Well it’s more than just the second letter! eHealth has quickly become the term to provide an overarching reference point for all elements of technical advancement that supports the provision of health care.
It’s not just a new ‘cool’ name and I don’t believe it is a passing fad. eHealth in 2014 describes an application of Moore’s law to all elements of technology relating to the provision of health care. Every 18 months, technology advances so much that it can provide solutions that will improve the delivery of health care by a factor of two. This shows eHealth following the tangent of Moore’s law and the relation to technology innovation and the size of the box it needs!
More than 10 years ago the NHS had Information for Health, then the National Programme for IT and then Connecting for Health. As we come to the last half of 2014 the technology advancements and the acceptance of the innovation that this brings mean that the levers that we want eHealth to pull can be pulled with some vigour!
All this change will enable the benefit to reach the person it matters most to, the patient.
At a recent Guardian event devoted to a discussion of how eHealth can be deployed, it was proposed that eHealth is simple – after all it is only about the capture, share and use of information. It’s always people who haven’t been around eHealth that say it’s simple though, normally followed up with a statement about how if the banks and airlines can do it, why can’t health care? In the last 12 months I have met health care informatics people from across the globe who all agree that eHealth is anything but simple. But without it, the systems in place to care for us as we get older are going to reach capacity.
Something different has to be done to enable the benefits which technology in health can bring.
If patients were to drive digitisation what could change? Millions of decisions are made every day based on evidence, but without data to facilitate a continuous test of that evidence. eHealth, applied appropriately, would remove so much risk associated to this.
If we can make informatics personal to the patient, help a patient understand that data will help them keep well, and that it need not only be about urgent and critical care, then just maybe the right lever that has not been pulled before could be. After all health care professionals have a desire to place the patient at the centre of health care delivery, so why not place them at the centre of eHealth delivery too? Technology can support this cultural change and ensure that information can truly support the clinical desire for data and the patient need for insight. The trick is maybe how to get people to become part of a clinical micro-system. If we can do this then we will avoid the fragmentation of data and systems and achieve the clinical benefits more easily.
Do we want a doctor to use data to become an expert in patient level costing or to use data to inform the delivery of care? We need to create an adult-to-adult relationship between the clinician and the patient (and by clinician we need to mean anyone who is involved in the provision of care). Both of these statements were made at a recent event, and how wonderfully accurate they are. I truly believe this relationship can evolve through the application of technology based on the requirements of both the clinician and the patient. To me it is important that we consider the needs of the patient and the clinician though, and based on an understanding of the desired benefits, create systems of delivery that have these defined benefits at the core. Ensuring that there is a value for money outcome in the implementation of eHealth can only be achieved by engaging the people who will use the systems. This then will ensure that they define the benefits that can be gained and that these are placed at the heart of the development, and therefore the delivery.
There is still the question of definition though. What is eHealth? Is eHealth a system where a patient:
decides what data to collect
decides what data to share
I think good eHealth will be able to do all of these, but a knowledgeable patient, who knows what it means to share or not to share, and a system that allows the right ‘degree’ of information to be shared, makes eHealth about a great deal more than simply the technology.
Current information systems often measure outcomes for budget and capacity management. That’s good but it’s neither eHealth nor Business Intelligence and could be one of the reasons that buy-in into these systems has not been achieved fully anywhere yet. Doing this, the counting of beans, is not the creation of intelligence; it’s the monitoring of the system. We need to overcome the issues around understanding, to allow health care provision to adopt eHealth at its core, not as simply the wires, or worse, an inconvenient burden.
Perhaps the best definition of eHealth comes from the EU eHealth Action Plan (2012 – 2020).
“eHealth can benefit citizens, patients, health and care professionals but also health organisations and public authorities. eHealth – when applied effectively – delivers more personalised ‘citizen-centric’ healthcare, which is more targeted effective and efficient and helps reduce errors, as well as the length of hospitalisation.”
The inclusive nature of the EU statement for me sets a good core strategy for the implementation of eHealth and ensures that both the health and wealth of the care providing system can benefit from a good adoption of eHealth principles.
Perhaps one of the issues impacting on recent attempts to implement eHealth is that a decision to adopt such a change requires a political might to be behind it. The might of politics behind the implementation of eHealth can skew objectives unnecessarily. We need to make IT big enough for leaders but allow patients to decide on the benefit they want to gain. If we don’t facilitate this through the type of systems deployed then it will always be difficult to stay out of the ‘controversy ditch’ that has impacted so many attempts. Whatever systems are deployed, the care required for information about the patient should never be underestimated and the ability for patients to make choices about the access to their information should be facilitated wherever possible.
I guess in summary we have the Perfect Storm – an increase in health care capability and a decrease in capacity against a backdrop of improving technology and the generation that has grown up with digital society coming of age.
Couple this with a need for inclusivity in the access to care and health care reform occurring globally, then we may well be being presented with the moment when eHealth becomes the hero of the health care provision rather than the controversial headline.