Today, citizens aged 65+ make up close to 18 % of the total population in all EU countries and the percentage of elderly will increase further in the following years. The most dramatic raise is expected in the 80+ age range. Ageing of the population together with unhealthy life styles are generating an increased prevalence of chronic conditions that place additional strains on both health and social support systems. In this scenario, existing health systems must make the transition to new models of care, with a shift towards integrated patient management.
The consolidated results of over 10 years of research on information and communication technologies (ICT) have generated evidence of the enabling role of ICT on the whole range of services, from life style and self health management, to improving health related quality of lives of patients and citizens, as well as managing chronic disease conditions such as asthma, chronic obstructive pulmonary disease (COPD), chronic heart disease (CHD) and mental health. Moreover, it is suggested that properly designed innovative health services supported by ICT may have a positive impact on chronic disease modulation and prognosis.
Despite the many advances in technology, deployment has lagged behind. The barriers originate at different levels and are associated to a multitude of technological, cultural, legal, political and market related factors.
How is Europe dealing with these challenges? In the first article, Angelo Rossi Mori and co-authors analyze the deployment of of Connected Health for chronic disorders as a perfect example for placing eHealth to the service of healthcare policies in order to effectively support the organizational models of shared care pathways. The authors argue that we need to consciously and systematically take the next step to move from 'inter-operability' among systems to the 'co-operability' among the actors in the care processes.
The electronic health record (EHR), being probably the most characteristic shared information service, can exemplify this concept of a new level of needed governance to achieve co-operability. Georg Heidenreich and Pantelis Aggelidis introduce a six step approach to EHR interoperability that focuses on contractual responsibilities, rules and collaborative relationships for wide acceptance and common understanding of an EHR, far beyond technical Interoperability.
EHTEL argues that we are close to having the technology we need, including interoperability of information and the systems that share it, but we are not yet there in terms of cultural change of mentality, nor the flexibility to collaborate and share among actors. Over the next decade we should aspire to a much more common community care model, wherein information is part of the care process, eHealth becomes just an integral part of care, and where ICT and medical technology converge at the level of usefulness and value. Innovation has to be encouraged, rewarded and deployed, reducing not just 'time to market' for products and services but also 'time to generate value' in successful user deployments.
Peter J. Groen and Douglas Goldstein agree that achieving deployment of EHR, Personal Health Record and Health Information Exchange systems within the next decade is very likely and they will lay the foundation for dramatically improving healthcare. However, the need for radical reengineering and transformation of health care will start to come about when the next generation of current front end research results on Genomics, Nanotechnology and Implantable Systems, Robotics, and Wearable Systems are eventually implemented in the coming decades. The transformational management strategies in the 21st century - are to be based on Collaboration, Open Solutions, and Innovation.
Simulation and modeling has been extensively used in other sectors to support policy and management of change. As data collection is becoming comparable and more precise, care management and policy making with the help of ICT tools will become more feasible and will become part of the everyday decision support practice. Efthymios Altsitsiadis and co-authors identify significant adoption barriers due to lack of simulated-mass and simulation interconnectivity and recommend practitioners to turn to 'open' interoperable models as a mean to address the systemic complexity of high level decisions and to add sustainability to their work.
New challenges also emerge as eHealth becomes an integral part of care. They are associated to privacy and -linked to it - acceptance of these new working models. How ready are we to accept cameras in our living room? Griet Verhenneman observes that despite the existing legal protection mechanisms of protection of personal data, the right to privacy and the right to personal portrayal, the use of cameras as a next step in eHomecare will have to be based on the consent of the patient. Once more the profile of a well informed health care consumer is emerging opening up yet more ethical issues and societal challenges. Interestingly enough this issue affects also individuals that that are filmed when interacting with the patients during occasional visits in monitored home environments.
Another example of legal and ethical issues associated to RFID/Wi-Fi tracking and collection of sensitive data and affecting user acceptance are amongst the aspects evaluated by D. S. Stodolsky and C. N. Zaharia in the last paper of this special volume.