What exactly do we mean when we talk about eHealth?
The global eHealth market had $41.52 billion in revenue in 2017 and that is expected to increase to $220.65 billion by 2026. Growing demand for eHealth solutions and services, our use of tablets, smartphones, wearables, the Internet of Medical Things (IoMT), increasing usage of big data, and the demands of an ageing population are just some of the factors driving the market growth.
Note: 41 billion is close to the revenue of the entire European cheese industry (55 billion)! While it might be more impressive were these figures reversed, we should consider that we have been eating cheese for more than two thousand years, while eHealth has been with us only about twenty years.
What is eHealth?
In the ever-growing spectrum of Digital Disruption, eHealth stands to make a huge impact on our lives. There are numerous ways in which our world can be improved by Digital Transformation (about which I have written in previous months), and it appears that Health Services is poised to profit from all of them.
What exactly do we mean when we talk about eHealth? Or is it mHealth? Some of the popular terms used in eHealth publications include: iHealth, eHealth, mHealth, digital health, integrated mobile health, as well as telemedicine, tele-intensive-medicine, virtual interventions, virtual behavioral interventions, virtual support interventions, and health-manager, health-coach, and e-therapy websites.
In the last few years we have been discussing the difference between “responsive”, “adaptive”, and “fluid” websites. We have run the gauntlet of “fake news”, “content marketing”, and “advertorials”. When it comes to our health, we should be quickly and confidently able to define terms. It is paramount that we are able to easily discern between health care, medical care, self-help – and which websites are there for our good and which are not.
The importance of defining eHealth terminology was addressed even before the first iPhone hit the shelves in 2007. “1. Standardization of health information is essential for its use and sharing by consumers, providers, policy-makers and others.” World Health Organisation, (118th Session 25 May 2006) Report by the Secretariat “Provisional agenda item 8.4 eHealth: standardized terminology”
Digital innovation in the health sector has been the subject of many discussions and policy initiatives within the EU as well. Such discussions and initiatives date back to 2004 when the first EU eHealth action plan was adopted.
Is That a Doctor in Your Pocket?
Let’s look first at the basics of eHealth, beginning with what we experience daily on our phones and computers – the electronic exchange of information. Symptoms, cures, experiences, doctors, and medicines were shared early on via blogs and health chat rooms. It seemed very simple to share your experiences for the benefit of others. As our world becomes more mobile access to information has become as easy as reaching for the phone in our pocket. Fitbits, calorie counters, jogging trackers … as we become more media literate it has become easier to monitor our health but obvious that this type of information sharing contains the risk of being purposefully manipulated.
Since manipulated information is not an invention of digital media there is a clearly positive aspect: People have become aware of the necessity to evaluate any given information. A well-informed patient is not traditionally welcomed by doctors; but as our population ages and health care resources become strained, a knowledgeable and digitally mature patient may be a necessary and welcome evolution.
Some clinics have already implemented What’sApp messenger services for their patients, as well as online appointment and checkin services. With the introduction of monitoring devices and an acceptance of the IoMT, a patient might soon be informed by the doctor that they need to come in for a checkup before they are even themselves aware of it. Our cars already have this function, as do our coffee machines, washing machines, refrigerators … when a few minutes can decide life or death he idea of an implanted chip and algorithms based on your medical history don’t sound so frightening.
One of the main obstacles to development and implementation within the field of e-Health is of course trust. Medical wearables are just as open to a virus as our phones. Our medical records just as open to hacking as our credit card data. The information that we find on the internet is obviously influenced by search machines and advertising. There are currently more than 1.5 billion websites in the net. How do we know what we are seeing is the best, or the most trustworthy information? Are we seeing the website because they spent a lot on google adwords? Is the website promoting a scientifically accepted procedure or are we seeing a very expensive advertorial?
Being a well-informed and digitally mature user is important. We have come to expect information found on social media portals to be taken with a grain of salt. What about search engines? Google is striving to ensure that websites appearing in their index are valid, and their 1 August core algorithm update seems to have affected Medical and Health websites more than any other sector.
eHealth In Germany
In the last 25 Years it has become quite simple to exchange Health-Data between health care professionals. At the beginning some companies tried to set proprietary standards, but this seems to be no longer a problem. At least in Germany. The German “Gesundheitskarte” projects was launched in 2003 and was aimed at a standardized storage and exchange of relevant data. Today we now have an EU health card.
The project consortium “bIT4health” (better IT for better health), consisting of the companies IBM Germany, the Fraunhofer Institute for Industrial Engineering (IAO), SAP Germany, the Intercomponentware and the ORGA card systems (now: Sagem Orga) was commissioned. The focus was on defining the telematics framework architecture and security infrastructure.
15 Years later politicians, health care professionals, and business are still discussing in which direction to go. Doctors call for e-health law and, in times of omnipresent mobile-services, interfaces to health apps. Getting such interfaces to Android and iOS securely is still a massive challenge. Other factors such as the high cost of deployment and maintenance of eHealth solutions, lack of skilled IT professionals, lack of reimbursement policies & privacy and licensing issues are also hindering market growth and implementation.
The full potential of digitalization in the health area at least here in Germany is still in a holding pattern, with breaks of sunshine in the cloud.
eHealth in the EU
As recognized by the eHealth action plan 2012-2020, the eHealth objectives of the EU are hindered by a number of challenges, such as a lack of awareness and trust in eHealth tools and services among patients and healthcare professionals, high start-up costs involved in setting up eHealth systems, inadequate or fragmented legal frameworks (for example, a lack of reimbursement schemes for eHealth services) and lack of interoperability between eHealth systems.
It should also be mentioned that the transfer of any health-related information is now getting more difficult due to the new GDPR -regulations. While privacy concerns are important, the GDPR may in fact hinder eHealth services across borders and between health service providers.
The EU General Data Protection Regulation (GDPR), which became applicable on 25 May 2018 and which provides a uniform set of data protection rules across the EU, constitutes a new challenge for the development of eHealth solutions. Under the GDPR, health data may only be processed in limited circumstances, such as where a data subject has provided its explicit consent to such processing, and the processing of health data must follow general data protection principles, for example data accuracy or data minimization. Any data collected through digital health solutions, including wearables, apps, devices and others, will necessarily encompass health-related data and therefore potentially raise privacy and cyber security concerns.
eHealth Case Studies
How can information transfer help patients? Joerg Geissler, founder of the Munich based agency “die-weboptimierer” tells about helping patients suffering from eating disorders.
“Like many people with mental illnesses, an anonymous search for help is much easier via the internet. It can also show therapy possibilities which are away from a person’s home. An aspect which proved to be helpful in the field of eating disorders. A simple but smart targeted AdWords Campaign connected hundreds of patients with a specialist in Bavaria. His clinic grew in just a few years from 10 to 60 Beds.”
Another of die-weboptimierer`s clients are an example of the internationalization of today’s health market. Audentic-AG is connecting German dentists with a dental lab in China to reduce costs for their patients. This business model is currently dominated by high-tech logistics, making it possible to take advantage of cost differentials.
As is already a reality in other industries, digitalization doesn´t stop here. Soon the standard for information transfer will not be physical tooth models – it will be via 3D Data. Transferring data to trusted partners opens yet another big field of opportunity.
Looking at a method called VATS (video assisted thorax surgery) new technology can make a live saving difference. This technology is a beneficial, micro-invasive method to – for example – remove lung cancer tumors. . Today, around Europe, there are 20 Doctors trained in the procedure. While these surgeries used to be a “manual work” for surgeons, trainings on remote joystick handling are on the way.
Caspar-health online resource aims at supporting medical professionals, increasing healthcare capacity, and strengthening treatment quality. With Caspar healthcare providers can treat patients onsite, as well as remotely. The online resource uses innovative therapy concepts, and offers its users clinical exercises, seminars, patient educational videos.
“Caspar is an interactive platform. For example, post-stroke rehabilitation can be performed online. A specialist will talk to the patient online and ensure that their instructions are followed correctly. In addition, the website offers quite a few interviews and presentations made by qualified medical specialists and doctors. Each patient receives a Caspar account from the healthcare provider, with a customized interdisciplinary therapy plan designed for them. It ensures that the patients can receive best quality care, during, as well as after the hospital stay.”
Quo Vadis eHealth?
While AI is opening new ways of better diagnosis and surgery, it can also help us manage our health and medical care. New technologies like Blockchain may be able to assist with keeping our data secure and exchangeable. As we become more digitally mature and informed, become more experienced with digital devices and online exchange of information, perhaps the hope for improvement of our Health will outweigh the possible negative effects.
The IoMT can potentially assist our healthcare system, which will continue to strain under an ever increasing and ageing population. By 2025, it is expected that 1.2 billion of the 8 billion people on earth will be over 65. Elderly people tend to have more healthcare issues. As life expectancy rises, it can be expected that healthcare costs will follow suit.
A report by Allied Market Research predicts that the IoT healthcare market will reach $136.8 billion in worldwide revenue by 2021. Today, there are 3.7 million medical devices in use that are connected to and monitor various parts of the body to inform healthcare and insurance decisions.
One of the main obstacles to development and implementation within the field of e-Health, as we have said, is trust. Another is a common understanding of the value of data and the right strategies to deal with it. Government is slow and is not (currently) highly trusted. Private companies face data protection laws, monopoly concerns, government scrutiny, and again a lack of trust by the public. Might not universities, specifically University Clinics be best positioned to provide practical and logical eHealth services?
Universities and University Clinics are, compared to government and private enterprise, at least still for the most part trusted by the populace. Most top universities have been in existence longer than any ruling government party and most private companies. While the university mission was in the past teaching and research, the mandate of a university in the 21st century extends to encompass the idea of public service.
University subsidies (our tax dollars) provide funding, and many of our own children attend, as many of us did. Think back to the last time you went to a university clinic? Did you not feel in more competent hands compared to a state hospital? Research into future health tools resides at the university clinic. Doctors and nurses are trained at the university clinic. Patients are cared for on site. Here is a relevant, consistent, accountable, and trustworthy partner in which to develop and provide eHealth information, research, and services.
With thanks to Natalia Naida for her insights and contribution to this article.
Disclosure: None of my clients are University Clinics.
Further Reading / Sources