International e-Health Initiatives Vary in Execution, Effectiveness
While many radiology leaders participating in the International Trends meeting at RSNA 2008 spoke of slow progress toward teleradiology and the electronic medical record (EMR) and a low return on investment, one leader inspired her colleagues with great hope for the future.
 The European Union, made up of 27 countries, has an ambitious plan to have full electronic health records by 2015, said European Society of Radiology President Iain McCall, M.D. (far right). Any doctor in any EU country would have access to records for all European citizens, Dr. McCall said. |
Hong Kong employs a government-led model, with compelling but not compulsory record sharing and a strong privacy/security base, said Lilian F. Leong, M.D., immediate past-president of the Hong Kong College of Radiologists. The Hospital Authority, a statutory body set up by the government in 1991, hosts a sizable information technology (IT) department managing 43 public hospitals and 120 public clinics in Hong Kong, said Dr. Leong. A clinical management system (CMS) operates throughout the Hospital Authority and is used by all frontline clinicians, with 3 million daily healthcare transactions, she said. In addition, the Hospital Authority offers an e-Knowledge Gateway to promote evidence-based practice and an e-Learning Center with online courses. Clinicians in Hong Kong working are heavily involved in the e-Health initiative, said Dr Leong, with a new program in progress to implement sharing of clinical information between Hospital Authority and private doctors. "In Asia, there is strong IT penetration and strong interest in electronic health records," said Dr. Leong. China is particularly interested in Hong Kong's solutions, she noted.
In addition to the government's initiatives, other non-governmental organizations like the eHealth Consortium are also actively promoting the use of IT in Hong Kong healthcare. Among the current goals of the eHealth Consortium, said Dr Leong, are data sharing and standardization, education and value creation. "It is a collaboration of patients, primary healthcare givers and hospitals," Dr. Leong said of the program.
Leaders from Asian countries attending the Asian Oceanian Congress of Radiology in October in Seoul were surveyed on EMR and teleradiology. Thirteen of the 19 countries said their hospital information systems were in the growing stage. Patient care, management, research and cost savings were the most important advantages offered by the systems, respondents said.
"E-health will have a major impact on 21st century medicine," said Byung Ihn Choi, M.D., Ph.D., president of the Korean Society of Radiology, who presented the survey results at the RSNA 2008 meeting. In making patient information available anywhere, e-health shifts medicine from being doctor/hospital centric to patient centric, said Dr. Choi.
Asked about the EMR, 12 of the 19 respondents to the Korean survey said digitalization and standardization were their top hopes. In terms of teleradiology, 13 of the 19 countries had new and developing programs, while one country reported never having tried teleradiology. Asked about their receptiveness to teleradiology, 14 respondents said it would be beneficial to their patients, while three expressed concern for loss of radiology jobs.
Overall, the survey found the EMR is used in clinical practice in Asia, said Dr. Choi, adding that reimbursement and the development of guidelines have supported growth of the EMR. For teleradiology, the benefits prevail over concerns because remote reading helps ease the shortage of doctors, he said.
There is an expectation that e-health in Asia will provide health services to previously unreachable areas, Dr. Choi added.
European Society of Radiology President Iain W. McCall, M.D., said the European Union (EU), made up of 27 countries, has an ambitious plan to have full electronic health records by 2015. Any doctor in any EU country would have access to electronic health records for all European citizens and could treat a patient while the patient traveled around the EU, said Dr. McCall.
In Europe, physicians look to teleradiology and teleconsultation to bring medical support to remote areas, specialized care when there are shortages of doctors and enhanced help for chronic disease, Dr. McCall said. "It would make a significant contribution to the EU economy, too," he added.
The draw of a cross-border healthcare directive, said Dr. McCall, is to allow the free movement of patients, giving them quality treatments while providing for their safety and privacy. He noted two significant problems, however, with the EU system under construction: there is a great need for translators for the multiple languages used by citizens of the EU—those translators must have strong knowledge of proper medical terms—and lack of regulations.
"No specific language exists to target e-Health services and products," said Dr. McCall.
Cooperation and cost are two other major problems, he added. "It is difficult getting all 27 states involved," he said. "In the United Kingdom, the government already has spent $25 billion pounds to try to set up a government-funded teleradiology program."
 Hans Ringertz, M.D., Ph.D., (far left), president of the International Society of Radiology, participated in the International Trends Meeting at RSNA 2008. |
EU member states have plans in 2010 to assess needs and priorities in telemedicine to form national strategies. In 2011, plans call for assessing and adapting national regulations—addressing accreditation, liability, reimbursement, privacy and data protection—to enable wider access to telemedicine.
In the U.S., one emphasis in electronic health initiatives is patient safety, said Ronald L. Arenson, M.D., RSNA board liaison for the annual meeting and technology. There is no monolithic healthcare system, he said, with services in the U.S. fragmented among community hospitals, academic institutions, federally based hospitals and other networks. "The penetration of EMR here is highly variable," Dr. Arenson said. "There are no national healthcare identifiers due to security concerns."
Some companies are working hard to improve the EMR, said Dr. Arenson, citing the Electronic Privacy Information Center (EPIC) and the VA System for working with customers to get the systems right. President-elect Barack Obama has proposed $10 billion per year for five years to improve digital medical records—a goal Dr. Arenson calls "ambitious."
"The U.S. has a long way to go, but I'm encouraged after hearing about the work in Hong Kong and Europe," said Dr. Arenson. Currently the costs are huge and the savings tiny, he said, "However, we hope the U.S. system will empower patients to have more control over their health."
