29 Juin What is the future of e-health in Europe?
A few months ago, Agnès Buzyn was introducing the plan Ma Santé 2022, making digitalization one of the major axis of transformation of the French healthcare system. In parallel, several other projects coming from the public and private sectors kept popping up through Europe. The willingness of European countries to develop e-health gets stronger and stronger, while the European Union, although the third largest economy in the world, is still struggling to find its place as the initiator and federating body of a European e-health. A turning point that is nevertheless crucial to make e-health a European and not only national stake.
A European governance in e-health is at stake
On November 1, 1993, the Maastricht treaty established a European Union to which signatory countries agreed to give part of their jurisdiction and sovereignty : since then, health is among the sectors reserved to member states, in which the Union cannot legislate. However on April 25, 2018, the European Commission put forward an action plan to encourage the digital transformation of health and care in what it calls the “Digital Single Market”. It sheds light on three top priorities. First, giving access to European citizens to their health data wherever they are in Europe; then, creating a shared infrastructure between member states to store health data; finally, accompanying European citizens in their use of digital tools along their care pathway.¹ The Commission also raised concern about the security of health data at stake in the process.
One might wonder about the legitimacy and value of such a governance. Europe has often been a factor of precaution and slow-down, and possesses inherent characteristics making its efforts difficult. The different languages and multiple institutions of its member states are as many ways of treating and storing health data, making interoperability harder. In addition, healthcare systems are by definition national, ruled by specific laws and sometimes with radically different functioning.
However, a European e-health is crucial to ensure a digital sovereignty to EU member states. In the case of France, the Health Data Hub had to hire Microsoft to store its collected data, raising numerous criticism and highlighting Europe’s technological inability to meet this growing need of the health sector. Cedric O, Secretary of State for the Digital Sector, underlined when called at in the Senate the dilemma between “sanitary efficiency and sovereignty issues”.² The creation of a European cloud for health data would be a major response to the situation.
E-health in Europe: a multi-speed democratization
A report from the EU published in 2018 confirms a significant increase in the adoption of e-health in Europe between 2013 and 2018, and underlines that the number of general practitioners enthusiastic about it have doubled. However, there are still critical disparities between member states, revealing the weaknesses of a two-speed Europe.³ A gap is slowly showing up between countries such as Denmark, Finland or the UK on one side, and Greece, Romania or Slovakia on the other. A crucial challenge for the EU will thus be to impulse the implementation of a digital health in every member state, regardless of their economic weigh.
On the other hand, an assessment of the situation in Europe demonstrate a prudent and progressive adoption of e-health. The digital care record, containing basic health and administrative data about patients, is becoming widespread. It is available in every European country and used by 96% of general practitioners in their day-to-day work.⁴ Health data sharing between European countries and their centralization to research ends shows slower progress, similarly to tele-medicine. Nevertheless, the use of these digital health tools became crucial in the pandemic context. Coronavirus gave a real push to digital health at the European scale.
The Covid-19 fostering cooperation in the EU
In the context of a global sanitary crisis, the ressources and potential of the EU in terms of cooperation was found to be a great asset to fight the virus. Three initiatives in particular caught my attention for their economic potential with regard to public health in the long term.
– Artificial intelligence to improve Covid-19 diagnosis
The European Commission has invested in the implementation of artificial intelligence tools to analyse patients arriving at the emergency room with one or more symptoms by tomography. This technologies may signal a pneumonia linked to the Covid-19 in less than a minute. It has already been deployed in ten European hospitals, including one in France.
– European cooperation for the research of a treatment against the virus
European super-computers joined forces with the biggest firms of the pharmaceutical industry through Europe, in the context of the Escalate4CoV Project. Artificial intelligence allowed the modeling of Covid-19 proteins and the testing of billions of existing molecules and drugs against it. Important French pharmaceutical manufacturers like Pierre Fabre or Sanofi participated in the project.⁵
– The creation of the Covid-19 Data Portal, a single European health data portal to accelerate research on Covid
The Covid-19 Data Portal is the result of a collaboration between the European Commission, the European Bioinformatic Institue (EMBL-EBI) and several member states. This database could be the first step of a European digital sovereignty.
More broadly, European guidelines concerning data interoperability and security in tracing apps against the virus gave to the EU the opportunity to reiterate its will to encourage and oversee e-health. Despite its lack of legislative authority in the health sector, the European Union progressively reassesses its role as a leader and coordinator of member states. Notwithstanding, two major challenges remain. First, less economically powerful states will need to be involved in this transformation, to make e-health a factor of inclusion and not of division between member states. Then, the interoperability of health data will have to be gradually ensured, to allow centralization and sharing, eventually leading to the improvement of the European public health.
Student in the Sciences Po-HEC dual-degree
Consulting intern at TechToMed
¹ “Communication on Enabling the Digital Transformation of Health and Care in the Digital Single Market; Empowering Citizens and Building a Healthier Society”. Shaping Europe’s digital future – European Commisions, April 25, 2018. https://ec.europa.eu/digital-single-market/en/news/communication-enabling-digital-transformation-health-and-care-digital-single-market-empowering
² “Données de santé : le controversé Health Data Hub conforté par le Conseil d’Etat.”. Le Monde.fr, June 19, 2020. https://www.lemonde.fr/economie/article/2020/06/19/donnees-de-sante-le-controverse-health-data-hub-conforte-par-le-conseil-d-etat_6043509_3234.html
³ “EHealth Adoption in Primary Healthcare in the Eu is on the Rise” Shaping Europe’s digital future – European Commision, June 18, 2019. https://ec.europa.eu/digital-single-market/en/news/ehealth-adoption-primary-healthcare-eu-rise
⁴ Union Publication Office of the European. “Benchmarking Deployement of EHealth among General Practitioners (2018) : Final Report”. Publications Office of the European Union, April 10, 2019. http://op.europa.eu/en/publication-detail/-/publication/d1286ce7-5c05-11e9-9c52-01aa75ed71a1/language-en
⁵ “Fighting Coronavirus : European Supercomputers Join Pharmaceutical Companies in Hunt for New Drugs”. Shaping Europe’s digital future – European Commission, May 4, 2020. https://ec.europa.eu/digital-single-market/en/news/fighting-coronavirus-european-supercomputers-join-pharmaceutical-companies-hunt-new-drugs