In an exclusive interview with Talkstandards, Professor David Ingram of openEHR, one of the most innovative players in the eHealth field, outlines some of his expectations for the future of ICT in the health care sector. This transcript has been prepared from notes taken during a telephone interview on February 22nd.
Part II: eHealth in an international perspective
(This is the second of three parts of the interview. Read Part I on The future of eHealth here, and Part III on Openness, implementation and governance here.)
Talkstandards [TS]: There is a significant difference between health care systems in the USA and Europe. How are these differences reflected in eHealth standardization in your opinion?
David Ingram [DI]: Without being too specific, I think it is important to recognize the cultural differences that separate the USA and Europe. Healthcare in Europe is sometimes characterized as “socialized medicine” in the American debate while the US healthcare system is sometimes giving negative vibes in Europe particularly when it comes to the lack of universal coverage.
However in terms of health informatics, innovative companies in health information technology emerged earlier in North America than in Europe and similarly, academic progress in the area was making progress earlier in the US. This is because the North American industry came to recognize the need to build bridges between different systems and applications at an early stage, thus working towards interoperable standards.
In Europe, an educational gap between clinical practice and science on the one hand and information technology on the other contributed to bringing the clinical challenge of information technology into focus later. Progress was sought through clinical practice rather than IT.
Some welfare states in Europe has a problem of scale; managing healthcare for a population of 5-10 million is easier than for a population of 50-60 million. Governments can and should make priorities for industry and the health care sector. New cooperation between industry and government is needed to handle the challenges at hand. This can also be vital in avoiding lock-in in outdated technologies, which is a dangerous trap in the fast moving IT sector. This is an important rationale for openEHR to be open; to maximize the possibility to detect and adapt to new and superior technology.
TS: Health care markets have historically been local and national. Is it possible that eHealth and ICT standards contribute to the longstanding European vision of a single market for healthcare services?
DI: The European single market is an important economic driver but considerable impediments exist, e.g. cultural, financial and political barriers, which mean that full integration will take time. I do believe that the goals are good, but it is key to have a bottom-up approach. Change needs to come from the grass root level. One particularly challenging task in this perspective is to reach harmonization of data.
In order to create a single healthcare service market, trust and understanding are vital elements. It is important not to generalize as patient preferences differ between areas of healthcare. For certain services familiarity is essential for assurance while in other areas patients are more open to evidence-based and innovative treatment.
