- By Chris Kremidas Courtney
To promote disruptive and innovative healthcare models that are not immediately restricted by current laws or based on obsolete technologies is a dream scenario – especially in the European Union with its 28 different healthcare systems. But it is precisely overcoming this initial hurdle that drove the catalysts of change to introduce new solutions in the United States and in Asia.
Europe does not have any trouble identifying needs, but rather struggles to put solutions into effect. This can somewhat be attributed to Europe’s cultural heritage and penchant for perfectionism, which is well-intentioned but often shoots beyond the target.
Above all, people lack confidence. Why are Europeans so hesitant to try things out and continue optimising along the way? The developers and companies in Silicon Valley are neither smarter nor better than the minds here in Europe – in truth, they are often Europeans who have emigrated. They try new ideas and if they don’t work, they learn from the experience and try something else. This is seen as entrepreneurial spirit in the US, but as failure in Europe.
Europe has an obsession with certifying everything. I am particularly concerned by the upcoming European legislative framework around health apps.
To promote disruptive and innovative healthcare models not immediately restricted by current laws or based on obsolete technologies is a dream scenario
There are more than 400,000 health apps, but very few of them have any relevance. After all, it is the patient who determines if the app is worth using. This was the basic takeaway from a survey conducted on mHealth, which was presented at the eHealth Europe conference in Riga. Much greater priority should be given to recommending general frameworks instead of creating laws and guidelines. Attempts to function as a regulator defining everything from the outset won’t work. The term ‘disruptive’ is by definition contrary to this.
Specific changes can be made on an ongoing basis depending on the current state of development. I believe that the European Commission is moving in the right direction on this. But as pleased as I am that the EU is taking strides with the digital domestic market strategy, I have doubts about the utility of an agenda that was drafted in 2015, to be adopted in Brussels by 2017 and finally implemented at member state level in 2020. How can this succeed if we do not foster a less prohibitive culture?
Take just one example from Germany. In 2009, the Federal Union of German Associations of Pharmacists (ABDA) engaged with the European Court of Justice to discuss a potential liberalisation of the pharmacy market. At the time, the national advisory council on health services made the following call for action in a special report:
“The present role of pharmacies as a rather passive institution for the distribution of medicines [must shift] towards an institution which, together with the doctors and members of non-medical health professions, must be integrated into the framework of new organisational and financial structures […] to become an active part in successful purchasing, proper selections, the effective use […] as well as in the monitoring of drug therapy.”
We need a culture of allowing, not of banning
Four years later, Professor Andreas Sönnichsen from the Witten/Herdecke University published an EU-funded study according to which there are as many as 58,000 deaths a year from drug side effects, most of which involve multi-morbid chronic illnesses. Josef Hecken, Chairman of the Federal Joint Committee, stated in Autumn 2014 that studies have shown that 30% of all hospital admissions of chronically-ill patients can be attributed to adverse side effects from medications. This is where innovation and technology should provide assistance.
In 2015, we finally saw the long-awaited German eHealth Act. It includes the new Section 31a Medication Schedule, which states:
- Effective 1 October 2016, insured persons who are taking at least three prescribed drugs at the same time are entitled to have a medication schedule prepared in paper form by a medical doctor who is a healthcare provider licensed under the statutory system.
- The medication schedule is to include the following information:
- All medications that have been prescribed to the insured patient;
- Drugs the insured person is taking without a prescription;
- Information concerning any medical products relevant to the medications listed under 1 & 2.
This example shows that it takes several years before the relevant insights are implemented as legislation, and even then it is too complex and addresses some of the wrong aspects. The end result of this new law is simply that the patient has a written medication schedule. Meanwhile, app developers have already released applications that fulfil the same purpose but are more cost-effective, efficient and, most importantly, easier to use. But the apps are not certified and cannot fit into any legal framework because such laws do not even exist yet.
There is no shortage of ideas. In the early phases of a given process, we need a culture of allowing, not of banning. Regulatory intervention is and must be possible, but technical innovation or disruptive models cannot be predicted by legislators. This calls for a continual process of review and fine-tuning, which will foster innovation and provide the necessary frameworks, laws and legislation, and at the same time will open up opportunities and facilitate improvement. In turn, the discussion concerning infrastructure should be steered by competition towards finding solutions rather than towards stifling innovation.
The experts, whether they are doctors, pharmacists or nurses, will benefit from digital solutions that offer a helpful tool for the right diagnosis and treatment – and above all, patients will benefit.
We are a continent of ideas, but unfortunately also a continent where many ideas take years if not decades to bear fruit and at far greater costs than were necessary. We must change this, or the market will change and shut us out of it.
This article is part of Friends of Europe’s upcoming discussion paper ‘Disruptive models of healthcare for Europe’, which brings together the views of Friends of Europe’s large network of health professionals, policymakers, scholars and business representatives on disruptive innovation for health. This discussion paper closes a series of three high-level roundtables that Friends of Europe organised last year to examine the steps needed to create “disruptive models” for overhauling and improving healthcare systems across the EU.
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