Digital health has the potential to make healthcare better for patients and for healthcare professionals, as well as to accelerate the shift towards more efficient and cost-effective ways of delivering care. It promises to make healthcare better, safer, and more centred on the patient.
Yet, despite this great potential, the people I speak to – including policymakers, experts, payers, patients, healthcare professionals and of course our member companies – have a shared sense that progress is too slow. There is a growing frustration that, in some instances, we have technologies that can solve pressing problems, but we are not putting them to use.
So, what’s holding us back?
One of the answers I hear most often is the lack of interoperability – the capacity of information systems, devices or applications from different vendors to connect and send or receive data. In a recent MedTech Europe member survey on digital, our members identified the lack of ‘common standards for interoperability and connectivity’ the single most important issue to address.
Interoperability in practice would mean that digital health technologies could ‘talk to’ one another; they would securely share data in ways that optimise the health of patients and populations, and make care more efficient. They would, for example, enable
- patients with chronic conditions to send their data to their general practitioner (GP), rather than having to go to the doctor’s office; or
- hospitals and GPs to access the same health record to coordinate care for a given patient; or
- health systems to aggregate data from different sources to derive insights and enable research.
Sadly, often technologies and systems cannot connect and share data. For example, hospital staff might not be able to access information held by their patient’s GP. Two hospitals cannot exchange medical records because they run on different IT systems. Or an advanced mobile app and connected device help people manage their diabetes by tracking their blood glucose level and coach them to avoid complications, but the app cannot send data to a clinical system or the office of a GP or endocrinologist because the systems don’t talk.
To me, it is clear that the lack of interoperability reflects market failure. To advance interoperability in European health systems, the responsibility is on healthcare authorities and governments to develop and publish common specifications for devices and systems to talk to one another, and to enforce these specs through guidance or mandates. *
But all stakeholders have a role to play. In a new paper, ‘MedTech Europe’s call to action for an interoperable data ecosystem for digital health, the members of the digital health committee at MedTech Europe set out how we can tackle the lack of interoperability together with healthcare authorities and other stakeholders. The answer is better and more consistent adoption of international specifications and standards, as promoted by standards initiatives like DICOM (Digital Imaging and Communications in Medicine), HL7 (Health Level 7), and IHE (Integrating the Healthcare Enterprise).
From my point of view, for a number of reasons the healthcare sector has not coalesced around these standards: the fragmentation of the markets, misaligned incentives, competing standards, and other factors have favoured the persistence of silos and data cemeteries. Sometimes, healthcare authorities issue national specifications because they want to create local jobs and protect local SMEs.
The European Commission in February 2019 sent a powerful signal in favour of international standards, with the Recommendation for an Electronic Health Record (EHR) Exchange Format for the exchange of medical information across European borders. This was arguably the first time that the Commission has taken a position on standards, delivering potentially impactful guidance for EU Member States and other parties to do the same.
Our paper calls lack of interoperability one of the most persistent barriers to the deployment of digital health technologies. We outline the benefits of an open and interoperable digital health ecosystem and propose actions for stakeholders to accelerate our path to get there.
We call on governments and healthcare authorities to develop guidance, recommendations and mandates that raise awareness about the benefits of interoperable data ecosystems, and advance these ecosystems on the regional, national and European level. Payers and providers can play their part by adopting common standards and mandating adherence to these in their procurements.
I strongly believe that at EU level, the European Commission (EC) and Member States can further promote the building of digital health infrastructures and solutions through targeted investments, and where they provide funding they could make financial support contingent on adherence to the specifications outlined in the EHR exchange format, and on collaboration with standards organisations.
We look also to other industries including the consumer devices sector, large IT companies, and social media giants to embrace an interoperable data ecosystem and open, international standards, and make data available to the healthcare sector.
And we, the medtech industry, reassert our commitment to supporting the digital transformation of health and care. We are making a positive contribution to a more interoperable digital health ecosystem where data flows, systems communicate, and information empowers citizens, patients and carers, and healthcare professionals.
As the position paper shows, we can solve this if we all commit to serious action on this major issue for European healthcare. If we get it right, the rewards will be significant for all. Patients and citizens expect nothing less.
Find out what MedTech Europe does to realise the potential of digital health in healthcare.
*This point is also made in the German Bertelsmann Foundation’s Smart Health Systems (2019) study, an international comparison of digital strategies in 17 countries, which identifies as critical building blocks of a successful digital health strategy the setting of technical standards and their enforcement. The full study is available here.