10 steps for better eHealth across E.U. borders

A well-defined IT strategy is crucial for the implementation of eHealth systems for a new generation of geographically mobile patients.

The eHealth market in the European Union offers a plethora of opportunities, but also challenges. Chief among these are the IT solutions needed to radically modernize health-care governance and management.

In her chapter "IT Governance in Health-Care Institutions" for the book eHealth: Legal, Ethical and Governance Challenges, IESE's Magda Rosenmöller explores how IT governance can be optimized.

Why eHealth?

From a policy point of view, the need for eHealth has never been greater, particularly in the context of patient mobility in the European Union.

In order for patients to have access to services across European borders, IT systems need to be more integrated. They also need to be more interoperable, so as to ensure continuity of care for geographically mobile patients.

This is particularly important in relation to chronic illnesses such as diabetes, dialysis-dependent kidney failure or rheumatoid arthritis, for which comparable electronic patient records would drastically improve cross-continental patient care.

Additionally, IT advances should dramatically improve the provision of post-op follow-up care across the continent.

Moving away from a "pilot mentality"

At the 2010 eHealth conference in Barcelona, one founder said during a visit to a telemedicine clinic that "what you see here is not a pilot, it is a real business."

The "pilot mentality" has been a persistent hindrance to evidence-based IT applications, many of which are running successfully but in limited contexts. As such, they miss out on the broad benefits of general rollout at national or European level.

Additional problems include high costs that inhibit necessary investment, and a general lack of clarity about who is responsible for taking the initiative.

Regulatory and legal issues also act as obstructions, as do perverse incentives. Users and stakeholders are often not involved, meaning systems end up being IT-centric instead of patient-centric.

Monitoring progress can also be a challenge. Ill-conceived and poorly planned IT strategies offer limited data and evaluation, making it all but impossible to judge the impact of IT on health systems in terms of quality and efficiency gains.

10 steps to good IT governance

After surveying CEOs and examining case studies from some of Europe's best examples of eHealth, Rosenmöller proposes the following 10 steps that health-care providers can take to ensure optimal IT governance.

1. Make IT a core part of the hospital's strategy or investment plan. The IT strategy should reflect the relevance and long-term importance of IT solutions. It should receive the strong support of the institution's CEO.

A good example is the Grup Mutua de Terrassa in Spain. The accuracy and efficient management of clinical information is a vital contributor to high-quality clinical service, and is at the heart of the hospital's strategy. It is also vital to the integration of care between the hospital and its outpatient primary-care clinics.

2. Establish a link between technical and clinical operations. The chief medical information officer should be a member of the organization's board or executive committee, as is the case at the Geneva University Hospital in Switzerland.

3. Set up an IT steering committee. This should bring together executives, stakeholders and users, ensuring that strategy and implementation are in line with users' needs.

Again, this was a key strategy employed by Grup Mutua de Terrassa. A steering committee that meets three times a year is in charge of the conception of the strategic plan, major budgetary decisions and the monitoring of its implementation.

4. Establish monitoring and evaluation
systems. These are essential to accurately measure the outcomes of IT-enabled business initiatives.

5. Appoint an executive sponsor. This person should champion the IT projects, as well as monitor implementation and oversee project management.

6. Encourage clinicians to take an active role in IT implementation and training. This training should foster ownership and uptake. Cross-departmental groups, following the clinical process, should facilitate IT implementation.

At the Asklepios Clinic Barmbek in Hamburg, Germany, suggestions from staff are welcome, and their active involvement in the IT conception process is regarded as crucial, in the spirit of an open-door and open-communication policy.

7. Increase patients' involvement and offer simple access. A significant issue is the empowerment of patients to use the new IT possibilities in an appropriate way.

8. Apply IT to integrated and home care. This should build on strong user involvement.

9. Continuous appraisal of technological and treatment innovation. This will mean incremental system updates, as well as supporting innovation and an entrepreneurial spirit in IT governance.

Geneva University Hospital in Switzerland has built on a long history of IT development and expertise in clinical applications to develop its own in-house system, adding new components as it sees fit.

10. Manage the impact of new technology on the care process. Managers should anticipate changes in strategy and their implications for process design. Social networks should be integrated into the IT strategy, anticipating both risks and opportunities.

Enormous growth potential

Good IT governance will ensure a good fit between IT and overall strategy, while implementation and daily use will foster ownership by users.

It will also boost innovative learning and encourage institutions to be more open to gaining knowledge about and adapting to new technological advances.

In a broader context, better collaboration between hospitals will encourage the exchange of best practices. The outcomes of monitoring and evaluation will support the dissemination and diffusion of improvements across the industry.

The true extent of the European eHealth market is only starting, and there is enormous growth potential. However, active steering is crucial.

This will mean developing better managerial capacity at all levels and adopting "pull" strategies to foster awareness among health-care users of the potential benefits of IT solutions.