The field of eHealth has long been seen as having great potential in making health care more efficient and in managing future conditions. But eHealth has not developed as expected. It is referred to as a sick market, and one which does not fully exploit its potential. There are many reasons for this and the EU Commission’s lead market initiative is now focusing especially on this problem. The main factors contributing to the sick market perception are lack of interoperability; obsolete and unharmonised laws and regulations; and lack of business plans to guarantee reimbursement for services offered. Finding solutions to these transnational problems requires transnational cooperation.
Another aspect is the need for infrastructure and software applications to support health cooperation across borders. This can be seen as a ‘chicken and egg’ dilemma, but this approach may still be relevant when looking at future issues. Making things happen might require two elements to co-exist and there might be problems in motivating the development of one element before the other exists. Can we have a chicken without an egg, or vice versa? The question is then to find out which task to start with: the applications or the infrastructure.
In the case of Internet there is no question. Some visionaries created the infrastructure a long time before most people had any idea of its potential uses. Even in the case of mobile telephones, a lot of money was invested in networks and in mobile handsets long before there was any demand for it. (By way of illustration, I will tell you that I won a mobile phone on a lottery in the late 1980s and I sold it, because I thought I had no use for it! OK, it was not a pocket size telephone, so one conclusion from this story may be that technology needs to reach a certain level of maturity before it can be exploited in large scale.)
Development of transnational cooperation in health care also needs both components -infrastructure and applications - but in this case we are to a great extent lacking the visionary investors paving the way for future applications. This is something which emerged when writing the report on “eHealth as a Facilitator of Transnational Cooperation on Health”. Although there are many reasons for cooperation in transnational in health care, the use of eHealth is not exploited very much. We use emails and attachments to emails, and that is all. Yes, there are of course exceptions, but it is true in general. The medical profession imagines that there are so many problems in establishing an eHealth solution that it is not worth the effort needed to convince their IT departments to create it. Medical staff are busy with everyday work and cannot mobilise enough power to fight for eHealth development and are not always even aware of possibilities offered by new technologies. The IT department is also very busy with everyday work to make existing systems work more efficiently, decrease costs and solve problems in local/regional health care services and to some extent for eHealth services at the inter-regional and national level. However, if you were to question an IT department about establishing transnational links to facilitate cooperation on health, you would most probably get the answer that this is not prioritised because there is no demand for it – the chicken and the egg dilemma again.
It is therefore important that those ultimately responsible for health care - the politicians - pay attention to the issue of development of eHealth for transnational cooperation. Fortunately, the European Commission is aware that the development drive within the regions is not enough to exploit eHealth fully for transnational cooperation and is pushing for development in this area. Several initiatives are taking place in different EU programmes, such as the Competitiveness and Innovation Framework Programme, Ambient Assisted Living Joint Programme, Seventh Framework Programme for research and technology development (FP7), Health Programme, Interregional funds, etc. An important task for the eHealth network is to monitor these programmes trying to find financing for development projects, but also to scrutinise ongoing projects in these programmes trying to utilise results for eHealth development.