Turning a Digital Page in European Health?

It won't make waves around the world, but on July 1 Estonia takes over the rotating presidency of the Council of the European Union. For lovers of history, it has a certain piquancy, because it is only a generation ago that this tiny Baltic territory was just one more part of Moscow’s empire across the sprawling Union of Soviet Socialist Republics. Now, as a freshly and fully independent country with a reputation for entrepreneurship, it is going to be leading high-level policy debates within the biggest single market on earth. And on top of that, it is determined to shift the needle on the way that Europe uses ICT in health.

"We want to launch a discussion to promote cooperation and coordination on e-health in order to create the necessary preconditions for a wider use and cross-border movement of health data for the purposes of treatment, research, and innovation and to promote data-based innovation in healthcare," it says in the program for its six-month spot in the EU chair. "We want to focus European Union cooperation on practical solutions that give people electronic access to, and greater control over, the use of their health data as well as enable them to consent to securely share their health data for the purposes of e-services."

This could be a welcome boost for an EU that is still struggling to reconcile its technology ambitions with a fragmented health policy and with a distinct reticence over data sharing. Estonia has no such hesitations. Its manifesto is full of references to "making the most of the opportunities offered by digital technologies." It insists that Europe "must keep pace with technological progress and fully exploit its potential," because this "will contribute to improving the everyday lives of citizens, businesses, and member states." And it says that the free movement of data is "essential."

The EU "should end the unjustified data location restrictions of non-personal data, achieve legal clarity on the ownership of non-personal data, and ensure the reliable storage and exchange of data based on the ‘once-only’ principle in the public sector." It is planning a broad debate on the free movement of data and on measures boosting the data economy, and specifically on health it will organize a high-level conference on a digital society for health, in its picture-book capital of Tallinn on October 16-18.

The second half of 2017 is going to be a tense period for the EU. In addition to the obvious distraction of the start of real negotiations with the UK on the terms of its withdrawal, the EU has to begin planning for its post-Brexit future, and will be pencilling in its budgets and strategies for the next decade. As part of this process, the European Commission will publish interim reports on the results and achievements of its major thematic funding schemes-notably Horizon 2020, its multi-billion research program.

Estonia has announced its intention to initiate a discussion on how to simplify the program’s research and innovation partnering instruments, and also to explore how EU money could be put into developing some of the crossborder infrastructure that will be needed to exploit big data fully, and to realise its vision of "modern, accessible, and secure electronic communications across Europe," what it terms a "Gigabit Society."

The scale of the challenge-self-imposed by Estonia, but faced in any case by health researchers and health practitioners right across Europe seeking to deploy IT-can be judged from the analysis by the Chairman of the EU Task Force on eHealth: "We know that in healthcare we lag at least 10 years behind virtually every other area in the implementation of IT solutions," according to Toomas Hendrik Ilves-who was, coincidentally, President of Estonia until last year.

The slow uptake "manifests itself in various canceled or delayed IT programs across the EU," said think-tank Friends of Europe in a recent paper on digital health ecosystems. "The lag in introducing information technology in healthcare systems is also evident in digital health innovation." And Europe notoriously fails to provide ways of connecting its health data across countries and systems in a way that could help research and care. Its largely public health systems contain vast amounts of patient data, but scattered across thousands of different sites and databases that are incapable of communicating with one another-and that would currently run into serious obstacles on data privacy grounds even if they tried to do so.

Against that background, Estonia task is indeed a challenge. But the country shows a degree of tenacity in its program too. Looking across the panorama of Europe's current difficulties-in membership, identity, common purpose, or at the thorny issues of unemployment, strained finances, inequalities, migration, terrorism, organized crime, environmental degradation-it is easy to become pessimistic. Not Estonia.

"Creating European unity, a journey that started 60 years ago, continues to be an ambitious and forward-looking endeavour. The European Union started as a dream of few and became the hope of many. The EU’s four fundamental freedoms-a distant dream and goal in 1957-are now functioning and accepted as self-evident. Europeans have been living together in peace for longer than ever before. European citizens and companies enjoy unprecedented freedoms and prosper across the globe," states the first paragraph of its program. This should be an interesting ride.