Europe is the global leader in nation-wide implementation of eHealth solutions

Results of the Monitoring National eHealth Strategies Study

Europe is the global leader in nation-wide implementation of eHealth solutions

"Europe is leading the rest of the world in advancing towards modern eHealth infrastructures and implementations" was the conclusion of Dr. Karl Stroetmann of empirica Consultants at an eHealth Strategies Symposium in Brussels. This is a field where Europe has achieved and even overachieved its Lisbon Strategy goals. Results of the Monitoring National eHealth Strategies study ( presented on Sept. 16, 2010 in Brussels, show that virtually all Member States of the European Union have either already begun or will begin shortly to undertake the implementation of national systems making basic patient data available to all healthcare professionals whenever and wherever needed.

More than 100 high level political representatives from European Ministries of Health, representatives of stakeholder associations and European policy institutions attended the workshop which showcased several good practice cases of Member States eHealth strategies and highlighted the overall trends across Europe with regards to eHealth initiatives and implementation.

Compared to four years ago, when Member States had published only high level official policy documents or roadmaps, now almost all EU and EEA Member States have detailed documents outlining concrete eHealth goals, implementation measures and past achievements. The following overview identifies key fields of national level activities and the considerable increase recorded between 2006/2007 and today:

While patient summary and Electronic Health Record (EHR)-like systems have already been high on the agenda for some time, most Member States (+16) now realise that there is an urgent need for (continuous) evaluation activities, both to better control policy progress and learn from challenges and experiences.

Ilias Iakovidis, Deputy Head of the ICT-for-Health Unit of the European Commission, which ordered this survey, noted "Services high on the agenda are the electronic transfer of prescriptions and the provision of telehealth services for doctors and patients in remote regions or for chronically ill patients at home. These are among the key activities identified in our 2004 eHealth Action Plan. We are happy to see that the development of this Lead Market Initiative, which we have supported for many years, is gaining such momentum." Another indication of the strong political commitment at the national policy level is the growing establishment of permanent administrative support structures. National competence centres like Gematik, Germany's Society for Telematic Applications of the Health Card in Berlin; ASIP, France's Agence pour les Systèmes d' Information de santé Partagés in Paris; and THL, Finland's National Institute for Health and Welfare in Helsinki are increasingly used models of organisation.

This support is further reflected by the initiation of the epSOS (Smart Open Services for European Patients) project by 12 Member States. The goal of this project is to establish interoperable cross-border services for the exchange of basic patient summary data and electronic prescriptions. "The European Parliament strongly supports this initiative and welcomes the fact that another 11 countries will soon join. We expect considerable benefits for all citizens in terms of the quality of health services they receive when abroad and in need of unplanned help", remarked Dr. Milan Cabrnoch, Member of the EP and its Committee on Employment and Social Affairs.

Electronic Health Record (EHR) systems are a consistent element in almost all strategies and roadmaps. However, EHRs are usually not well defined, and they often (implicitly) refer only to a kind of patient summary or similarly brief or basic patient record. It is also becoming apparent that clinicians’ enthusiasm for comprehensive electronic health records, which may also connect patient data in diverse record systems at hospitals, community services etc., often relates more to perceived benefits on their immediate surroundings than to a geographically widespread sharing of patient data.

The actual stage of implementing patient summary and EHR-like systems in Europe is shown in this table:

ePrescription is another key application that the majority of Member States have as a part of their national eHealth strategy and/or intentions. ePrescription is the electronic capture and then transfer of a prescription by a healthcare provider to a pharmacy for retrieval of the medicine by the patient, and the recording of dispensation in the patient's record. As the following table illustrates, only a few European countries have implemented a fully operational ePrescription service, and these are mainly in primary care, i.e. excluding dispensations in hospitals:

Up until now, patients rarely have had access to their own medication profiles and the ability to reorder certain repeat medications themselves via the Internet. This access is expected to increase considerably in the coming years in those countries where it would be within the constraints of regulatory boundaries.

The results of the Monitoring National eHealth Strategies study reveal that reaching agreements with regards to eHealth strategies and, to a greater extent, implementation of these strategies across Europe have proven to be much more complex and time-consuming than initially anticipated. In addition, the complexity of eHealth as a management challenge has been vastly underestimated. It is evident that further exchanges of information on national and regional experiences are needed; both in relation to successes and failures, and that these lessons learned may prove particularly beneficial to eHealth in Europe as a whole.

Many challenges remain and there are many obstacles yet to be overcome: Issues of legality, semantic interoperability, standardisation and electronic identification domains must be resolved before these services can be regarded as truly Europe-wide and accessible to every citizen. Luc Nicolas from the Belgian Federal Public Health Services underlined that all Member States therefore "Strongly support the recently established eHealth Governance Initiative of European countries intended to tackle these and other issues at the highest political level."

The symposium was kindly supported by the Belgian Government in the context of its Presidency of the EU.

Presentations held at the symposium:

empirica: Monitoring national eHealth strategies - Study approach, results, outlook and recommendations

Claudio Saccavini, Arsenàl.IT: Integrating the Veneto regional, collaborative eHealth platform into the Italian eHealth Strategy context

Wendy Currie & David Finnegan, Warwick Business School: Progressing at different speeds towards national e-Health infrastructure and solutions for europe: findings from a study on enabling technologies for e-Health

Michal Danilák: The citizen centric eHealth approach and implementation measures in Slovakia

Michal Danilák: Mind map - Slovak National eHealth Programme

Michal Danilák: Lessons learned - eHealth Slovakia

Michal Danilák: Health Challenges

Hans B. Haveman: eHealth and Interoperability in the Netherlands

Luc Nicolas: Building trust - step by step - in a federated system in Belgium

Michèle Thonnet: eHealth for Health - From strategy to implementation : some progress and lessons

The study has also been reported on by eHealth Europe: