Health Affairs: Common ground scarce in global e-health adoption
The full potential of e-health to meet both U.S. and global health objectives is not being tapped, which will remain the case until a conducive environment and appropriate global e-health policy are in place, according to an article in the February issue of Health Affairs.

“Attention needs to be directed toward policy issues that will enable and facilitate patient mobility, data mobility and sharing across both international borders and regional boundaries within countries,” wrote Maurice Mars, MD, head of the department of telehealth at the Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal in Durban, South Africa, and Richard E. Scott, PhD, from the department of community health services at the University of Calgary in Canada.

E-health, or the use of information and communication technology in the health sector, provides an example of freedom to function in a borderless or interjurisdictional environment, the authors wrote. Defined as “a set of statements, regulations, laws and judicial interpretation that direct and manage the life cycle of e-health,” e-health policy is relatively new for legislators, the authors noted.

"In defining appropriate e-health policy—applying an expansive interpretation of what constitutes 'policy' (legislation, strategic plan, roadmap or action plan)—it would appear that about half of the world’s nations have some form of e-health policy but little commonality in what they aim to achieve," the authors stated.

According to the report, in many developed countries, e-health law is an ad hoc patchwork that focuses on only a handful of the 99 e-health policy issues that have been identified. “For example, Canada has some federal legislation around e-health privacy,” the authors wrote. “British Columbia became the first Canadian province to create a specific legislative framework governing provincial e-health initiatives in 2008. Similarly, France has legislation for data protection, telemedicine, e-health service provision, health IT product liability and EHRs.”

The European Union’s (EU) experience offers some insight into differences in e-health policy, according to Mars and Scott. There is no uniformity throughout the EU in who drafts e-health "policy," the authors wrote. The Ministry of Health is the sole policy developer for health policy in 16 countries; in other countries, policy is developed by the Ministry of Health and the government, they reported.

The EU also lacks adherence to seemingly common goals, noted the authors. “For example, despite the call for free patient mobility in the EU e-Health Action Plan, only Luxembourg and Slovenia have included this as a policy target,” Mars and Scott stated.

The developing and developed worlds have markedly different e-health expectations and requirements, the authors attested. Developing nations seek ways to overcome extreme healthcare worker shortages and improve rural healthcare while simultaneously improving or perhaps implementing district-level electronic health information systems, the authors stated. In contrast, e-health policy issues in the developed world relate to data security, data quality, licensure, patient confidentiality and privacy, and "may be major impediments in the developing world,” they said.

“Developing countries already find themselves disadvantaged from the standpoint of access to information and communication technology, human resource capacity and economic capacity,” the authors concluded. “They require assistance with developing relevant of e-health strategies and policies that fit their needs and infrastructures, and which will also allow for cross-border e-health."

When viewed from a global perspective, e-health policy is being formulated in a narrow-minded manner as nations, states and regions introduce e-health policies that meet only their own needs, the authors concluded. "Such national and local e-health policies may entrench a silo mentality in e-health, so that instead of e-health leading to a borderless global environment, the developing world will be further isolated from the international benefits of global e-health.”