The editorial series “e-Citizens: Being Human in the Digital Age” aims to explore the rich set of technologies and applications that characterise the living environment of citizens in the digital age and is intended to call attention to fundamental transformations in social organisation and structure. The main technologies and issues have been carefully described in volume one; applications devoted to e-Democracy are the core of volume two; the present volume is devoted to e-Services, encompassing Health, Learning, Culture, Media and News. In order to introduce this volume, let us review a little bit of the history of information technology. One of the most signiﬁcant changes to occur in the ﬁeld of information technology over the last few decades was the implementation of real-time communication and information exchange between computers—in one word: networking. A computer was originally considered to be like Leibniz’s1 “monad”, an ultimate atom without windows and doors: a sealed entity. Intercommunication processes enabled external access to these monads, allowing information and data exchange
between them and thus multiplying their added value; networks of computers possess expanded functionalities and services. A number of different stand-alone proprietary networks were gradually merged into the network of networks: the Internet. The Internet represents one of the most successful examples of the beneﬁts of sustained investment and commitment to research and development of information infrastructure. Beginning with the early research in packet switching, the government, industry and academia have been partners in evolving and deploying this exciting new technology.2
1 Gottfried Wilhelm Leibniz (also Leibnitz or von Leibniz) was born on 1 July 1646 (Leipzig, Germany) and died on 14 November 1716 (Hanover, Germany). School tradition: rationalism. Main interests: metaphysics, epistemology, science, mathematics and theodicy. Notable ideas: calculus, innate knowledge, optimism and monad. See http://en.wikipedia.org/wiki/Gottfried_Leibniz, last accessed February 2019. 2 B. M. Leiner et al. (2003) A brief history of the Internet. Internet Society, Reston, VA (see http:// www.isoc.org/internet/history/brief.shtml, last accessed February 2019).
Of course, one of the main drivers for Internet usage was the introduction of the hypertext transfer protocol (http), which led to the birth of the World Wide Web, thanks to the contributions of Tim Berners-Lee and Robert Cailliau at CERN3 in 1990 and the success of Mosaic at NCSA4 in 1992, the ﬁrst web browser. Conceived and developed by “end-users”, one of the most important characteristics of the Web community, in the ﬁrst two or three years of its life, was the bottomup decision mechanism it employed. Enhancements and extensions were proposed, discussed and implemented mainly by active members of the community of researchers and experts involved in the process. The Web community at that time was a mixture of ICT experts and scientiﬁc content managers. The double role of these prosumers was probably one of the key innovative aspects of that community during that period. The subsequent gradual drift from technology developers to general users is a natural process that often occurs with mature technologies. It happened, for instance, in the ﬁeld of computer graphics, where computer graphics pioneers worked side by side with creative people and special effects (fx) designers. The development of Internet technology unleashed creative energies, the ﬁrst generations of Websites, mainly due to volunteers often not belonging to the IT sector; don’t forget that the cradle of the Web was CERN, the temple of physics and subatomic particles. Web technology was for sure an enabling technology, offering to almost everyone the opportunity to contribute to the creation of the textual and, later on, visual cyberspace. The Internet has incredibly facilitated access to mass communication. This inﬂuenced even news and journalism as we will describe later. It combines a worldwide broadcasting capability with a mechanism for information dissemination, which offers us the opportunity to reach a wide audience with minimal effort. Before the Internet, the only way to reach wide audiences was radio and television broadcasting, and before these were invented, mainly printed materials or heralds. In addition, it is a medium that encourages collaborations and interactions between individuals and their computers almost without regard for geographic location. After the “publishing” hangover, it was the time to manage and structure and index this blob of content and upgrade from information provision to service provision. ICT-based innovation “is not only a matter of technology”. The main aim of this work is to bridge the gap between technological solutions and successful implementation and fruitful utilisation of the main set of e-Services. Different parameters are actively inﬂuencing the success or failure of e-Services: cultural
3 The name CERN is derived from the acronym for the French “Conseil Européen pour la Recherche Nucléaire”, or European Council for Nuclear Research, a provisional body founded in 1952 with the mandate of establishing a world-class fundamental physics research organization in Europe. At that time, pure physics research concentrated on understanding the inside of the atom, hence the word “nuclear”. https://home.cern, last accessed February 2019. 4 National Center for Supercomputing Applications, http://www.ncsa.illinois.edu, last accessed February 2019.
aspects, organisational issues, bureaucracy and workﬂow, infrastructure and technology in general, users’ habits, literacy, capacity or merely interaction design. This requires having a signiﬁcant population of citizens willing and able to adopt and use online services and developing the managerial and technical capability to implement applications to meet the needs of citizens. A selection of success stories and failures, duly commented on, will help the reader in identifying the right approach to innovation in governmental and private e-Services. This volume is part of a collection of books; the ﬁrst three volumes are e-Citizens: Toward a New Model of (Inter)active Citizenry, e-Democracy: Toward a New Model of (Inter)active Society and e-Services: Toward a New Model of (Inter)active Community, all of them published by Springer International 2019. Target Audience Public authorities, decision-makers, stakeholders, solution developers, university students. Prerequisite Knowledge of Audience Informed on e-Content and e-Services, basics on technology side. Milano, Italy
Alfredo M. Ronchi
Being Human in the Digital Age
Interior laboratory—Scene 53 “The two enter a cylindrical laboratory. There is a huge glass turbine in the middle with the metal glove inside. A DNA chain scrolls on the computer screen. . . Mactilburgh starts the operation rolling as Munro puts his hand on the self-destruct button, ready to use it. Thousands of cells form in the heart of the generator, an assemblage of DNA elements. Then the cells move down a tube, like a ﬂuid, and gather in an imprint of a HUMAN body. Step by step bones are reconstructed, then the nervous and muscular systems. Whole veins wrap around the muscles. An entire body is reconstructing before our very eyes. . . ASSISTANT. . . End of reconstruction, beginning of reanimation.” [LE CINQUIÈME ÉLÉMENT (THE FIFTH ELEMENT) IS A 1997 FRENCH SCIENCE FICTION FILM DIRECTED BY LUC BESSON AND STARRING BRUCE WILLIS, GARY OLDMAN AND MILLA JOVOVICH.]
This scene shows the way to reconstruct human bodies starting from a minimum portion of DNA; the science ﬁction machinery performs a “3D print” of an entire body, decoding the instructions encapsulated in the DNA; the scene looks very close to addictive 3D printing. This technology enjoyed great popularity in different ﬁelds from dentists to hobbyists; a very special 3D printer was on display on the occasion of the WSIS Forum 2018 in Geneva; this 3D printer used chocolate instead of monomers, printing chocolate blocks instead of bones. Does science ﬁction anticipate our near future even in the ﬁeld of e-Health? Some experiments carried out in the ﬁeld of biomaterials and biotechnologies have already tested the use of 3D printers with nanoparticles, so we never know. Anyhow 3D graphics and printing are already in use to create different prostheses. The ﬁeld of education and learning was till now the one that didn’t beneﬁt too much from digital technologies, but at the same time suffered more than many other sectors from the shift of paradigm due to cyber technologies. The young are signiﬁcantly inﬂuenced by digital technology; as we will see later in the chapter devoted to e-Learning, the huge number of hours spent playing videogames and watching television has trained their brains to behave in a very different way enabling parallel processing and immediate interaction. These completely new
Being Human in the Digital Age
abilities, together with the digitally empowered direct access to information, have created an increasing gap in information transmission between “digital immigrant” teachers and “digital native” pupils. They are used to processing parallel input from audio, video and chats, incredibly improving their ability to absorb information and rather complex concepts. They take advantage of virtual and enhanced reality to activate the most powerful and phylogenetic learning system, the perceptive-motor system. They learn by directly experiencing the speciﬁc subject by being virtually immersed in that environment, by being “hands-on”, trying and trying again; in other words, “learning by doing”. Following the same ﬁl rouge, we approach “Culture” as a wide territory encompassing different humanities such as heritage in the UNESCO vision, as described in detail in e-Culture5, but even issues and drawbacks due to the combined action of information communication technologies and globalisation. The global trend tends to homogenise and ﬂatten diversities in many ﬁelds; diversities have to be considered richness not barriers. As a consequence, a relevant number of cultural models and languages risk being jeopardised and disappearing; they refer to “minorities”, or as better expressed by UNESCO IFAP they refer to “minoritised” languages and cultural models under the pressure of the dominant ones. After learning and culture, the last chapter is devoted to media and news, one of the sectors that on one side deeply took advantage of ICTs and on the other side signiﬁcantly contributed to forging the brains of young generations. This phenomenon is termed neuroplasticity by experts; social psychology offers compelling proof that thinking patterns change depending on an individual’s experiences. It is a common understanding that people who grow up in different cultures do not just think about different things; they actually think differently. The environment and culture in which people are raised affects and even determines many of their thought processes. A major part of the population has already started the journey from Citizens to e-Citizens: already books medical services and downloads the reports through the Internet or receives customised press reviews thanks to news aggregators collecting breaking news concerning their preferred topics on the ﬂy. Let’s now start this journey from Health to Media. Milano, Italy
Alfredo M. Ronchi
5 Ronchi A.M. (2009), e-Culture: Cultural Content in the Digital Age, ISBN 978-3-540-75273-8, Springer, Berlin Heidelberg.
AAAA AfDB App CARICOM CDO CIO CPI DESA DPADM EEA EGDI EIA EPI FOI FOIAs G2G GCC GFW GIS GNI GODAN GPS HCI HCI HTML ICT ICTs IDRC ILO INTOSAI
Addis Ababa Action Agenda African Development Bank Software Applications Caribbean Community and Common Market Chief Data Ofﬁcer Chief Information Ofﬁcer Corruption Perceptions Index Department of Economic and Social Affairs Division for Public Administration and Development Management European Environment Agency e-Government Development Index Environmental Impact Assessment e-Participation Index Freedom of Information Freedom of Information Acts Government-to-Government Gulf Cooperation Council Global Forest Watch Geographic Information System Gross National Income Global Open Data for Agriculture and Nutrition Global Positioning System Human Capital Index Human–Computer Interface Hypertext Markup Language Information and Communication Technology Information and Communication Technologies International Development Research Centre International Labour Organization International Organization of Supreme Audit Institutions xv
IoT ITU LDC MAMA MDGs MENA METEP MFI MYS NEPAD NGO OECD OGD OSI OSM PPPP RSS SDGs SIDS SME SMS SWOT TGEG TII UGC UNCTAD UNDG UNDP UNECA UNECE UNECLAC UNEP UNESCAP UNESCO UNESCWA UN-OHRLLS
List of Abbreviations
Internet of Things International Telecommunication Union Least Developed Country Mobile Alliance for Maternal Action Millennium Development Goals Middle East and North America Measurement and Evaluation Tool for Engagement and e-Participation Micro Finance Institutions Mean Years of Schooling New Partnership for Africa’s Development Non-governmental Organisation Organisation for Economic Co-operation and Development Open Government Data Online Service Index Open Street Map Public–Private–People Partnerships Really Simple Syndication Sustainable Development Goals Small Island Developing States Small and Medium Enterprise Short Message Service Strengths, Weaknesses, Opportunities and Threats Task Group on e-Government Telecommunication Infrastructure Index User-Generated Content United Nations Conference on Trade and Development United Nations Development Group United Nations Development Programme United Nations Economic Commission for Africa United Nations Economic Commission for Europe United Nations Economic Commission for Latin America and the Caribbean United Nations Environment Programme United Nations Economic and Social Commission for Asia and the Paciﬁc United Nations Educational, Scientiﬁc and Cultural Organization United Nations Economic and Social Commission for Western Asia United Nations Ofﬁce of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States United Nations Project Ofﬁce on Governance United Nations Statistical Commission
List of Abbreviations
UNU-IAS URL W3C WOG WRI WSIS
United Nations University Institute for the Advanced Study of Sustainability Uniform Resource Locator World Wide Web Consortium Whole of Government World Resources Institute World Summit on the Information Society
e-Health: Background, Today’s Implementation and Future Trends
The analysis will adequately take into account the overall context including social, ethical and technological issues. It draws a “big picture” where we consider different regions of the world and different needs. The contribution outlines to what extent e-Health represents true innovation, which means having positive impact on society, making better the life of citizens in a broad sense. We all know that the healthcare sector differs from country to country as a unique mix of public, unlicensed private, private and even voluntary set of services; not to forget insurance companies. Starting from today’s added value applications we will try to identify future trends and goals.
1 e-Health: Background, Today’s Implementation and Future Trends
How can we measure success in e-Health? Is it a mere question of saving money or does it involve more? It is a foreseeable win-win strategy, better service, more success stories, less costs? Is e-Health an opportunity to bridge the healthcare gap around the world? What can we expect from virtual laboratories and electronic patient folders? Do online medical services impact patient privacy? Last but not least, do electronic patient folders last forever as usually required by law? Moreover, very often we hear of user-centred design, and interaction design and of the positive effects that good “design” can have, especially for industrial products and on-line services; but what effect can a proper design have “indirectly” on the user? How much can the “design” do for our welfare, to help us feel better in our home or even exert a positive inﬂuence on our overall health? The healthcare sector cannot be considered as any other “e-Sector”. What do patients, or more simply Citizens, expect accessing healthcare premises or services? What is really relevant for them in the different regions of the world (e.g. on-line solution to check if a medicine is “original” or a dangerous clone)? Does the “big brother” effect due to remote monitoring and tele-medicine1 play a positive role in such a context? What are the indicators of success of the operation; how do we determine the degree of satisfaction of the user? By “commercial” success, the content of dedicated interviews, the expressed appreciation? The expectancy of life in the last century has signiﬁcantly grown; if we consider this aspect as a performance indicator we can probably agree on a positive trend. Performance measuring in the healthcare sector may be related to a set of parameters having as the main one the effect on the patient. Apart from this we can consider organisational issues, the promotion of a culture of wellbeing as a follow-up of the well-known motto “prevention is better than cure”, time and money savings, information and knowledge sharing and more. Applications and services will cover information, monitoring, education, safety and more.
The health sector, if compared with other industries in adopting information technology, suffered a delay of 10/15 years until recent times. Early deployment of health information technology (HIT as it was known at that time) was primarily for ﬁnancial accounting of medical transactions. Even if in some way the health sector has been the birthplace of one of the most relevant and pervasive inventions of the last century, the transistor, it was originally developed and patented as a device to
Term ﬁrst coined in the 1970s by Thomas Bird.
1.2 Recent Background
ﬁght deafness2. Later on, over time a number of cutting edge technologies added value application in the Health sector: computer graphics, virtual reality, robotics, tele-presence, artiﬁcial intelligence and of course networking, to mention the main ones. Experiments with computerized medical recordkeeping began in the 1960s mainly in the US. The ﬁrst electronic health records (EHRs) were designed and deployed starting in late 1960s and early 1970s. By the middle of the 1970s approximately 90% of the hospitals in the US used computers for business functions; there was similar penetration in Europe. Hospitals used to access mainly big mainframes as shared computational resources in order to manage their own accounting systems. Later on, they extended the use to manage partial patient folders related to medical exams. In that period of time 1743 sites in the US processed electronic data with some medical content. The majority of physicians adopted EHR systems in the 1980s thanks to the diffusion in the market of the personal computer. Of course, PCs at that time they were mainly stand-alone resources; few of them were connected to mainframes as “intelligent” terminals. The early use of EHR systems by medical doctors was mainly to keep a personal record of patient references, speciﬁc health conditions and treatments and last but not least billing. In the 1980s and 1990s incredible steps forward in diagnosis and care were due to the increasing use of information technology; many times the re-use of computer graphics turned into medical imaging led to cutting edge medical systems. Moreover, late in the 1990s the introduction of 3D colour graphics broke the ﬂat, greyshaded and cryptic world of medical imaging. PACS (Picture Archiving and Communication System) and laser printers revolutionised the management of medical images as well. Of course, the enabling technology acting as backbone of such evolution or, better, revolution in medical imagery was the creation of local broadband networks. Between the 1980s and the 1990s, the number of computer-based medical exams increased signiﬁcantly from CT to NMR, 3D imagery, endoscopy Nano-devices and “cyborg” prostheses.
The invention of Transistors by John Bardeen, Walter Brattain, and William Shockley in 1947. R.R. Henley and G. Widerhold, An analysis on automated ambulatory medical record systems, AARMS Study Group, UCSF, June 1975. 3
1 e-Health: Background, Today’s Implementation and Future Trends
3D digital reconstruction from Medical Imagery (EC Project Argonaute 3D)
In 1991, the Institute of Medicine4 in the United States declared the computerbased patient record (CPR) as essential for health care, a message reinforced 7 years later on the occasion of the revised version. The use of ICT in the medical sector enabled relevant innovations: distant assistance and information sharing. The medical system called Telehealth means “medicine at distance”, where “medicine” includes not only medical activities— involving ill patients—but also public health activities—involving healthy people  (Wootton 1999)5. In other words, telehealth is a process and not a technology, including many different health care activities carried out at a distance. For these reasons, the term “e-Health” is an umbrella word used to deﬁne the electronic enablement of the health and disability support services in order to [2, 3]: • empower individuals and their families to manage their own health and participate better; • improve the co-ordination and integration of care delivery to individuals; and • allow population health initiatives such as mapping notiﬁable diseases to occur in a timely fashion. In summary, e-Health services provide a unique set of tools for overcoming many of the challenges that health delivery systems are facing today. On one side, citizens want, and ageing societies will need, more and better healthcare. On the other side public funds are limited, and many citizens cannot afford, or do not want to pay more for it. As underlined by Robinson , “For healthcare providers in modern healthcare systems, this is a challenge. The right approach to developing, implementing and using effective e-Health can help address this challenge. Healthcare providers can use e-Health to improve quality and expand their capacity to meet this increasing demand within available resources.”
4 Richard S. Dick, Elaine B. Steen, and Don E. Detmer, Editors—Institute of Medicine, The computer based electronic medical record: essential technology for healthcare, National Academy Press, Washington, DC, 1991. 5 Wootton, R. (Ed.). (1999b). European telemedicine 1998/99. London: Kensington Publications Ltd.
1.2 Recent Background
According to Wootton  there are basically two reasons why e-Health is used: “either because there is no alternative, or because it is in some sense better than traditional medicine”. Addressing this issue, the goal of the chapter is to show that a wide spectrum of e-Health applications provided better quality and improved productivity. In particular we will focus on the actual European situation. However, the success of e-Health is not linked to the solution of technical problems only. e-Health is a complex process whose successful exploitation requires a signiﬁcant attention to ergonomics, human factors and organizational changes in the structure of the relevant health service. For quite a long time Healthcare Information Technology (HIT) has been mostly a chimera and pioneers in the realm have faced relevant difﬁculties and unsuccessful stories. Some implementations played the role of bad ambassadors, slowing down the progress. Some European telecom operators, for instance, invested time and resources in tele-medicine having no positive return of investment. Practitioners have generally regarded EHR as costly, cumbersome, and offering little help for tasks at hand. A number of experiences were carried out in the past but these were mainly considered as experimental services, addressing a limited number of users/patients, having almost no real impact on the ﬁeld. The incredible and quick diffusion of the Internet and broadband connection has to be considered as a turning point in the health care domain, as it happened in other domains such as e-Government or e-Learning. Internet and broadband enabled a completely new scenario: e-Health was born! The evolution trend was from one to one to one to many and many to many and broadband made the difference. Thanks to the characteristics of the Internet some of the early projects addressed the need to exchange and share medical information, more speciﬁcally that related to rare pathologies. One of the ﬁrst high-level projects in this ﬁeld was the so-called G7 CARDIO project (1993–95); at that time the focus in the ﬁeld of networking was on ATM connections, the “silver bullet” of the time. Back to CARDIO, the basic concept was to share as much as possible information and medical data related to rare heart pathologies in an attempt to combine the efforts in order to solve serious problems. Thanks to an innovative approach, multimedia documents such as medical standard pictures (DICOM) and medical standard video clips were available on line for the beneﬁt of the medical service. Tele-medicine, remote-ECG, tele-monitoring, tele-consultation and more are very well-known keywords. Tele-medicine and tele-consultation are still the key approaches to providing medical care in developing countries. Telecommunication networks and IT-enabled peer-to-peer connections and data transfer thanks to modems and, later on, digital lines.
1 e-Health: Background, Today’s Implementation and Future Trends
Tiny “computers” have been embedded in a number of portable medical devices and computer aided design systems have become the digital companions of bio-engineers, together with nanotechnologies6 and mechatronics. The current environment in which health care is practiced and information technology available to its practitioners is signiﬁcantly different from that which existed in the last decades. Due to the Internet technology the overall architecture of distance services has been reshaped and a limited set of peer-to-peer services have become, at the end, a full set of bidirectional multimedia interactive services including web 2.0 applications and more advanced and sophisticated solutions. There are differences in the temporal nature of information, the responsibilities of each member of the health care team, the need for a communications infrastructure to facilitate coordination of care, and other logistical7 concerns which impact the detailed design of information systems. Changes in the health care environment produced fundamental shifts in the delivery of health care, favouring outpatient care over impatient care, primary care over specialty care, and guidelines-driven care over autonomous decision-making. Technological advances have overcome some barriers to computer-based patient records (CPRs) (e.g., World Wide Web applications that operate across distances on many different computers) and heightened the visibility of others (e.g. conﬁdentiality policies and legislation). Let’s try to better focus on this domain. A ﬁrst attempt to classify the services might be by user: medical doctors, patients/citizens, and institutions. Another potential taxonomy might be by service: web portals (hospitals, experts, medical/chemical companies, patients, etc.), on-line or off-line medical care services (exams and consultations, virtual reality therapies, etc.), management systems (medical unit information systems, etc.), and educational applications (medical doctors, paramedics, employees, patients and citizens). The opportunities offered by e-Health may beneﬁt additional sectors such as rare pathologies, developing and emerging countries and “travellers”.
e-Health in Europe
Healthcare is one of the most information-intensive sectors of European economies and can greatly proﬁt from recent advances in information and communications technology. Given that the health sector currently lags behind other
Researchers working in medical nanorobotics are creating technologies that could lead to novel health-care applications, such as new ways of accessing areas of the human body that would otherwise be unreachable without invasive surgery. 7 In principle, in order to fully beneﬁt from the e-Health approach, a general reshape of the organisation is needed including logistics and other infrastructure. Communication and access to information are strictly related to organisational and infrastructural issues.
1.3 e-Health in Europe
sectors in the use of this technology, e-Health, there is great potential for rapid, sustained growth8. For more than 30 years, the European Commission has developed through R&D programmes ways of improving the delivery of healthcare through the application of state-of-the-art technologies, and the promotion of new systems and services based on these9. EU action on health is based on three key principles10: integration, sustainability and focus on priority issues. This has led to an integrated approach to health-related work at the Community level, making health-related policy areas work together towards achieving health objectives. The EU Health Strategy, set out in May 2000, aims to integrate all EU healthrelated policies and concentrate resources where the Community can provide real added value, without duplicating the work of the Member States or international organizations11. General health policy lines were set out in the concept of a Europe of Health in 2002. Work was undertaken on addressing health threats, including the creation of a European Centre for Disease Prevention and Control12 (ECDC), developing crossborder co-operation between health systems and tackling health determinants. A short presentation of ECDC, as provided by the centre, is: “The European Centre for Disease Prevention and Control (ECDC) was established in 2005. It is an EU agency aimed at strengthening Europe’s defences against infectious diseases. It is located in Stockholm, Sweden. ECDC works in three key strategic areas: it provides evidence for effective and efﬁcient decision-making, it strengthens public health systems, and it supports the response to public health threats. ECDC core functions cover a wide spectrum of activities: surveillance, epidemic intelligence, response, scientiﬁc advice, microbiology, preparedness, public health training, international relations, health communication, and the scientiﬁc journal Eurosurveillance. ECDC disease programmes cover antimicrobial resistance and healthcare-associated infections; emerging and vector-borne diseases; food- and waterborne diseases and zoonosis; HIV, sexually transmitted infections and viral hepatitis; inﬂuenza and other respiratory viruses; tuberculosis; and vaccine-preventable diseases. All in all, ECDC monitors 52 communicable diseases.” The EU Health Forum13, which brings together organizations active in health to advise the European Commission on health policy, is also a key element of the EU 8
Stroetmann et al., 2006—Carolyn Steele Gray, Stewart W. Mercer, et al., 2017. May you need further information, please refer to http://ec.europa.eu/health/, last accessed February 2019. 10 European Commission, 2000. 11 European Commission, 2000. 12 European Centre for Disease Prevention and Control https://ecdc.europa.eu/en/home, last accessed February 2019. 13 EU Health Forum 2010 https://ec.europa.eu/health/interest_groups/eu_health_forum/open_ forum/2010_en, last accessed February 2019—EU Health Forum 2017 Gastein https://www.ehfg. org/conference/programme/, last accessed February 2019. 9
1 e-Health: Background, Today’s Implementation and Future Trends
Health policy. The Forum enables the health community to participate in health policy-making from the start. EU health policy increasingly involves co-operation with and between the Member States, in particular on cross-border issues such as patient mobility. In 2004, in order to review the May 2000 Health Strategy and consider whether and how it needed to be revised in the light of developments, the Commission launched a reﬂection process14. The main outcome of this work is the concept that e-Health should be supported by the widespread dissemination of best practices. These should include the impact on access to healthcare and on its quality, assessments of cost productivity gains, as well as examples of addressing liability in telemedicine, reimbursement schemes, and accreditation of e-Health products and services. In 2005, the Commission proposed a new strategic framework: i2010. One of the key societal challenges recognized in the i2010 strategy is to make real improvements in the provision of healthcare, when our ageing society is placing increasing demands on the underlying services and infrastructure. The e-Health market was in 2005 some 2% of total healthcare expenditure in Europe but has the potential to more than double in size, almost reaching the volume of the market for medical devices or half the size of the pharmaceuticals market. Revenue in the “e-Health” market will amount to more than three million euros in 2018. Revenue is expected to show an annual growth rate in the period 2018–2020 of 14.3%15, resulting in a market volume of more than four million euros in 2020. The market’s largest segment is the segment “Heart Failure”, with a market volume of about 1200 million euros in 2018. If we compare the European market with the United States one it is shown that most revenue is generated in the United States (US $ 3821 million in 2018). Research projects funded by the EU seek to develop e-Health systems and services that focus on prevention, personalization and patient empowerment; special care is posed on gender-related medical treatments. Current research activities focus on: personal health systems and the prevention of illness and diseases; improving patient safety; modelling and simulation of human physiology and disease-related processes.
European Commission (2004). e-Health—making healthcare better for European citizens: An actionplan for a European e-Health area—com 356. Brussels: Commission of the European Communities. Online: https://ec.europa.eu/digital-single-market/en/news/e-health-making-healthcare-better-euro pean-citizens-action-plan-european-e-health-area, last accessed February 2019. 15 Source Statista: https://www.statista.com/study/29501/digital-health-industry-in-europe-statistadossier/, last accessed February 2019.
1.4 A Global Vision
A Global Vision
In every country and at every level, information and communication tools are central to health. Access to ICTs, supported by a sound enabling environment, is critical for health services development, progress and their availability. This applies whether e-Health is used by individuals searching for health information or support, professionals and facilities providing health care services, or public health services ensuring monitoring, alert and response; or for strengthening citizen-centred health systems. There are some pillars related to the renovated vision. (a) Encourage the adoption of national e-Health strategies focusing on integrating ICTs to support the priorities of the health sector and to provide reliable and affordable connectivity to beneﬁt all citizens; (b) Promote the use of ICTs to strengthen health care and public health services, with special efforts to reach citizens in remote and under-served areas in developing countries; (c) Facilitate innovation and access to e-Health applications to support health professionals, improve local access to information, and enable the ﬂow of information in health services and systems; (d) Ensure public trust and conﬁdence in e-Health, through collaboration and broad adoption of legislations, policies, regulations and other measures that address the concerns of the health sector, including those of a cross-border nature; (e) Integrate the use of ICTs in preparing for, sharing information on, and responding to disease outbreaks, disasters and other emergencies requiring inter-sectoral collaboration and exchange of information in real-time; (f) Encourage to creating effective funding mechanisms, business models and partnerships to accelerate and sustain e-Health efforts beyond pilot stages and ensure scalability; (g) Enable access to the world’s medical knowledge through the use of ICT; (h) Share good practice, evidence and progress on e-Health, to enable informed development of e-Health activities worldwide; (i) Promote the measurement of e-Health and its impact the social and economic development at national and regional levels. The use of digital technologies contributes even to the preservation and exploitation of traditional medicine as it happens, for instance, for both Chinese Traditional Medicine and African natural medicine. Beijing Traditional Chinese Medicine Digital Museum16, original title 北京中医 药数字博物馆, is a virtual museum of popular science available in both Chinese and English aiming to spread the culture of Traditional Chinese Medicine as it relates to
Beijing Traditional Chinese Medicine Digital Museum (China 2011) Producer: Ms. Wang Ting— Beijing Traditional Chinese Medicine International Exchange and Cooperating Center (BTCMIECC), http://en.tcm-china.org, last accessed February 2019.