WHO & eHealth in EuropeThe role of eHealth in achieving Universal

Health Coverage and strengtheningnational health systems

Clayton Hamilton, eHealth and InnovationWHO Regional Office for Europe

Tenth Jubilee edition of the national e-Health conferenceSofia, Bulgaria

Clayton Hamilton, eHealth and InnovationWHO Regional Office for Europe

Tenth Jubilee edition of the national e-Health conferenceSofia, Bulgaria

Geography of the WHO European Region

WHO Regional Office for EuropeCopenhagen, Denmark

53 Member States900 million population

The role of WHO in eHealth

WHO’s key undertaking within eHealth is to provide independent adviceand assistance to countries towards the long-term development ofsustainable national eHealth solutions - in particular - in relation tostrengthening health systems performance and the capacity for countriesto gather and analyze health information.

WHO’s key undertaking within eHealth is to provide independent adviceand assistance to countries towards the long-term development ofsustainable national eHealth solutions - in particular - in relation tostrengthening health systems performance and the capacity for countriesto gather and analyze health information.

How does WHO deliver for eHealth?

In Europe, WHO delivers on this mandate in 3 ways:

• As a knowledge-broker and facilitator between nations and theInternational Community at large.

• By developing and sharing best practices and standards precipitatedfrom successful eHealth implementations.

• By working directly with Ministries of Health to address theirtechnical and strategic needs for eHealth & Health Information.

In Europe, WHO delivers on this mandate in 3 ways:

• As a knowledge-broker and facilitator between nations and theInternational Community at large.

• By developing and sharing best practices and standards precipitatedfrom successful eHealth implementations.

• By working directly with Ministries of Health to address theirtechnical and strategic needs for eHealth & Health Information.

Universal Health Coverage

“In 2005, all WHO Member States made the commitment to achieveUniversal Health Coverage (UHC).The commitment was a collective expression of the belief that all peopleshould have access to the health services they need without risk offinancial ruin or impoverishment.Working towards universal health coverage is a powerful mechanism forachieving better health and well-being, and for promoting humandevelopment.”

World Health Report, Research for Universal Health Coverage, 2013

“In 2005, all WHO Member States made the commitment to achieveUniversal Health Coverage (UHC).The commitment was a collective expression of the belief that all peopleshould have access to the health services they need without risk offinancial ruin or impoverishment.Working towards universal health coverage is a powerful mechanism forachieving better health and well-being, and for promoting humandevelopment.”

World Health Report, Research for Universal Health Coverage, 2013

Achieving Universal Health Coverage

“How much”

eHealth is seenas a majorcontributor ofthe “How” inattainingUniversal HealthCoverage

“Who” “What”

“How much”

eHealth is seenas a majorcontributor ofthe “How” inattainingUniversal HealthCoverage

Health 2020Health 2020 is the new European health policy framework.

It aims to support action across government and society to:“significantly improve the health and well-being ofpopulations, reduce health inequalities, strengthen publichealth and ensure people-centred health systems that areuniversal, equitable, sustainable and of high quality”.

It has two strategic objectives, constructed around equity,gender and human rights and improved governance forhealth.

Health 2020 is the new European health policy framework.

It aims to support action across government and society to:“significantly improve the health and well-being ofpopulations, reduce health inequalities, strengthen publichealth and ensure people-centred health systems that areuniversal, equitable, sustainable and of high quality”.

It has two strategic objectives, constructed around equity,gender and human rights and improved governance forhealth.

European Health Information Initiative

The European Health Information Initiativeis committed to improving the health of thepeople of the European Region by improvingthe information that underpins policy.This involves fostering internationalcooperation in order to exchange expertise,build capacity and harmonize datacollection.

The European Health Information Initiativeis committed to improving the health of thepeople of the European Region by improvingthe information that underpins policy.This involves fostering internationalcooperation in order to exchange expertise,build capacity and harmonize datacollection.

European Health Information Initiative1. Expert group developing new indicators on well-

being and health for WHO’s Health 2020 strategy.

2. Collaboration with the Dutch Institute for PublicHealth and the Environment to create a new webportal for health information at the RegionalOffice.

3. The WHO Autumn School on Health Informationand Evidence for Policy Making.

4. Setup of new health information networks such asthe Central Asian Republics Information Networks(CARINFONET).

5. A dedicated working group is creating a tool tosupport countries developing health informationstrategies.

1. Expert group developing new indicators on well-being and health for WHO’s Health 2020 strategy.

2. Collaboration with the Dutch Institute for PublicHealth and the Environment to create a new webportal for health information at the RegionalOffice.

3. The WHO Autumn School on Health Informationand Evidence for Policy Making.

4. Setup of new health information networks such asthe Central Asian Republics Information Networks(CARINFONET).

5. A dedicated working group is creating a tool tosupport countries developing health informationstrategies.

International eHealth milestone

Special focus reporteHealth & Innovation in women’s and children’s health

A baseline review compiling information from 64 ofthe 75 Commission on Information and Accountabilityfor Women’s and Children’s Health (CoIA) countrieswhich together have 98% of the world’s maternal andinfant mortality.

It demonstrates how, every day, eHealth is saving thelives of women, their babies and infants in some of themost vulnerable populations around the world, in awide variety of innovative ways.

A baseline review compiling information from 64 ofthe 75 Commission on Information and Accountabilityfor Women’s and Children’s Health (CoIA) countrieswhich together have 98% of the world’s maternal andinfant mortality.

It demonstrates how, every day, eHealth is saving thelives of women, their babies and infants in some of themost vulnerable populations around the world, in awide variety of innovative ways.

Fighting the global health burdenthrough collaboration &

technology

mHealth for Noncommunicable Diseases (NCDs)

Globally 57 million totaldeaths in 2008

of which 36 millionwere due to NCDs

Globally 57 million totaldeaths in 2008

of which 36 millionwere due to NCDs

RESEARCHINTERVENTIONS

DEVELOP‘TOOLKITS’

INSTITUTIONALISATION,KNOWLEDGE SHARING

mHealthKNOWLEDGE &

INNOVATION HUBS

SCALE or BUILDCAPACITY

IN COUNTRY

EVALUATE &REFINE

KNOWLEDGE

mHealth scale-up programme

RESEARCHINTERVENTIONS

DEVELOP‘TOOLKITS’

INSTITUTIONALISATION,KNOWLEDGE SHARING

20-06-2014 mHealth Scale-Up Proposal 13

2013 – 2016: Be Healthy Be Mobile ProgrammeDevelop best practice for mHealth at scaleWHO-ITU build & trial reusable tools to be shared globally

SCALE or BUILDCAPACITY

IN COUNTRY

EVALUATE &REFINE

KNOWLEDGE

Beyond 2016Scale mHealth globally in a meaningful wayDevelop light touch service models

National eHealth Strategy Toolkit

• A resource for developing or renewing a country’seHealth strategy

• From countries just setting out to those that have alreadyinvested in eHealth

• A framework and method for the development of avision, action plan and monitoring framework

• A resource for developing or renewing a country’seHealth strategy

• From countries just setting out to those that have alreadyinvested in eHealth

• A framework and method for the development of avision, action plan and monitoring framework

Source: Dr. Ramesh Krishnamurthy, WHO/HQ. Toolkit source: http://apps.who.int/iris/bitstream/10665/75211/1/9789241548465_eng.pdf

National context for eHealth developmentEstablished ICT environment

Establishedenablingenvironmentfor eHealth

Emergingenablingenvironment foreHealth

StrengtheningeHealth enablingenvironment, createfoundations

Scaling-up andintegration, cost-effectiveness,policies forprivacy, securityand innovationDeveloping and

Building up Scaling up

Mainstreaming

Emerging ICT environment

Establishedenablingenvironmentfor eHealth

Emergingenablingenvironment foreHealth

ExperimentationStrengtheninginfrastructure,make the case foreHealth

Source: http://www.who.int/goe/en/

Overall market and penetration of infrastructure

Governance, policy, standards andhuman resources

Early adoption

eHealth standards for health data exchange andinteroperability

eHealth European Interoperability Framework

Source: EU, Antilope Project http://www.antilope-project.eu

The landscape of eHealth in the WHOEuropean Region in 2015

What does it look like?

The landscape of eHealth in the WHOEuropean Region in 2015

What does it look like?

eHealth in Europe in 2015 (Drivers)Factors driving the shift towards technology employment in the health sector

• An increasing cost of healthcare, stable or slight decline in health spending proportion of GDP• Decline in the number of healthcare workers• An ageing population, decline in birth rates• An increasingly mobile population• Continued austerity measures and other cost containment• Broadband penetration and mobile network usage is high, with data costs rapidly declining for

both• Technology, product and market maturation. Emerging standards.• More tangible Return on Investment from eHealth.

Factors driving the shift towards technology employment in the health sector• An increasing cost of healthcare, stable or slight decline in health spending proportion of GDP• Decline in the number of healthcare workers• An ageing population, decline in birth rates• An increasingly mobile population• Continued austerity measures and other cost containment• Broadband penetration and mobile network usage is high, with data costs rapidly declining for

both• Technology, product and market maturation. Emerging standards.• More tangible Return on Investment from eHealth.

eHealth in Europe in 2015 (Actions & Trends)• Concerted push for developing patient-centric healthcare systems and increasing measures

for engaging the patient in the delivery of care.

• A majority of countries are implementing (or refining) national Electronic Health Records(often using ePrescription as the starting point).

• Telemedicine/Telecare/Telehealth are gradually taking hold and are increasingly beingutilized as a component to help manage the burden on the health system.

• Health information is still (in general) extremely “siloed” and Integrated Health InformationSystems are being sought.

• Concerted push for developing patient-centric healthcare systems and increasing measuresfor engaging the patient in the delivery of care.

• A majority of countries are implementing (or refining) national Electronic Health Records(often using ePrescription as the starting point).

• Telemedicine/Telecare/Telehealth are gradually taking hold and are increasingly beingutilized as a component to help manage the burden on the health system.

• Health information is still (in general) extremely “siloed” and Integrated Health InformationSystems are being sought.

Common eHealth challenges observed in Europe• Ownership and governance of eHealth, developing and delivering on national

eHealth strategies and managing the burden of ongoing system development andmaintenance.

• Developing and adopting appropriate legislation to allow for eHealth.• Ensuring security, privacy, identity management and ethical issues are addressed.• Workforce issues: education, awareness and retraining.• Acceptance of solutions by health professionals.• Regionalization (within country) can be both a strength and a weakness.• Digital literacy issues are contributing to a delay in eHealth adoption.

• Ownership and governance of eHealth, developing and delivering on nationaleHealth strategies and managing the burden of ongoing system development andmaintenance.

• Developing and adopting appropriate legislation to allow for eHealth.• Ensuring security, privacy, identity management and ethical issues are addressed.• Workforce issues: education, awareness and retraining.• Acceptance of solutions by health professionals.• Regionalization (within country) can be both a strength and a weakness.• Digital literacy issues are contributing to a delay in eHealth adoption.

Trends in eHealth markets in Europe today

Services forhealthcare

professionals

Services forhealthcare

professionals

Services for remotemonitoring

Services for remotemonitoring

Services for healthpromotion, health

awareness ordisease prevention

Services for healthpromotion, health

awareness ordisease prevention

Serviceportfolio

Diabetes &Cardiovascular

Disease

Diabetes &Cardiovascular

Disease

Chronic lungdisease (COPD)

Chronic lungdisease (COPD)

Mental Health/Tobacco cessation

Mental Health/Tobacco cessation

DiseaseBurden

Diabetes &Cardiovascular

Disease

Diabetes &Cardiovascular

Disease

Chronic lungdisease (COPD)

Chronic lungdisease (COPD)

Mental Health/Tobacco cessation

Mental Health/Tobacco cessation

DiseaseBurden

EHR &ePrescription

EHR &ePrescription

Mobile AppdevelopmentMobile App

developmentTelehealth &TelemedicineTelehealth &Telemedicine

Technologyfocus

ConclusionsKey Messages• WHO has both a normative role and a support role to Member States in the field

of eHealth.

• It is heavily engaged in bringing together representatives from all Member Statesto advocate for national eHealth strategy development, standards adoption forinteroperability and promoting the use of eHealth for attaining Universal HealthCoverage.

• WHO’s unique position in public health will continue to drive a focus on eHealthfor attaining Universal Health Coverage through improvement of national healthinformation systems in addition to the adoption of eHealth for clinical excellence.

Key Messages• WHO has both a normative role and a support role to Member States in the field

of eHealth.

• It is heavily engaged in bringing together representatives from all Member Statesto advocate for national eHealth strategy development, standards adoption forinteroperability and promoting the use of eHealth for attaining Universal HealthCoverage.

• WHO’s unique position in public health will continue to drive a focus on eHealthfor attaining Universal Health Coverage through improvement of national healthinformation systems in addition to the adoption of eHealth for clinical excellence.

Thank you!

http://www.euro.who.inthttp://www.who.int

Thank you!

http://www.euro.who.inthttp://www.who.int