by Peter O'Donnell
BRUSSELS, 18 May (APM) - Sceptics about the importance of e-health - and until recently that included much of Europe's pharmaceutical industry - are going to have to adapt to its growing impact on EU healthcare, as revealed by a comprehensive survey of how national administrations are implementing digital policies.
The EU's Digital Economy and Society Index released on Friday shows that nearly half the population of some countries are using online health services - for example by getting a prescription or a consultation online.
By contrast, in slow-adopting countries the proportion is less than 10%.
Top of the list for e-health performance is the EU's digital poster-child Estonia, where 95% of health data is digitised, 99% of prescriptions are digital and billing is 100% digital.
Each person in Estonia who has visited a doctor has an online e-health record that can be tracked through a central system.
And the e-prescription system draws on data from the national health insurance fund, so patients entitled to state medical subsidies have the medicine discounted automatically.
And patients no longer need to visit a doctor or hospital for repeat prescriptions.
An electronic patient record system in Finland - that ranks equal first with Estonia - allows citizens to access their medical records, as well as prescription services.
Physicians use this database to view patient records and also to access a picture archiving and communications system that lets them see and transmit relevant information around the healthcare system.
A legislative reform due for adoption before the summer of 2018 is planned to increase use of digital and electronic services - and to boost cost efficiency.
Bottom of the list
Germany sits conspicuously among the low-performing countries, with only 7% of the population using online health services from time to time.
"The extremely low use of e-health services reflects the comparatively low adoption of e-health among both general practitioners and hospitals," comments the European Commission.
While the country has an e-health law that envisages a digital e-health infrastructure and comprehensive use of an electronic health card from mid-2018, "it is still unclear whether this objective will be met," adds the Commission.
Even Bulgaria outperforms Germany, with 10% of the population using e-health services, and plans under way for health registries, a system to flag possible drug interactions and an electronic health record, referral, and prescription.
France and Ireland too languish near the bottom of the ranking, along with Cyprus, Greece, Hungary, Malta and Romania.
UK 'above average'
The UK is dubbed "an above-average performer" by the survey, with 25% of UK citizens going online to use health and care services.
Following recognition by the NHS that it must make better use of information and technology to meet its growing challenges, the UK has made a commitment to ensure patient records are digital and interoperable by 2020 - and the process is under way, with local health and care systems producing their own preparatory digital roadmaps towards that goal.
Denmark "is performing well", and ranks first for general practitioners using electronic health records and fourth in terms of e-health records in hospitals, as well as boasting "a well-established set of disease registries."
Spain also wins high ranking, with 29% of Spaniards having used health and care services provided online.
Italy ranks highly too, with 16 of its 21 regions having adopted the electronic health record, and 11 of them ready for interoperability.
Slovenia and Sweden are other members of the high-performance club.
Austria's score of 18% for public online healthcare usage is right on the EU average level.
A new government programme aims to improve this by developing the country's existing electronic health record - an information system offering personalised health data to all citizens and eligible health service providers in hospitals, pharmacies, general practice or specialisations.
Contracted general physicians and specialists are required to document prescribed medications within the e-medication record, and the aim is to roll out the system across Austria by September 2019.
Pilot projects in telemedicine are also running, including Gesundheitsdialog Diabetes and HerzMobil Tirol, a telemonitoring system for cardiovascular disease.
Belgium also "scores well in pre-filled forms and e-health services", according to the survey. E-prescription "is widespread and will become mandatory (with a few exceptions) on 1 June 2018".
Croatia too "performs well", with its Central Health Care Information System providing "a good basis for the informatisation of the entire healthcare system", to which all healthcare providers and the Croatian Institute for Health Insurance are connected.
Latvia, Lithuania, Luxembourg, Poland, Portugal and Slovakia jostle around the average level, while the Netherlands ranks better than average, and has "a substantial e-health offering" - but suffers from "a limited (albeit slight increased) uptake of e-health services".