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Scope of eHealth and telecare
The term ‘eHealth’ is now widely accepted as a general description that covers everything associated with the deployment of IT in healthcare. eHealth therefore includes the full spectrum of applications from acute hospital care for inpatients to remote telecare services offered by community providers at, or close to, the patient’s home. eHealth strategies have remained high on European priority lists for the past 5 years, but progress has been much slower than expected – due to lack of clear objectives, together with cultural and technology issues relating to modernisation of clinical processes.
Progress towards shared care
One key factor that is vital for successfully integrating hospital and community care is the Electronic Health Record. There is no clear consensus on the nature or content of EHR, but the term has become synonymous with sharing patient level clinical information. Implementation of EHR turns out to be a long process involving significant elements of cultural change and business process re-engineering. The picture is further complicated by constant changes in the scope and understanding of EHR and its technical implications, typically involving large scale collaborative partnerships. Following 25 years of experience with locally based Electronic Patient Records (EPR), the new concept of a lifetime EHR is now just at the start of its own evolutionary cycle and still has much more progress to make as healthcare IT eco-structures continue to evolve.
Global healthcare markets have made significant progress in developing new patterns of shared care delivery. Boundaries between acute and primary care are being broken down, with hospitals concentrating on intensive care while other elements (such as preadmission procedures and post operative care) are assigned to social and community care providers. This presents new challenges in terms of interoperability between individual care provider organisations previously used to working in isolation from their wider health communities.
After 20 years in pursuit of a single set of universally accepted comprehensive standards, strategic emphasis has switched to addressing interoperability in terms of practical support for local business processes. By constraining the context in which standards are actually applied, it is already possible to achieve working levels of interoperability that are good enough to support current telecare systems and to enable their effective integration with acute care.
Role of ICT in healthcare provision
In contrast with other sectors, healthcare has consistently failed to take full advantage of available information technology. Why is this so, and what are the common causes of failure to invest sufficient in healthcare IT? Practical working experience of implementing healthcare systems has revealed that we can’t yet achieve ‘fly by wire’ in healthcare. In practice, we still have to rely on ‘last resort’ intervention by clinical end users to ensure that IT systems actually work safely. One important cause of this situation is the current crisis in healthcare service delivery, which has contributed to instability of healthcare processes in many European markets. This is a worldwide healthcare problem, and is unlikely to be solved solely by IT — or even by any European country on its own.
Until we are able to achieve significantly higher levels of standardisation in clinical process, it will remain difficult to apply IT at the point of care on similar scale to other service sectors. In the meantime, there are still a number of things that can be done to accelerate the transition process and help ensure that at least the basic elements of IT support for healthcare are met effectively. Pending the availability of a new generation of ‘smart’ clinical systems, local healthcare managers will have to take responsibility themselves for ensuring continuity and evolution of clinical processes.
Balancing local and central initiatives
The major challenge lies not only with the technology itself, but also its application to basic business processes. This can only be addressed effectively at local level, in contrast to many European attempts to enforce unproven central solutions based on impractical system concepts. The indication is that European markets are beginning to appreciate this point, but still finding it hard to accept the scale on which some of their original aspirations have been misjudged.
Until ‘full’ EHR systems (whatever these may eventually take) are widely available, GPs and hospitals must either implement their own local electronic patient record (EPR) systems or continue to operate with manual paper records. The reality of mixed paper and electronic systems will become increasingly difficult to support without using interim local document-management systems. It is no surprise that one of the hottest new application areas forecast by European hospitals is medical document management.
Challenge for European industry
The challenge for European healthcare IT providers is to adopt a new and more pragmatic approach to the needs of healthcare managers and clinical users. Local healthcare providers, already suffering from financial pressures, need convincing of the scale of resources and funding needed just to secure their current business processes and to prepare for essential changes implicit in the healthcare consumer agenda.
The suppliers groups likely to gain most from current European market conditions are technology companies providing the servers, desktops, commodity software and telecoms devices required to support essential infrastructure. But new ‘lean’ sales and support strategies mean fewer supplier staff available to deal directly with third-party healthcare system builders and end users, so emphasis is shifting towards large scale government or regional contracts.
Medical devices and diagnostic companies are also forging new high-level links with healthcare, but also maintaining their traditional contacts with local clinicians. Global industry sources are agreed that medical technology will have an increasing impact on transformational change in healthcare service delivery and hence on the future evolution of European healthcare IT markets.
Murray Bywater
Managing Director
Silicon Bridge Research
Original article published by Hospital IT Europe in March 2008
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