The 2015 eHealth forum, organised under the auspices of the Latvian Presidency will discuss the next steps regarding the further roll-out of eHealth in Europe. Mobile smartphone applications in particular have propelled eHealth centre stage in recent years. As noted in the European Commission’s Green Paper on mobile Health (mHealth)1, 100,000 health apps are already on the market, and it is estimated that 50% of smartphone owners will be using them by 2017. Their uses are broad, ranging from clinical solutions that may fall under the rules for medical devices to ‘lifestyle and wellbeing’ apps that satisfy desires such as monitoring physical activity and stress management.
While overall, these solutions hold great potential for individuals to engage more with their own health – which could result in healthier behaviours and better awareness of prevention – the distinction between solutions is not always clear. Given the intricacies of new technology and relationships between different actors, the option of introducing specific legislation should be discussed since self-regulation does not always work to the benefit of patients. In this context, EPHA calls for transparency about who is behind these apps and clarity over the relevant rules pertaining to, inter alia, their quality, protection of privacy, liability and redress. This is especially vital in an immature market where many solutions collecting personal health information are short-lived.
It is also important that developers talk with front-line users about the design of applications. In all EU calls for tenders, users, patients and healthcare professionals should evaluate proposals as most evaluators still work according to the old medical model.
Moreover, in order for Europe to effectively exploit e/mHealth and herald a new ‘prevention culture’, it will be crucial to ensure that investments are coupled with health system changes that allow all actors to use it effectively. For healthcare professionals, this means sufficient time for analysing patient-generated information and for communication. eHealth should be incorporated into the ongoing dialogue between healthcare professionals and patients, and both parties’ responsibilities must be clear. Healthcare professionals also require training to integrate new technologies into their work. This calls for concrete and evidence-based user guidelines such as those currently being drafted for nurses and social workers by the ENS4Care project partners in five areas2.
The sheer number of available solutions, coupled with low health literacy rates in Europe3 means that users will require more guidance about uses and benefits. This is fundamental for protecting patient safety and achieving optimal health outcomes, including for society’s most vulnerable who may have little or no experience of navigating digital environments.
“People living in Europe should not be ‘left to their own devices’ when it comes to e/mHealth’,” argued Sascha Marschang, EPHA Policy Manager for Health Systems. “In today’s world there are many competing demands on people’s time and the more information we have access to, the more it becomes imperative to distinguish between what is truly valuable and what is mere noise. Advancing the everyday embedding of eHealth into health systems is crucial to move forward now, especially given the huge disparities between member states in this domain,” concluded Mr Marschang.
(1) European Commission, COM(2014) 219 final, Green Paper on mobile Health. http://ec.europa.eu/digital-agenda/en/news/green-paper-mobile-health-mhealth
(2) The ENS4Care project will create eHealth guidelines in the areas of healthy lifestyle and prevention, clinical practice, integrated care, skills development for advanced roles and nurse ePrescribing. More information is available at http://www.ens4care.eu/
(3) The European health literacy survey (HLS-EU) was conducted in 8 countries and found that almost 1 in 2 (47%) respondents had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%) and by population subgroups. See Sørensen K. et al., ‘Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)’, Eur J Public Health, 2015 Apr 5. pii: ckv043.
European Public Health Alliance