HTA & ICTs: Can they interface?Plenary Session 27.6.2012

HTAi2012 Bilbao, Spain

Dr. Persephone Doupi

Information Department, THL, Finland

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Session Objectives

• Scope the field of eHealth – HTA intersection• Identify state of progress• Discuss open challenges• Delineate potential areas and means for collaboration;

take ideas home for further work in local and international networks

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“HTA and eHealth: aiming for synergy”

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Definitions: eHealth• e-Health tools or solutions include products, systems and

services that go beyond simply Internet-based applications. They include tools for both health authorities and professionals as well as personalised health systems for patients and citizens.

• Examples include: – health information networks– electronic health records– telemedicine services– personal wearable and portable communicable systems,

health portals, and – many other information and communication technology-based

tools assisting prevention, diagnosis, treatment, health monitoring, and lifestyle management.

eHealth Action Plan, 2004

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Definitions: Telemedicine• Telemedicine is the provision of healthcare services,

through use of ICT, in situations where the health professional and the patient (or two health professionals) are not in the same location.Eg. teleradiology, telepathology, teledermatology, teleconsultation, telemonitoring

• Health information portals, electronic health record systems, electronic transmission of prescriptions or referrals (e-prescription, e-referrals) are not regarded as telemedicine services

• Telemonitoring is a telemedicine service aimed at monitoring the health status of patients at a distance - particularly useful in the case of individuals with chronic illnesses (such as diabetes or chronic heart failure)

EC Communication on telemedicine, 2008

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Definitions: Telehealth – Telecare (UK)

• Telehealth is the delivery of health related services and information via telecommunications technologies. ‘Telehealth’ is an expansion of the functionality of telemedicine and unlike telemedicine (which focuses on the curative aspect) it encompasses preventive, promotive and curative aspects.

• Telecare is a combination of equipment, monitoring and response that can help individuals to remain independent at home. It can include basic community alarm services able to respond in an emergency and provide regular contact by telephone as well as detectors which detect factors such as falls, fire or gas and trigger a warning to a response centre

Source: EHTEL Briefing Paper Sustainable telemedicine

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What Is eHealth (4): A Scoping Exercise to Map the FieldPagliari C et al. J Med Internet Res 2005;7(1):e9doi:10.2196/jmir.7.1.e9

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eHealth: the claims

Source: Nicole Denjoy, COCIR Secretary General

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The Proof?

“The major finding from reviewing the empirical evidence – which is of variable quality - …is that there is very limited rigorous evidence

demonstrating that these technologies actually improve either the quality or safety of healthcare”

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Why is this a serious problem?

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The policy context (an EU view)

• Policy consistently promoting eHealth uptake: – eHealth Action plan – Series of ministerial conferences

and decisions – Communication on Telemedicine & large scale pilots– eHealth Task force report (Redesigning Health 2020)

• Transition from hospital-based care to extramural care - shortened periods of hospitalization; IT an essential tool

• Cross-border care – new demands and challenges

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WHO: Call to Action on Global eHealth Evaluation

•  “To improve health and reduce health inequalities, rigorous evaluation of eHealth is necessary to generate evidence and promote the appropriate integration and use of technologies.”

• “If used improperly, eHealth may divert valuable resources and even cause harm.”

Consensus Statement of the WHO Global eHealth Evaluation Meeting, Bellagio, September 2011

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Recommendations and identified action items

• Identify and adapt, where necessary, robust and relevant tools for the evaluation of eHealth.

• Develop simple and pragmatic tools to enable decision makers to review and select eHealth systems, based on appropriate evaluation-generated evidence of impact, and potential for scalability and sustainability

• Develop principles and recommended practices to evaluate and assess eHealth, with a view to increasing transparency, accountability and integrity

• Develop an “eHealth Evaluation Learning Network”; learn from similar initiatives in other sectors.

• Create a registry of eHealth evaluation studies and results, and a repository of evidence-based eHealth best principles and practices

WHO Call to Action on Global eHealth Evaluation

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The role of HTA

• Assessment of individual health technologies in a manner useful to decision makers

• Adopting a global perspective in the process:ensuring that the medical, social, ethical, and economic implications of the development, diffusion, and integrated use of those technologies is addressed

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Challenge I: timing

• Ehealth: innovation and speed are desirable properties resulting in continuously changing technologies. As a result, any form of evaluation and assessment activity has been often perceived as a hindering factor.

• HTA methodology traditionally comes into play only after a technology has matured enough and evidence has been gathered that can inform decision making.

• How to align these needs and traditions in the best way in order to achieve the desired development and implementation of evidence-based Health-ITs?

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Challenge II: technology & service mix

• eHealth applications are socio-technical systems.

• constant interplay between the technology and human/social factors in the environment of implementation, which brings about changes in all involved (systems, humans, organizations, services). Further, Health-ITs are usually a combination of technologies and services, or a means supporting innovative service provision.

• How well does the HTA approach transfer to a domain with the features of eHealth?

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Challenge III: the patients’ view & role

• eHealth developers and scientists, as well as the HTA community have each in their own ways approached the subject of the patient taking up a different, more defining and determining role in modern healthcare delivery.

• Is there a shared view and vision of the role of the patient between the two communities? What has been done in practice to achieve it? What remains to be done?