International e-health standards not delivering, conference told

MALAGA, SPAIN – Interoperability, standardization and political will are barriers to the adoption of e-health initiatives, and health-care stakeholders should work together to overcome these barriers, according to speakers at the fourth annual global eHealth Conference held here this week.

“Doctors are not all the same and health care is not comparable to retail banking,” said Daniel Mart, president of the Standing Committee of European Doctors. Sometimes technology is imposed upon doctors, he said, and in some cases they have to be persuaded to use it. The benefits of e-health initiatives tend to be financial, which don’t directly affect doctors, he added. At the same time, doctors risk losing their autonomy, and confidentiality of patient information is still not guaranteed.

The promise of e-health revolves around increasing efficiencies. “But does it give us more time with patients, or more patients?” he said, adding this contributes to the already-growing problem of burnout in the medical profession.

The EU launched an e-health action plan in 2004 that calls for international cooperation with countries such as Canada, the U.S. and Australia.

But international standards have not been delivering on their promise, said Charles Parisot, manager of standards and testing with GE Healthcare in France and co-chair of the IHE IT Infrastructure Technical Committee.

“We need to deliver more consistency across the use of standards,” he said. Standards are critical, but on their own are not enough because those standards can be customized. “This is the power of standards, to be general, but it’s also a challenge,” he said.

Care providers must work with vendors to coordinate the implementation of standards to meet their needs, he said. While the challenge appears so big as to be impossible, he said it can and already has been done.

IHE drives standards adoption to address specific clinical needs for interoperability. It’s in clinical use in Italy and Spain, and in deployment in Canada, the U.S., Norway, France and Austria. IHE Canada is run by ITAC and has a mission to help Canada’s health-care community lower costs, gain clinical efficiencies and improve patient care by resolving interoperability issues between applications and equipment from different vendors.

While the world of standards in health care is complex, Parisot said the Canadian program has grown to handle that complexity.

The challenges, however, continue to be extreme, said Sarah Muttit, group director of investment, strategy and planning with Canada Health Infoway. With a goal of providing an electronic health record to 50 per cent of Canadians by 2009, Infoway was initially criticized for getting off to a slow start. It now has 150 active and completed projects valued at $700 million. But she said there’s a need for both functional and semantic interoperability.

“Standards are a critical foundation for EHRs,” said Muttit. “How do we encourage vendors to adopt standards?” This has led to the creation of Infoway Standards Collaboration to establish a pan-Canadian interoperable electronic health record – though few definitive standards exist today.

“There are dedicated IT health projects where we understand the benefits and potentials on a national domestic level, like Canada Health Infoway,” said Volker Wetekam, president of global solutions with Siemens Medical Solutions Health Services. But the general understanding of concrete benefits is still in an infancy stage, he said, and efforts should be made to quantify these domestic benefits.

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Vawn Himmelsbach
Vawn Himmelsbach
Is a Toronto-based journalist and regular contributor to IT World Canada's publications.

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