Technology meets Healthcare but faces Interoperability.

The use of information and communication technology to support health solutions is a good perspective for improving global access to healthcare services, data records and patient assistance. It would be great if we could access our medical records wherever they are needed, or if the monitoring of the heart bit rate for high risk cardiac respiratory patients could be performed directly form home simply by using a wrist-worn device with wireless connection to telemedicine centre, thus making life more easy, flexible, and efficient for everyone. The advancement of Wireless technology continue to hold great promises for a better health system, but how far are we in this process and what is the factor that can possibly slow down the advancement of eHealth?
The vision behind wireless oriented health systems is focused on a citizen centered structure where the citizen takes an active role in the entire process, receiving information about his own health and participating in every stage of the system from prevention, simple care to diagnosis and rehabilitation. Almost everyone has nowadays a smartphone or other mobile device, and constant efficiency improvements will easily allow individuals to access and manage a variety of health activities. These technologies should be clearly easy to use for the consumer in order to guarantee not only a transparent service but also a healthcare provider selection. So, easy technology for the consumer is a key requirement. Until now it doesn't appear to be any problem for the development of electronic oriented health devices: today let's say that almost everyone has a computer, a mobile phone or iPad and a Wireless connection at their home, so where does the problem stand? These technologies should be not only easy for the customer, but also secure (someone can access his own medical report modifying the data asking for more money form their insurance company), interoperable and therefore Standardized. Everything in this world is STANDARDIZED, from the A4 paper that we all use for printing, GSM specifications for mobile phone to most recent LTE standard. Thus, very generally a standard can be defined as a set of specifications for ensuring compatibility, accessibility and quality of the specific product. More specifically you can have an idea of what standards mean by reading the above definition form the ISO/IEC Guide 2:1996 [1], definition 3.2 that defines a standard as:

'A document established by consensus and approved by a recognized body that provides for common and repeated use, rules, guidelines or characteristics for activities or their results, aimed at the achievement of the optimum degree of order in a given context'.

If a wireless system has to be integrated with health related devices then it is an obvious consequence that a common communication protocol needs to be established and the communication between various devices everywhere, should be functional, not complicated and should require the user to have little knowledge of the characteristics of those systems. Integrating an ICT system with a health device using standards, will indeed encourage innovation of the health sector along with technology evolution thus making also the consumer or citizen aware of the entire health process he will go through. In this complex process different information technology system and networks are involved, which means that those systems must have the ability to communicate and exchange data effectively and securely in various settings ensuring that the exchanged data are not altered. The combination of devices, technologies and networks, and their integration with the whole system involved, pose INTEROPERABILITY challenges making evident that interoperability must be seen as the key requirement if the promise of an integrated Wireless health is to be fulfilled. If different elements deriving form a variety of technological developments, can be combined into a health oriented product with interoperability, then the effectiveness will be increased and the quality of service will be superior. With interoperability not only large vendors can benefit, but also small companies can enter the market with their products creating a system where economy has less barriers, more competition and innovation. Interoperability is a term that can be referred to software or device as well as to the medical sector and its principal goal is to assure communication and exchange of data between autonomous systems without any external intervention. Specifically, analyzing the eHealth sector, interoperability means that all the heterogeneous information devices that are used in the process for exchanging health data, medical records or information from medical sensors, are designed to be compatible with each other and with the entire network that is involved in this health based data flow. Developing a wireless system that is based on interoperability is essential for the eHealth system and this can be achieved either by adopting an already published Standard or by making use of Structures that can convert different products interfaces to another. Once operability is granted a system can result in increased functionality, ease of use, lower costs, widespread and faster data flow. Developing standards common to individual devices is the solution for the wireless-health systems and the principal factor for achieving interoperability and it requires the involvement of all the parts involved in the process. 

Figure : ITU-T Technology watch report on Standards and eHealth, that illustrates visibly the various obstacles eHealth has to face and solve. 

Everyone involved in the development of eHealth systems is aware of the importance of interoperability, however for example less than 25% of the hospitals in the United States has adopted in their structure the electronic health record, which not only limits the diffusion of personal health record but also decrease the level of interoperability. On the other side of the world the lack of EU Standards in the eHealth market creates fragmentation and insufficient interoperability, reflecting the different national systems that are adopted by competent authority. The direct consequence of a tailored eHealth system is that the ICT devices proposed are not accessible everywhere and very often non-interoperable. The action taken form EU in order to ensure the creation of standards and interoperability while exchanging data, was the launch in March 2010 of the Digital Agenda for Europe, set out to define the role that the ICT development will have if the digital technology is oriented towards innovation and better quality of life for the Europeans. Specifically one of the main areas of interest of the Digital Agenda is the ICT for social challenges, Action 77 [2] which aims to ensure the creation and selection of Standards to promote interoperability and develop certification and testing for the eHealth sector. The commission by 2012 proposes to realize a European eHealth Interoperability Framework showing that interoperability and testing is possible on a European scale, and concentrate on the implementation of the EU-US Memorandum on eHealth signed by the end of 2010 which will ensure interoperability between the parts. At European level another important action taken by the European Commission is the creation of an EU Task Force on eHealth development. In May 2012 the Task Force's report "Redesigning health in Europe for 2020" was handed to the European Commission. The report is focused on the definition of the key issues faced by a possible ICT health care system in terms of  accessibility of data records, privacy and legislation on interoperability. Starting from the consideration that today more than ever, EU citizens move easily across the borders, the Task Force's report outlines that in order to ensure to every EU citizen mobility of data and health care assistance, we need to operate with the same rules, ensuring in this way that incompatible national rules or private companies initiatives will not put at risk fundamental health care rights. Despite the efforts that all the sectors involved in this process are making encouraging the production of interoperable devices, interoperability on a large scale remains still a major challenge. 



References: 

[1] ISO/IEC Guide 2:1996
[2] http://ec.europa.eu/information_society/newsroom/cf/pillar.cfm?pillar_id=43&pillar=Digital%20Single%20Market