Martin Seychell, Deputy Director-General for Health at the Directorate-General for Health and Food Safety (DG SANTE), explains why the European Commission cares about the digital transformation of healthcare
The 2017 State of Health in the EU(1) concluded that only by fundamentally rethinking our health and care systems(2) can we ensure that they remain fit-for-purpose. However, the 2019 State of Health in the EU alerted the risks of a “digital divide” where the digital transformation of healthcare may give rise to new or increased inequalities between people who do and who do not have the skills to harness their potential.
At the European Commission, we strive to reach the right balance between innovation, transformation(3) and accessibility. Ultimately, it is not about how much innovation we can push forward, but how much transformation our health systems and society are capable of absorbing.
Bridging the gap
Over the course of the past 10 years, Member States, stakeholders and the European Commission have been working hand-in-hand to bridge the gap from potential innovation to concrete outcomes, particularly in areas where the EU-wide approach benefits are uncontested. This is the case of the work conducted so far for the eHealth Digital Service Infrastructure(4) (through the eHealth Network) and the European Reference Networks (ERNs)(5), which both provide clear examples of how digital transformation of healthcare can improve healthcare services delivered to citizens in Europe.
The following two initiatives are remarkable achievements and powerful symbols of what the European project is and stands for. They are the culmination of the best efforts of hundreds of citizens, health and care providers, information technology architects, engineers and policymakers. All united in their diversity of thought and skills to deliver a unique contribution to the freedoms and protection without internal frontiers.
The “My Health @ EU”(6) (also known as: eHealth Digital Service Infrastructure) is now up and running providing two main services: i) Patients travelling to another EU country can obtain their pharmaceuticals, thanks to interoperable ePrescriptions; and ii) Patients being treated in another EU country by health professionals who access their health data, thanks to interoperable Patient Summaries. The “My Health @ EU” services are available in a growing number of EU countries and EU wide coverage is being pursued to avoid exacerbating inequalities and the risk of the digital divide.
The European Reference Networks (ERNs) are virtual networks involving healthcare providers and expert centres across Europe. They aim at facilitating the discussion on complex or rare diseases and conditions that require highly specialised treatment, as well as concentrated knowledge and resources. The ERNs rely on the use of a virtual consultation platform called Clinical Patient Management System (CPMS), where healthcare professionals can discuss the most complicated patients’ cases and benefit from the expertise of their peers belonging to different EU countries, saving the patient from the need to travel to receive a diagnosis or treatment plan.
At the same time that they complement the national health systems by overcoming existing limitations due to national borders, the “My Health @ EU” and the ERN-CPMS represent a strong commitment with interoperability and are encouraging the transformational efforts required from the national infrastructures to support new paradigms in the provision of healthcare.
While the “My Health @ EU” and the ERN-CPMS are established initiatives contributing to the improvement of today’s healthcare services, new challenges and opportunities are emerging in the field of digital health.
One of the most relevant challenges derives from the vast amounts of digital health data collected at the points of care and also by the patients’ medical devices. The use of health data to support healthcare delivery to patients and re-use of health data to foster research and health policymaking is at the centre of current agendas. Some may argue that the re-use of health data is not a new thing. At the same time, it is agreeable that the regulatory frameworks (e.g. the General Data Protection Regulation) and technology developments (e.g. artificial intelligence) have reached a maturity stage that makes feasible the further use of health data in full compliance with the personal data protection provisions.
The mission letter to Commissioner Kyriakides(7) sets a challenging but feasible level of ambition: “We need to make the most of the potential of e-health to provide high-quality healthcare and reduce inequalities. I want you to work on the creation of a European Health Data Space to promote health-data exchange and support research on new preventive strategies, as well as on treatments, medicines, medical devices and outcomes. As part of this, we should ensure citizens have control over their own personal data.”
The next stage of digital health transformation
Recent initiatives like the work on the creation of the European Health Data Space and the 1+ Million Genomes initiative(8) are representing the next stage of development and frontier of digital health transformation: how to pool health data beyond borders to improve disease prevention and personalised treatments, following the EU citizens’ demands, as well as coping with the necessary scale for new clinically impactful research. A common European Health Data Space would promote better exchange and sharing of different types of health data (electronic health records, genomics data, data from patient registries, etc.) in Europe to foster the development of new treatments, medicines, medical devices and services, meeting the needs of different users and actors in the system, while at the same time, protecting citizens’ data.
In a time where new technologies set the pace of what is possible and define the size of everyone expectations, it is important to keep present the mission of Commissioner Vestager(9): “Over the next five years, Europe must focus on maintaining our digital leadership where we have it, catching up where we lag behind and moving first on new-generation technologies. This must cut across all of our work, from industry to innovation. At the same time, we must ensure that the European way is characterised by our human and ethical approach. New technologies can never mean new values.”
1 State of Health in the EU “Companion Report 2017”, https://ec.europa.eu/health/state
2 The term “health and care systems” implies a broader notion than “health systems” or “healthcare systems”, notably encompassing public health and social care.
3 Innovation Vs. Transformation: The Difference In A Digital World, https://www.forbes.com/sites/danielnewman/2017/02/16/innovation-vs-transformation-the-difference-in-a-digital-world/
4 https://ec.europa.eu/health/ehealth/electronic_crossborder_health-services_en and eHealth Network, https://ec.europa.eu/health/ehealth/policy/network_en
5 ERN, https://ec.europa.eu/health/ern_en