TOWARDSA HEALTHIEREUROPE - Joinup · 2017. 10. 3. · TOWARDSA HEALTHIEREUROPE How innovations in eHealth can improve medical care, increase efficiency, and create new jobs A SPECIAL

TOWARDS AHEALTHIER EUROPE

How innovations in eHealthcan improve medical care, increase

efficiency, and create new jobs

A S P E C I A L R E P O R T

John Vassallo is Vice President, Corporate Affairs, Microsoft Europe

Healthcare is one of the biggest challenges facing our societies, oureconomies and our governments over the coming decades. At a personallevel almost everyone has a story, an experience and a personal view not onlyabout healthcare but even more so about healthcare innovation. At theorganisational level, the private sector has a key opportunity to contributeto transform and innovate healthcare.

The long-term aim is to facilitate prevention and lifelong wellness ratherthan only treatment and cure. Today’s technology enables us to transformhow we will think about the problem tomorrow, for example by empoweringphysicians to anticipate rather than being busy with gathering medical data.

More than 12 years ago, Microsoft started making investments in the healthindustry. We saw software and the Internet as essential tools to transformhealthcare, as they have so many other industries – opening new ways ofworking, new ways of communicating, and new economics.

We have increased our investments and commitment to health globally. Wehave focused on openness and interoperability to drive truly scalablesolutions that can benefit all.

The vision for healthcare innovation is very broad. Both in Europe andglobally the private sector is developing an information infrastructure thatconnects data, systems, and people. Today’s focus on making medicalrecords electronic is an important piece of the broader vision – but it is onlyone part of that vision. The key is to enable consumers and large healthsystems to connect and share data to help them build their health dataassets.

To move away from today’s fragmented delivery system to tomorrow’sconnected network, we need technology infrastructure that allows data toflow freely throughout the system and be reused. This infrastructure mustbe flexible, to enable many different players across the ecosystem to dowhat they need to do; it must be interoperable, to leverage existingstandards and infrastructure investments that work towards more unifiedways of organising and sharing data; it must be scalable, to adapt to therate of medical and technology advances; and it must be secure and private,to foster consumer trust and responsibility.

Technology enables us to reinvent healthcare. Such a venture deserves to beundertaken through deep partnership and broad collaboration withstakeholders. As a technology company, Microsoft shares the vision ofenabling the modernisation of healthcare, focusing on better outcomes, noton technology adoption per se but rather on its usability.

1TOWARDS A HEALTHIER EUROPE

How innovations in eHealth can improve medical care, increase efficiency, and create new jobs

CONTENTS

1 The future of healthcare in Europe . . . . . . . . . . . . . . . . . . . . . . . .2

2 The role of technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

3 What are governments doing about eHealth now? . . . . . . . . . . .6

4 The barriers to eHealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

5 Conclusions and recommendations . . . . . . . . . . . . . . . . . . . . . .11

CASE STUDIES

Slovakia: Wireless information system helps doctorscommunicate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

The Netherlands: Healthcare firm to save 10 per cent Inoperating costs with easy remote access . . . . . . . . . . . . . . . . . . . . .5

Czech Republic: Seamless integration with current andfuture systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

UK: Foundation Trust set to boost patient care with contentmanagement system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Finland: Hospital district connects systems, improvescommunications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Spain: Hospital boosts patient quality of service,legal compliance with mobile solution . . . . . . . . . . . . . . . . . . . . . .12

INTERVIEWS

Ilias Iakovidis, Deputy Head of Unit, ICT for Health,European Commission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Philippe Swennen, the Association Internationalede la Mutualité . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Martin Denz, President, European HealthTelematics Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Octavian Purcarea, Global Solution Manager,World Wide Health Group, Microsoft . . . . . . . . . . . . . . . . . . . . . .10

Peter Neupert, Corporate Vice President,Health Solutions Group, Microsoft . . . . . . . . . . . . . . . . . . . . . . . .11

Information and communication technologies(ICT) have the potential to change the face ofhealthcare.

In the US, President Barack Obama has putcomputerisation and the electronic patientrecord at the heart of his push for reform.

In Europe, there is a vision and understandingof the central role of ICT in improving thedelivery of health services and its role as theglue that will hold together an array of medicaltechnologies, improving care while curbingcosts. This paper explores Microsoft’s visionfor health-focused information technology, oreHealth, built upon a culture of partnershipand collaboration.

FOREWORD



SECTION ONE

Developed economies are already finding it hard tomaintain standards of healthcare on existing budg-ets. Now payers are facing a huge dose of extra cost

as, building on advances in biotechnology, pharmaceuti-cals, imaging, diagnostics and other fields, medical tech-nology is delivering the potential for new treatments anddiagnostics. eHealth – the application of information andcommunications technologies to the healthcare sector –stands out as a way to improve service and raise effi-ciency. As EU Health Commissioner Androulla Vassiliounoted in December 2008: “Investment in health paysfuture dividends.”

The problems are big, of course. A Europe that should becelebrating the increasing life span of its citizens findsitself preoccupied with the cost of caring for an ageingpopulation. By 2050, a third of the population will be over60, an increase of 44 per cent over 2006. The number over80 years of age will increase by 180 per cent. And theprevalence of most chronic conditions increases with age.Cancer and cardiovascular disease in the over-65s accountfor three-quarters of deaths across Europe. Demographicchange is now combining with a recession that seems cer-tain to threaten healthcare budgets, putting vulnerablegroups at greater risk.

There are also chronic inequalities. Life expectancy atbirth for females ranges from 76 years in several EasternEuropean countries to 84 in France, Italy and Spain. Thedisparities within countries can be greater still: according

The future of healthcarein Europe

eHealth is the application of information andcommunication technologies to the practiceof healthcare. It is not just about convertingpaper records to electronic ones, but alsoabout making these electronic records avail-able, as and when required, to healthcareproviders across the chain, from general prac-tioners to hospitals, and pharmacies.Beyond this, it applies ICT to telemedi-

cine, enabling, for example, patients to havea consultation with hospital-based specialistsover a video link from their GP’s surgery. Itpermits X-rays and magnetic resonanceimages to be transmitted for assessment byspecialists. It allows patients to monitorchronic conditions themselves from home.One of the most important developments

arising from eHealth is likely to be givingindividuals the information and the tools theyneed to monitor their own health, and tosupport disease prevention programmes.eHealth systems will also pull together all

the medical information that clinicians needto keep on top of developments in theirfields, backed up by decision-support andsearch tools to enable them to apply thisknowledge.In the words of Daniela Filipiová, Czech

Minister of Health, during the opening of theEuropean ministerial conference of healthministers, eHealth for Individuals, Societyand Economy, which took place in February2009, “Primarily, eHealth brings benefits topatients and healthcare workers. It will beeasier for doctors to access information onhealth conditions of their patients, and, also,they will be able to control their expendi-tures and gain greater mobility. Patients willhave information on their health conditionsor drug dosage; with rigorous observation oftheir personal data protection, naturally.” Tosummarise, eHealth helps increase qualityand safety of healthcare services as well astheir efficiency.

What is eHealth?

to the World Health Organization’s Commission on theSocial Determinants of Health, the life expectancy of achild born in the poorest part of Glasgow, Scotland, is 28years less than that of a child born in the most prosperouspart of the city. Such disparities have social causes that canbe addressed through the application of eHealth to ensureequity of access to healthcare, improved medical informa-tion and giving individuals the means to monitor andmanage their own health.

But there’s a paradox: information – patient records, med-ical know-how, test results – is at the heart of healthcare;it is, in fact, one of the most information-intensive sectorsof the economy. Yet it is also among the least comput-erised. That means that, compared with the retailing,finance or manufacturing industries, the healthcare sectorin Europe has the greatest potential to boost the effi-ciency and quality of its service.



One of the key missions ofthe ICT for Health Unit is topromote interoperabilityof eHealth systems, toenable information to move

from one system to another. HereIlias Iakovidis highlights why this isimportant.

Patients are at the centre of any eHealthstrategy. How will they benefit frominteroperability?The first and most important benefitis safety. Interoperability is the way forevery carer to have all the relevant infor-mation at his or her fingertips, in thesurgery, the hospital, or on the move.That obviously improves safety. The endresult is better treatment and bettercare.Interoperability also makes it possi-

ble to deal efficiently with publichealth emergencies and to improveevidence and knowledge creationin health research.

The vision of improving efficiency and qual-ity by having correct up-to-date informationreadily available is common to most sectors,and many have achieved it. Why, aftermany years of trying, is healthcare still notthere?The hurdles faced by healthcare reallyare higher than elsewhere. First, you aredealing with personal data aboutmedical conditions, so you only wantto share it with authorised people. Inother areas, such as finance, confiden-tiality is important too, but there theinformation isn’t so complex. Numbersand simple concepts on one machinecan, with appropriate security, bereadily transmitted to anothermachine.In healthcare it is far more difficult

to preserve the meaning and integrityof medical information when it goesfrom one system to another. A doctor’s

INTERVIEW

Ilias Iakovidis, Deputy Head of Unit, ICT for Health,European Commission

report in one electronic health recordin one system is not easily under-stood and automatically translated byanother doctor’s system.On top of this, there are far more

interests to be reconciled in healthcare.It involves big chunks of every country’sGDP, and there is much sensitivityaround the availability, interpretationand use of information that interoper-ability enables on a large scale.

So, are the problems that exist aroundinteroperability purely around the culturalissues of who controls information?Political, organisational and legalissues are very critical for achievinginteroperability as well as cultural anduser incentives. But the technology isnot all ready. Despite much progressthere do remainmore straightforwardtechnical issues. Amajor one is the pro-liferation of standards for electronichealth records. These are competing,and confusing matters with respect tointeroperability.Then, on the other hand, there are

not enough guidelines and standardsto enable new technologies such as per-sonal monitoring devices to be inte-grated into healthcare networks. Thereneed to be agreed approaches and pos-sibly new standards for wireless datatransmission from devices such aspersonal blood pressure or glucose levelmonitors into health records.Then there is the issue of bringing the

profusion of legacy systems, manyrunning bespoke software, into inte-grated, interoperable networks.But the biggest andmost significant

technical barrier is in data input andoutput (user friendly human com-puter interaction). The keyboard andthe mouse just aren’t appropriate forhealthcare. Voice input is part of theanswer, but digitising voice into free text

does not provide structured data thatcomputers can process.

To what extent would handing individualscontrol of their own electronic health recordsovercome the barriers to applying ICTto improve quality and control costs, inthe same way as it has done in so many othersectors?Individuals will play a role, and thethrust of much of our effort is to helpthem. But the idea of giving peoplecomplete control has been oversold –many just are not in a position toassume control, or simply wouldn’twant to. The health professionals mayalso not want to trust such data. So itwould be wrong to focus on this as themeans to the end.

What is the next big milestone in achievingthe widespread adoption of eHealth?I think we need to convince the politi-cians that this is a battle that must beengaged and won now. The statisticsare stacking up in terms of the inex-orable rise in healthcare costs comingfrom citizens’ demand for the highestquality care, the increasing burden ofchronic disease and the ageing of thepopulation. But there is still a view thatthe crisis in healthcare is far off.One way to convince politicians to

act now is to prove the benefits ofeHealth on a large scale – somethinglike a large clinical trial level of proof.For example, six or seven regions inEurope using personal heart monitorsto follow people with cardiovascularconditions and then pooling the datacould demonstrate the cost benefitsand the improved health outcomes ofusing ICT to deal with chronic disease.This kind of large scale deployment willbe supported by European Commis-sion within the Competitiveness andInnovation Framework this year.



eHealth systems can deliver high-quality informa-tion, in real time and in a manner that is easilyaccessible everywhere, while at the same time

improving the operational efficiency of all the supportingprocesses involved in the delivery of healthcare. The rewardwill not only be better healthcare. It will, as a contributorto Europe’s knowledge economy, create new jobs, drivegrowth in the healthcare sector, boost healthcare innova-tion and provide greater value for the 11 per cent of GDPthat Europe spends on health services.

Many significant new technologies such as point-of-carediagnostics and improved imaging are poised for action.But it will take pervasive eHealth networks for them tocome together to change the paradigm of medicine fromtreating people after the pathology is well established, to

SECTION T WO

The role of technology

a model of personalisation, prediction and prevention.The increasing prevalence of chronic conditions calls formore sympathetic disease management, and integratedcare models that link health and social care, allowing careto be delivered at home. By furnishing new ways of com-municating between service providers, patients, cliniciansand carers, eHealth systems can be used to build andsupport more people-centric models.

Here’s an alarming statistic: between 8 and 12 per cent ofpeople admitted to hospital in Europe each year sufferharm from the healthcare they receive there. Hospital-acquired infections and inept surgery are two causes. Theother two, incorrect or delayed diagnosis and medication-related errors, would surely be reduced by theup-to-date and complete information of eHealth systems.This provides a concrete demonstration of the oppor-tunity that eHealth holds for Europe’s economy, societyand citizens.

eHealth can also make the system more efficient. Cur-rently, there is huge complexity in moving patients througha healthcare system, from when they first report to ageneral practitioner, to referral, scans or biopsies, anoperation and follow-up.

eHealth systems – electronic patient records, networks forsecure transmission of diagnostic tests or the inputs frompersonal monitoring devices, centralised analysis of MRIscans or X-rays, underpinned by end-to-end data poweredhealthcare systems – have the power if not to reduce, thento manage, this complexity.

There are huge implications for policy makers and health-care administrators with their silo budgeting. Point-of-care diagnostics will increase the cost of primary care,but will save on hospital time performing biopsies or run-ning centralised pathology labs, while reducing the eco-nomic burden of ill health. With eHealth systems in placenew, targeted interventions can be introduced more rap-idly, at a scale that reduces costs and provides relevant,concentrated clinical feedback.

And the advent of “cloud computing” – the developmentof software and services on-line – can transform the waythe healthcare profession actually works. It can link doc-tors to hospitals, labs, insurers and to patients in new waysthat even the most “wired” healthcare systems are onlybeginning to explore today.

Indeed, a central role for eHealth will be to support peo-ple in taking responsibility for and managing their ownhealthcare, from home, within their own country butalso across the EU. The potential is highlighted in thelatest Euro Health Consumer Powerhouse ranking of

The Kosice Children’s Teaching Hos-pital started a six-month MobilePoint of Care (MPoC) trial in theOncology Department with a view tostreamlining the doctors` workingprocesses and helping deliver increas-ingly sophisticated levels of care.Each patient was provided with abedside wireless Internet accesspoint, and the five doctors within theOncology Department began usingthe tablet PCs in their daily work.These provided real-time access topatient’s case histories and medica-tion files. Doctors could view and

enter new information at the bedside–previously information was writ-ten down and then entered into thehospital’s information system at alater date. The immediate insight intopatient histories and medicationregimes enabled the doctors to bemore responsive to patients’ needs,optimised workflows and supporteddecision-making. TheMPoC enablesthe hospital staff to save at least 25per cent of the time spent on admin-istration tasks, eliminate duplicateexaminations or prescriptions andreduce or eliminate waiting periods.

C ASE STUDY

Irina Oravkinova, Director of the Oncology Department, KosiceChildren’s Teaching Hospital:“Communication is a very important part of our work. Fast gaining ofinformation is the key to making the right decisions. We hope that this systemimproves information transmission and simplifies our communication andcommunication with our patients’ parents.”

Slovakia:Wirelessinformationsystem helpsdoctorscommunicate



Europe’s national systems according to their attitudes topatients/consumers, published in November 2008. Thisanalysis includes measures of eHealth for the first time,and concludes that ICT is a key factor in the consumer-friendliness of healthcare systems, supporting partner-ship between the individual and the care system andclosing the gap between patients and professionals.“Information will re-shape healthcare in the way wehave seen in other major service industries,” says JohanHjertqvist, president of the Health ConsumerPowerhouse, a leading provider of information andanalysis of European healthcare.

Hjertqvist notes that at present it is essentially impossibleto get any type of official data on the quality of cardiovas-cular healthcare in most European countries. Withoutsuch information there is little opportunity to increase thequality of that care. “After four years of comparison wenow see the leading healthcare systems starting to adoptconsumer trends. The leaders aim to support choice byproviding information and, via consumer priorities, creat-ing pressure for improvement of services and quality ofcare.”

“From this perspective it becomes evident that eHealth isa spearhead to radically reduce costs, open up the possi-bility of rapid access to treatment and improved patientsafety.”

Amsta Zorginstelling is a growinghealthcare organisation located inthe Netherlands. Because Amstamust comply with stringent industryreporting regulations, it needs to pro-vide strong security for its proprietaryhealthcare application, which isused to collect patient data. Thecompany also needs to providesecure remote access because anincreasing number of employeeswork remotely and require easyaccess to applications. With help

from technology integration partnerB-able, Amsta implementedMicrosoft Intelligent ApplicationGateway (IAG) 2007, which solvedboth of these challenges by simpli-fying remote access and ensuringaccess control and application secu-rity. As a result, IAG 2007 is helpingAmsta employees access vital datafrom anywhere without compro-mising patient privacy. In addition,the company is saving administrativetime and IT management costs.

C ASE STUDY

Shebab Davoudi, Head of IT, Amsta:“We had an audit that showed that we will save more than 10 per cent ofour operating costs by using IAG 2007. That is money we would be spendingon time and management without this solution.”

The Netherlands:Healthcareorganisation tosave 10 per centin operatingcosts with easyremote access



SECTION THREE

While healthcare is the responsibility of MemberStates, the European Union provides a useful,proactive focus for elements of eHealth such as

standards and interoperability, and research funds for eHealthprojects that can act as exemplars. The Commission’s 2004eHealth Action Plan1 aims to harness ICT to provide bet-ter healthcare for the entire EU population, with the focusfirmly on the development of interoperable healthcare sys-tems and services and cross-border healthcare provision.Moreover, the Commission response to the “Aho2 report”on Creating an Innovative Europe3 in a new initiative – called theLead Market Initiative – aims at the creation and market-ing of innovative products and services in promising indus-trial and social areas. Chief among the areas of Europeanindustry that are ripe for further development is eHealth. Oneof the four key areas targeted for action in a proposed pro-gramme to support eHealth as a leadmarket is eHealth inter-operability, in particular electronic health records (EHRs)interoperability.

With a dozen countries working to set up electronic healthrecords, the Commission is trying to ensure these systemscan work together. Its Recommendation on cross-borderinteroperability of electronic health records, published in July20084 aims to provide the basic principles and guidelinesenabling doctors to access the records of patients, wherever

the information may be located in Europe.

In support of this, the Commission is sponsoring the€22million European Patient Smart Open Services (epSOS)project – Microsoft is part of the industrial consortium – todemonstrate the benefits of interoperability. epSOS is co-funded by the Commission and countries that have nationalelectronic health records projects, along with the suppliersinstalling them.

“Travelling around the European Union is taken for granted,until something goes wrong,” said Viviane Reding, the EUCommissioner for Information Society andMedia, launch-ing the project.

The epSOS project will work to ensure compatibility ofelectronic medical information, regardless of language, orsophistication of technology, without having to establish acommon system throughout Europe. It is the first time thatthe Commission has attempted to set out the steps neededto ensure compatibility between different national systems.

In January 2009 the roadmap for the most difficult part ofthe task, ensuring the semantic interoperability of electronichealth records, was published. This covers the job ofensuring that the meaning of information is preserved whenit is sent from one computer to another.

Ilias Iakovidis, Deputy Head of Unit for Health ICT at theCommission, forecasts it will take 20 years to achieve fullinteroperability across Europe. Tomaintain themomentumhe says the benefits of exchanging consistent patient infor-mation must be highlighted, confidence must be nurturedthat the data will be secure and confidential, organisationsmust trust those they share information with, and sharinginformation must not conflict with the commercial or legalinterests of any participants.

Incorrect or late diagnoses and mistakes with medicationare major causes of medical harm to patients. The Commis-sion’s Pharmaceutical Package seeks to address this, requir-ing eHealth systems that give citizens access to high-qualityinformation on prescription-only medicines and to improvepatient protection by strengthening the EU system for mon-itoring the safety of medicines.

Announcing the Pharmaceutical Package, CommissionVice President Günter Verheugen said, “[This] builds on theneeds and interests of patients. European citizens should ben-efit from safe, innovative and accessible medicines. Theyshould be best informed about availablemedicines and treat-ments since their health is at stake.”

When it comes to modernisation of healthcare and imple-mentation of innovation, Member States vary in theirapproaches. Several countries are working to implement elec-tronic health record and other eHealth systems.

What are governments doingabout eHealth now?

C ASE STUDY

Na Homolce Hospital in Prague hasdeployed Microsoft Dynamics NAVto cover all its activities. The founda-tion of the solution is efficient finan-cial f low control, transparentmanagement of procurement, stockoptimisation, supply chain manage-ment, and insurer/patient relation-ship management. These contributeto improved employee efficiency andreduced operating costs.Managers find it difficult to predict

the way health care will be funded for

more than half a year ahead, so theyneed to carefully monitor all inputcosts.The project included an Invoicing

to Insurers module, implementedoutside the standard product anddeveloped by Webcom to meet thecustomer’s specific requirements.Among the major benefits of thesolution is its seamless integrationwith the current as well as potentialfuture information systems deployedat the hospital.

Czech Republic:Seamlessintegration withcurrent andfuture systems



The most ambitious and comprehensive of these is inthe UK: the £13 billion Connecting for Health programme,the largest project in the history of civil computing. Whilethe heart of this is a standardised electronic health record,it has other elements such as electronic prescriptions, asystem to book appointments, and a national networkfor transmitting X-rays and other diagnostic imageselectronically.

The recent eHealthMinisterial Conference in Prague calledfor increased efforts to facilitate the building of a EuropeaneHealth area which will enable access to healthcare for

INTERVIEW

Are current developments in eHealthsupportive of AIM’s principle ofmutuality?I think of eHealth as a tool that canimprove the quality of the healthsector. It could be a big help, for exam-ple, in e-telemedicine for the manage-ment of chronic diseases andimproving healthcare in general.Except in some conditions, I don’tthink there is any strong evidenceICT can reduce the cost of care, butit can improve its quality.

What is AIM’s priority in the deploymentof eHealth?We wouldn’t have a single priority.Obviously confidentiality, data protec-tion and privacy are critical, but

beyond this we need formal healthtechnology assessments to informthe use of these tools. A lot of invest-ment will be needed in the full scaledeployment of eHealth systems, andas insurers we therefore need a busi-ness case. Concerning telemedicine, weneed to resolve the issue of reimburse-ment, by updating the nomenclatureof medical acts.

How important is the development ofelectronic health records?Electronic medical records are at theheart of the eHealth systems thatare being developed in a number ofEuropean countries. They should gen-erate better information and improve[appropriate] sharing of medical data.

France, the UK, Switzerland and Bel-gium have national projects, but inmany cases these projects have stalledbecause of the sheer complexity of theprocess and the huge financial invest-ment.

Are developments in eHealth supportinginsurers when dealing with cross-border reim-bursement?Of course, cross-border reimburse-ment is very important for us, even ifin practice it represents a very smallpercentage of what we fund.It’s why we are following carefully

the proposals of the EU cross-border healthcare Directive. Similarly,the push to create standards for inter-operability is important.

The Association Internationale de la Mutualité (AIM)represents private not for profit health insurers thatprovide healthcare for 160 million Europeans.Dr Philippe Swennen, Project Manager, says eHealthobjectives are important to AIM’s members

all citizens. For this purpose continued efforts are needed,saidministers, particularly in the areas of telemedicine serv-ices deployment, interoperability as well as Europe-widecooperation and exchange of best practices. MemberStates are encouraged to adapt their national eHealthstrategies so that the individuals (patients and healthcareprofessionals), society and economy are all the beneficiaries of eHealth’s positive effects. Microsoft welcomedthe minister’s call for Member States to participate in dis-cussions about a Europe-wide governance structure foreHealth that will give additional impetus to the introduc-tion of new services and the removal of existing obstacles.



SECTION FOUR

One impediment to innovation is the traditionalstructure of many healthcare systems. Most care isdelivered in the same context – of general practi-

tioners’ surgeries, accident and emergency, outpatientsand hospital wards – as in the 19th century. New technolo-gies that empower patients would force change. But as theEuropean Commission’s recommendations highlight, whilethere are rocks on the road, it’s worth the effort. Develop-ments such as a Common User Interface5, designed in acollaboration between Microsoft and the UK’s NationalHealth Service, and innovative products such asMicrosoft’s Personal Health Record (HealthVault)6, showthe potential.

Moreover developments such as Connected Health Plat-form – an open architecture for eHealth – are opening theroad to build an infrastructure which is (1) flexible,enabling many different players across the ecosystem todo what they need to do; (2) interoperable, to leverageexisting standards and infrastructure investmentsthat work toward more unified ways of organisingand sharing data; (3) scalable, to adapt to the rate ofmedical and technology advances; and (4) secureand private, to foster consumer trust.

One of the key objectives of the European Union’s eHealthAction Plan is to support and boost investment in thearea. But a recent report concludes that merely increasingbudgets is not enough. More ICT skills are needed acrosshealthcare, to ensure systems can be used to their fullpotential. This includes improving the ICT skills and knowl-edge of medical staff who use the systems, the managerswho handle the investment, and the knowledge and under-standing of the needs of healthcare among vendors. “Anexpanded [skills] capability is essential to achieve more suc-cess and so help to boost eHealth investment,” says thereport, Financing eHealth, published by Empirica in Jan-uary. (http://www.financing-ehealth.eu/)

And there is a further issue: the risk perceptions of citizenson emerging technologies and scientific innovation wasidentified as an invisible barrier by the Commission in areport, “Future challenges for EU health and consumerpolicies”. This can and should be addressed by illustratingthe power of eHealth as evidenced by the case studies inthis publication.

More than 7,000 employees at Uni-versity Hospitals Bristol rely on tech-nology to communicate across eightdifferent sites. But its existingintranet was underused, proving abarrier to effective collaboration andknowledge transfer. Users requiredintensive training and it demandeddedicated support from the IT team.With a solution based onMicrosoftOffice SharePoint Server 2007, thetrust is rolling out a new intranetwhere users can create sites and

workgroups and edit content inde-pendently. Staff have faster access toup-to-date information, while theIT team saves eight hours a week,and has time for value-added taskselsewhere.Improved collaboration and new

tools, such as a Web part that inte-grates a real-time view of bed avail-ability, mean the trust can makebetter-informed decisions thatimprove the quality of health serv-ices for the community it serves.

C ASE STUDY

The barriers to eHealth

BUILDING A CULTURE OF ONLINE TRUST

Privacy, compatibility andsecurityCreated in cooperation with leading privacy advo-cates, respected security experts and dozens of theworld’s leading healthcare organisations, Microsoft’sPersonal Health Record (HealthVault) is designedand built to enhance privacy while providing peoplewith the control they expect and require.“Microsoft is the first major technology company

to engage with the Coalition for Patient Privacy in athoroughgoing way. The privacy protections builtinto HealthVault reflect the privacy principles of theCoalition. HealthVault prohibits onward transfer ofdata without explicit informed consent; its contrac-tual obligations with advertisers require protection ofany data transferred from the platform; its privacypolicy is simple and easy to understand,” said DrDeborah Peel, founder of the Patient Privacy RightsFoundation.

“That means consumers finally have a trustedplace to store their personal health informationthat will not be data-mined, because they alone con-trol it. Microsoft’s use of strong privacy principlesincluding the principles of the Coalition, its ongoingrelationship with consumer advocates, and its com-mitment to independent third-party audits set a newstandard for privacy protections in health informationtechnology.”

UK: FoundationTrust set toboost patientcare with contentmanagementsystem



structure is a computer on a desk, ora wire in the ground. But we also needlegal, regulatory and standards ele-ments and an organisation frame-work as essential building blocks for thisinfrastructure.

Do you think there is progress in reconcilingthe different interests of the wide array of bod-ies and individuals that have an interest ineHealth systems?Well, I’m Swiss, but I would certainlypoint to the exemplary activities ofthe European Commission, which ismaking good progress in overcomingthe silos. The major shift is the under-standing that healthcare is not onlyabout the practice of medicine, it isabout how a healthy populationgenerates a healthy economy. Thebenefits are two-fold: budgets arespent more productively and Europecan create jobs and build a healthyservice industry.

EHTEL has taken a lead in ensuring eHealth

INTERVIEW

C ASE STUDY

The Hospital District of Helsinki andUusimaa (HUS) is Finland’s largesthealthcare organisation. With over445,000 people using its servicesannually, it needs an outstandinginformation system to ensure thewellbeing of patients. In 2007, HUS

upgraded its IT environment from ahost of disparate software toMicrosoft BizTalk Server 2006 R2Enterprise Edition. HUS hospitalscan now collaborate efficiently in anenvironment that integrates differentcritical applications.

The development ofeHealth is poised at a cru-cial point where all thetechnology ingredients arein place and the many

interested parties, from governmentsand payers to clinicians and vendors,patients and citizens, appreciate thehuge potential of systematically inte-grating ICT into healthcare, believesMartin Denz. Now a catalyst is neededto move everything forward.

The number one rule when designing anddeploying computer systems is to get consentand buy-in from all the users.Why does thisso rarely happen in healthcare?We all have the right ideas I think, butwe still have cultural differences andmisunderstandings. We need to betterunderstand the issues, and what otherpeople’s perspectives are on theseissues. This may sound general, butwhat I am talking about is building aneHealth infrastructure in a sustainableway. The usual understanding of infra-

Martin Denz, President of the European HealthTelematics Association (EHTEL), which representsinterests from across the range of ehealth

Finland: Hospitaldistrict connectssystems,improvescommunications

Mikko Rotonen, Development Director, HUS ICT and MedicalEngineering:“The efficiency of how we deal with patients has improved remarkably and thescalability of the solution means we can continue to grow for the foreseeablefuture and this at a low cost.”

systems are patient-focused. Are you confi-dent patients’ rights are being properlyprotected?We need a framework for patients’rights in relation to eHealth, butbecause of the complexity and array ofissues there is a risk of over-regulation.Regulation should reinforce trust,safety and privacy, not be a barrier toinnovation and against the enhance-ment of health systems. Healthcare issegmented, it is not comparable withone-dimensional markets: we need tobe careful that regulation does not rein-force protectionism to patients’ disad-vantage.

Has the argument for eHealth been won asfar as the main users in the medical profes-sion are concerned?I am now talking from the perspectiveof a doctor: I do not fear new technolo-gies – since it reinforces my basic aimof achieving the best outcome for mypatient. It is a brain extension, and atthe same time relieves me from time-consuming hunt for data and improvesmy knowledge and quality manage-ment.The issue is how to integrate it into

my culture: the industry has little ideaof what happens when I am in front ofa patient. Working in healthcarerequests a set of skills as relationshiphandling, complexity managementand dexterity in reef navigation. A bigbang approachwon’t do; such eco-sys-tems need a systemic understanding.Healthcare systems – and by this alsoeHealth – represent the greatest chal-lenge in change management.

Where are the successful eHealth models?Healthcare will always be local. Suc-cessful examples as Medcom maywork for Denmark, but for each othercountry you need to adapt such anapproach to local conditions. Butonce we have a large-scale, standard-ised eHealth infrastructure, this impactsas an incentive to use it for better acces-sibility, quality, safety and efficiency ofhealthcare systems, while providingindividual, tailored services – such aconcept of sensible medical mass cus-tomisation is portable everywhere.



example, for telemonitoring anddisease management. We are work-ing closer with many partners,adding new applications to the enduser solutions, with products likeHealthVault [see box, p8] andAmalga. With HealthVault andAmalga, Microsoft is releasinghealthcare information, traditionallytrapped within data silos, toempower citizens and professionals.

The fact is, the eHealth market remains acomplete miasma of competing laws, stan-dards and vested interests. How can youcut through this?The answer is to find new businessmodels by looking from the oppositeend and asking: What is the prob-lem? Classic electronic healthrecords are just static data reposito-ries; they won’t improve the out-come. To achieve the full potential ofeHealth we need to add the knowl-edge in a dynamic way along thecontinuum of care and transformthe classic electronic health record ina workflow management system,including the Personal Health Recordon this platform. On the hospitalside, solutions such as AmalgaHospital Information Systems,Unified Intelligence Systems canbridge and feed the information con-tinuum from care providers to theindividual.Moreover, advanced intelligence

systems aggregate information fromdifferent sources, and can automat-ically interrogate it, looking for pat-terns. Rather than answeringpredetermined questions it could,

for example, highlight a rise in noso-comial [hospital-acquired] infec-tions.

How do you make a business case foreHealth?There are two main answers. One isto meet the requirements of all theusers – not only the health profes-sionals. Find out what are the incen-tives for patients, for insurers, forpayers, and use this to provide whatthey want and build the businesscase.The second element is to build

trust the between health profession-als and the authorities. What health-care professionals need are systemsthat are common to them as a pro-fession and follow their normal workprocess, rather than an adjunct of ahuge management or administrationsystem. Such systems could be man-aged by professional associations.

What one aspect of the technology could dothe most to improve the prospects foreHealth?The main problem at the moment isusability. You need standard inter-faces like those based onMicrosoft’sCommon User Interface, so thatevery time a health professional goesto any computer the interface isfamiliar and consistent. You needcommon specifications and openstandards and architectures under-pinning this so that independentdevelopers can use it to build stan-dardised applications. This will avoidmedical errors and increase theusability of eHealth systems.

INTERVIEW

Cultural barriers continue toimpede the use of eHealth sys-tems and healthcare remainsfar behind the rest of the econ-omy in its use of ICT. What

insights can Microsoft offer to end the cul-tural impasse?The key thing is to me the most obvi-ous – we are talking about knowl-edge-driven healthcare. This meanseveryone involved in healthcareshould have the right (evidence-based) knowledge, at the right time,improving outcomes, saving cost andimproving quality.A broad range of IT solutions have

to come together to give all thoseinvolved the knowledge they needalong the continuum of care, fromproducts like the Personal HealthRecords (such as HealthVault), whereindividuals can store their own healthrecords, to collaboration and pro-ductivity tools for health profession-als, to business intelligence and otherepidemiology and statistical tools forinsurance companies and other pay-ers such as the local and regional gov-ernments.All of this has to be underpinned

and connected on a secure, robustplatform which would ensure the fun-damental functions such as messag-ing identity and access management,unified communications, system anddocument management etc.

So how are these components applied?We are trying to give the world a morecomprehensive vision. We are not justsupplying the nuts and bolts, butdeveloping specialised solutions, for

Octavian Purcarea, Global Solution Managerin Microsoft’s World Wide Health group



For our health and our economy, action is needed nowto speed the development and deployment ofeHealth systems in Europe. Here are some thoughts

for policy action, gathered from experts and stakeholdersin the field.

1. Invest in eHealth innovation and spurgrowth and jobs

Our current economic crisis provides a spur to action.The US government’s stimulus plan includes major neweHealth IT spending. President Obama signalled its impor-tance by including it, along with investment in educationand research, in his inaugural address.

The global market for eHealth in Europe is the third largestEuropean health industry, after pharmaceuticals and med-ical devices. It is also a sector of growth and jobs, even anddespite the current economic outlook. For example, thedemand for clinical information systems and tools fortelemedicine and homecare is increasing regularly. But, totap into its full potential, eHealth needs an environmentthat is favourable to innovation.

To support the transition to innovative eHealth systemsand tools we need:

� Improvement of the skills base of healthcarepractitioners.

� Promotion of clusters of healthcare innovation, cen-tred around Europe’s great medical universities andteaching hospitals, is recommended. This involvesseveral steps ranging from the reform of tangled intel-lectual property rules that discourage private invest-ment, to measures that foster the growth of small,innovative healthcare companies with, collectively,the power to create millions of new jobs.

� The Science|Business Innovation Board7 recentlyurged in the Wall Street Journal that Europe act now.The Board is an independent panel of leaders in Euro-pean industry, academia and policy, to whichMicrosoft International President and EuropeanCommission Ambassador for the Year of Creativityand Innovation Jean-Philippe Courtois belongs.

� eHealth should be part of that investment pro-gramme.

2. Promote interoperability

Interoperability is a key enabler for the seamless transferof information and health data along the continuum ofcare.

The ability of one system to work with or “talk to” anotheris a precondition for innovation and growth of the eHealthsector. It is also a necessary and desirable element to ensurepatients’ seamless access to healthcare when travelling acrossEurope.

� European, international and global cooperation is

SECTION FIVE INTERVIEW

available at the appropriate timeand place. This means putting thefocus on making systems interoper-ate and insisting that vendors sepa-rate data from applications.

You recently spent time talking to peopleinvolved in healthcare in Europe. Whatwas your overriding impression?Everywhere there is a deep interestin personally controlled healthrecords – more than I anticipated,and despite the fact that some earlyprojects in the category haveperformed poorly and have lowadoption. It is recognised that citi-zens/consumers need to be activelyengaged in their health in order toimprove the results and economicsof the health system and view per-sonally controlled health records asan important tool to motivate andengage them. They don’t see otheroptions that can accomplish thisgoal.Privacy is a major issue surround-

ing the sharing of health data andmany have concluded that person-ally controlled health records arethe best solution.The search is on for ways to con-

nect the health delivery systemacross institutional boundaries,from GP systems to hospitals andspecialists. No one is doing it wellyet. But this is seen as critical todelivering better outcomes and con-taining costs. Seamless data sharingis acknowledged to be the route tonew work flows. Unfortunatelythere remain many barriers to thisseamless data sharing.

eHealth covers a broad array of technol-ogy for a broad array of users. Whereshould the focus be?We really need to focus on thehealth outcomes we want toachieve, and adopt technology inways to achieve better outcomes –such as better management ofchronic diseases or more effectivehospital management. Technologyis important but it isn’t the silverbullet. The way to encourage inno-vation in healthcare is by settinggoals, not by mandating specifictechnologies.

What would be one of the greatestadvances that eHealth could deliver inyour view?A lot of care happens in the home.As the population continues to agethis will be increasingly true. Weneed to enable physicians and con-sumers to use technology such asautomated monitoring systems andgive patients the means to takeresponsibility for their own health.The Internet presents itself as thefoundation for patient/physicianconnection.

Healthcare is acknowledged to be 10 to15 years behind other sectors in deploy-ing ICT. What can be done to speedadoption and catch up with the rest of theworld?Everyone points to cultural issuessuch as professional vested inter-ests, and the need to ensure patientconfidentiality as an explanation forthis lag. So there needs to be incen-tives to share data and to make it

PeterNeupert, CorporateVice President, HealthSolutionsGroup,Microsoft, and formerCEOof the onlinepharmacy drugstore.com

Conclusions andrecommendations



C ASE STUDY

Fundacio Salut Emporda, a smallhospital in Spain, needed to bettermanage its patient consent formsand comply with a governmentmandate to digitise its records. UsingWindows Mobile 6, PDAs, and acustom line-of-business (LOB)

application, the hospital has createdan efficient electronic forms process.Its customer service has improved,and staff can more easily complylegally. Now they are findingother innovative uses for WindowsMobile.

needed in the development of interoperability ofeHealth solutions and systems. It will do us littlegood to wire hospitals and clinics in one country, onlyto discover they can’t connect with those in anothercountry; that robs us of the opportunity for the sav-ings that arise from a global, competitive market ineHealth solutions.

During the Czech Presidency of the EuropeanUnion, Deputy Ministers and States Secretaries ofthe Member States responsible for healthcare metinformally for the first time. Their final agreement,and the aim of establishing a high-level coordinationstructure which should deal with issues such as datacompatibility of individual systems and patients’ dataprotection, is a welcome step in the process ofeHealth implementation in future.

� Recent efforts, driven by the Commission, todevelop a transatlantic relationship on eHealthshould be continued and encouraged on both sidesof the ocean.

� Discussion and collaboration programmes devel-oped by organisations such as the European Ameri-can Business Council, TransAtlantic BusinessDialogue and the America Chamber of Commerce tothe European Union are of crucial importanceto ensure alignment and coordination inthe transatlantic developments around eHealthinteroperability.

Spain: Hospitalboosts patientquality of service,legal compliancewith mobilesolution

Francesc Luque, IT Manager, Fundacio Salut Emporda:“The doctors can spend less time finding paperwork and just focus on givingquality care to the patients.”

3. Enhance the health and wellness of citizens

Health authorities face a daunting set of challenges: theymust, with an ageing population, focus on chronic diseasemanagement, address cost containment, quality of care anderror-free service – all at the same time.

But citizens demand these improvements.� Progress can come from collaboration among con-sumer organisations, associations of healthcareproviders and patient associations, at national andEuropean level. Microsoft has an ongoing commit-ment to continue the consultation with consumerorganisations, associations of healthcare providersand patient associations.

� Governments should foster the development andtesting of new economic models based on incentives.Pay per performance and organisational changescould offer sustainability to health care systems inpartnership with the healthcare professionals.

� Tackling inequalities and the digital divide remainsof crucial importance to fulfil the promise of eHealth.Governments should promote the creation of partner-ships among public, private and non-governmentalorganisations.

� Industry and healthcare authorities together with theusers should continue in their efforts of collaborationand innovation to drive e-inclusion and to promotean inclusive information society.

� Special campaign and awareness-raising efforts likethose of the e-inclusion Awards promoted by theCommission’s DG INFSO could be continued.

4. Transform health delivery

Implicit in eHealth, as in any new technology, is fundamen-tal change in the way people work. People change behav-iour based upon evidence and real cases. Microsoft has setup a specialist division with a mission to improve the wayhealthcare is delivered.

� Government and local authorities should fund“proof of concept implementation” able to con-vince the health professionals of the necessity tochange the way they work.

� Training of healthcare knowledge managers isanother element required for professionals to be ableto deal with ever-increasing amounts of information.

� If Europe is to develop a new class of health profes-sionals it is of paramount importance to equip userswith the right skill sets along with managementtools that are both innovative and usable.

� Usability is a fundamental component of how wetransform health delivery.Usability should be tested.

� Government-funded evaluation centres and labs incollaboration with universities and SMEs should bepromoted in order to assess the usability and safetyof eHealth applications. In turn, this will also increasethe level of trust of health professionals andpatients’ groups.

WORDS

Nuala Moran, Science Business Publishing Ltd

DESIGN

Chris Jones, Design4Science Ltd

EDITORIAL PRODUCTION

Peter Wrobel, Science Business Publishing Ltd

PRINTERS

Holbrooks Printers Ltd, Norway Road,Portsmouth, Hampshire PO3 HX, UK

© Microsoft Corporation 2009

Jan Muehlfeit is Chairman Microsoft Europe

We have a vision of how health will be provided in the future. In this vision,technology supports and extends the capabilities of clinicians andhealthcare facility administrators. It brings information smoothly intoexisting ways of working and uses ICT to reduce the complexity ofburdensome processes. In this New World of Healthcare Work, cliniciansand administrators have pervasive access to the latest knowledge toimprove outcomes. Hospitals, clinics, and doctors’ offices can operatemore efficiently and focus their resources on patient care. The latestinnovations in medical science can spread immediately across theprofessional community and around the world. Providers can extend thereach of their skills to even remote, poorly served areas. Payers can alignreimbursement plans to support preventative care and effective treatmentswithout looming over the shoulders of providers and patients. Althoughmedical information and records are standardised, portable, anduniversally accessible, privacy and confidentiality are protected by thestrongest technologies and practices.

REFERENCES1 COM(2004)356 final. e-Health – making healthcare better for

European citizens: An action plan for a European e-Health Area.2 Esko Aho chaired the working group which first drafted and

published this report on innovation in Europe. It is his name whichhas since been used to refer to the report.

3 See http://ec.europa.eu/invest-in-research/pdf/download_en/aho_report.pdf

4 Seehttp://ec.europa.eu/information_society/newsroom/cf/itemlongdetail.cfm?item_id=4224

5 See www.mscui.org6 See http://healthvault.com/7 http://www.sciencebusiness.net/info/innovationboard.php

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