The rise of telehealth in the European Region: insights from Norway

Forty countries in the WHO European Region either have a national telehealth strategy or include telehealth in a broader digital health strategy - with teleradiology, telemedicine and telepsychiatry being the most used telehealth services across the Region, a new study finds. The study, carried out by WHO/Europe and the Norwegian Centre for E-health Research, based on a 2022 survey, uses Norway's experience as an example of progress made and challenges faced in telehealth development among the 53 Member States of the Region following the COVID-19 pandemic.

WHO defines telehealth as the delivery of health-care services, where patients and providers are separated by distance. This can include consultations through video conferencing, remote monitoring using wearable devices or management of chronic diseases through mobile health apps. Telehealth can contribute to achieving universal health coverage by improving patients' access to quality and cost-effective health and welfare services, irrespective of where they are, making it an accessible option for those living in remote areas and for people with disabilities.

Since the onset of the pandemic, countries in the European Region have experienced rapid advancements in the adoption and use of telehealth and other digital health solutions. The regional survey shows teleradiology leading the way, with 84% of countries reporting its use. Telepsychiatry and telemedicine are also increasingly popular, with 51% of countries offering telepsychiatry and 77% providing telemedicine or remote patient monitoring services.

Norway leading by example

Norway has demonstrated significant advancements in telehealth, particularly in response to the COVID-19 crisis. The country has been a leader in teleradiology, a service well-established for over 30 years, and has also seen a rise in telemedicine and telepsychiatry usage.

Recent innovations include the integration of artificial intelligence in image analysis, which is expected to enhance diagnostic accuracy and reduce waiting times in radiology departments. Norway has also made permanent regulatory changes to support telemedicine, such as allowing e-consultations for issuing sick leave certificates, which was legalized in 2023. Moreover, digital platforms like eMeistring, which provides online therapy support, have become crucial for delivering mental health services.

Barriers and solutions

While Norway and other countries of the Region have made strides in telehealth, funding, infrastructure and human resources were identified as key barriers to increasing uptake and implementation across the Region. In addition, telehealth programmes often lack systematic evaluation, which is essential for determining whether a technology is safe, cost-effective and appropriate for local context and needs.

Only 37% of countries reported evaluating their telehealth services. In Norway, a trial on digital home monitoring for chronic diseases demonstrated improved patient safety and a reduction in hospital readmissions. However, the trial also highlighted concerns over cost-effectiveness, as new telehealth services require substantial operational resources.

Telehealth, including Norway's initiatives, continues to prove its value as an essential tool for health-care access, offering promising solutions for equitable and efficient care delivery across the Region. At the same time, survey results and Norway's experiences underscore the need for comprehensive telehealth strategies, integrating legal, financial and infrastructural support to ensure the sustainability of digital health services.

The "Regional digital health action plan for the WHO European Region 2023-2030" seeks the implementation of horizon-scanning and landscape analysis to identify solutions that are patient-centred and can be scaled up at country or regional level. As countries continue to refine their telehealth services, regular evaluation and alignment with broader health policy goals will be essential. WHO/Europe's 2024 "Support tool to strengthen telemedicine" aims to help countries enhance their telemedicine services at different levels, from individual health facilities to nationwide health systems.

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