MATERIALS

Future of eHealth. From Health 1.0 to Health 3.0

Success or failure of our present healthcare systems is in big part related to the developments happening in the eHealth arena. We strongly believe that technological innovation and the underlying business models can make a tremendous difference in the lives of patients and in the work of doctors in the near future. To understand the future, we need to understand the past and present. Different nations are in different stages of development, so this distribution is not based on time, but it is based on how and how much information is used, shared and analysed.

Health 1.0 is the first stage of digitalization. We go from paper to paperless. Now widely deployed and popular computer application electronic medical record (EMR) in many countries, is in basic version a digitalized version of the regular traditional paper-based medical chart for each individual. It contains all of the patient's medical and clinical data history in a single facility such as a hospital, clinic or GP office. It is used by healthcare providers to monitor and manage care delivery within the facility. In the same time there are different services and devices which you can use and collect data to each of their own personal health record (PHR). At this stage they are stand-alone solutions – one device or service which each has their own data storage.

Health 2.0 is the stage of integrations. We go from different systems that can’t or won’t communicate with eachother to sharing data between them. An electronic health record (EHR) is shared instantly and securely among multiple healthcare facilities within a community, region, state or in some cases the whole country. Effective implementation of EHRs can be done after healthcare organisations have adopted complete EMR systems. Like EMRs EHRs are longitudinal patient-centred records that contain patient's full health profile (we should say sickness profile, because they carry medical history primarily)  starting from the first attendance or admission to the facility. The primary aim of the EHR is integration, data sharing between healthcare providers, automatation of tasks and streamlining of healthcare provider’s workflow. It is very important to ensure that information generated in EHR is timely, accurate and available all the time. PHR-s of different services and devices in this stage are more sophisticated, but their data is still separated from EHRs.

The study of Green and others (1) shows that in a group of 1000 adults during one month period 800 of them have health related problems and 329 of those decide to book a time and see a doctor. They become patients and their sickness episodes are documented in the EMR and shared among medical professionals through the EHR. This is the situation that most of the developed nations are in now.

Health 3.0 is the stage of personalisation. We go from general knowledge to personalised approach. First preconditions for Health 3.0 is personal Health Account (HA), which consists of  data generated from PHR and EHR and will be fully controlled and managed by citizens themselves. PHR and EHR service providers feed HA with data. From the perspective of the citizen the process must be simple and easy to manage. For that we need HA with unique international health account number (IHAN). Why IHAN? People use more and more digital services, which lead to global digital services. IHAN gives us possibility to collect data from different providers, for what clear and open standards are needed. The closest example to IHAN from another sector is IBAN - international bank account number that gives us simple address of a person’s account for bank transactions. It is smart to use a similar solution for health information. The second precondition is consent management. Making decisions over which service to use, every citizen has to also give certain level of consent for service provider. This can be solved, using MyData model– model that equips individuals to control who uses their personal data, to stipulate for what purposes it can be used, and to give informed consent in accordance with personal data protection regulations. It makes data collection and processing more transparent and it helps companies or other organizations implement comprehensive privacy protections.  (2)

 The main idea is to use computer power, algorithms and machine learning elements to collect, interpret and analyse this evergrowing amount of data mankind is producing to act faster and smarter in preventing diseases and curing them.  As we start to possess these new tools, we can add genomic data to the mix. This means possibilities for real personalised care, as we know many times more about each and every person as we do now. Artificial intelligence (AI) will help to find problems and suitable services, which will lead to faster cure. Decision support systems won’t be only in the hands of the healthcare providors but will become tools for selfcare. People can now decide themselves what data to share and what services they need the most. General practicioners work will transition to health coaching and assisting people in their treatments together with AI. As you can understand we have come a long way, but there is still a long way to go. Health 3.0 has potential to revolutize how people think about their health and medical care.  

Reference:
1.Green, LA. Fryer, GE Jr. Yawn, BP. Lanier, D. Dovey, SM (2001). ‘The ecology of medical care revisited.’ New England Journal of Medicine, 344(26): 2021–2025
2. Mydata https://www.lvm.fi/documents/20181/859937/MyData-nordic-model/2e9b4eb0-68d7-463b-9460-821493449a63?version=1.0