Archive for 15 junio 2016

The process from research to market for any drug includes, in a nut-shell, four phases: identify the need, research, test, and bring it to the market. The last two tasks could be translated into proving the efficacy of the drug (testing), and proving its efficiency (bringing it to the market) so that it is cost-effective. Are all those phases undertaken when dealing with eHealth systems? I think that a clear no is the answer. And if any of those phases are clearly missing, they are the last two a) is the eHealth system more efficient than the current system? b) is the eHealth system cost-effective? Therein lies probably one of the keys to the lack of adoption of eHealth systems across the EU in particular and the world in general.

We’ll assume that organizations are rational entities (I know it is a big assumption) and will not plunge into costs just for the sake of it. So, let us think that if an organization launches the research effort to develop a new eHealth system, it is because it has spotted a need for such a system.

Now for the testing phase. We all know that no drug will be approved if it has not been properly tested. We also understand that the specifications for testing an eHealth system, even if they could be inspired in the methodology for drug testing, have to be adapted to the particularities of ICT. We cannot expect an app to go through the same process as a drug. Developing an app is in the range of thousands of euros, while the development phase for a drug is in the order of millions of euros. But some kind of testing should be done and its results made public so as to prove the efficacy of the system. Please go to any of the online stores that sell apps and check how many include, or make reference to, their efficacy tests results.

eHealth has also a particular characteristic that a drug does not: eHealth interferes with the healthcare process in a way that a drug doesn’t. In this respect, testing the efficacy of a particular eHealth system poses some problems since the efficacy effect is spread throughout the whole healthcare system, while a drug focusses clearly on its effect on patients.

But if testing eHealth has been, in the best of cases, a patchy process, efficiency is completely forgotten. How can we convince a healthcare provider to adopt a particular eHealth system without demonstrating its cost-saving potential? How many eHealth systems do you know that have carried out any of the available techniques for measuring the probable added value to the patient and the healthcare provider? And again we should recognize the difficulty involved in evaluating the efficiency of eHealth. It is not only the previously mentioned spread effect across the healthcare system, but also its effect across other systems such as the social care system. In fact, sometimes an eHealth system has a more profound effect on the social care system than on the healthcare system itself.

But all those difficulties should not blind us to the need to perform, and make available to the public, the testing procedure and the added value calculation of our eHealth systems. I would recommend that the healthcare authorities who have started to approve certain apps, such as in Andalusia or England, make available the results of the efficacy and efficiency evaluations of those apps they approve.


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