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26 April, 2014 – The first reports of the eHealth Stakeholder Group, a European Commission advisory body led by DG CONNECT, were released in April. There are four major areas in which the EHSG made specific recommendations for action, including patient access to electronic health records (EHRs), wider deployment of telemedicine services, and increasing interoperability between eHealth solutions and healthcare systems. As an issue leader on health inequalities and e-Health, EPHA led a subgroup dedicated to this topic and drafted the fourth report.

While the overall message of the eHealth Stakeholder Group (EHSG) is that the European Commission should continue to support the wider use of digital tools in healthcare in order to reap important benefits for individuals, health professionals and health systems, the subgroup on health inequalities and eHealth also underlined that digital inclusion is the key to successful diffusion of eHealth in society and to build up trust in its potential.

The four reports released on 11 April 2014 discuss different aspects of how the implementation of the 2012-2020 eHealth Action Plan can be achieved effectively.


Health inequalities and eHealth


The report on ‘Health inequalities and eHealth’, drafted by EPHA and its subgroup partners, explores the interplay between the vision for eHealth at European level and eHealth’s potential to tackle health inequalities. At the same time, it identifies a number of barriers experienced by end users including various categories of patients, their family and carers, members of vulnerable groups, health professionals, health system managers, and other members of the general population.

The report also highlights that, while access problems are likely to become less severe over time given the popularity and ubiquity of mobile devices, which are bringing eHealth solutions much closer to individuals, it is important not to neglect the question of how different members of society can use eHealth / mHealth in an efficient and meaningful way. It discusses the important role of literacy when it comes to ICT use (as a combination of basic literacy, digital and media literacy, and health literacy), as well as of education at all levels for the benefit of end users. Given that everybody uses technology in a different way and occupies a different ‘starting position’, eHealth needs to be integrated into health systems in such a way that it allows all members of society to benefit from it according to their abilities, which in some cases might involve very low tech solutions that are easy to use for non-traditional ICT users, especially individuals with physical, literacy and learning problems.

The report also advocates for a stronger link between EU and national / regional policies on health inequalities and specific policies focusing on eHealth and the Digital Agenda for Europe. In spite of the recent attention health inequalities have received at EU level, following the work of Sir Michael Marmot for the European Commission and the report by MEP Edite Estrela (S&D, Portugal), the question of how technology can reduce and/or increase health inequalities remains largely underexplored in the eHealth context.

In addition to including ‘everyone’, as recommended by the eHealth Task Force in 2011, it will also be important to create eHealth environments that enable health professionals to meet their patients’ increasing demands, including for ICT-enabled communication and advice. On one hand, better informed patients implies a new relationship between them and health professionals, which in turn implies building up new professional skills and also includes time demands: eHealth tasks must not simply be viewed as ‘add on’ jobs for already stretched healthcare professionals. On the other hand, there is a danger that patients might be misinformed given the wide range of information sources at their disposal, including through social media, smartphone ‘apps’ and various online fora where individuals discuss their health conditions. In order to guarantee patient safety and quality of care, it will become ever more important to distinguish ‘good’ from ‘bad’ information sources and provide proper guidance.

The EHSG report stresses that everybody has a role to play for eHealth to be deployed successfully: in addition to patients and consumers, health professionals , civil society and industry organisations, this also includes regional and local authorities, which are the closest administrative level to the people.

Moreover, the report describes some innovative approaches taken by industry to overcome the remaining hurdles and promote eHealth inclusion. It concludes with a number of recommendations that emphasise the need to improve access, affordability and user-friendliness of eHealth solutions and involve all stakeholders in the ongoing policy and implementation dialogue. The EHSG also proposes further action on accommodating diverse needs in a changing Europe, promotion of digital health literacy and user education, integration of eHealth into the wider health / social system, and building up an evidence base for the positive and negative impacts of eHealth.

Finally, a non-exhaustive compilation of best practices from different EU countries and regions is included that demonstrates how eHealth solutions can help overcome health inequalities and increase healthcare access, in particular of disadvantaged groups.

Other reports

The report drafted by the subgroup on ‘Patient access to the electronic health record’ provides an overview of levels of patients’ access to EHRs in the EU. Denmark and Estonia are leaders in the field, while most other countries are taking active steps to introduce EHRs (e.g. Portugal, France, Malta, Poland, Austria), sometimes experiencing drawbacks related to privacy and data protection concerns. The report suggests Member States and eHealth actors take measures to boost Europeans’ access to their personal EHRs, for instance by ensuring secure storage of EHRs or by taking into account the needs of vulnerable groups when developing such tools (e.g. visual impairment or language level).

The subgroup report on ‘Widespread deployment of telemedicine services in Europe’, gives concrete examples of how telemedicine services can benefit healthcare systems, for example by supporting telemonitoring of patients from home. Moreover, it suggests that the legal ground for telemedicine services should be the informed consent of the patient. It also suggests, among other things, that to increase user acceptance and trust in telemedicine safety and reliability standards should be comparable to those applicable to conventional health services.

Finally, the report on ‘Perspectives and recommendations on Interoperability’ contains an overview of the most used standards in eHealth throughout the EU, as well as a list of all EU projects dealing with interoperability in eHealth. It recommends that efforts towards interoperability in healthcare focus on a set of priority use cases, like patient summaries (i.e. basic health records) or ePrescriptions, to ensure systems are able to ‘talk to each other’ where it matters most.

Next steps

The Commission will analyse all recommendations and integrate the most relevant elements in its eHealth policy, in support of the implementation of the 2012-2020 eHealth Action Plan.

EPHA will also present the report on Health inequalities and eHealth at the 2014 eHealth Forum in Athens.

Further information
EPHA Briefing on eHealth
EPHA Briefing on mHealth