The spread and evolutions of information technologies and digital tools have enabled an entire new dimension of big-data storage and analytics that can bring tremendous improvements across industries, including healthcare. This paper recommends the creation of a European wide connected Electronic Health Records Organisation (EHRO) empowering patients by enabling the effective collection and usage of patients' health data across member states, revolutionising healthcare and ultimately leading to better health outcomes for patients and payers irrespective of national borders. The creation of the EHRO aims at overcoming past hurdles and challenges faced by various member states, and catapults Europe to the forefront of the new digital century of health. A raft of recommendations and steps are provided, explaining how such an organisation would support member states to build, connect and use this platform. The proposal illustrates a scale-up approach leveraging on prototypes and building from existing pillars of success, while using an open and transparent approach to platform creation. A patient driven opt-in system will lead to fast adoption, while targeted education campaigns and an incentive-based system at health provider level will accelerate uptake and build trust. The system will not only empower patients and assist clinicians, but also will provide a wealth of knowledge to advance medical science, preventing diseases and improve health for everyone.
‘EU Member States are facing major health-related and societal challenges that could threaten the sustainability of their healthcare systems.' This accurate diagnosis calls for urgent political action, at EU and national level. There is a need for innovative solutions, both therapeutic and organizational, that will accompany the health and societal changes. e/mHealth might have the potential to be a game-changer. But to unleash this potential, a comprehensive political strategy going beyond mere technicalities will also be needed, since mHealth is not only a public health issue. The e/mHealth market is growing rapidly and the policy environment cannot lag behind it. This paper aims to identify steps across policy areas for the uptake of mHealth in Europe, namely, research, development and innovation; market access; awareness raising among patients and healthcare practitioners; and integration to the healthcare systems.
e/mHealth should be considered as the building block of a comprehensive political health strategy, contributing to better health and economic outcomes by preventing chronic diseases and redefining the patient's position within the traditional health care systems. The Big Data, and access to these innovative solutions, and their reimbursement will feature prominently on the EU health policy agenda. The private sector has already recognised the potential of e-/m-health solutions. The lack of regulatory harmonisation is not preventing it from changing the way our healthcare systems are working. Innovations so far relate more to digital solutions than traditional health care services, and the EU can help promote these solutions within the European single market. Most importantly, the EU should go beyond technical regulatory harmonisation and support the entire innovation process, from the laboratory through to uptake by physicians.
PREVENTION OF CHRONIC DISEASES
Alcohol is a major contributor to loss of life and to the burden of chronic disease in Europe. The harmful use of alcohol is associated with a wide range of physical, psychological and social harms, and the costs to individuals, communities and society are widely recognised. While a single uniform alcohol policy relevant to all member states is close to impossible, there is a necessity to complement national actions, create synergy between individual national policies and share best practice.
This report suggests that progress has been made at both strategic EU and Member State levels, with a decline in consumption and changes in drinking patterns in some countries over the past thirty years. However, Europe's per capita alcohol consumption still remains the highest in the world and a coordinated and collaborative EU response is therefore imperative.
There is currently a unique window of opportunity in Europe for a significant expansion of activity in the prevention of alcohol-related harm. This committee proposes strong recommendations supported by sound evidence aimed at changing the way in which alcohol-related harm is prevented at a European level.
ECONOMIC DIMENSION OF HEALTHCARE
Evaluating the current European healthcare system scenario marks a first step towards aspiring to improve it. Thus, before looking ahead and proposing ways for a more effective functioning of health systems, we must first identify the challenges and barriers to delivering equitable and sustainable high quality care services to all European citizens.
In light of ageing demographics, the economic climate, dwindling resources, increasing demand and rising costs, it is important to explore ways of doing more and better with less, and proposing smart and feasible solutions for better healthcare, whilst safeguarding common EU health values.
Improving healthcare across the EU calls for political will and enhanced co-operation between and within EU countries, and pulling resources together, especially in cases of specialised care and rare diseases. This co-operation is not about reinventing the wheel, but more about sustaining and maximising what we have achieved over recent decades and re-thinking the way we do things.
Delivering healthcare must also become patient-centred. A one-size-fits-all approach to healthcare must make way for a more personalised, inclusive and integrated care approach that empowers patients to play a more active role in their own health. The use of ehealth and telemedicine, tailored to patients' needs, has role here. But balance is needed between innovation and the use of new medical technologies and equity, ensuring that all patients have equal affordable access to the latest, high quality and safe medical treatments.
The paper opens with an exploration of the healthcare challenges Europe is facing particularly in light of the recent economic crisis, which triggered enhanced EU intervention in healthcare and the call for more efficient yet sustainable care. Against this background, it then brings forward concrete recommendations on how to design and manage European healthcare systems in such a manner that we are able to do MORE and BETTER with LESS. We demonstrate how European governments can reap simultaneous economic and health benefits if they begin to see health as an investment rather than a cost and account for cost-effectiveness and sustainability of their health services across the healthcare life course; be it through preventive and diagnostic provisions of care, curative or more complex interventions and palliative care. Consequently, the paper illustrates solutions for better and cost-effective healthcare system practices at different stages of healthcare delivery - in primary, secondary and tertiary cross-border care settings.
PATIENT EMPOWERMENT AND CENTREDNESS
There is a widespread consensus that empowering patients is good for healthcare systems. Empowerment is increasingly recognised as an essential element of future high-quality, patient-centred healthcare systems with regard to tackling the expanding burden of chronic diseases. Patients are expected to take more control over their illnesses or treatments where possible, and doctors are expected to encourage or 'empower' them to do so. But how do we translate this into reality at all levels (i.e. individual, organisational, and national)?
The Patient Empowerment and Centredness Committee call for the adoption of a Pan-European framework to ensure that patient empowerment is a top priority for Europe's healthcare systems and contributes to improved healthcare across Europe's national realities. Achieving patient-centredness is a key enabler in the process of creating sustainable and equitable systems for all.
A concrete action plan on health literacy and information to patients relating to all aspects of health is needed. Although empowerment is much more than education, the right information and resources are fundamental tools for enabling patients to become equal partners in the team managing their health.
The informed patient also needs a counterpart: the health professional who creates the right environment to enable patients' active participation in the decision-making process. There is clearly a need for targeted education of health professionals to build the skillset needed to effectively communicate with empowered patients, and to provide advice to less empowered patients on how they can take a more active part in the management of their condition.
This strategy should embed patient involvement at every level of the health system. This involves supporting the active participation of citizens with chronic diseases in their own care, but also in policy-making and in designing future care delivery systems.
ACCESS TO INNOVATIVE THERAPIES
There are multiple explanations to inequity on access, multiple views as to what constitutes a priority in healthcare, and multiple perceptions of what qualifies as an innovation. Together among this multiplicity of ideas, there is a clear need for an improved approach to enhance patient access to the best innovation that medical technology has to offer. A first step in connecting the dots is the development of a tool that would assist in identifying and prioritising the areas of health where EU collaboration could be appropriate to reduce health inequalities between and within Member States.
The Sub-Committee on Access to Innovative Therapies has developed a "matrix" approach designed to define the level of EU intervention required to enhance the access of innovative therapies across Europe. This tool could be used to assess current and future EU policies or to support the development of an EU budget in the field of health. By assessing the medical unmet need and the access issues, the matrix identifies where national and where European integration on a specific disease area may be most appropriate.
Based on this initial research, the further development of improved access for patients and a reduction of unnecessary barriers are envisaged through a three-step approach, including concrete actions at both EU and Member State level.
- UNDERSTAND: Creation of a European Access Observatory (EAO) to annually assess the uptake of new products and therapeutic alternatives in Member States.
- MAXIMISE: Leverage valuable EU initiatives to address the existing barriers to access.
- ANTICIPATE: Development, in collaboration with healthcare stakeholders and policymakers, an EU-level analytical tool to support the prioritisation and decision-making specifically focused on addressing access questions in health policies.
CROSS BORDER HEALTH THREATS
Disease does not respect national borders. Disease can spread from country to country in the time of an airplane journey. Within the EU, member states retain primary responsibility for healthcare, including responding to cross-border health threats such as the spread of disease. Given the freedom of movement within the EU, member states need to be well prepared to respond to these threats. However, the answer is not to close European borders, but rather to strengthen national healthcare systems, with proactive support from EU institutions, to prevent disease and protect European citizens.
The paper uses a framework of comparing novel and emerging threats through a case study of seasonal influenza, compared with a case study of tuberculosis, and its multi-drug resistant strain (MDR-TB), to assess long term endemic threats. From this framework, four key recommendations are made to European policy makers:
- The EU should develop a public and defined framework for disease intervention in the event of a cross-border health threat emerging.
- The EU and its member states should develop a proactive vaccination plan, including monitoring coverage rates and supporting vaccination development, to prevent emerging threats such as seasonal influenza.
- The EU should strengthen political efforts to eradicate MDR-TB, with a focus on exacerbating factors such as social marginalisation, to deal with long term threats.
- The EU should enhance cooperation to deal with cross-border health threats, ensuring a level playing field between its member states to allow a proactive and preventative response.
Cross-border health threats will always be a challenge in an EU with open borders. Disease does not stop at our national borders, so our health care systems in turn must be equally mobile, cross-national and proactive.