Denmark, a country that started digitizing health data more than a decade ago, is a recognized world leader. So it is not surprising that when some 480 people gather in Paris April 6 for a Health 2.0 conference they will hear about the country’s ongoing programs and those of other innovative European governments. But the conference will also focus on Internet start-ups in places like Hungary, Italy, Spain, Sweden and France, which are empowering patients and doctors within their own borders and beyond.
Transforming the Internet into a health care platform, is not a new idea. Jim Clark, the founder of Silicon Graphics and Netscape, launched Healtheon, a dotcom with a business plan to streamline communication and paperwork for the United States’ health system, some 14 years ago. (The company eventually merged with rival WebMD and today it provides the American public with a variety of health care information services.)
But, experts agree that the U.S. lags far behind Europe in embracing Health 2.0, a phrase used to refer to disruptive technologies that are transforming every part of health care. The Danish government, for example, established its first Health Data Network as far back as 1992 and launched a national eHealth portal in 2003. It is thought to have a far greater share of its citizens connecting electronically with their doctors and health records than any country in the world.
The country’s eHealth portal, which today links labs, pharmacies, doctors, patients, hospitals and local municipalities country-wide, has been in the headlines again recently, because policymakers in the U.S. are studying it to see whether its successes can be replicated as part of the overhaul of the health system recently approved by Congress.
Among other things, the Danish system digitalizes citizen’s health records, allowing both health care professional and patients to access them on-line. It also encourages patients to make appointments with their general practioners on-line rather than calling on the phone. Under the system “each doctor becomes the gatekeeper in keeping down the cost of healthcare,” Morten Elbaek Petersen, (pictured on Informilo’s home page), an economist by training who has been managing director of the national Danish e-health portal since May 2002, said in an interview with Informilo.
Studies suggest that electronic health records save 50 minutes per day in each general practitioner’s office, that phone calls to hospitals are reduced by 66% and that 2.3 minutes are saved per message. This translates into €60 million saved per year. An additional savings of €22.5 million, or 25 thousand person months, can be saved in human resources, according to studies cited in a 2008 report by the Healthcare Information and Management Systems Society.
To safeguard security and ease fears about privacy, the Danish healthcare system requires user identification and authentication passwords. There are strict rules regarding logging of the use of the systems, i.e. read, write, change, delete. To date, patients and healthcare professionals use a national digital certificate and signature solution to access the National Health Portal.
Of course, the transition has not been entirely smooth, There has been some reluctance, on the part of patients, for instance, to adopt the digital signature system developed by the government, says Petersen. Only one million people out of a national population of 5.4 million people use it, compared to the four million who use Internet banking services, he says. So, the government has now reached an agreement with a national banking association to use the same on-line authentication process.
Between this year and 2012 the government plans some other moves to boost use of the system, including adding more patient-to-patient dialogue services, more opportunities for citizens to comment and add to their own data records and providing eHealth portal services to other platforms, such as mobile phones..
There are questions, though, about just how replicable the Danish model is. Petersen acknowledges that such a system can only work in countries where there is a homogenous health care system, one source of financing for healthcare, a free choice of healthcare provider, agreed standards of data exchange between operators and authorities, and a high level of trust regarding the public sector and access to personal information.
The criteria clearly doesn’t map to every country, including those in Europe. Despite efforts from the European Commission to create a common market for e-health, Europe remains a patchwork of different systems in different phases of development. In Germany, for example, there are some 265 health insurance systems, so it is impossible to emulate Denmark, acknowledges Denmark’s Petersen. That is not keeping other European governments from moving ahead.
The Dutch government, in a new Health 2.0 report to be presented at the Paris conference, wants healthcare providers, insurers and the government to make greater use of the social media in order to provide information more transparently and to involve patients, policy-holders and the general public in the formulation of new policy, according to a presentation that is scheduled to be delivered at the Paris conference by Pieter Vos, a psychologist in charge of running the Dutch government’s Council for health and Care (rVZ) .
A big focus of the Dutch government’s efforts going forward will be new types of interaction between health care providers and consumers. Most importantly, the government is encouraging consumers to collect and store their own health record data electronically, rather than waiting for the government to do it. In short, the message is that consumers should take charge of their own health.
Across Europe, consumers are doing just that, experimenting with a variety of private sector on-line communities which empower patients, but due to national borders and language barriers , the efforts have pretty much remained below the radar outside their home markets, says Denise Silber, an e-health consultant who heads Paris-based Basil Strategies. That is one of the reasons why she said she helped orchestrate the European premiere of the Health 2.0 conference, an established U.S. event. “There are some fantastic things going on in Europe and I am expecting that there will be many bridges built among projects and that this will help accelerate things,” she says.
Among European companies showcasing local efforts will be Webbeteg, a cluster of patient sites which includes one which allows women to ask online questions to gynecologists and another called Kamaszpanasz, which is aimed at teenagers. Another company presenting at the conference is Italy’s PagineMediche.it, founded by Italian physician Roberto Ascione, which uses artificial intelligence to help patients find answers to their medical queries. These companies will share the stage and compare notes with more internationally known sites such as the U.S.’s PatientsLikeMe and Britian’s iWantGreatCare.org ,which allows ratings and reviews of doctors, dentists, hospitals, medicines and care homes.
But private-sector sites are not just catering to patients. Just like in the U.S, in Europe physician social networks are, in some aspects, replacing the function of traditional professional organizations. Some of the European sites are global, giving doctors without borders a whole new meaning. Take the case of Medting, the brainchild of CEO Miguel Cabrer, which currently links some 6,000 doctors from more than 20 countries in North and South America, Asia, the Middle East and Europe. Cabrer, a Spanish computer scientist, has deep experience working on projects connected to telemedicine and eHealth, including a five-year- stint as chief information officer of Hospital Son Llatzer, on the outskirts of Palma de Mallorca, in Spain’s Balearic Islands, which has received numerous awards for its digital hospital project.
He founded Medting.com to provide an easy way for doctors across the globe to exchange clinical information. The site allows the sharing of medical images (including pathology and radiology) and videos, enabling collaboration on clinical cases, regardless of the location of the doctors. To safeguard privacy, specific information about patients is never used.
Medting is in English and Spanish and uses Google Translate for doctors who want to read about the cases into 40 other languages. The translation is not perfect but good enough, says Cabrer, who runs the site from his home in the Balearic Islands, although the company itself is headquartered in Ireland.
The site allows doctors in remote locations to upload images from the field. The service is free for doctors. Medting, which is profitable, makes it money by building, and sometimes hosting, private, exclusive platforms for medical organizations and hospitals which want to share data with a specific group.
Among those clients is a “second opinion network” which allows 12 hospitals in countries such as Kenya, Mexico and Peru, to upload images and provide data about specific problems they are trying to solve and get feedback from European doctors. That specific initiative received EU funding and Medting provided the enterprise platform. The company has bootstrapped from an initial 500,000 euros investment by a private Spanish eHealth company called C2C.
Medting also makes money from licensing its technology platform to university hospitals, such as Germany’s Heidelberg University and Spain’s Gregorio Maranon, and from both licensing the platform and hosting a service to clients such as the Mayo Clinic in the U.S. for the Global Stroke initiative. “The technology platform has been profitable but we could grow very fast with some outside investment,” says Cabrer.
A Sweden-based online portal for neurosurgeons called Neurosurgic, which is attracting visitors from 185 countries, was also built without the help of venture capital. Swedish neurosurgeons Thomas Skoglund and Steen Fridriksson, said they recognized the need to go global immediately because there are only about 100 neurosurgeons in Sweden and 30,000 in the world. They built they site with their own money and funds from the European Regional Development Fund.
The site, which was launched for beta testing in 2008, currently has 1,915 registered members, says Skoglund. It generates revenues through advertising but has not yet broken even. The aim is to promote networking between neurosurgeons and others with an interest in neurosurgery, to help members stay updated on various neurosurgical issues, and to provide a spectrum of useful resources, including material to help residents in neurosurgery prepare for their board certification exams, says Skoglund. The site´s content includes original content and some user- generated material.
Neurosurgic has proved effective in drawing the attention of the world’s neurosurgeons to Ethiopia, one of the poorest countries in the world, with a specialist density of one neurosurgeon per 25 million or three in a population of 80 million, says Skoglund. Patients with a brain tumor, intracranial hemorrhage, head trauma, or children with hydrocephalus have no treatment options within the country. Knut Wester, a professor of Neurosurgery at Haukeland University Hospital, in Bergen, Norway, launched a training program in Addis Ababa to educate new specialists in order to make Ethiopia self-supplied with specialists in neurosurgery but had trouble attracting volunteers until he posted an advertisement on Neurosurgic. Wester had so many responses he asked Neurosurgic to take the ad down, says Skoglund.
While it is easy for doctors to connect and exchange data across borders it is more difficult for nationally- run government programs to exchange info with systems in other countries. A global system of digitalized health records, even if it were possible, would be too expensive, too unwieldly and too risky, says Denmark’s Petersen. There is one important aspect of the Danish system that governments can emulate, he says. If patients are empowered to access their own health records electronically in a secure way, they will be able to do that from any place they happen to be, anywhere in the world, as long as there is a working Internet connection. Once that is possible the Internet will truly become a platform for health care for people, not just in Europe, but everywhere on the planet.