Is the time right for e-Health?
It was some nine years ago that I travelled to Florida for a meeting of the American Telemedicine Association’s annual meeting. I think that this was the third or fourth of its kind and we were languishing in the wake of the dot-com bubble explosion which had left everyone cynical of the transformational power of new business models enabled by the proliferation of internet applications. The opportunity had been oversold ahead of its time but the seeds of a transformational future had been sown.
Today, some of the issues on the table are the same but some have moved on and suggest that we might just be at a tipping point for e-Health, m-Health and all of the other names for what is essentially nothing more than using ICT to transform processes to the benefit of all parties. Discussed at that conference nine years ago were the self same issues around who pays for new services and how reimbursement can be restructured to provide incentives for those investing in the creation of new ways of managing patients. The debate and examples were sadly very narrow and focused on the provision of health services to those in remote regions such as Alaska or marketing on-line consultations from US centres of excellence to clinicians and patients across the globe. Almost totally absent was any recognition that e-Health could play any role in transforming the way that care was delivered in urban environments where most of the people and costs were and are present. Essentially it was a case of ‘don’t rock the boat’ and challenge the structures and modus operandi of the system, especially the way that the economic players interact.
What has changed in these past nine years is the discussion about infrastructure. The internet and mobile telephony have blossomed and the serious communications capacity constraints have almost totally disappeared whereas they were at the centre of discussion then.
So where are we today? The Brussels ecosystem is full of discussion on e-Health with three Directorate Generals very focused on seeing ways to realise its potential and realising that technology is the enabler that will allow health systems to deliver better value for money and address the chronic shortages of healthcare professionals that is emerging. DG Sanco, DG Information Society and DG Research have found a critical and appropriate vehicle for addressing the challenge with the laudable project on ‘Active and Healthy Ageing’ and it seems that, at last, there is a will to embrace the opportunities afforded, not just by advances in ICT, but also medical technologies which are targeted at the healthcare challenges of our time. These are chronic non-communicable diseases which are to a large extent a function of ageing and exacerbated by poor life-style choices.
e-Health and m-Health are on the cusp but there are enormous barriers to change. Health is a complex environment and operates more like a political system than an industry, so change management is key. And change management is so hard when so many decisions have to be made on the basis of consensus and key operators in the system have a huge degree of autonomy. Addressing the professional and economic interests of the winners and losers during changes of patterns of care delivery will be central to the successful execution of projects. We have already seen examples of perverse, economically driven behaviour follow the introduction of prospective payment (DRG) systems across Europe. Patients being happily treated in a home-care setting suddenly started being called into expensive hospitals because that was the most economically advantageous way to maximise income for the hospital. e-Health will face the same resistance and perverse behaviour unless managers are determined to follow-through and deal with the inconsistencies and the losers, whilst creating very strong incentives to do the sensible thing.
Medical technologies such as those provided by my industry can be considered as offering a suite of applications that can be used to diagnose, monitor and treat patients whilst they participate in daily life. In fact, they should not be called patients but people who are in need of a little extra help to lead their lives. Patients with heart disease can carry on in confidence that their cardiac function is being watched 24/7; diabetics can get feedback on how closely their therapy is matching their physiological needs and so minimise the potential for the complications that can go hand-in-hand with the disease. Those with chronic lung disease can be monitored remotely with simple old-technology measures of blood pressure and oxygen saturation packaging in a simple easy to use format which gives their carers and clinicians vital information about their status. Wiring up technologies like these to redesigned services keeps people safe and happy in their homes and away from very expensive hospitals. Everyone wins.