E-health, an innovation in long-term care

Published on: 11 June 2009

The Court of Audit has investigated barriers to the dissemination of care innovations. We looked at one particular innovation in long-term care: the provision of health services by means of information and communication technology, also known as e-health. We investigated the measures the Ministry of Health, Welfare and Sport (VWS) had taken since 2005 to remove barriers to the dissemination of care innovations.

Audit

Conclusions
Recommendations
Responses
Current status

Conclusions

In our report, E-health, an innovation in long-term care, we conclude that the care sectors have too few incentives to encourage innovation and the dissemination of innovations. Furthermore, continuity in the financing of innovations such as e-health is still uncertain. Legislation and regulations also hold back the dissemination of care innovations, for example because of the medical/legal issues at issue and the uncertainties at play. Furthermore, the availability of uniform standards for ICT applications is inadequate. As a result, the wheel is continuously being reinvented. Finally, we conclude that the support for e-health among clients, care providers and administrators is sometimes still inadequate.

Recommendations

To improve the dissemination of innovations such as e-health, we recommend that the Dutch Healthcare Authority (NZa) ensure that care offices purchase more innovative forms of care. Project evaluations of e-health initiatives should also pay more attention to the effects, costs and benefits (not only financial). The Minister of VWS should then have an overarching evaluation carried out of the project evaluations. We also make the following recommendations to the minister:

investigate the cause of the current underspend of the budgets available for care innovations;
ensure that the long-term care system is adapted so that sufficient attention is paid to incentives for care innovations;
identify medical/legal issues and uncertainties so that changes in the law and regulations can be considered;
promote uniform ICT standards at both national and European level;
increase the consideration given to ICT applications in care training courses.

We further recommend that the Health Care Insurance Board (CVZ) follow up the investigation of inappropriate barriers in the assessment procedure for e-health and similar care innovations.

Responses

In her response to our audit, the State Secretary for VWS agrees with our conclusions. She thinks, however, that uncertainty in the financing of care innovations is not a problem because it is inherent in all innovations. Like the other organisations involved, she writes that she will adopt the greater part of our recommendations or that she is already implementing them. The full responses of the State Secretary for VWS, the Netherlands Organisation for Health Research and Development, the Dutch Health Care Authority and the Health Care Insurance Board and our afterword can be read on this website.