The European eHealth patchwork

Healthcare IT continues to be insufficiently funded and supported in many parts of Europe. As a result, a lot of healthcare facilities are not as digitally mature as they could be. This is a key result of the Annual European eHealth Survey, conducted by HIMSS Analytics. The results also show that priorities in healthcare IT vary considerably across the continent. What does not vary is the eagerness of eHealth professionals to improve their leadership skills.

Grätzel von Grätz

For this year’s Annual European eHealth Survey, 559 healthcare or healthcare IT professionals from all over Europe were interviewed via an Internet tool. The survey traditionally aims to represent the broad healthcare IT market in Europe: 4 out of 10 participants came from health facilities, 2 out of 10 from software vendors, 1 out of 10 from governmental health authorities, and 3 out of 10 from other organisations including research and academia, consultancies, and hardware vendors.

Europe-wide, the two top eHealth priorities for healthcare providers are considered to be the implementation of electronic medical records (EMR), mentioned by 23% of the survey’s participants, and health information exchange with external partners, mentioned by 17% of all participants. Among health facility representatives, 29% actually regard EMR implementation as their top eHealth priority. Given that only 18% of software vendor representatives say that they see EMR implementation as a top priority for healthcare providers, one might argue that industry somewhat underestimates the pressure on healthcare facilities when it comes to EMR implementation.

In the regional analysis, somewhat unsurprisingly, EMR implementation is an especially urgent topic in Central Europe. Around a third of all participants in Germany, Austria and Switzerland say that EMR is the top priority for healthcare providers, compared to only 9% in the Netherlands, 11% in the Nordics, and 5% in Spain. This, in all probability, reflects the higher degree of digitisation of hospitals in these countries compared to Central Europe. With 22% of respondents saying that EMR implementation is the top priority, the UK is somewhere in the middle.

(Almost nobody) cares about patient access

What are the eHealth priorities in those European countries that don’t score high on EMR implementation? One thing that is striking from the perspective of a magazine like Insights, that has been championing patient access to digital information ever since its inception, is the low priority that survey participants give to this topic. In most parts of Europe only somewhere between 3% and 9% of respondents say that patient access to information is the biggest priority for healthcare providers.

There are two exceptions though. In the Nordic Countries, 15% of respondents say that patient access to information is the top priority, and in the Netherlands, the share is a whopping 32%, suggesting that these are the regions in Europe that are relatively more advanced in healthcare digitisation, not so much on a technical level but mentally. What is also interesting is cybersecurity. In the UK, 19% of survey participants mention cybersecurity as the top priority, more than anywhere else in Europe. This could well be related to the WannaCry series of attacks that took place not long before the survey. In Germany, Austria, and Switzerland, 12-15% of respondents say that cybersecurity is the top priority for healthcare providers. In all other countries, it is less.

What are the big trends in the years to come?

European eHealth professionals were also asked what they consider to be the biggest eHealth trend in the next couple of years. The spectrum of answers was pretty broad on this one. Personal health records (PHRs) scored higher than other applications, with an approval rating of 17% overall, followed by health information exchange with external providers, mentioned by 13% of the experts. Next in line were EMR implementation (11%), patient self-monitoring (11%), data analytics (9%), and provision of telemedicine services (9%).

Again, eHealth experts in different European countries may observe different trends that will become relevant for their respective markets. Not surprisingly, given the debates around the MedMij-framework, PHRs get an approval rating of 31% as the biggest eHealth trend in the Netherlands. This is different in the UK (11%) and Spain (9%), two countries with other ideas about how an electronic record landscape in healthcare should look.

Telemedicine is another interesting case. With an approval rating of 29%, it scores relatively high in Austria as an imminent eHealth trend. The background is probably that the Austrian government is pushing for a standardised telemedicine framework and plans to integrate telemedicine services into its electronic patient record architecture, ELGA. Telemedicine is also fairly high on the agenda in Germany, with 23% of experts mentioning it as an emerging trend. It is far less often mentioned in the Netherlands and the Nordics. The likely reason is not that telemedicine is not relevant there, but that it is already far too common there to be considered an emerging trend.

IT staff turns clinical - but not everywhere to a similar degree

The Annual European eHealth Survey also tapped into the question of how healthcare is organised on the level of healthcare institutions. There has been a broad trend in recent years for healthcare IT experts to go "more clinical", reflected in an increasing number of chief clinical information officers (CCIO) and chief nursing information officers (CNIO). Europe-wide, 40% of the experts stated that a CCIO was available in their organisation, and 15% said that this was also true for a CNIO.

"Patient access is a top priority only in the Netherlands and the Nordics."

There are huge differences though. In the Netherlands, 60% of survey participants state that their organisation features a CMIO, and 14% say that there is also a CNIO. Only 14% say that there is no clinically focused IT representative available at all. This is completely the other way round next door in Germany, where 73% say that there is no clinically focused IT representative available at all, and only 12% say that there is a CMIO and a CNIO respectively. Other countries are somewhere in the middle. The UK scores pretty high with CCIOs (55%), and it leads the pack in CNIOs (24%). Italy is divided, with 40% saying that their organisation has an CMIO, but 47% saying that there is no clinically focussed IT representative at all.

What about perceived funding and perceived digital maturity, finally? The bottom-line is that healthcare IT is broadly underfunded in Europe. On average, one out of three experts say that the organisation they work for has a sufficient IT budget, two out of three say that this is not the case. In every single country covered in the survey – except for Switzerland – there is a majority that says there is underfunding in their respective organisation. Not surprisingly, experts in Italy, Spain, Ireland and the UK are more worried about budgets than their colleagues in Central and Northern Europe.

Underfunding is mirrored in a no better than average perceived digital maturity. On a scale from 1 to 10, most experts place their institutions somewhere around 6. With scores of 7.3 and 6.7 in Italy and Spain are above average, and with a score of 4.4, Ireland is the one country in the survey that is below average in the digital maturity self-rating. This is interesting, because all three of these countries consider themselves particularly underfunded. So in summary, perceived underfunding and perceived digital maturity don’t really correlate. You can achieve a lot with restricted budgets, it seems.

View Insights 6.1 eBook - The European eHealth patchwork

Philipp Grätzel von Grätz

(Germany) specialises in medicine, health policy and, in particular, eHealth and information technology in healthcare. He is one of Europe’s leading journalists in the field and author of the German book Connected Health.

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