The implementation of the roadmap raises a number of questions: What policies and strategies of cooperation should be adopted to maximise the effectiveness of eHealth? How should these policies and strategies fit in with existing ones? What standards should there be in eHealth? How should these standards be established and maintained? How should the problem of interoperability of electronic health records (EHRs) be solved? How should healthcare workers be trained to operate ICT-based technology and systems? What proportions of which healthcare professions should acquire these skills?
Since the EU-US collaboration on eHealth is underway, dialogue with stakeholders has been welcomed. This journal issue offers a number of responses to these questions. They follow the overall approach of the cooperation between the EU and US, starting from more policy- and organisational-related matters, and move towards human resource issues while including technological and interoperability challenges. Arising on several occasions are the specific challenges of privacy, security, safety, and consent. Among the institutions represented in this issue are international non-governmental organisations such as the World Health Organization and European-based professional-representative bodies like the European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry and the European Federation of Nurses. Some of the articles draw directly on the work of the EU-US eHealth formal arrangements; others use the existing collaboration to suggest related or additional activities and tasks that might be explored together in the future. Examples of what is happening in two specific countries, such as Ireland and Italy, are proposed as opportunities and initiatives that could be explored under the umbrella of the EU-US cooperation on eHealth through further pilot initiatives or standards-setting. They cover EHRs (and patient summaries), which are core components of the EU-US Memorandum of Understanding. A third example examines how web-based care for patients could also be investigated under the same Memorandum of Understanding and roadmap. Skills-related papers draw attention to implications for the training of two professions in health-related IT/eHealth, one on the technical side of eHealth, and the other with a healthcare orientation: information technology (IT) specialists, and nurses. Last but not least, the final paper of the journal issue places the work of the EU-US collaboration on eHealth within a proposed wider theoretical model that draws on work developed through the 1990s and first decade of the twenty-first century on transnationalism and globalism. It ends with the tantalising possibility of the establishment of an even more concrete translatlantic eHealth-related organisation in the future than that which exists today and, like suggestions made by the very first author in the issue, one which could have implications for the globe overall.
The first paper looks at the big picture of EU-US cooperation from a wider background. Clayton Hamilton places the EU-US Memorandum of Understanding and the roadmap in its global context. In particular, he views these issues from the perspective of the World Health Organization and its forum, the World Health Assembly, and especially from a recently adopted World Health Assembly resolution on eHealth standardisation and interoperability. He further discusses the importance and advantages of establishing global eHealth standards and interoperability, what the transatlantic cooperation can and will achieve, and what its impact will be – not only for Europe and the US, but also for the rest of the world.
In the issue’s second paper, Nicole Denjoy presents the perspective of the European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry (COCIR), in the light of the EC-US roadmap. The paper focuses on eHealth policies and large-scale strategies and the future of healthcare. It discusses many of the subject areas which are central to the roadmap, including interoperability and the training of the healthcare workforce, as well as other issues such as mHealth and digital hospitals. The aim is to underline the potential of eHealth to transform healthcare into a seamless integrated care system that encompasses the hospital, the patient’s home and elsewhere, and to provide some insight on how this could be achieved. In this way, the paper strives to provide a common vision and implementation strategy which can guide the development of digital hospitals and clinical information systems.
The third paper, by Barbara Foley, Rachel Flynn, Tracy O’Carroll and Jane Grimson, turns to standards, and in particular standards relating to the collection of health data. They discuss the importance of the “Guiding Principles for national health and social care data collections” published in 2013 by Ireland’s Health Information and Quality Authority (HIQA). Although this publication was geared to setting national standards in data collection, the authors show that its solutions can also be applied to their advantage in other countries in Europe or the US. Moreover, given the central role of data in providing a national overview of a particular health or social care service, the adoption of effective data-collection standards could lead to improved analysis of the healthcare situation. In this way, the standards would help to inform developments in eHealth strategies and policies, including helping to shape the nature of international collaboration in the area.
The fourth paper, by Claudio Dario, Tommaso Piazza, Elena Vio, Arianna Cocchiglia and Sergio D’Angelo, moves on to the subject of the interoperability of electronic health records (EHRs). The authors propose a solution for how EHRs can be used for people travelling in foreign countries, for business or for leisure, and in particular for transatlantic travel. They note that there is currently no infrastructure or 'infostructure' which is able to support intercontinental document-sharing in the way they envisage. Thus they propose a framework based on the Patient Summary, a standardised set of basic medical data. If the Patient Summary is digitised and utilises international standards of interoperability, they foresee that it could help to ensure the continuity of care for people who are travelling, particularly for patients with chronic conditions. In order to demonstrate the feasibility of using the Patient Summary for these purposes, the authors aim to implement a pilot project involving people travelling between Italy and the US.
Another take on interoperability is presented in the fifth paper of this issue by Ed Conley. Conley says that EU-US collaborative developments in eHealth should be patient-centred rather than technically driven. Patient-centred ‘webs-of-care’, which illustrate a patient’s relationships with different elements of the health system, could provide the foundation required. He argues that the web-of-care comprises multiple participants who need standards of interoperability to be implemented in order to work together most effectively for the benefit of the patient. Moreover, patients understand non-operability as ‘fragmentation’ of their web-of-care. The author argues that this patient-centred approach would facilitate many benefits, not just providing a solution to issues of interoperability (such as the ‘many-to-many’ problem), but also a better general functioning of the health system and better information-sharing to facilitate research.
The sixth paper in the journal shifts the emphasis to the training of the healthcare workforce. Jean-Pierre Thierry looks at the numbers of IT specialists employed in the health services of various countries. He notes that there seems to be a notable difference among developed countries regarding the proportion of Health Information Technology (HIT) professionals in health systems, and wonders whether this might provide evidence of a digital divide. With the use of digital technologies set to increase, the author argues that the importance of IT training should not be underestimated. However, the number of studies conducted in this area is still small. More studies are recommended to get a clearer understanding of the situation.
Training related to eHealth is also important for healthcare staff. In the seventh paper, Paul De Raeve, Alessia Clocchiatti and Silvia Gomez Recio focus on the training and role of nurses. They argue that nurses are hugely important in implementing eHealth systems, particularly telehealth services, since they coordinate healthcare from the patient’s perspective, and they play a key role in changing traditional healthcare approaches towards integrated care. Nurses are helping to facilitate the evolution of the health services, including the shift from a hospital-centred model to community-based care and integrated services. The authors argue that cooperation and joint activities between the EU and US on investing in the nursing workforce, especially in regard to eSkills development and standards of care, will help to further develop the healthcare sector, so that it becomes a key driver of well-being, productivity and growth. It is essential to facilitate new eHealth strategies through the use of standards and guidelines for effective, sustainable and integrated care which will enable the optimal deployment of these services.
The final paper in the issue employs political theory to put the EU-US cooperation on eHealth into a theoretical context. Alexandros Stylianou discusses how globalisation alters the rules of the game by creating transgovernmental networks. This facilitates the emergence of new actors that function above and below the state, which in turn leads to the creation of regimes and what came to be known as institutional transgovernmentalism – a theory valuable to understand some current trends on eHealth transatlantic cooperation. Towards the end of his paper, Dr Stylianou explores various aspects of EU-US collaboration on eHealth and indicates how they fit within the theoretical model he describes.