At the Estonian EU Presidency’s eHealth Conference in Tallinn on 16-18 October technology companies and health policy makers were enthusiastic about how digital technologies could deliver better healthcare at lower cost. Commission plans to facilitate data sharing and interoperability between national eHealth systems were welcomed. But might this seemingly uncontroversial agenda open the door to a radical shake-up of Europe’s health sector?

Ben Duncan
Senior Adviser
The Estonian Presidency of the EU says the free movement of data should become the EU’s “fifth freedom”. Working with the European Commission, they are keen to build on the mid-term review of EU Digital Single Market Strategy, published in May, and deepen Europe’s digital integration. With healthcare spending accounting for about 10% of GDP in most EU countries, it is perhaps not surprising attention has turned to the health sector. Estonia is working a set of Council Conclusions, for adoption by EU health ministers in December, giving political momentum to an EU digital health drive. In parallel, the Commission plans to publish a Communication (policy statement) on Health and Care in the Digital Single Market before the end of the year.
Medical consultations via web-cam and being able to access your medical records from anywhere in the EU. What’s not to like?
That’s certainly the view Vytenis Andriukaitis, the European Commissioner for Health, took in his keynote address to the Tallinn Conference. “At the informal Council meeting in July (see blog), health ministers articulated their willingness to be more ambitious on digital health and to collaborate more effectively on issues such as data security, cybersecurity and new software products for data sharing…It seems that the momentum to converge our efforts has finally arrived. Let us all work together with governments, health professionals, businesses, and researchers, but above all with the patients to make digital health in Europe a reality.”
Indeed, in a written message to the Conference Dr Andriukaitis, claimed the 1500 or so responses from a Public Consultation launched by the EU in July showed “a broad support for health related actions in the Digital Single Market”. It seems that, “More than 90% of respondents agree that citizens should be able to manage their own data” and “More than 80% agree that sharing health data can be beneficial.” During the Conference the 600 or so health technology organisations and interest groups attending it were invited to sign up to The Digital Health Society Declaration, which creates a platform through for contributing ideas for the EU’s eHealth policy.
The technophobes and Neanderthals who might oppose the glorious digital future clearly had not gone to the Tallinn conference. The Commission’s Public Consultation probably also passed them by, given it was publicised on the Internet rather than by fax and telex. But there are doubtless some people in the health sector who will not welcome the move to more online services. Patients in the EU have, up until now, been rather reluctant to go to other Member States to seek medical treatment and other health services. Despite a series of European Court of Justice cases and a 2011 EU Directive defining the right to cross-border healthcare, very few Europeans exercise this right. Research shows most Europeans want to be treated near where they live. The emergence of eHealth, with the possibility to consult a doctor or other health professional via a digital device at home, could be a game changer. A service provider from another Member State can suddenly be tele-present in your living room. Soon, as mobile health monitoring becomes more common in Europe, he or she will be able to listen to your heart, check your blood pressure and your blood-sugar levels remotely. If the health professional you connect to speaks your language, can write an e-prescription and can give you the documents you need to be reimbursed by your health system then, what’s not to like?
Nothing, perhaps, from the point of view of the patient. Quite a bit, though, from the point of view of national health professionals and national health regulators. The former might feel undercut by “unfair” competition from lower cost countries. The later will worry about how to police such cross-border e-consultations and how to protect the public from incompetent professionals. Longer term, might we see providers based in emerging economies such as India and Brazil offering cut price eHealth consultations in the EU? Could we see the emergence of powerful multi-national online health service providers – eHealth equivalents of Amazon and Google? What might be the effect of this on health ministries’ power over their national health sectors.
These are not yet pressing issues in much of Europe. During the conference the Commission highlighted Eurobarometer results showing huge difference in use of eHealth across the EU. It tweeted (of course!) a graphic showing that fewer than one in ten Germans, Hungarians and Cypriots made use of online health services over the past 12 months. However, over the same period in Spain, Sweden, Denmark, Finland and Estonia between a third and a half of citizens used online health services. At least in parts of Europe the emergence of an “eHealth Amazon” might not be too far away.