EUROPEAN FORUM FOR NEW IDEAS 2015

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1 EUROPEAN FORUM FOR NEW IDEAS 2015 Panel discussion, Friday, 2 October 2015, 15:30-17:00 Partner: Silvermedia How Will Modern Technologies Influence the Health Care Systems? Can we expect new organizational models of health care systems? Experiences of developed countries in the implementation of wireless medical solutions How will ICT affect public health, in particular care of elderly and dependent persons? Can we expect new organizational models of health care systems? Poland has witnessed a demographic slowdown, as well as major changes in the population's age structure over the last 25 years. The ageing of the population, resulting from a greater life expectancy, is further increased by the low birth rate. These alterations advance particularly fast also due to the growing emigration of young people. Population ageing upsets the ratio of people of working age to people of non-working age. At present it is 100 working people to 29 people of retirement age, yet within the next 50 years these numbers will become equal. According to Poland's Central Statistical Office, in 2050 people at the age of 65 or more will account for 32.7% of the population, i.e. one third. Every second Pole will be at least 52 years old, that is on the average 13 years older than today. This will have a major impact on the ratio of young people to older ones, with some of the latter requiring care and support for many years. The growing life expectancy is of course a reason to be pleased, but in addition it brings a great deal of new challenges not only for the pension scheme or the health care system, but for the entire economy. First of all it entails a radical increase in the cost of health care systems. These expenditures tend to grow more rapidly than GDP in Poland even three times faster. That is a serious social and political problem in almost every country, including those which we would like to see as role models. The leader of the rankings when it comes to the accessibility and efficiency of treatment is the Netherlands. The country spends as much as approx. 12% of its GDP on health care. However, the Dutch health care system is extremely cost-intensive, and the expenditures keep 1

2 growing. At present they account for 13% of GDP and grow at the rate of approximately 4% a year. They may reach the level of as much as 30% of GDP by The ageing of the population, the growing costs of medical services and, paradoxically, the development of new technologies have the consequence that even the best models are revealed as inefficient. All European health care systems are currently facing huge challenges. They will all be forced to alter and adjust. We cannot count on simple formulas and universal solutions. The entire Europe is facing a debate and a confrontation with the changing reality. This concerns Poland, likewise. It is certain that our country cannot avoid modifications. Yet, there is no universal model for these adjustments. How is it possible to effectively manage health care and optimize the system in order to fully benefit from the development of medicine, using it to improve human health and life expectancy? How should the doctors of the future be educated so that they can keep up with the technological changes in medicine and help patients profit from the progress? Which types of activities can boost the use of new treatment methods and forms (including preventive treatment) by doctors and patients, especially the elderly ones? How can we change the people's attitude to healthy life and ageing? Experiences of developed countries in the implementation of wireless medical solutions A growing demand for medical services paired with an insufficient number of health care professionals necessitate the development of telemedicine. The principal conditions for the popularization of wireless medical solutions are appropriate legal regulations, data safety, technical possibilities, results, economical and substantial grounds, approval from the payer, the patients and the medical environment. Activities aimed at promoting wireless medical solutions started in Poland several years ago. Yet so far, they have been oriented towards separate branches of medicine, as for instance neurosurgery, radiology, orthopaedics or cardiology. One of the fundamental barriers is also the insufficient clarity of legal regulations. The applicable regulations need to be amended so as to allow for the provision of telemedical advice, but also to unambiguously solve the issue of liability for such advice and to 2

3 guarantee personal data protection. Another barrier is posed by technical issues, since both a financial support scheme for the development of telemedicine and common standards for e.g. equipment and data format are lacking. Due to their purpose, wireless medical solutions ought to be subject to medical certification the implementation of appropriate norms will render it possible to determine and verify quality requirements. The value of the global telemedicine market is growing rapidly. According to estimates, it will reach USD 12.6 billion in By comparison, in 2009 it was worth approximately USD 3.1 billion. A study carried out in the EU, Norway and Iceland in the years for the European Commission was intended to measure the scope of ehealth services provided in the EU countries. The questions concerned the ICT infrastructure, the ICT applications in use and the safety of their usage. The questionnaire for primary health care physicians put particular emphasis on the use of electronic medical records. The majority of hospitals on the average 81% in the EU, Norway and Iceland use EMR/EHR/EPR (Electronic Medical Records/Electronic Health Records/Electronic Patient Records) or similar solutions. In most cases, hospital-wide systems are applied. ERP/EHR/EPR are accessible in all hospitals in Estonia, Norway, Denmark and Hungary. In Poland, 35% of hospitals declare that they have no such systems at their disposal, which is one of the worst results in our region. On the average 43% of hospitals declare that they do not exchange data with other health care service suppliers. West European countries and Estonia have the best results in this respect. The exchange takes place mostly with other hospitals, general practitioners and specialists. Only 9% of hospitals (EU average) provide medical records online. In Poland it is mostly private health care providers that render medical documentation accessible for patients online. Telemonitoring and telecare are not commonly used in hospital treatment in Europe. 9% of hospitals on the average provide that type of services. The largest proportion of hospitals (22%) using such specialist systems are available in Spain and in the UK. Making appointments via an information system has become a European standard. 70% of hospitals in the EU on average use such solutions. A considerable part (88%) of the records in the EU, Norway, Iceland and Turkey are kept in an electronic form or parallel to paper records. The majority of Danish, Norwegian, Spanish and British physicians declare that they keep medical records entirely or mostly electronically. In the remaining Western European countries as well as in Central and Eastern Europe the relation between electronic and paper records is balanced. In Poland, paper or mostly paper records stand for 51% of the documentation. 3

4 Most doctors practising in Denmark, Norway, Spain and the UK declare that they exchange information electronically with other health care service providers and with specialists. Less than a half of all doctors in the remaining Western European countries as well as in Central and Eastern Europe exchange medical information. In Poland that number amounts to 15%. The largest group of primary health care physicians who provide medical records online for their patients is present in Denmark (50%) and Estonia (40%). In Poland only 10% of physicians offer that kind of service. When it comes to telemedical services, the largest number of physicians have access to training and education (on the average 37% in the EU, Iceland, Norway and Turkey), and, next, to online consultation with other specialists and patients. The least available service (3%) is remote monitoring of a patient at home. That number amounts to 8% in the UK. How can we balance the need to use medical data on the one hand, and to guarantee their safety and protect the patients rights to privacy on the other? What are the most efficient forms of exchange of knowledge and experience among the persons involved in the health care sector (producers, providers, physicians, patients) concerning the new opportunities offered by the technological progress in medicine? Is the transfer of knowledge between business and science in the area of telemedicine possible? How can we influence the quality of services and solutions and improve the patients' comfort and life standard? How will ICT affect public health, in particular care of elderly and dependent persons? The technological change has diametrically altered the world of medicine and health care. This sector witnesses particularly rapid progress resulting from the development of new application programmes, the availability of advanced diagnostic equipment (ultrasound scanners, CT scanners, ophthalmoscopes), and the opportunities to use systems supporting the management of both individual medical facilities and the entire health care system. What reinforces this trend is the possibility to use the Internet and mobile technologies facilitating treatment, as well as the accessibility of virtual data storage spaces, where huge quantities of medical data may be stored. New technologies may be a great support in taking care of the elderly. They render it possible to considerably relieve the health care system, facilitate the everyday functioning of elderly people and allow the carers to reconcile their social roles. Providing telemedical services or, more generally, using electronic communication in medicine depends on the perception and growing acknowledgement of 4

5 the value of these methods by the medical environment. It should be the role of health care institutions to create the conditions for the development of such services, to prepare guidelines and standards when it comes to technology and quality. Another vital task is to indicate the benefits and promote the best solutions. It is worth noting that telemedicine and, more generally, ehealth create a wide variety of opportunities for both diagnostics and treatment. We know of a number of wellfunctioning solutions in teleconsultations, telemonitoring and telediagnostics in Poland. Unfortunately, solutions meant to facilitate telediagnostics and telecare are often improperly designed, manufactured or implemented, and therefore resented and ultimately rejected by elderly people. That is why the key to success in using any technology, device or system seems to be an in-depth analysis, the will to comprehend the needs of the elderly and their participation at the project and test stage when developing a new product. The Polish government is currently working on an amendment to the act on healthcare information system in order to enable the introduction of innovative diagnostic and treatment methods with the application of ICT solutions within the sickness insurance scheme. The progress of ehealth in Poland requires a coherent state policy concerning the implementation and popularization of medical e- services, as well as appropriate conditions in which the society can broaden their knowledge and deepen their health awareness, while the health care workers can acquire new qualifications and skills. The European Union recommends and financially supports initiatives aimed at the development of telemedical services. What does the quality of telemedical services mean in practice? How can it be verified? What types of activities can boost the use of new treatment methods and forms (including preventive treatment) by doctors and patients, especially the elderly ones? How can we change the people's attitude to healthy life and ageing? Can new technologies in health care services or teleprevention hinder their own popularization due to their dehumanization? AUTHOR: JAKUB GOŁĄB, EXPERT, CENTRE FOR INTERNATIONAL RELATIONS (CSM) CSM IS A KNOWLEDGE PARTNER OF EFNI

6 Sources: 1. European Hospital Survey: Benchmarking Deployment of ehealth Services ( ) 2. Communication from the Minister of Labour and Social Policy of 23 June 2015 for the Parliamentary Commission on Policy Concerning Senior Citizens 3. Report Konstruktywni. Zdrowi Aktywni Konstruktywni ( Constructive. Healthy Active Constructive ) F. Raciborski 4. ezdrowie i Telemedycyna w Europie (ehealth and Telemedicine in Europe), A. Pruszko 5. Communication from the Minister of Health of 22 June 2015 for the Parliamentary Commission on Policy Concerning Senior Citizens 6. Telemedycyna w Polsce bariery rozwoju w opinii lekarzy (Telemedicine in Poland Development Barriers According to Physicians), Medycyna Ogólna i Nauki o Zdrowiu 2013, Vol. 19 No 4 6

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