EY – responsible for performing the report – analyzed 38 regulatory documents on the digitization of healthcare drawn up in 27 countries of the European Union, Scotland, and Norway. The authors looked at five key elements which have the greatest impact on the adaptation of digital health: digital health governance, security and interoperability, the approach towards the deployment of e-health solutions, the deployment of e-health platforms on the national level, and the promotion of innovation.
What are the key conclusions from the 213-page report?
The strategies are already there
Some good news for a start: 25 out of 29 of the analyzed countries have implemented national digital health strategies. A vast majority has also determined strategic goals and a roadmap for digitization.
In most cases, ambitions are the same: “the creation of a patient-centered health system.” However, it is not that good when it comes to the particulars because what we need is digitization supported by a reform of the whole healthcare system. 2/3 of the countries have a dedicated entity or agency which coordinates the digitization of healthcare, and some countries have even set up committees, including health professionals and patient representatives, to give advice on the use and assessment of digital health technology.
75% of the countries have created an interoperability framework for health data based on standards such as SNOMED-CT, HL7 FHIR, or IHE profiles. What can be observed is that there are highly uniform interoperability standards and strategies in the EU. 56% of the countries have health data security regulations. Secondary use of health data has already been regulated in 20 countries, but only 14 of these countries have the required technical infrastructure.
E-prescription rolls out slowly
The most popular solution is e-prescription, but it is mandatory only in 5 countries. Almost 70% of the countries have deployed national e-health portals allowing patients to access their data – but only in theory – because differences in the deployment progress are large across EU countries. What is surprising is the conclusion that the GDPR provisions on data processing are not complied with in many digital health systems.
OVID-19 accelerated the digitization of health, which is also visible in the discussed digital health report requested by the French Ministry for Solidarity and Health. Before the pandemic, only a few European countries reimbursed telemedicine appointments, whereas now it is the majority (20 out of 29). Moreover, 38% of the countries reimburse the use of mobile health applications. Project funding has also improved – a majority of the analyzed systems have specific research funds for the development of e-health solutions.
It is visible that digital health is beginning to mature. However, it is still an early stage of building infrastructure and gradually implementing solutions by health professionals and patients. The study clearly shows that we are just beginning to be aware of issues such as ethics in healthcare, environmentally-friendly digitization, and equal access to e-health solutions. For example, only 7 of the analyzed countries give patients a direct opportunity to decide whether their data can be used for research purposes.
Main trends observed
- Digital Health is a top priority
All countries have established a strategy dedicated to Digital Health, mainly focusing on core national services deployment, telemedicine, and improving the ecosystem’s interoperability and security.
- Regulation must keep pace with innovation
A lack of coercive regulative frameworks may limit Digital Health deployment and efficiency: Few regulations are currently enforced, especially in innovative areas such as mHealth, digital therapies, or AI-based solutions.
- Interoperability standards but limited enforceability
Strengthening the implementation and enforceability of interoperability standards is key to improving health data transfers, which would benefit from agreed European standards and could rely on a European e-ID, or even a future e-Wallet.
- Ethics is not sufficiently being addressed in Digital Health
Most countries are aware of the challenges regarding ethics, but few directly and comprehensively address them. Giving individuals power over their health data and developing innovative solutions (such as AI) still have to be tackled.
- Ethics by design is a lever for acceptability
For Digital Health to be actually used, it must be acceptable to healthcare providers and individuals, which relies on their trust in the solutions. Developing ethics-by-design approaches (including all four ethics dimensions) is a lever to improve trust and Digital Health use.
- Eco-responsible Digital Health is still largely unexplored
Digital Health sustainability is an emerging matter that EU countries are starting to tackle: Overall, work must be conducted to highlight best practices and strategies focused on reducing Digital Health energy consumption.