ETSI and eHealth

I'm trying to get a white paper published through ETSI on why standards are important to eHealth. I've extracted a part of the introduction here prior to the publication by ETSI. As is indicated in the acknowledgements of the draft (and which will hopefully be retained after the publication editing process) this has been supported by the UNCAP project. I've taken a few liberties in modifying the introduction section here mainly to remove the self referential bits. What I've tried to retain is the primary argument which you'll see expanded in the white paper when it's published.


There are approximately 7.5 billion people living on our planet[1]. Those people will collectively live for some 547.5 billion years[2], and will classify themselves as unwell for a not insignificant percentage of that time. Even a few days of illness, or feeling poorly, means that the health networks need to be ready to treat several hundred million years of illness every calendar year. If there are only 15 million doctors in the world[3],[4] it would be reasonable to suggest that there are not enough health professionals to go around. It is asserted that technology, when used with appropriate controls, can augment the availability of health professionals and the combinational name given to this technology is eHealth.

For governments across the world, developed and undeveloped nations alike, the challenge of meeting the demand for health services is growing in complexity and cost. Europe[5] with its wide range of member states is also facing a demand from citizens for increased involvement in medical decisions, full access to their own records, and an assurance that they are receiving the best treatment possible.

The question posed is: what is the role that should be played by eHealth technology, and in particular by eHealth standards, in serving the global population in managing health?

The approach taken in this white paper is from the assertion that for eHealth to succeed, global interoperability is essential. Standardisation is the preferred path to achieve it. In collating this white paper this assertion has been kept in mind and used to address a number of key questions:

  • What are the boundaries of eHealth?
  • Who will benefit from provision of eHealth solutions?
  • What are the expectations and scope of standardisation in eHealth?

We understand that caring for, treating and preventing illness is not to be ignored. It is important to think creatively in eHealth - the challenge is to apply technology in novel ways, perhaps in complex combinations, to improve global health innovatively, practically and cost-effectively. The result is that we have to enable a climate of innovation in eHealth underpinned by standards that ensure interoperability, efficiency, security, privacy and safety.

A few caveats are obviously essential:
  • Traumatic injury will always happen.
  • Disease and illness from environmental sources (pollution, tainted food and water sources for example) will always occur.
  • Catastrophic epidemics will always happen and the impact will depend on how quickly we gain awareness and apply resources.

In all instances occurrences may vary in frequency and in intensity.

The sharing of information to treat health events is very similar to the need to share data for any other security event (e.g. distribution of malware, terrorist activity) in order to trigger a defence. This white paper thus maps many similarities to the security of any distributed system to the particularities of eHealth.

Ultimately eHealth has aspects of big data, of IoT, of big society. One of the distinguishing characteristics of eHealth is that its primary concern is with the doctor-patient relationship and not the connection of devices and of data. However, it is also clear that it is essential that devices and data have to be able to interoperate. A challenge to be addressed is therefore ensuring that eHealth is doctor-patient centric and not device centric. The role of standards in building eHealth is presented as a core enabling capability that brings together many players in achieving a common goal.

How big is the market for eHealth? Is it bigger than the mobile phone market? Is it bigger than the automotive market? The rough and ready answer is that the health and welfare market is the biggest market on the globe. Everything that constitutes human behaviour impacts the health and well-being of the population. The OECD’s figures for health spending per capita[6] suggests that if median cost per capita per year is $5000 then if just 1% is given to eHealth the global market would be of the order of $350billion, but this ignores all the aspects of human behaviour that contribute to health and more realistic level is almost impossible to predict and the purpose of this white paper is not to speculate but to inspire. An obvious and all too simple comparison is to look at the global spend on mobile telecommunications: 30 years ago it was essentially zero; today it exceeds $1 trillion/year. This market which is ubiquitous today took huge commitment from its stakeholders to achieve and a key enabler was a global strategy towards standardisation. Realising the potential of the eHealth market requires a similar commitment from its stakeholders as did the mobile telecommunications market. The challenge is bigger, the market is bigger, the impact is bigger. The purpose of the white paper is to suggest that ETSI and its partner SDOs will be key enablers of unlocking the potential of this market.

[2] Global average life expectancy is 73.5 years and is growing year on year
[4] This covers all health professionals: doctors, nurses, dentists, surgeons et al.
[5] This refers to continental Europe and not simply to the member states of the EU


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