“While our respondents all identified the basics (a strategic plan, focus on core elements, and the need to win over health professionals) it was surprising to see that few projects attended to all of these critical issues in a systematic way,” said Mark Britnell.
Adequate and sustained funding is critical
One of the primary considerations for strategic planners is funding. Participants in our survey were clear that any eHealth system would depend on adequate long-term funding to achieve its long-term goals. In part, this is because eHealth carries high upfront implementation costs for technology and systems. An industry so young lacks a variety of service providers and platform developers, which are essential to building a large market – a real “catch-22”.
A number of interviewees asserted that their countries had significantly under invested in eHealth. Some blamed the lack of funding on the cyclical nature of government budgeting; others saw a need for clear metrics-based Return on Investment (ROI) models. It is clear that both eHealth leaders and the IT industry are actively seeking innovative funding alternatives such as contracting to deliver more secure sources of investment.
Creating a sound governance and policy framework
Building the right environment to support an eHealth structure also requires active participation from policy makers. Governments and regulators will need to consider the broader implications of eHealth. They must go beyond creating a supportive policy environment for transformative change – they must also deal with more technical considerations of issues like data ownership and the role of third parties. Participants in this research also stressed the benefits of eHealth in addressing access disparities, suggesting the universal nature of a system will open doors.
eHealth also creates a number of complex challenges in medical ethics. In this regard, medical authorities and physicians’ colleges will need to carefully consider the broader implications of eHealth on key medical principles such as informed consent, privacy and patient confidentiality. Sound governance models and clear policy in this area will be critical to facilitating the new provider-patient relationship under eHealth, as will the important concepts of crowd accelerated innovation, collaborative alignment and creative dislocation.
Most of all, political leaders and top administrators will need to articulate a strong vision for eHealth that engages all stakeholders and formalizes the integration of care as the predominant objective.
The importance of this cannot be overstated. eHealth initiatives focused primarily on cost-cutting or back-office consolidation will never add up to a whole system. Instead, eHealth must be championed as a method for delivering a safer, more responsive and more efficient form of healthcare; only then will it win the support and active engagement of stakeholders. Indeed, the top-down approach of mandating a certain software or program will likely not succeed in eHealth, particularly given that healthcare professionals need to be convinced they are making the right investment decisions for their patients.
Collaborate across the system
Taking a strategic approach to eHealth requires planners to work throughout the healthcare industry to ensure that eHealth solutions meet the needs of professionals throughout the care continuum.
In part, this is because much of the value of eHealth is driven by a strong network effect – where the sum value of a system grows each time a new node joins the network – that underpins the system.
Yet eHealth also demands a more holistic view of the way the patient interacts with the health system, from their first contact with a general practitioner or hospital admission, through to the completion of treatment (otherwise known as the ‘patient pathway’). This is critical to ensuring that everyone – from primary care providers to payers – understands the role they play in the system. According to some interview respondents, this alignment of stakeholder interests can also be used to identify and develop innovative ideas to make the system more valuable.
Focus on clinical outcomes, then technology
Participants in our research were overwhelmingly clear that any eHealth strategy – whether on an institutional, regional or national level – must have improving clinical outcomes as its overarching goal.
Too often, eHealth is positioned more as a technology to implement than what it actually is: a clinical transformation. And while technology will certainly be a key enabler of any eHealth strategy, planners must be careful to make sure that any IT decisions are carefully aligned to a specific clinical objective.
Case Study: United Kingdom: National Programme for IT in the National Health Service (NPFIT)
- eHealth requires stable and secure funding to achieve system-wide goals.
- Supportive policy and political vision are critical to long-term success.
- End-users, such as doctors, nurses and patients, must be involved early in the process to achieve participatory medicine.
- Program focus should always be based on clinical outcomes, with technology as an enabler.