“Telemedicine and m-health are an opportunity for citizens and a driver of great economic impact”, says Terje Peetso, Policy officer at European Commission (Unit Health and Wellbeing in DG Communications Networks).
Written by eHealth Trends & Talks (interview by Artur Olesch)
I would call you “an EU ambassador of -health and m-health solutions”. Why do new technologies fascinate you so much?
Digital solutions are part of our everyday life in many areas – we use them for banking, booking hotels and buying tickets for our trips, parking a car – it makes many procedures certainly faster, easily accessible (24/7) and sometimes cheaper. We are used to it and do not imagine life without these tools. I believe digital tools can bring similar effects in healthcare – booking an appointment to a doctor over the Internet, accessing my health record similarly to an access to my bank account, asking questions to healthcare professionals – from anywhere and at any time.
There are not so many things in digital healthcare that are completely new and have never been done before. Data collection has been, is and will be a fundamental part of every aspect of healthcare – prevention, diagnosis, treatment, monitoring and rehabilitation. Doctors and nurses collect data all the time – from subjective descriptions of feelings and complaints to the objective description of a status of a patient. Thus, there is nothing new in data collection per se – it is only that instead of writing on a paper we now introduce this information into a PC. Thanks to this small, rather technical change in the procedure we can actually make a big difference in healthcare service in general– it is not only that having my electronic health record containing a full description of my health history that prevents me from doing it all again every time I see a different doctor (the question is also whether we actually remember everything?). It may also become useful when selecting a treatment method as the system may automatically highlight allergic reactions that have occurred in the past and contra-indications because of some diseases in my medical history. Furthermore, if my medical record would be a part of a bigger database, it would allow my doctor to seek a treatment method that has been most effective for patients in the same age group, with similar underlying diseases, with the same phenotype and genotype. Such a database and effective data analytics can lead to a new quality of treatment and significantly improve health outcomes. In fact, it would help personalized medicine to become a reality. Indeed, it fascinates me!
Big Data will allow faster and more precise diagnosis and selection of more effective treatment methods.
What about security issues?
Health data is indeed sensitive data and should be handled with care while fully applying data protection rules. It is very important to have in place systems for identification and authentication, rules for data access and rules for anonymisation or pseudonymisation of data for research and data analysis purposes. It is not easy to find a good balance between the two objectives – firstly, to guarantee data privacy and secondly, to allow the use of health data for health research and for public health policy making. However, I believe that with a good explanation people would easily understand how their individual health data could contribute to better health outcomes both at personal as well as population level and provide consent when needed. There would be much less worries if people would understand of how their personal health data could help themselves and their family getting faster diagnosing and more effective treatment and how data privacy requirements are met.
How the healthcare will be transformed in the digital age?
I do not think that diseases and sufferings will change – we will have colds and flu, headache and gallstones, bone fractures and depression as we had in previous eras. We will continuously need doctors and nurses; we need personal contact and physical support. But that thanks to much easier access to information and increased role of citizens/patients in managing their own health and disease the center of healthcare universe will shift towards citizens/patients and healthcare providers could pay more attention on health care i.e. on prevention. As I already stressed in my answer to your first question – access to large amounts of data (often called as Big Data) will allow faster and more precise diagnosis and selection of more effective treatment methods. We will use more often an opportunity to monitor health status of people with chronic diseases from their homes and this will make possible to note worsening of their condition hours or even days before patients themselves will feel that their physical condition has got worse. If we can add here the fact that data sharing would avoid duplication of analysis and that unnecessary hospitalizations can be avoided by tele-monitoring, we will not only have more effective healthcare, we can actually have more efficient healthcare.
The center of healthcare universe will shift towards citizens/patient.
Who – in your opinion – can benefit most from m-health?
Everybody can. Children can learn about health through games, young healthy people can find in m-health support for adopting healthy lifestyle, people with chronic diseases can use apps reminding them taking their medications or register important data e.g. blood sugar or blood pressure, informal carers can have real-time contact with their ward from a distance. Citizens can have an access to their health records and data that was recorded using health and wellbeing or medical apps can be linked to their health records. There are many opportunities how m-health can contribute to better health outcomes – you name it and m-health has it. And if it does not yet have it, it is just a matter of time when it will be there. This is why involvement of end-users – citizens, patients, healthcare professionals, informal carers – in the process of developing new tools is crucial. It is the involvement of end-users that makes new tools user–friendly, thus, they will be used.
You keep an eye on the development of European ICT market. Which countries are the leaders now? What are the success factors of efficient adaptation of ICTs?
There are good developments taking place in every Member State. Some are more advanced at a national level, in some Member States good progress is made in regions, in some regions excellent results have been achieved at a municipality level – there is a lot of good practice to share and learn from everywhere in the EU. I would like to stress that some good lessons have actually been learned from failure as well. Thus, most important is to share experience.
Another success criterion is a good coordination. I think in the healthcare sector it is important that we do not forget about the main goal – better health for all citizens. Whether we are creating an electronic health record, introducing implementing tele-consultation for mental health, launching e-prescription or developing an app for elderly reminding them to take a blood pressure medication twice a day – all these are part of the same system and results will only get better if there is good interoperability of these tools.
Telemedicine and m-health are tools that may help doctors react to the worsening of a condition (smart systems call attention only to changes that need intervention) in an early stage and thus help avoid complications and unnecessary hospitalization.
Could you please give some examples of m-health solutions that you have you discovered recently?
I try to follow the developments as part of my everyday work, but it is almost impossible to be aware of everything that is happening in this field. Again, most of these tools are not introducing something completely new, but replacing the procedures with faster, easily accessible and more efficient ones. For example, considering the increasing prevalence of 2nd Type Diabetes, apps that help in monitoring blood glucose level and physical exercise combined with food intake are valuable tools for diabetes management. Or a tool that helps analyzing electrocardiogram seems to help in many occasions, as the analysis of EKG is one of the most common diagnostic tests, but still often mislead. There are tools useful for healthcare professionals, healthy citizens, patients and informal carers as they contribute to better health and care outcomes.
Are health apps present in your daily life?
I have one health app in my telephone and it is measuring my steps. I wanted to know how many steps I make a day and was rather surprised finding that without any special effort I never reach more than 8000! To meet suggested 10.000 steps I have to get out from the metro three stops earlier. Lesson learned!
How European Commission is supporting the development of m-health tools?
The Commission’s public consultation on the Green Paper on mobile health (April 2014) collected stakeholder views on how to tackle the challenges to the m-health market in Europe. The results of the public consultation were published in January 2015.
As a follow-up to the Green Paper on m-health and the public consultation we have organised two stakeholder meetings to further discuss possible policy actions, in particular as regards data protection and quality and reliability of m-health apps – on 12 May 2015 in Riga and on 6 July in Brussels.
The Commission is facilitating the development of an industry-led code of conduct for mobile health apps, covering privacy and security issues. A drafting team, consisting of industry members, was set up in March 2015. The Code of Conduct is targeted at app developers and its purpose is to provide easily understandable guidance on how to respect EU data protection rules in relation to m-health apps.
A first draft of the code was presented to all other interested stakeholders at a meeting on 7 December 2015. Once finalized, the aim is to submit the code of conduct to the Article 29 Working Party established under the Data Protection Directive (EU Member States Data Protection Authorities) for approval.
Secondly, we are working enhancing the reliability of health and wellness apps and are currently setting up a working group representing different stakeholders to develop guidelines for assessing data validity and reliability of m-health apps, in particular in the context of linking data to the electronic health records.
Actions in the Horizon2020 Work Programme 2016-2017 related to m-health include funding of research and innovation in the field of big data, digital security for healthcare, empowering patients/citizens and improving digital health literacy. A grant to WHO and ITU has been foreseen in the Work Programme for establishing EU m-health hub. The m-health hub is expected to become the focal point for expertise on m-health in the EU. The hub should act as a convening platform to bring together experts and innovators for institutionalizing best practices in m-health whilst avoiding the creation of silos and fragmentation in m-health knowledge across the EU. One of the objectives will be to support the development and implementation of m-health strategies in selected pilot countries/regions.
Analytics suggest that the app categories that have the highest expected market potential in the near future are remote monitoring (53%) and consultation apps (38%).
Do you think that in the future health apps, wearables, telemedicine will become a part of the healthcare so the doctors will prescribe them and health insurance companies will reimburse new tools?
I do. Today, majority of m-health apps address health or wellbeing, but analytics suggest that the app categories that have the highest expected market potential in the near future are remote monitoring (53%) and consultation apps (38%). Of course, such apps should meet the requirements for medical devices and are proven to be safe, reliable and preserve privacy.
Read the full report here .