The British government has achieved an earlier commitment to having 95% of primary care physicians and 25% of National Health Service (NHS) hospitals connected to the NHS Net intranet system by March. By the same time next year, all NHS clinical staff should have a desktop connection to e-mail, the Internet and office systems.
Sean Brennan, head of health care strategy at Northgate Information Solutions (London), an information technology (IT) supplier, was a member of the team that created the United Kingdom's Internet health plan in 1998. He believes that the Internet has "revolutionized health care in hospitals" because it is so much easier to use than other computer systems.
"There are lots of technophobes in health care, but browsers are just so easy to grasp, and they are iterative, so you only need to learn one basic interface – anyone can pick it up, and people can quickly see that there is nothing to be scared of," he said.
McKessonHBOC (San Francisco, California), one of the world's biggest health care IT companies, has developed an application, used in the UK, that allows physicians to book hospital appointments online during the patient consultation. This replaces older systems where referral letters were sent by the physician, resulting in a delay of up to weeks between the patient seeing the family physician and an appointment being made.
IBM (Armonk, New York) has developed eCHIN, the electronic Child Health Information Network used at Toronto's Hospital for Sick Children in Canada, which enables Internet-based consultations between local pediatricians or oncologists and the hospitals specialists. The network also provides information for parents on the diseases their children have, and a site for the children themselves.
Huddinge University Hospital, near Stockholm, Sweden, is connected to other hospitals in the area by a network supplied by Ericcson (Lund, Sweden) which allows them to work together closely in real time. This is focused on minimally invasive surgery techniques where the surgeon uses optical instruments guided by a live video image. "We are using our network to provide training and second-line support between hospitals," said Bo Wilkstrom, a pathologist at Huddinge. "For training purposes, surgeons can comment on and visualize the operating technique. They can guide students and colleagues through new techniques or especially interesting cases," he said.
Four hospitals in Britain are operating trials of e-prescription systems. Such technology prevents the patient from losing or altering a prescription and avoids any mistakes that might arise from the notoriously bad handwriting of physicians.
E-procurement has failed so far to make a large impact in European hospitals. The market is smaller than in the U.S., fragmented both linguistically and culturally and tightly regulated. Nevertheless, proponents of e-procurement calculate that such a system would at least halve processing costs initially, with further declines over time.
"Every third order is incorrect, holds the wrong product description, the wrong amount, or the delivery is not in conformity with the actual order," said Stefan Muennighoff, co-founder of Munich-based GloMediX, a leading German health care marketplace. "By integrating our marketplace into the ERP (enterprise resource planning) systems of the hospitals, the potential for reducing costs is immense."
Although there are several reasons for resistance to change in the European health care sector, perhaps the most significant factor is a financial one. Constraints on budgets are severe, with the cost of health care rising dramatically as new and more expensive treatments and drugs come onto the market. Ironically, the savings made from installation of an e-procurement system could free up valuable resources for use elsewhere.
"Flexibility is the key," according to Sean Flanagan, chairman and CEO of Medexonline (London), an e-procurement software supplier and e-marketplace for the European health care marketplace. "We offer to install our system for free at no cost to the hospital, with the suppliers making the investment in return for the savings they make on transactions," he said.
Even this approach has had only limited success because of the number of companies and institutions involved in the decision-making process on both the purchasing and supply sides of the equation.
Despite a slow acceptance by the health care industry of e-commerce, Flanagan said the past six months have seen a shift in opinion toward new technology. "I think there is now an acknowledgement within the European health care sector of the unique opportunity that it has. The 'win' here is so compelling."
Deeply embedded administrative attitudes in hospitals and national health services are a major hindrance to change. "Most purchasing officers accept that e-procurement is the way forward, but there is no leadership to tell them to actually go and do it," complained Ian Hunter, managing director of Smartmission, a German e-business solutions group. "The fault lies with the most senior purchasing management. Peoples' perception of e-commerce in the health service is one of a very consumer-oriented medium," Hunter said. "B2B is still not on their agenda."
France drops premarket approval demand
In late 1997, the French government introduced plans to require a premarket approval system for high-risk medical devices after they had been CE-marked and three months before market launch in France. Vigorous lobbying by EUCOMED (Brussels, Belgium), the European medical device industry organization and by SNITEM, its French counterpart, together with opposition from many other European regulators, seems to have had an effect.
The original approval system was initially modified to become merely a notification and has now been dropped entirely. However, in a letter to SNITEM, the French Ministry of Employment and Solidarity, which has health care responsibilities, has said it will issue a new proposal for some (as yet unspecified) devices that should be subject to registration requirement for Class IIb and III products as permitted in the context of the amended Medical Devices Directive, Article 14. It remains to be seen how the French government intends to operate within the requirements of the directive.
Germany glaucoma screening fight
A turf battle is on in Germany between ophthalmologists and opticians over whether opticians should be permitted to measure intra-ocular pressure by non-contact tonometry (NCT).
Professor Jurgen Wasem and Dr. Franz Hessel from the University of Greifswald have completed a report that concludes that the screening of 4 million people over 40 would help to prevent 13,000 cases of blindness each year. The report claims this would result in annual savings of $670 million to health insurance organizations (Krankenkassen).
The report was commissioned after the federal constitutional court overturned an initial verdict by the federal supreme court instituting a ban on NCT measurements by opticians. Dieter Mollenkopf, chairman of the southwest German association of opticians (SWAV), said the case had been referred back to the supreme court and that he was confident of a verdict in opticians' favor. "Meanwhile, we must not remain idle, but prepare to provide our colleagues with the necessary screening devices," Mollenkopf said.
Professor Martin Wenzel of the Brothers Hospital eye clinic (Trier, Germany), upon viewing the report, said, "The court states the optician may only advise the patient as to the level of pressure and may not offer any more information as to how this level would affect health." The ophthalmologists' view is that at least 50% of NCT measurements carried out by opticians do not detect glaucoma.
Stefan Diepenbrock of the central German association of opticians, who commissioned the Wassen report, said, "We have never argued with this figure, but it must be made clear that the number of undetected cases of glaucoma would be much higher if opticians were not allowed to undertake these tests."
At present, glaucoma screening tests are only reimbursed when carried out by ophthalmologists after specific referral by the family physician.
Germany offers empty beds to Norway, UK
The Norwegian government has made $112 million available for treatment abroad because of shortages of hospital capacity in Norway. A total of 1,500 Norwegian patients will receive hospital treatment in Germany this year, with the first group of 300 who received hip and knee prostheses in January already back in Norway.
The initiative was organized by the Committee for the Promotion of German Medicine Abroad in Bonn, Germany. J rg Robbers, principal director of the German Hospitals Association, sees it as a vote of confidence for German health care. "We are happy that German hospitals are now able to offer their high quality of care at an international level," he said.
The committee also is planning to approach UK Health Secretary Alan Milburn shortly with an offer to put the network of 115 German hospitals specializing in the treatment of foreigners at his disposal.
George Westphal, managing director of the committee organization, said, "We offer top quality [care] – and we have beds free." The committee is receiving "a lot of inquiries daily" from potential UK private patients, according to Westphal. The group is keen to attract private patients, but Westphal is planning to ask Milburn "whether we could not put our network at his disposal to help bottlenecks in the NHS or other areas of public provision."
The UK Department of Health already has rejected the idea, which underlines yet again the inadequacies of the National Health Service. "We don't want to send them our patients – we want to recruit their doctors," an NHS spokesman said. "NHS patients don't want to go abroad, and the concordat we have signed with the private sector means the NHS can take advantage of private health beds in this country rather than sending patients abroad."
The committee also is planning to negotiate deals with Italy, Poland and Russia similar to the groundbreaking Norwegian project.
H. pylori proteome map published
Researchers from the Institut Pasteur (Paris) and Hybrigenics (also Paris) have completed the first-ever published protein-protein interaction map of a prokaryotic organism, Helicobacter pylori, which was published in a recent issue of Nature.
Using yeast two-hybrids assays and high throughput screens for selected interacting domains (SID) in a complex protein library, the SIDS were statistically based on binding competition between fragments, and a map has, as a result, been generated connecting 46.6% of the 1,590 H. pylori putative proteins.
Validation of the map as a tool for revealing biological pathways and predicting protein function, along with the complementary PIMRider software, should "shorten the path between genomic information and validated targets ... leading to [drugs with] less side effects," according to lead author Pierre Legrain.
Stem cell issues in Europe
Although Britain's House of Lords has voted overwhelmingly in favor of allowing embryonic stem cell research for therapeutic purposes, the majority of more than two to one reflects an 11th-hour agreement that a select committee be set up to reassess the Donaldson report, published last August to advise the government on the issue. The House of Commons had already voted in favor last December.
In contrast, German officials and church leaders have condemned the UK's legislation on stem cell research. Chancellor Gerhard Schroder maintained that cloning embryo cells for research should remain banned in Germany until more is known about what could be achieved with stem cells extracted from adult organs. Germany's federal law of December 1990 forbids all research on the embryo. It also forbids the creation of clones, chimeras and other hybrids.
In France, the bioethics law of July 1994 forbids research on the embryo with the exception of purely medical studies that do not impair the embryo. This exception implicitly refers to therapeutic cloning, although this was not stated at the time. It was intended that the law should be revised after five years, taking account of scientific advances. It is exactly the revision of this law, already two years overdue, that is currently the subject of impassioned debate, with Prime Minister Lionel Jospin in favor of moves similar to those taken in Britain, and President Jacques Chirac firmly opposed to therapeutic cloning.
In Denmark, the law of June 1997 forbids cloning but authorizes research on already existing embryos, while in Italy current legislation leaves a legal gap, as is true in many other countries. The Italian health ministry in its recommendations has effectively echoed a UK policy in proposing that embryonic stem cells should be sourced "exclusively from embryos that, surplus to artificial insemination requirements, would otherwise be destroyed."
A Spanish law of November 1998 authorizes research on embryos less than 15 days old with the consent of the parents. All cloning, including for therapeutic use, is forbidden at present.
The possibility of reprogramming adult cells has been raised as an alternative to the use of embryonic stem cells. Alan Colman and his team at PPL Therapeutics (Roslin, Scotland) reported at a recent meeting of British fertility experts that they have evolved a technique in which at the laboratory level "reprogrammed" adult bovine dermal cells behave like embryonic stem cells, with some of them evolving into a cluster of heart cells that beat. The technology used in their method will not be disclosed until patent coverage has been cleared up, Colman said.
Photodynamic therapy developments
Photocure (Oslo, Norway) has reported successful Phase III trial results using its topical photodynamic therapy (PDT) agent, Medvix. In the trial, more than 90% of skin cancer lesions were healed after three months in the treatment of primary superficial basal cell carcinoma. The trial findings also showed that Medvix PDT was equally as effective as cryotherapy in removing BCC lesions, but with a better cosmetic outcome.
The continuing survival of Scotia Holdings (Stirling, Scotland) is in question after the European Medicines Evaluation Agency rejected its major product, Foscan, for use in PDT therapy for head and neck tumors. Scotia has been in a difficult position since September 2000, when the FDA unexpectedly rejected its Foscan application.
Scotia plans to appeal the EMEA decision, based on trial results showing positive results on a quarter of patients. The appeal is likely to take up to three months, by which time available cash will have run out. Scotia is urgently considering its options, which include the sale of remaining assets or a takeover.
European business developments
Merck KGaA (Darmstadt, Germany) has acquired a majority stake in Molteni Pharma (Florence, Italy), which was formed recently after the demerger of its parent company, L. Molteni & C dei Lili Alitti (also Florence). Merck will take over full management after completion of the acquisition, with the company name changing to Merck Pharma SpA. Merck also plans to acquire the remaining shares in the near future.
Delft Instruments (Delft, the Netherlands) has increased its shareholding in Rogan Medical System (Zeist, the Netherlands) from 35% to 52%. Rogan, which develops picture archiving and communication systems, will continue to trade as a separate operating company, marketing its HyperPACS system through distributors and OEM customers.
Bracco (Milan, Italy) is to acquire from Resolution Pharmaceutical of Canada rights to a line of products used in the diagnosis, staging and treatment of neoplasias. "Not only does this acquisition broaden our pipeline of new potential products for diagnosis and therapy of tumors, but it also significantly strengthens our patent portfolio," said Michael Tweedle, president of Bracco Research.