COPENHAGEN, Denmark – No one is as frustrated with the soft approach that the European Commission (EC) is constrained to take in promoting e-health across the 27 member states than the commissioner responsible for e-health.

At the World of Health IT congress here, the EC announced the adoption of a formal e-health communication titled, "Telemedicine and Innovative ICT Tools for Chronic Disease Management," which aims to support and improve access to telemedicine for Europe's citizens and healthcare professionals.

This latest e-health initiative was issued in response to a call for action from member states, according to the EC, which said it expects to increase and broaden telemedicine services including diagnosis, treatment and monitoring at a distance across Europe.

Promoting an estimate from BCC Research (Wellesley, Massachusetts) that the global market for telemedicine is expected to grow 19% annually to reach a value of $13.9 billion by 2012, the EC communication sets out a policy framework and spells out actions to achieve wider deployment of telemedicine.

Translated into American English, the terms of the EC communication will likely have all the force of pushing a string, or considering the past reception of the decidedly independent-minded 27 member states for recommendations on e-health, this telemedicine effort may be more like trying to herd cats.

In a press conference, Commissioner Viviane Reding, who leads the Directorate General for the Information Society and Media (DG InfoSoc; Brussels), which is responsible for e-health, shared her frustration.

As head of DG InfoSoc, Reding said she holds considerable powers over Europe's telecommunications companies and forced a dramatic reduction of 60% in excessive roaming fees for voice calls.

"I then told the telecoms I wanted the SMS (short message service) roaming fees to drop, but they did not respond," she said. "So I have put a new regulation on the table, which will be voted into law and applied beginning in July 2009."

Reding said she now is working on "these so-called 'shock bills,' where people reading newspapers with their portable devices are given a bill for thousands of euros."

Under the treaties that create the European Union and give the EC its powers, Reding can act swiftly and with authority in telecommunications matters.

But the EC is barred by Article 152 from entering into the sensitive areas of healthcare. As she expressed it, "Health services remain a national competence."

European nations sorely need to accelerate actions to address the approaching train wreck for their already overburdened healthcare systems, with the coming wave of a fast-aging population that brings with it multiple chronic diseases that are famous for consuming 80% of health expenditures.

But the formal telemedicine communications issued last week is not going to get the job done.

After two years of consultations with member states, the 10 actions proposed by the EC in its telemedicine initiative taken together amount to little more than an agenda for more discussion.

The commission calls for increasing confidence and acceptance of telemedicine services among users, bringing legal clarity on existing EU legislation regarding telemedicine services, and encouraging member states to improve provision of telemedicine services.

Some of the action steps, by inference, actually describe the formidable obstacles to putting an effective telemedicine system in place in time to stem the crisis, such as the current lack of interoperability among devices and a woefully inadequate broadband infrastructure in many European nations.

In one concrete action step, however, the EC committed to creating a large-scale telemonitoring pilot project in 2010 to include a network of procurers and payers for healthcare services.

This proposal follows the pattern the EC used to set up the European Patient Smart Open Services pilot among 12 countries and 35 companies that is now under way and will force a consensus across Europe for standards and processes to exchange patient summaries for emergency medical care across borders.

Virtual modeling of patients from EHR data

Even as the EU struggles to get ahead of the curve on telemedicine, another wing of the DG InfoSoc delivered at WHIT a view of the ultimate potential the EC sees in e-health and where it believes European universitis and companies can gain a competitive edge.

Ilias Iakovidis, deputy director of the ICT for Health Unit responsible for research, described a three-stage development of e-health in Europe over the next 30 years. First as a tool for assisting the delivery of health services, then to nurture good health among citizens, and finally to manage endogenous determinants of health, or the ability of advanced IT applications to identify genetic, environmental and lifestyle profiles for each citizen and then anticipate appropriate care practices.

In the context of the current challenges faced by the EU in healthcare, Iakovidis said he realized his discussion sounded like he was from a different planet and in his presentation took the audience on a mission to Mars.

The electronic health record today is filled with the observations of doctors, he said, but in the future the record will progressively become populated with a richer set of highly personal data that today is ethically and legally difficult to record.

Capturing and modeling this data will enable future physicians to view a kind of Google Body, not unlike the now-familiar imaging of Google Earth.

The zoom into a patient's health status will be to the power of 10-minus-nine, the equivalent of moving from a whole view of the earth down to the button on a person's shirt.

On a human scale it mean moving from a view of the entire body to the level of organs and then closer to the tissue of a specific organ, then even closer to cells in the tissue, to the 200 proteins in the cells and finally to the genetic level with 23,000 variables.

Combining in vivo digital images with in silico models, new computing tools would enable the visualization of actual, or probable, tumor evolution to quantify a diagnosis and optimize therapies.

The work already is under way, he said.

Under the EU's innovation funding for Framework Seven (FP7), Philips (Eindhoven, the Netherlands) is leading the euHeart project with the University of Oxford and 17 other partners to create the European Heart model that will dynamically display physical structures, such as tissue and vessels, along with blood flow and electrical charges.

Using data inputs from a patient's record, the virtual model will become a representation of a specific individual's heart condition for diagnosis.

Iakovidis said the European Heart model was selected by a Japanese team building a new peta-scale supercomputer to optimize computer processing and problem-solving.

He said in September that the Osteoporotic Virtual Physiological Human project, with 19 million ($11.5 million) of FP7 funding, will create a multi-scale predictive model for diagnosis and treatment of osteoporosis.

In an upcoming call for proposals the EU will be seeking companies and universities from anywhere in the world to partner on the development of a virtual physiological human to create multi-scale models and simulations of organs and the development of IT tools for biomedical research.

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