues in the health sector apply irrespective of whether access is online or offline.  Quality assurance strategies developed for static health situations need to be updated to accommodate the new dynamism of the eHealth world.  Poor eHealth applications may result in inappropriate treatment or delays in seeking appropriate health care.  Patient-health care provider relationship can suffer through lack of appropriate procedures.  Privacy and confidentiality can be violated.  Users need to know how sites are certified or rated and who is doing the certification.

Privacy, confidentiality and security

Privacy, confidentially and security remain a major concern and will likely delay solutions that enable the transfer of personal health records.  Standards and interoperability of databases has been one of the main bugbears restraining growth in eHealth applications.  Certain of the EU initiatives have actively addressed this.  However it is likely that data conversion requirement and proprietary legacy systems will retard developments in many areas.

Integration of disparate healthcare domains
Issues such as the lack of integration between the worlds of health care, public health and personal health will likely continue into the eHealth world.  eHealth offers an opportunity to seamlessly integrate various health related sectors.

Existing traditional health related demarcation, often on an economic social or political basis, will most likely continue into the emerging internet based eHealth world.
Imagine the gain to be made from integrating e-health tools and features - health information and support, personal records, compliance and disease management programmes, behavioural change and health promotion into one seamless system.  Or is this too much like big brother?

Demand

In the present climate the public focus is on health service availability and efficiency rather than on eHealth?  According to the Commission, up to 5% of health budgets will be invested in eHealth systems and services by 2010. The idea is that the money diverted from directly dealing with patients can be justified because the technology will save time and money in the long run.  Is this likely to be acceptable to patients?  Does this mean that it will be some considerable time before we see meaningful eHealth services in a rural context?

Leadership

Who takes the lead in implementing eHealth?  Is there a role for local government/authorities?  Should eHealth be combined with eLearning and eGovernment initiatives?  Can we bundle these sectors together to create a demand that will justify speedier rural broadband roll-out?  One of the problems that rural broadband roll out is facing is the lack of proven demand to justify a viable business case.

Prioritisation

Many organisations are likely to divert eHealth budgets to administrative and back office tasks rather than on patient interaction. Should patient interaction get priority?

Collaboration

Collaboration and interworking between different health service providers and services is crucial. How should this process be encouraged?

Why is eHealth important in the context of A-BARD?

It is expected that eHealth will change the existing health service delivery model from one based on a series of transactions with different and separate organisations to one centred around the citizen interacting with a series of interconnected services.  This should benefit all residents whether urban or rural. Rural residents and all citizens can be better informed about their options in terms of healthy living and treatment. 

Clinicians and other health care professionals can provide more informed services to patients.  In turn they can be better informed about treatments and related logistics in other parts of the general health service.
Local health care managers can make more informed decisions on resource allocation and services deployment.

Rural residents should benefit from eHealth developments.  However, access for rural inhabitants to eHealth based services will be non-existent if appropriate telecommunications infrastructure is not available in rural areas. 
On the other hand with appropriate telecommunications infrastructure, rural residents should have a comparable access to services as their urban counterparts.  Widespread emergence of eHealth solutions could improve the quality of life for rural residents.
Rural communities have many additional eHealth challenges and issues including a growing elderly population and a feeling of isolation from central health services.

Examples of eHealth projects in Europe

Distance Monitoring in Skellefteå

Skellefteå is a Municipality in the North of Sweden, it is very rural, 140 km from north to south, 80 km  wide east to west.  The Skellefteå project uses mobile wireless with the aim of allowing older people stay at home as long as possible.
The project started in January 2005 and aimed to:

• Increase safety
• Decrease transport
• Use specialist consultants
• Increase knowledge about dementia
• Costs before the projects

Costs before the projects were of 10,000sek for every examination.  Studies showed 95% of those cases could be solved by video conference.  About 10 people get to hospital every day for 2 or 3 days. About 40% of them probably do not need to be in hospital.  50 million could be saved if the problem was addressed..The project aimed at saving costs but also meant hospital stafftime could be better spent treating other patients.
The PCs were equipped with video equipment. Wimax wireless was used to allow nurses to move freely with their PC and to talk to doctors back in the hospital.
In part of the trial the nurses also used medical systems with sensors measuring blood pressure, sugar, weight and whether patients had taken their medicine. These systems used Bluetooth and RFID.
The results were transmitted using GPRS Telia network. A secured network was used and data were stored on a database.

eCare in Katrineholm
Municipality
The Linköpings University project was about the perceived future need to move care away from hospitalisation.
The purpose of the project was to:

• Increase knowledge of the possibilities for distributed care
• Encourage companies to develop products for the area
• Give caregivers the possibility to test products in the early stage of development. 5 projects are running at present:
• Development of system for measurement of physiological parameters in home health care
• Development of textile sensors
• Screenlabs: pc/webcam based on a platform for Kolorometrial test
• Prevention of pressure wounds

• ICT based system for home health care

eHealth in Sörmland County
The eHealth support services that are being developed in Sörmland are intended to relieve pressure on health teams and to increase the ability to reach care by telecommunication.  Services provided include:

• Prescription renewal
• Bookings
• Aidcard renewal
• Leave messages

During the period April 2004 – May 2005 the most frequent users were in the 45 to 64 year old age group.  The next step in developing the service will include the provision of a clinical reservations facility.
The main 2 effects of the introduction of the internet based service are:

• It is a way for citizens to get in touch with the healthcare services independent of time and location
• It increases citizen’s ability to reach care by telephone for those who do not have access to Internet.

Future Directions

Based on discussions held at the A-BARD workshop and work to date by the consortium it appears that when it comes to eHealth in a rural context some of the following factors are important:

• There is an acceptance that “patient-centred care”, care at home or within the community, is the approach that will be pursued in the future and will require greater use of ICT aids and especially networking. 

• Health care delivery is extremely expensive; there can be major resource constraints both in specialist personnel and available finances.

• How local health services are structured and organised appears to be important.  For example in Sweden local authorities have taken on responsibility both for broadband provision and local health services.  This means that e-health related services can be planned and initiated on a community basis and developed to coincide

• with broadband provision.  This is not the case in all other member states. 

• The local public sector needs to drive broadband availability and take-up.  There is a need for a regional or local rural eHealth task force in the context of rural broadband.

• The topic/issue of rural eHealth (including eCare) in a European context is as yet poorly understood.  There is a glaring lack of knowledge of developments, what is possible and accumulated experience in this area.  This would appear to contrast with the real benefits that such developments could have on improving “quality of life” for rural residents.  It could be argued that real rural eHealth projects are now feasible with the wider availability of rural broadband.  Leadership is needed in this area especially in identifying what is happening and what could be achieved. 

Next Issue December 2005

• Wireless broadband
• Communities broadband solutions
• Wimax, hype or reality what can rural Europe expect from it?