1. A look at progress in the development of eHealth in the European Region Results and recommendations from the 2016 report “From Innovation to Implementation: eHealth in the WHO European Region” Clayton Hamilton, eHealth and Innovation WHO Regional Office for Europe eHealth Development in Ukraine workshop 27 April, 2016

2. Geography of the WHO European Region 53 Member States 900 million population WHO Regional Office for Europe Copenhagen, Denmark

3. The 2016 report on eHealth in the WHO European Region

4. The 2015 WHO Global eHealth Survey and report methodology Global survey sent to all WHO Member States (health responsible ministries) under the theme of eHealth in support of universal health coverage. European Region response rate to the survey was 89% (47 of 53 Member States responded, results for 46 presented in the report). Report responses were “taken at face value” and don’t include input from other stakeholders (patients, communities, healthcare providers and industry). One response per country. Not all countries responded to all questions. Percentages, where given, are based on non-blank responses to each question. Selected case examples from national implementations are included in the report.

5. Overall report findings A notable transition of eHealth to a subject of strategic importance for policy makers. eHealth has become a key enabler of effective health service delivery and for health information accessibility. Countries are actively building upon their national eHealth foundations to deliver public health and health services in a more integrated, cross- sectoral manner. Successful investment in eHealth requires far more than technology acquisition. Better understanding the holistic picture of changes required to org. processes & structures, roles, standards, legislation as well as considerations for Human Resources, education, literacy, reimbursement and cultural contexts of health. Funding, over any other aspect, is now the biggest barrier to adoption.

6. Thematic chapters of the report eHealth Foundations Electronic Health Records Telehealth mHealth eLearning in health Social media in health Health analytics and big data Legislative frameworks for eHealth

7. 84% (38 countries) have a national universal health coverage policy or strategy, of which 74% (28 countries) report a specific reference to eHealth or ICT in support of universal health coverage. 70% (30 countries) report having a national eHealth policy or strategy. 69% (31 countries) report having financial support available for the implementation of their national eHealth strategy or policy. 89% (40 countries) have universities or technical colleges providing students with training on how to use ICT and eHealth. 82% (37 countries) provide training to health professionals on how to use ICT and eHealth. eHealth Foundations - main findings

8. Public funding is the most available type is the region with 93% (42 countries) reporting that public funding is available for eHealth programmes, followed by donor or non-public development funding (53%, 24 countries). 35% (16 countries) report having a policy or strategy on multilingualism applicable to health. 76% (34 countries) report government-sponsored health websites provide information in multiple languages. eHealth Foundations - main findings

9. eHealth Foundations – funding types by subregion

10. 59% (27 countries) report the existence of a national EHR (according to the definition provided) 69% (18 countries) have legislation governing use of EHRs. 50% (22 countries) report that funding is the most important barrier to EHR adoption. Electronic Health Records – main findings

11. Electronic Health Records – legislation and use

12. EHR ancillary systems and ICT-assisted functions

13. EHR - barriers

14. 27% (12 countries) have a dedicated policy or strategy for telehealth. Teleradiology is the most prevalent telehealth programme in the WHO European Region (83%, 38 countries) followed by Remote Patient Monitoring (72%, 33 countries) and Telepathology (63%, 29 countries). 71% (30 countries) report a lack of funding to develop and support telehealth programmes as the most significant barrier. Telehealth – main findings

15. Telehealth – growth in key initiatives

16. Telehealth – barriers

17. 49% (22 countries) report having government-sponsored mHealth programmes. 73% (33 countries) do not have an entity responsible for the regulatory oversight of the quality, safety and reliability of mHealth applications. Only 11 countries (26%) report that health authorities regulate mobile devices and software for quality, safety and reliability. Few Member States (7%) report evaluations of government-sponsored mHealth programmes. mHealth – main findings

18. mHealth – guiding policies and the role of health authorities

19. mHealth – barriers

20. 71% of countries use eLearning to train health professionals and 66% use it to educate students of health sciences. 96% of countries report the main reason for use of eLearning for students is to improve access to educational content and to experts (the same applies to training of health professionals in 94% of countries). eLearning – main findings

22. eLearning – barriers

23. Only 7 countries (16%) have a national strategy/policy on the use of social media by government organizations Only 6 countries (14%) have a national policy governing the use of social media in health professions. However, almost all countries (91%, 40 countries) report that individuals and communities are using social media to learn about health issues. Social media is most often used by national entities for the promotion of health messages and/or campaigns. Social Media – main findings

24. Social Media – use

25. Social Media – training for health professionals

26. 6 countries (13%) reported having a national policy/strategy regulating the use of big data in the health sector. Only 4 countries (9%) have a national policy/strategy regulating the use of big data by private companies. Health analytics and big data – main findings

27. Health analytics and big data – barriers

28. 60% of Member States (27 countries) have legislation on sharing data through EHRs within their own country. 61% of Member States (27 countries) have legislation allowing the sharing of personal and health data between research entities. 38% of Member States (17 countries) have legislation governing the sharing of EHR data between countries. Legal frameworks – main findings

29. Legal frameworks – legislation on patient access and control

30. So is the news all good? Does the data reported by countries support what we observe? Low presence of Telehealth policies doesn’t support (or is in contradiction to) the actual growth that is being observed. Data doesn’t represent the strength of Health Insurance funds in many national settings, nor does it give a true representation of the discontinuity and division in many national health information systems. Doesn’t illustrate the lack of cross-sectoral engagement for health in many countries, nor highlight this as a barrier.

31. So is the news all good? Does the data reported by countries support what we observe? Does reflect the efforts made by those countries moving towards a patient- centric care model. Does show that legislation and privacy are still key issues that threaten uptake of solutions. Does show that digital and health literacy are emerging issues that, if not sufficiently addressed, will have the potential to increase the equity gap in access to healthcare.

32. So what are the key recommendations? 1.Explicit political commitment for eHealth by governments backed by sustainable funding for implementation and innovation activities is needed. 2.Dedicated national eHealth strategies that link to the achievement of tangible health goals are recommended – BUT - such strategies need to be “alive” in terms of an action plan and M&E framework. 3.Legislation on the use of Electronic Health Records needs to be strengthened, clarifying in particular, data ownership and the right of the patient to access and manage data. 4.Targeted, intersectoral strategies and policies for telehealth are encouraged.

33. So what are the key recommendations? 5.A systematic approach to the adoption of standards is paramount. Following the EU Refined eHealth European Interoperability Framework (ReEIF) + a quality management system for interoperability testing, a set of appropriate testing tools, and a quality label and certification process. 6.Establish national entities responsible for regulatory oversight of mHealth and to carry out evaluations on the impact and benefits of mHealth applications. 7.Digital and Health literacy among health professionals and the public should become an area of strategic focus. 8.eLearning in health for both students and healthcare professionals needs to be institutionalized and formally evaluated.

34. So what are the key recommendations? 9.National policies and strategies on regulating the use of big data in the health sector need to be addressed by national health and ICT entities and should include a clear position on the use of big data by private companies. 10.National policies governing the use of social media in health professions need to be put in place.

35. THANK YOU! Clayton Hamilton hamiltonc@who.int Twitter: @ClaytonHamilton http://www.euro.who.int/en/health-topics/Health-systems/e-health http://www.euro.who.int #eHealthUkraine #е-здоров’я