Hans van den Heuvel

2 covered by the respective social security system. Difficulties arise on liability and creating uniformed rules in the European Union, as Member States have very intrinsic differences in national rules on health care, privacy and liability. One advice would be for each Member State to provide a legal framework for telemedicine, while the role of the EU would be limited to regulation 108. The costs associated with development, purchase and maintenance of e-health equipment have dropped in recent years due to technological advancements. 107 Primary investments to implement e-health in perinatal care are now attributed to personnel costs for both providers and technical support. However, to deliver care with the help of e-health can also create savings on personnel costs and clinic visits. A systematic review of economic evaluation in telehealth solutions concluded that 29 out of 39 studies (74%) reported cost- effective, economically beneficial e-health interventions in different conditions and diseases. The conclusion highlighted the fact that many studies did not report all recommended economic outcome items leading to inconsistent analyses. 109 The challenges for reimbursement are delaying the widespread adoption of e-health in all ranges of sections of hospital care. Coverage is fragmented, varying at level of country, within hospitals in the same country and within different specialties of health care. 29 Health insurance companies seemto be inclined to cover onlywell researched e-health interventions with according economic evaluations. The use of low-risk, inexpensive care models can operate as opportunities to objectify possible reduction in health care costs. Successes will motivate policy makers and drive the insurance market for additional coverage. Rigorous medical evidence can act as an extra stimulant, however the duration and costs of designs and trials need to be taken into consideration. 107 Table 3. Advantages and disadvantages of e-health implementation in perinatal care Advantages Disadvantages Indistinct Patient satisfaction Reimbursement issues Impact on health outcome Patient engagement Legal issues Impact on costs Fewer clinic visits Technical issues Limited A-level evidence Clinician satisfaction Remote monitoring Access to care in low- and middle-income countries Conclusion and future perspectives This review provided an overview of e-health as the next generation perinatal care. Table 3 provides a condensed summary of the advantages (as described in Principle findings) and disadvantages (as described in Additional considerations) of the implementation of e-health in perinatal care. If e-health is to achieve its full potential, it should attain all domains of quality in care including safety, timeliness, effectiveness, efficiency and patient centeredness. LITERATURE OVERVIEW OF E-HEALTH IN PERINATAL CARE 29