eHealth and the Ageing Society

Marcelino Cabrera, IPTS

e-Health, the combined use of information society technologies (ISTs) in the health sector, is moving up health policy agendas at the European, national and regional levels. Productivity gains from the optimization of healthcare systems and achieving cost reductions are prime goals, while healthcare providers, health insurance organizations and politicians at all levels (EU, national, regional) are drawing up plans to support healthcare by means of the application of modern ISTs. In particular, EU policy has set up specific action plans (eEurope2002 and eEurope2005¹) to contribute to the development of eHealth across the EU and thereby achieve some of the ambitious goals of the Lisbon strategy decided at the European Council in Lisbon in March 2000².

eHealth is an empowering tool for European citizens and, in the context of an ageing society, for active independent living by older people in an enlarged European Union with considerable income disparities and heterogeneous healthcare systems. In this Special Issue, the topics discussed are in one way or another related to the context of an ageing society, while highlighting bottlenecks and prominent technological trends that need policy attention.Health and social care for the elderly can be provided with new services based on appropriate ISTs, such as so-called "independent living" services. However, policy-related technological and organizational aspects of strategic plans are key factors for success in satisfying the real needs of the elderly. The cost-effectiveness of new assistive technologies enabled by mobile and "ambient" systems, wearable and embedded devices, as well as new business and services provision models, will need to be assessed.The case of emerging mHealth services (mobile health) is illustrative for its potential impacts on the financial and liability schemas since insurance systems may have to accommodate new expenses as a result of services delivered by mobile phone providers. Also, mHealth services will have implications for the provision of care itself, resulting in changing paradigms for healthcare professionals and patient-clinician relationships. When combined with location data processing, mobile terminals will improve eHealth possibilities. Clearly these services will rely not only on location information, but also on the mobility of the terminals. However, before widespread use can be made of location-based healthcare services, a number of privacy issues will have to be addressed. The potential large-scale tracking of ordinary citizens (whether deliberate or incidental) will certainly raise ethical concerns that could cause delays in the deployment of these services, thus postponing the realization of their benefits.The privacy issue can be extended to what it is agreed will become the central piece of information around which many citizen-oriented eHealth applications will be developed, i.e. the electronic health record (EHR). With the EHR, it will be possible to enable access to relevant information, collaboration between healthcare providers and telecare more effectively. However, confidentiality and privacy are critical issues that will need widespread consensus among all stakeholders (public authorities, medical professionals and citizens). The EHR, as the cornerstone of many developments in this field, undoubtedly deserves focused and coordinated actions at all levels, including EU-level.One important, but often under-emphasized, prerequisite for the introduction of new ISTs in the health sector is the acquisition of new types of skills by citizens, patients, doctors, nurses and other healthcare professionals. Without human resource development through appropriate education and training, healthcare faces major obstacles to the crucial knowledge-sharing process. This is particularly relevant considering the under-investment in training and education that is endemic in the health sector.The above-mentioned topics -and there are many others not discussed here due to space limitations- suffice to give an idea of the challenges that eHealth raises, particularly for time-pressed policy-makers, who need to grasp at a glance the various scientific and technological, economic, political and social dimensions. In this context, roadmaps are valuable ways of presenting and analysing the causal and temporal relations between successive or parallel steps. Equally valuable are the results from existing foresight exercises. These results can help to gain a better understanding of the expected evolution of the demand side of eHealth during the next two decades.

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Marcelino Cabrera, IPTS

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Notes

1. http://europa.eu.int/information_society/eeurope/2005/index_en.htm

2. European Council meeting in Lisbon set an ambitious objective for Europe to become the most competitive and dynamic economy in the world. To achieve this, the Council later endorsed the above mentioned action plan entitled "eEurope - An Information Society for All".