1. eHealth policies review: From European Union to
the Valencia Region
José Enrique Borrás Morell#1, Rosa Valenzuela Juan*2, Vicente Traver Salcedo#3
#
ITACA - Health and Wellbeing Technologies,
Universidad Politécnica de Valencia
1
jobormo@itaca.upv.es
3
vtraver@itaca.upv.es
*
Agencia Valenciana de Salud, Consellería de Sanitat
2
valenzuela_ros@gva.es
Abstract— The Information and Communication Technologies Health Organization and the European Union on eHealth.
(ICT) offer an endless opportunities and challenges, besides Once this analysis is performed, a more detailed analysis of
nowadays, their usages do not stop growing and expanding, and eHealth in Valencia Region will be done, to know the
health sector is taking part in this revolution. Telemedicine, guidelines that have been taking in Valencia Region. Then
ePrescription, Patient Summary, etc. shows a new reality in
there is a detailed study of Valencia eHealth System,
health sector, the eHealth. A tour, along the policies and actions
that are been performed in the eHealth sector is being made analyzing the current state of the art and considering some of
through this document. Starting from a global case, as the basis the experiences of eHealth that are being executed in Valencia
of our review, the World Health Organization, continuing with Region. Finally there is a conclusion point, with an analysis of
the European Union as an example of policies evolution and future eHealth trends.
eHealth actions, and the Spanish Ministry of Health as the
Ministry responsible of health in Spain, until to reach a II. WORLD HEALTH ORGANIZATION
particular case, the Valencia Region and its actions and policies The United Nations system responsible for health is the
on eHealth through the Valencia Region Health Agency.
World Health Organization (WHO). In 2004 as a part of the
Strategic Plans, actions, policies, and new trends that are being
made on eHealth will be analysed, with the aim to show how, step
Department of Knowledge Management and Sharing (KMS)
was created the e-Health unit, with the objective of sharing the
by step, the eHealth goes from to the health of the future, to the
current health, which is heading to the future. use of knowledge through ICT. In 2005 after the Fifty-eighth
World Health Assembly, the WHO established an eHealth
I. INTRODUCTION strategy. The basis for policy coordination, at the
According to the World Health Organization “eHealth is international and WHO activities, in the eHealth area, are
the use, in the health sector, of digital data—transmitted, provided in this strategy. The strategy is divided in two parts,
stored and retrieved electronically— in support of health care, the first one aimed to countries, where the WHO urges
both at the local site and at a distance.” [1]. member states to develop an eHealth action plan as a main
Everyday ICT are becoming more important in our goal to develop their eHealth activities and the second one,
environment, from our private life until our work, and health which are the WHO commitments to provide support to
sector is no exception. Combined correctly, health and ICT member states with the promotion and the development of
can be a powerful set of tools to help to improve life quality their eHealth activities, such as provide technical support to
and have more efficient healthcare services for all. member states or the submission of regular reports with
Electronic medical records, telemedicine, management of eHealth state [2].
health centers, such as economic and human resource Following the same direction, the study and analysis of
management, are some of the key application areas of e- eHealth impact, The Global Observatory for the eHealth (GOe)
Health, but there are much more, such as optimize the sources, was created in 2005, and its functions are aimed to:
improve the efficient in health processes, improve the quality a) Study the eHealth benefits on the countries and
of the service, etc. analyse eHealth policy.
eHealth helps the interaction between patients and health- b) Know what strategies and developments are being
service providers or health professionals, improving the done around the eHealth.
quality of health tasks and processes. eHealth offers a way for c) Provide strategic management practices and effective
citizens and health professionals to access to health policies.
information. eHealth can be a tool to complete diagnosis and d) Give the standards in eHealth to the member states in
a pillar to health tasks and processes. the WHO.
During this paper a tour is being performed along the
different policies that have been proposed from the World

2. The Observatory's mission is to improve health by providing III. EUROPEAN UNION
Member States with strategic information and guidance on Since 1990 the European Union has been working on
effective practices, policies and standards in eHealth [3]. developing and research of eHealth tools and systems. In 2004
A global survey was the first action GOe performed. This was approved the eHealth Action Plan 2004 (eHAP). This
survey had two objectives: First to understand the state of art plan was the first commitment between member states of the
in eHealth in the world. Second to know in what key areas European Union to cooperate in the eHealth sector [6].
the WHO should act, such as create an international network The eHAP main objective was to allow the European Union
to share practical experiences or study the development of to achieve the full potential of e-Health systems and services
generic tools for eHealth. Following this line a second global within a European e-Health Area. The eHAP main points were:
survey was done in 2009 to know the development of on the side of the Member States, to draw up national or
eHealth plans, in every country, and set new requirements on regional roadmaps for eHealth, the commitment of national
eHealth area, these were the new objectives. These surveys and regional health authorities with the eHealth , and provide
have been the basis for the elaboration of a series of tools and leadership to eHealth implementation efforts. On the other
guidelines, about strategies and polices on eHealth, aimed at side, the European Union in collaboration with the States
governments and Health institutions. Members had to identify and elaborate standards for electronic
Since 2005 a series of papers have been given from the health records and health data messages and study of a
GOe for assisting in the development of eHealth strategies. framework for better legal certainty of e-health products.
The first one was the “eHealth tools and services Needs of the Finally, on the side of the European Union, continue with the
Member States”. Published in 2006 this document gives an investment in eHealth area and the publication of documents
idea about the state of eHealth tools in the world in 2006, related with the European best practices, the state of art in
includes a collection of proposed actions on eHealth by the deployment, etc. as guidance for Member States for
WHO. In 2007 was published the “Building Foundations for developing their eHealth plans.
eHealth Progress of Member States”. This document contains In 2005, the i2010 subgroup on eHealth, on i2010 High-
the results and findings of the first survey, giving a global Level Group was created to provide advice for the correct
vision of eHealth; some recommendations for the implementation of the eHealth action plan. For the period
development of eHealth strategies are there. 2005-2009, the EU policy framework for the information
Continuing with the results of the first survey, in 2008 was society and media with the information and communication
published "Building Foundations for eHealth in Europe". technologies was promoted by i2010 High-Level Group. The
Unlike “the Building Foundations for eHealth document” this i2010 subgroup tasks on eHealth were focused on: innovation
documents contains a more detailed survey analysis of the and the better access to all eHealth initiatives and the
contents and findings, in the European Region. involvement and inclusion of Europe’s citizens in healthcare
Once the second survey was completed, was published, in through electronic means. From 2010 this task be assigned to
2010, the “Global Observatory for eHealth series - Volume 1”. a new initiative – the Digital Agenda (Digital Agenda is an
Data from second survey and findings are in this document initiative of the Europe 2020 Strategy to prepare Europe for
and describes the current status of eHealth; finally it provides the next decade, which objective is to maximize the potential
information about the current eHealth development. of ICT) [7:10].
In 2011 two documents have been published: First the In 2006, with the objective to create the proper framework
“Global Observatory for eHealth series - Volume 2” a to foster lead markets, was launched The Lead Market
document based on the second survey and focalized on Initiative (LMI), one of this markets was the eHealth. In the
Telemedicine, as an essential part of eHealth; note that the action plan of the LMI was included a roadmap of policy
document is intended for health professionals. This document recommendations on the period 2008-2010 in eHealth, with
brings an analysis of four fields of telemedicine: teleradiology, the goal to reduce market fragmentation, promote
teledermatogy, telepathology, and telepsychology. By the standardization and increase interoperability between eHealth
middle of 2011 was published the “Global Observatory for systems [11].
eHealth series - Volume 3”, based on the second survey. This In 2009, with the idea to facilitate the cooperation between
document gives and analysis of mHealth (mobile health), as Member States and the European Commission, in the update
an opportunity to apply mobile technology for health [4]. of the 2004 action plan, was established by the Employment,
The previous documents are a complete guide for the Social Policy, Health and Consumer Affairs Council (EPSCO)
governments, to improve their eHealth policy, for the practice The High Level eHealth Governance Group. This initiative
and management of eHealth, and for knowledge generation. will bring forward eHealth for the "deployment and actual use
Besides, with the objective to explore the potential of of interoperable eHealth services within and between national
collaboration between WHO and public or private entities, healthcare systems"
involved to achieve the goals of the organization in the health
sector, was created the eHealth Standardization Coordination A. Actions
Group (eHSCG); with the goal to define the framework and During this point is going to review some of the most
guidelines to ensure that such collaborations reach their significant achievements have been performed, or are being
objectives in a measurable actions [5]. performed by the European Union.

3. The first one is a 10-point action plan. These points are based professionals in Europe. Besides the card may
on the communication "Telemedicine for the benefit of serve as medical validation or for access to
patients, healthcare systems and society". This communication medical records [17].
is centered on telemedicine and it relationship with eHealth. b) The European epSOS (Smart Open Services for
Below are some of the most significant achievements [12]: European Patients). Citizens’ treatments are a
a) Actions at the level of the Member States: the report problem when they are in a foreign country.
“eHealth in Action: Good Practice in European This project helps to access to their health
Countries”, that contains an analysis and description information, electronics health records and
of some eHealth projects. Also the report “eHealth ePrescription, all over Europe. Making easier a
priorities and strategies in European countries”. It personalized citizen treatment [18].
contains a completely analysis of the eHealth c) RenewingHealth (REgioNs of Europe WorkINg
strategies in 2006. toGether for HEALTH). Telemedicine is a
b) The member states actions to be supported at EU powerful tool for eHealth. This project aims to
level: the document “study on the Legal Framework conduct studies to validate and evaluate
for Interoperable eHealth in Europe”, providing an innovative telemedicine services targeted to
idea about the legal and regulatory framework for patients [19].
electronic health services in the European Union d) Calliope Network. This project has established
member states. a successful collaborative platform for
c) Actions to be undertaken by the Commission: The interoperability in Europe. The goal is making
study “Economic Impact of Interoperable Electronic value makers for the national eHealth
Health Records and ePrescription in Europe”. implementations and how to establish
Continuing with the actions performed, in 2008 was interoperable eHealth services [20].
established a recommendation on cross-border interoperability Finally to note a European Commission's proposal,
of electronic health record systems. The objective is to get the launch of a European Innovation Partnership on Active
interoperability between different healthcare systems [13]. and Healthy Ageing, to enable our citizens to live longer in
In December 2010 the “European eHealth Interoperability good health, by increasing the average number of healthy life
Roadmap”, a study about interoperability in Europe was years by 2 in 2020 [21] [22].
presented [14]. In January 2011 the study "Enhancing
procurement of ICT solutions for healthcare", a guide for the
healthcare authorities and care delivery organizations to plan
eHealth policy, was carried out. A specific consultation
between members of Union European has been performed in
2011, by The European Commission, to continue monitoring
eHealth development and eHealth initiatives deployment
across Europe.
Highlight the eHealth ministerial Conferences, annual
meetings between health experts and ministry of health
workers, to discuss the actions to perform on Action Plan
objectives.
Other important point is being done by the EU is the
research in eHealth. More than 450 collaborative R&D
projects in eHealth have been done by the European
Commission. The Seventh Research Framework Programme
(FP7) is a program to improve Europeans’ standards of living, Figure 1: epSOS participating nations
with a total budget of more than €50 billion for the period
B. Action Plan 2012-2020
2007 to 2013. The FP7 has focused on three fields, the
Personal Health Systems (PHS) with researches related with In 2009 conclusions of the European Union Council called
personalized monitoring, the Patient Guidance Services (PGS) upon the European Commission to update the 2004 eHealth
with researches about Risk assessment and patient safety, and Action Plan. Once consolidate the goals, which had been
the Virtual Physiological Human (VPH) with researches about achieved through the 2004 Action Plan, the objective is to set
Computer models for personalized and predictive healthcare the eHealth in the new context of the Europe 2020 strategy
[15] [16]. [13] [23].
Finally, to note some of the most important European The following action points related with eHealth are
Large Scale Pilots: included in the Digital Agenda, as a part of the Europe 2020
a) In 2009 was presented the HPRO card. This strategy:
project allows, with a professional card, the free a) “Undertake pilot actions to equip Europeans with
movement of citizens with the health secure online access to their medical health data by

4. 2015 and to achieve by 2020 widespread deployment V. VALENCIA REGION HEALTH AGENCY
of telemedicine services”. The Valencia Region Health Agency (AVS) carries out the
b) “Propose a recommendation defining a minimum management and administration of the health in Valencia and
common set of patient data for interoperability of healthcare delivery in the Valencia Region. It is organized in
patient records to be accessed or exchanged health departments. There are 24 health departments and they
electronically across Member States by 2012”. are equivalent to the areas of health where they act.
c) “Foster EU-wide standards, interoperability testing The organism responsible for the coordination between the
and certification of eHealth systems by 2015 through AVS and health departments, in computing and
stakeholder dialogue”. telecommunications terms, is CITESAN, while AITO is the
d) “Reinforce the Ambient Assisted Living (AAL) Joint organism responsible for the development of the Information
Programme to allow older people and persons with Systems Plan of the Valencian Health Service.
disabilities to live independently and be active in The Information Systems Plan 2009 - 2011 is aimed at
society”. enhancing the global integration of systems and ensures the
e) “Demonstrate eHealth interoperability testing and sustainability of the solution, improve the capacity of the
certification on a large scale”. citizens to access to their health data and implant the
f) “Develop a European eHealth Interoperability Electronic Health Record. The following action points,
Framework” [24]. related with eHealth, are included in the Health Plan of the
Valencia Region 2010-2013 [30]:
IV. SPANISH MINISTRY OF HEALTH
a) Develop ITCs and e-health as a strategic tool to
The Spanish Ministry of Health is the responsible for the improve interaction with patient.
management and administration of health in Spain. In 2006 b) Incorporate intelligence to systems as a tool to improve
the eHealth program on the Quality Plan for the National efficiency and outcomes. The objective is on the one
Health System (SNS) was approved. The goal is to improve hand incorporating support systems to daily
services to citizens in the SNS through ICT, this includes professional health; and on the other hand, to analyze
some important points, such as ensure the unique the data information from the patients and to identify
identification of citizens throughout the SNS by the health the patterns of patients with special problems to be able
card, promote electronic medical records and ePrescription to design differentiated programs tasks.
system ,offer new services for the relationship between c) Develop and maintain the technological channels
citizens and professionals, improve the accessibility of the (access to information for mobile programming, visitors
eHealth services, etc. [25]. on-line, etc.) of communication with the user, according
In Spain nowadays more than 90% of the health centers to the Information Systems Plan.
use ICT to improve clinical management assistance, help d) Analyze the situation of intersectional channels, to
doctors to consult the primary medical record, information propose and to develop them. The main objective is to
systems for the management of health care centers and record show the Department of Health as technical leader on
the outcome of consultation [26]. health issues for different sectors of society, to provide
Some initiatives have been carried out from the eHealth information for eHealth interventions, or to improve
program are related with de medical prescription like the health and habits of the population.
ePrescription project. This project allows the electronic The AVS systems plan budget was €51 million for 2010
prescribing of medicine through ICT level and collaborates and €46 million for the 2011.
with the European project EpSOS on the exchange of clinical The Health Information System of Valencia is called
information; others initiatives are related with the Patient SISAN [31]. SISAN is composed of different subsystems, the
Summary like the HCDSNS project (Clinical History Digital Clinical and care subsystem, the economic management
from the National System Health). This project allows, health logistics and human resources subsystem, and the business
workers, to have access to the patients’ health information Intelligence subsystem. A global vision of the information
(electronic health record (EHR) Patient Summary), regardless system is showed by the union of all of them.
of the region where they are. To note that this project foresees To understand the SISAN is needed to know ARTERIAS,
a future integration into the electronic medical record at the network that interconnects all health centers and
European level and also collaborates with the European administrative services in Valencia Region. It is a network
project EpSOS. But there are other initiatives, such as The designed to handle voice, data and image [32].
Health Card, a project that uses a personal card as an Nowadays AVS is working on the improvement of the
identification system in all the Autonomous Communities and SISAN systems; many of their developments are focused to
allows that all health cards can be read anywhere in the improve each subsystem of SISAN.
national health system; and more projects related with the One of the most ambitious projects of the SISAN, in the Care
encouragement of telehealth and the use of Internet to Subsystem, is the project HSEAVS, the Electronic Health
facilitate the administrative relationship between citizens and Record in AVS. HSEAVS is a Service-oriented architecture
the health system, such as online previous engagement or based on interoperability standards. A platform that allows
increasing the bandwidth, etc. [27:29]. access to the Clinical History Summary, Emergency care

5. reports, high clinical reports of hospitalization, reports be analyzed. The objective is to know the interoperability with
laboratory test results, reports test results image and nursing the SISAN and to study the advantages and disadvantages of
Care Report, is based on the project HCDSNS from the integrating each experience in the SISAN.
Spanish Ministry of Health. The intention is to integrate
HSEAVS in the European Union initiative epSOS [33] and VI. CONCLUSIONS
obtain interoperability between different health systems EU Neelie Kroes, Vice President of the European Commission
member states. Continuing with the Care Subsystems, for the and Commissioner for Digital Agenda says "30% of the EU's
ambulatory care, the health centers can use a system called inhabitants will be over 65 years in 2050. Furthermore we see
ABUCASIS. This system, based on other sub-modules, can be estimates point to a shortage of one million health
used for healthcare activities and administrative task, such as: professionals in the EU by 2020, and this is likely to reach
ePrescription, registry vaccine, or request an appointment. On two million if other employees in the healthcare sector are
the other side, for the management of the health centers there accounted for”. Besides World Bank studies show that public
is Orion-Clinic a hospital information system [34]. Orion- expenditure on healthcare in the EU could jump from 8% of
Clinic is based on three modules, Orion-HIS responsible for GDP in 2000 to 14% in 2030 [37][38].
the management of patients, Orion-Farma responsible for the The eHealth policies are reflected on the facts cited before,
management of ePrescription and Orion-Ris responsible for this document show how new trends are heading to:
the management of medical images. Finally for the a) Utilization of eHealth to extend healthcare from the
coordination of extra urgent hospital care there is the hospital to home, with the same quality of healthcare,
CORDES system [35]. to reduce financial and human resources in healthcare.
The other main module of SISAN is about the economic This includes the analysis of the RenewingHealth
and logistics management, for the management resource of the project results, the development of solutions on
hospital, SISAN offers Orion-Gesto. Orion-Gesto is a system telehealth to expand hospital processes into telehealth
for the management of hospital resource and is based on two processes, the improvement of the access to
modules, the Orion-Logis a system for the management of specialized clinical services, the improvement of the
economic and logistics issues, whereas the Orion-Person disabilities and chronic disease management and
allows the management of human resources. improve and save client care time.
There are others significant projects where SISAN is working, b) Greater cooperation between the European
like IDESAN, a project that shows the information stored, in Commission and member states. This includes
corporate information systems, on Internet mapping, or the interoperability of national eHealth systems in Europe,
Oficina 2.0 a website that provides support and training tools for the simplification and reduction of administrative
for citizens and health professionals [36]. task, and the improvement of the provision of
One of the objectives of AVS is to get interoperability healthcare in Europe. Analysis of the Calliope
between the different healthcare systems; on figure 1 appears Network project, HPROCard project and epSOS
how the interoperability is achieved. project, with the objective to develop solutions to
improve cross-border interoperability of eHealth; and
the development of common electronics health
records, for all the EU member states, through the
experience gained from the projects cited before.
Finally both tasks should develop an appropriate level
of security due to the transfer of health personal
information.
c) Exchange of knowledge between EU Member States,
it allow them, to know the latest progresses and
decisions in eHealth sector.
d) New systems to give healthcare professionals more
time to treat patients and spending less time in
bureaucratic paperwork.
e) Study of active and healthy ageing. Promotion of
healthy and active ageing to live longer in good
Figure 2: Example of interoperability health.
f) Continue with research programs in eHealth
Besides, there are some experiences on eHealth
development.
implemented on each health center, such as Teleradiology,
To emphasize, after to analyse the eHealth policies, actions
Teledermatology, Teleophthalmology, Telecardiology,
and new trends, is observed that in general, new trends match
Remote Access Medical History, Videoconferencing and
up with the conclusions given in the eHealth Ministerial
others like Health Web Portal.
Conferences [39].
AVS is working on the future eHealth strategic plan, where
all the health centers individual experiences on eHealth should ACKNOWLEDGMENT

6. We appreciate the important contributions of the Valencia union/index_en.cfm?section=active-healthy-ageing Last time accessed
15th Nov 2011
Region Health Agency for its collaboration in the elaboration
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