Why Europe’s provision of eHealth services needs a digital injection

Health and wellbeing have been uppermost in our minds in the past two years as we’ve all learned to live with the coronavirus pandemic. Who hasn’t used at least one digital health service, such as booking a vaccination via a mobile phone or requesting a medical consultation online? For public sector health organizations, the pandemic has accelerated the shift to online services provision, with digital now increasingly the norm.

But how do eHealth services match up to other areas of eGovernment service delivery? What’s working well, and where is there room for improvement? The European Commission has recently published the eGovernment Benchmark 2022, in which we find answers to these questions. Although this is the 19^th edition of the report, it is the first time that services relating specifically to health have been included in the annual assessment of digital government services. The findings are based on a survey of businesses and citizens from 35 participating countries, comprising 27 EU Member States and eight other countries. They visited more than 14,000 public sector websites to rank online government services based on a combination of factors (user centricity, transparency, key enablers, and cross-border services). This enabled the report authors, led by Capgemini, to allocate digital maturity scores and recommend next steps on the eGovernment journey.

eHealth services – laggards and leaders

So, just how mature is the delivery of eHealth services across Europe? Before we delve into this, let’s first clarify what we mean by eHealth services in this context. The eGovernment Benchmark report measured services related to obtaining basic healthcare, searching relevant healthcare providers, applying for the European Health Insurance Card (EHIC), e-consultations and medical records.

An average maturity score of 63 percent shows eHealth services falling short when compared to other eGovernment services. For example, the level of online services when moving home was ranked at 71 percent. It’s clear that online options for people in need of healthcare services have room to improve. As always, there are leaders and laggards, with Luxembourg (97 percent), Estonia (93 percent) and Malta (91 percent) setting a precedent for the maturity of eHealth services. Turkey too is among those paving the way with well-integrated solutions. It integrates multiple healthcare services via the mhrs.gov.tr portal and enabiz.gov.tr health records. This enables multiple healthcare institutions to provide their services via a single platform and health data to be securely accessed. In another best practice example, we see ePrescriptions being proactively shared between doctors and the pharmacy without the need for any user action (except for picking up the medicine) in Estonia, the Netherlands, and Sweden.

At the other end of the scale, eight countries have a maturity score below 50 percent, meaning that citizens in these countries still need to refer to non-digital means to access government health services. And while in almost nine out of ten countries (88%) citizens can apply for and access their personal health records online, the completeness of these online health records differs. In some countries citizens can access their entire medical history. In others only minimal information about vaccinations and medical visits is available. And in some, such as the Netherlands, patients cannot access their full health records online– only partial records from a single provider.

Highs and lows of eHealth

Just as some countries are ahead of the digital curve, so too are certain aspects of eHealth service delivery. There is generally a difference in maturity between administrative eHealth services, such as booking an appointment, and actual healthcare services, such as e-consultations.

The administrative procedures around healthcare, such as looking for information about where and how you can get healthcare, are now to a large extent digitalized. Three out of four health-related services are available online, with 93 percent of those being mobile friendly. Another high note is that websites where users can obtain e-prescriptions are almost always mobile friendly (99 percent). However, compare these high scores with just 64 percent for the transparency of health data and an even lower 53 percent for the transparency of service design on government health portals. The use of eDocuments is something of a success story. The ability to download or submit documentation electronically (eDocuments), rather than having to send them in physical format, is possible in almost nine out of ten services. However, while being able to authenticate yourself using electronic identity (eID) is possible in 76 percent of services, this drops to just 58 percent when it comes to applying for e-consultations with a hospital doctor, with 22 percent of countries still requiring authentication offline and in person. Here we see the difference in maturity between administrative and actual healthcare services noted above.

One area in particular stands out as in need of improvement: the ease of cross border access to online public eHealth services. Currently, just 42 percent of services are entirely available online, while users from another country can find information about only 14 percent of the services in a language other than the national language of the respective country. Further, for over 40 percent of health-related services, cross border users do not know how to obtain the service, nor can they find any information about the service online. In May 2022, the European Commission launched the European Health Data Space, the first common EU data space for health data which promises to create a single market for electronic health record systems, which should help EU Member States address this issue.

Recommendations for improving eHealth services

So, how should healthcare organizations ramp up their delivery of eHealth services? The eGovernment Benchmark report offers a number of recommendations. These are designed to help healthcare organizations achieve the EC’s three health priorities of giving citizens secure access to their health data, including across borders, providing personalized medicine through shared European data infrastructure, and empowering citizens with digital tools for user feedback and citizen-centered care.

The following extrapolates health-specific guidance from the broader eGovernment services recommendations:

• Realign the citizen journey and create a well-aligned ecosystem. Health interventions often involve multiple service providers who must reorganize themselves to fulfill the entire patient journey online. Currently, 71% of the health entities assessed offer a digital mailbox solution. These help citizens to safely communicate with their governments and find all relevant communication in a single online environment.
• Respect both national and cross-border patient needs. Offer interoperable services in multiple languages and accept interoperable eIDs — currently the ability to register and (re)schedule a hospital appointment is possible for only 34 percent of cross border users.
• Co-create services with users. In line with the EU’s Declaration on European Digital Rights and Principles, citizens should be able to engage in policy-making processes online and help to design online government services.
• Adopt more data-driven service processes. By reusing previously provided information, more citizen journey services can be provided proactively. Prefilled personal information is at its best in services for obtaining an e-prescription from a hospital doctor and applying for electronic health records(prefilled in 93% of the countries for both services).

The coronavirus pandemic has highlighted the need for digital health services. Mature eHealth services also provide wider environmental and societal benefits – for example, they can reduce unnecessary travel for patients to care providers, while making it easier for informal caregivers  to provide support.

Online health portals and well-orchestrated patient journeys. Transparent and inclusive health service design. Interoperable cross-border services. The eGovernment Benchmark 2022 discusses the different aspects of eHealth transformation currently underway and benchmarks eHealth services maturity against other eGovernment service areas. How mature are your organization’s digital services? Read the full report to see the bigger picture and benchmark your organization.

Find out more

• Read the full eGovernment Benchmark 2022
• Find out more about our services in health and social care