**4. The contribution of e-health to smart and pervasive healthcare. Challenges for Greece in formulating a national strategy for the future of e-health**

e-Health certainly does not constitute the "magic solution" for the existing health system's various problems in infrastructure, staffing, organization and resources. However, it can significantly enable the successful dealing with its chief function issues, optimizing the provided services of Primary Healthcare. In particular, e-Health ensures fast, valid, reliable and directly accessible medical information for everyone, which covers not only topics of general interest, but also specific issues that cope with specific needs. By the exploitation of the possibilities it grants, the prompt and correct diagnosis of diseases becomes feasible, as well as the regular monitoring of patients and the remote provision of medical consultation, with an emphasis on preventive medicine. It also facilitates both the medical care of people who reside in isolated areas and individualized medical healthcare in combination with patients' safety [52].

The applications of e-Health contribute to the correct diagnosis, with the assistance of non-invasive systems that base their function on imaging. Thus, the sector of Primary Healthcare provision is re-determined and expanded, regionally and temporally, as well as with regard to the speediness, utilization easiness, availability, operability, possibilities of control and cost reduction, the degree of participation and awareness, combined with the improvement of service of the patients-users [53].

By utilizing e-Health extensively, the exchange of data is facilitated, while at the same time, standardized forms of communication are now created between health professionals. Primarily, however, a new status is given to the interaction and mutual cooperation of the doctor with the patient, which must, nonetheless, be governed by honesty, trustworthiness and confidentiality [54].

e-Health is a key component that the European Union also emphasizes in the setting of Europe 2020 targets [10]. As of 2011, the European Commission's Implementing Decision of 22 December laying down the rules for the establishment, management and operation of the network of national authorities responsible for e-Health (Decision 2011/890/EU) entered into force. The following year, the European Commission, through the Directorate-General for Health of the European Union, adopted common rules of procedure for the implementation of the e-Health network in European countries, aiming at interoperability and uniform evaluation [12]. Concerning the Member States of the European Union, according to a press release issued by the European Commission on the extent of e-Health in Europe, the use of e-Health systems has been generalized in most European countries. The pioneers are: Denmark, the Netherlands, Great Britain, Estonia, Sweden, Finland and Germany. More specifically, the countries that perform best in the implementation of e-Health in hospitals are Denmark (66%), Estonia (63%) and closely followed by Sweden and Finland (62%). In the digitization of medical files the best performance has been made by the Netherlands (83.2%), followed by Denmark (80.6%) and Great Britain (80.5%), while Estonia stands out (100%) in e-prescription followed by Croatia (99%) and Sweden (97%) [55].

In 2015, the top ten European States in e-Health applications between doctors and patients were as follows: Denmark, Finland, Spain, the Netherlands, Sweden, Estonia, Croatia, Portugal, Germany and France. The e-Health applications evaluated included physicians' ability to diagnose and prescribe electronically, the ability of health professionals to exchange data, make appointments with patients, and communicate with care providers, medical surveillance, patients' electronic information about their health and the ability to obtain valid information via the Internet [56].

In Greece, e-Health has experienced a rapid development in the last two decades. As contradictory as it may sound, the economic crisis following 2019 became an opportunity for the country to proceed to extensive changes in the National Health System. That was necessary since health expenditure had to be significantly reduced. In this context, e-Health applications were deemed very effective so that the country could secure resources for the repayment of foreign loans. According to the European Union data, per capita expenditure in the health sector in Greece in 2009 amounted to 2,287 Euros. That amount decreased to 1,650 Euros in 2015 [57], a sum which is 45% lower than the European Union average [58].

An additional pressure to the National Health System was given by the thousands of refugees who arrived in the country in the last few years. According to the data, only in the year of 2015, Greece in collaboration with NPO, provided medical care to approximately 870,000 refugees. The available data shows that, from the e-Health sectors, e-prescription has proved to be an essential factor towards expenditure restriction. It is estimated that in the time period 2009–2014, 3 billion Euros were saved thanks to intangible prescription [59].

The last pandemic of COVID-19 is expected to contribute even more towards the reinforcement of e-Health. In various countries, there have already been made and are currently functioning applications of tracking of contacts for cell phones. The said applications are installed voluntarily and, by using the Bluetooth technology, warn the users who were very close to a person affected by the virus for a period of time. In this way, it is possible to control the expansion of the infection more easily. Nonetheless, it is vital that the privacy and personal information of the users be protected, with the commitment from the national authorities that they will not make use of them and that they will deactivate the respective applications as soon as the pandemic has been overcome [60].

However, the way towards the direction of a smart and pervasive healthcare is still long both for Greece and the rest of the world. The only thing certain is that it is a one-way street. In our era, the era of the Fourth Industrial Revolution, e-Health is expected to experience an exponential growth in the years to come.

Unfortunately, in the case of Greece there are still no reliable financial data on the cost of implementing e-Health programmes and the benefits of their implementation. This is a significant lag in relation to the European reality, which is undoubtedly an obstacle on the further promotion of e-Health in Greece. The only reliable data that has been able to be found are based on research by the Association of Greek Industries which include as good practice the application of the National Network of Telemedicine in the remote Greek islands as well as the case of a public hospital, which is included in smart hospitals, i.e. those hospitals that have largely implemented the digitization of their services [61].

### **5. Conclusions**

e-Health can yield significant benefits to the society as a whole, contributing conspicuously to the accessibility and quality of the provided health services to the citizens who are in need of them. Furthermore, it helps towards the development of a National Health System with an anthropocentric orientation, founded on the viability of the health field, with the spreading of correct practices and the optimal exploitation of the available resources, both material and human. Moreover, e-Health is bound to increase the effectiveness and efficiency of the services provided by health professionals, thus contributing to the rationalization and reduction of expenditure.

The promotion of e-Health renders possible the provision of better care to more patients, releasing the institutional resources (of Hospitals, Clinics, Health Centers,

### *E-Health Applications for Smart and Pervasive Healthcare in Greece. What Can We Expect? DOI: http://dx.doi.org/10.5772/intechopen.95859*

Regional Surgeries) and limiting healthcare expenses. The new technologies provide various possibilities, readjusting the provided healthcare forms, depending on the individualized needs and expectations of every patient. Geographical distances are nullified and the provision range of health services is expanded, granting equal access even to residents of removed from the urban centers areas. This way, the citizens' feeling of their equal participation to the public commodities is consolidated, particularly to those who live in remote and isolated areas.

There are certainly several issues which must be resolved so as for e-Health to be reinforced. It is essential that all bodies concerned, and especially Leadership, realize the value and the advantages which derive from its utilization. It is also necessary that e-Health applications be more user-friendly. Above all, though, there must be ensured the confidentiality of the transmitted information and the patients' personal data. Only in this way will everybody understand that e-Health can really contribute towards the direction of a smart and pervasive healthcare.

In the case of Greece, it is necessary to have measurable results that prove in practice the benefits of implementing smart and pervasive healthcare. In addition, the Greek National Health System needs to adopt good practices, which are already successfully applied in other European countries, such as Denmark, Estonia and Finland.
