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The New Health IT Arms Race Between The US And EU
By: Nicole Fisher and Ben Heubl
If you were to ask anyone in the United States what “health access” meant to them, you would get a different answer. In the UK, for most people, it means the ability to access National Health Service (NHS) amenities. To Londoner’s for example, it might mean getting an appointment without complication, inconvenience, or a fee. In the US however, health access is often associated not with the care itself, but with insurance eligibility or ability to schedule an appointment. Further, it can mean ones ability to pay for care out of their own pocket, with quality relating to ability to pay. While great differences exist, on both sides of the pond four major trends in digital health have taken center stage in recent years: wearable technologies, self monitoring systems and interest, technology to support greater health access and electronic health record (EHR) systems.
Growing Demand, Innovation, Cost And Regulation
In the US and EU digital trends, mobility, telehealth & telecare are changing demand for services forever. We also have more citizens over the age of 65, more long-term comorbidities and growing problems such as heart failure and diabetes than ever before, driving the need and cost for care to new levels.
According to Deloitte UK, basic primary care consultation rate grew from an annual 7.9 in 2000 to 12.3 in 2008. Here in the US, the Patient Protection and Affordable Care Act (ACA), “will help millions of people to gain coverage,” according to President Obama. This will no doubt create new pressures to meet greater demand with less resources, making similar trends likely to those in the EU.
In the United States, these issues are often addressed by the teams that work within the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). InEurope, It is the National Health Service (NHS).
Europe Is Catching Up
The US has built broad ecosystems around various health trends. In wearable technologies, Fitbit, Nike Fuel-band and others have started multi-billion dollar business models. In the UK, there is now a company called FitBug that takes advantages of the similar trends, and is starting to generate real traction. Similarly, when Apple made clear its plans to move into health, EU companies like French SME Withings and electronics giant Philips started to invest heavily in local markets that develop comparable products before they hit the European market.
The same can be seen in the EHR ecosystem. Cerner and Epic are two of the market leaders in the US. However, EMIS and SystemOne developed so quickly in the UK that they effectively now rule the NHS primary care medical practice management software (PMS) sector.
Additionally, US-based companies like ZocDoc and Practice Fusion are managing to unlock the multi-billion dollar potential of digital health access in the UK. These companies realize that to exploit the potential for simple, transparent and quick access to care, innovators have to be in the right place at the right time, and online at least, that is now Europe.
Ironically, The United States Was A Model
Following the early success in the US, Europe is now reinventing and adapting local market solutions to solve day-to-day issues in health care.
It is well accepted that engaged patients are more likely to keep appointments, follow instructions, take medications and practice better preventative care. But engaged patients also come back more often for more services. It is ultimately the curse of good service. Innovators become the victims of their own success.
According to the Journal of Medical Internet Research, frequent Internet users are more likely to participate in their own health care. New services like NHS England’s Care Connect initiative (a patient feedback engine) have created new opportunities for patient engagement, similar to those in the US. “Patients will be able to review hospitals and general practitioners as quickly and easily as leaving a restaurant or hotel review online”, says the NHS England website.
Launching Care Connect, Tim Kelsey, NHS National Director for Patients and Information, said that it was inspired by the 311 hotline service. He says that by listening to the public, we can make sure that NHS services are based on the needs of patients.
Disruption In Mass Volume
Early stage Skype investor Mangrove Capital Partners agrees. The company sees online health care access as the next big disruptive trend in health, and has provided first and second-round funding to Zesty to help them realize this vision. Zesty currently manages online bookings for 1,000+ health care professionals in and around London with ambitious plans to roll out across the UK and beyond in 2014. It offers an online appointment booking service enabling anyone to gain access to European-style care and book available appointments in just two clicks.
“You can book a health care appointment as simply as you would order take away food, cinema tickets or a flight ticket”, says Lloyd Price, co-founder of Zesty. “Why shouldn’t the established online booking model work for health access, too?”
What Are The Challenges?
Health professionals in all countries are notoriously suspicious of change and technology, and have valid concerns over data management and privacy. This is understandable given the history of technology regulations and rollouts in both the UK and US health systems in recent decades.
In the UK, Patient Access helps UK patients make local doctor and surgery appointments online. However, only an estimated one in four UK practices currently offer the service, and they must be using the EMIS back-end medical records system to do so. This is very relatable to any US provider who has attempted to integrate their EHRs to those of other physician groups, care clinics or provider systems. Not only are there too many options, but one never knows what new technology they will need to be compatible with in the coming years.
Additionally, booking systems need to appeal to both doctors and patients. Michael Seres, an e-patient expert and digital health advocate says that we must all, “Innovate from the bottom up and not top down.” He contends that it does not matter where one is based in a developed country, “If you don’t design from the patient perspective you won’t get true engagement”. In the US, this is certainly a concern for everyone trying to be compliant with future Meaningful Use requirements.
In addition to access, transparency – or trust – is the commodity with the power to propel companies like ZodDoc, Zesty and the many other providers of services in the health care delivery chain to mainstream acceptance and profitability.
Tim Kelsey, NHS National Director for Patients and Information, recently made transparency a key operating principle of the NHS. In the context of technology, that includes a bunch of practical issues: interoperability, data security, mobility, ‘one version of the truth’: all the things which exercise technologists daily, and which remain significant challenges for the NHS to surmount. In this respect, the NHS may not be the right environment in which to scale innovation rapidly first.
While most content that the US is presently winning the “health care arms race,” there is real patient demand for health access revolution and solutions on both sides of the pond.