eHealth Across Europe

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eHealth Across Europe

• Niels Rossing, M.D.
• Centre for Health-Telematics, Denmark
• nr_at_health-telematics.dk
• www.medcom.dk

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Supranational Bodies

• Int.Telecom. Union
• Standards Developing countries -satelites
• WHO
• Content and strategies Develop. countries
• European Space Agency
• Connectivity satelli
• tes
• EU i2010
• Interoperability across borders patient summary
  
• Makes it happen

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The European Region

• approx. 870 million people in 53 countries
• annual expenditure on health per capita differs
  by a factor of 100
• life expectancy differs by 10 years

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3 Groups

• EU15 EFTA countries (legacies)
• long established health systems ? hard to change
• resource rich national funds
• cross-border interoperability, change management,
  patient safety
• EU10 4 accession countries (leapfroggers)
• not bound to legacy health systems ? quick
  adoptors
• resources medium ID and national funds
• Legal and ethical considerations
• Non EU Member States (pilots)
• not bound to legacy health systems ? not e-ready
• resource scarce ID funds ? little
  sustainability
• rapid, rather uncoordinated growth, unreliable
  utilities

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eHealth Prerequisites

• Enabling environment - policies and strategies
• Infrastructure - access to ICT
• Content - access to information and knowledge
• Capacity - human resources knowledge and skills.
  Cultural and linguistic diversity, and cultural
  identity
• National centres for eHealth
• eHealth systems and services

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WhyeHealth?
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eHealth to Fulfill Delivery Demands !!!

• Equal, ubiquitous and flexible access to services
• Empowering citizens and patients
• Improving quality by enabling professionals
• Community and Home Care
• Seamless care Chronic diseases account for 60
  of health care costs

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Industry Performance

• Health Care
• Medical records ? 5-10 misplaced
  
• Hospital transactions ? 2 or higher error
  rate
• Medication administration ? 7-10 error
  rate
• Appointment scheduling ? Give info each
  time

• Other Industries
• Federal Express ? 1/100,000 misplaced
• Banking transactions ? 1/10,000,000 error rate
• Plane landing/takeoff ? 1 in 1,000,000 miles
• Hertz 1 reservations ? Customer profile stored

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eHealth Tools Services
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eHealth Tools and Services

• Telehealth
• Patient Admin. Systems (PAS)
• Hospital Information Systems (HIS)
• General Practitioner Information Systems (GPIS)
• Electronic health records (eHR)
• National electronic registries
• (eg. Cancer, diabetes, blindness etc)
• National drug registries
• Directories of healthcare professionals and
  institutions
• Decision Support Systems (DSS)
• Geographical Information Systems (GIS)

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Service Provision Examples

• Citizen centered Care Seamless Care
• Equal Access
• Telecare including Tele-homecare
• Information Services Yellow Pages
• Surveillance and Early Warning Systems

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Ressource Generation

• Continuous Training by eLearning
• Tele-collaboration
• Change Management Strategies
• Evidence based practices
• Self Supporting Patient Groups
• Health Promotion

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Financing

• DRG
• Third Party Payer Systems
• Reimbursement
• Health Insurance Cards

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eHealth comprises

• Clinical applications including telemedicine,
  decision support with access to databases, vital
  signs monitoring and tele-homecare
• Generic and individualized professional education
  and training
• Information and education for the public
• Knowledge management
• Health services such as distance specialist
  diagnosis and treatment, IT assisted home-care,
  distributed imaging, ePrescribing.
• Health related research
• Health care administration such as cost
  reimbursement, patient and professional
  identification
• Sharing information and experiences between
  professionals and patients in both closed and
  open groupings

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The Real Challenge

• Not the Technology
• but
• The People

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The Internet Threat to Established Systems

• Globalization may lead to
• Loss of national/regional autonomy
• Shift of power and roles for professionals and
  decision makers
• And may keep us from reaching out to the World
  for solutions and support

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Change is Needed

• BUT Systems of the past are hard to change.
• It is easier to start from scratch.

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Barriers (You know them all)

• Confidentiality
• Ethical
• Organisational
• Economic
• Lack of infrastructure, etc

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The Political and Professional Concerns

• From Local via Regional to Global Interaction
• Will I lose my grip and who will take over?
• Infrastructure ?
• Who will pay?
• Who is responsible and is it safe?
• Changes may destabilize the care delivery. How do
  we reorganize?

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Industry and Vendors

• Industry and vendors are
• Frustrated from
• Broken promises and expectations
• No international market penetration
• Bottom figures in red
• Scared and non-responding to user needs
• Stick to easy solutions and proprietary systems

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Other Requirements

• Political Will
• Championship
• Adherence to Standards
• Coding, Classifications,
• Nomenclature SNOWMED CT
• Investment
• Sustainability

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The time is right

• Technological Opportunities
• Digital revolution
• Computing power
• Smart devices, sensors, nanotechnology,
  imaging/visualization, etc.
• Biological revolution
• Tissue engineering, advanced materials, genetics,
  genomics, proteomics, etc.
• The ability to put all this together is key!

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Universal Access

• Access by any (authorized) user to (appropriate)
  digital content and information from anywhere
  and at anytime
• Utopia?
• I dont think so!
• Difficult?
• Yes, definitely!
• We need to develop appropriate methods and
  tools Thats why we are here!

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Drivers for Change

• EU accession
• aging population ? chronic conditions
• educated and demanding and mobile citizens
• demands of higher quality of care consumerism
• foreseen shortage of health professionals
• rising costs of care
• increases in capacity /decreases cost of
  technology
• Non-EU
• prevalence of communicable diseases
• need for early warning systems
• decaying physical and organizational
  infrastructures
• capacity building / threat of professional
  brain-drain
• data, info, knowledge on performance, cost,
  quality

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Basic Principles

• Implementations must be need driven
• Realistic Budget including training
• Change Management
• User Involvement
• No isolated information islands
• Follow Standards

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Data Security, Ethical, Legal Considerations

• Council of Europe- Rec(2004)17
• EU Directive on Data Protection 95/46
• OECD, WHO
• Recommendations on Use of Internet
• Infrastructure Connectivity
• Adherence to Standards

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What is The EU Issue?

• The EU treaty claims free movement of
  people,goods, labour and services
• Citizens want access to health data and services
• Transparency on cost, quality and options
• eHealth can engage people in making decisions

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EU

• eEurope 2005 Document IST for All
• General
• Secure services, applications and content over an
  interoperable broadband infrastructurefor a
  number of sectors including
• Healthcare
• Health cards, health information networks,
  on-line services

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i2010
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EU Interoperability

• e-Inclusion and 7thFP
• Interoperability via
• Patient Summary
• eMedication and Prescription
• Emergency Data
• ID-Management
• i2010 working group and stakeholder group

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Necessary actions EC/MS

• Collecting feedback on national/regional roadmaps
  and MS responsibilities in area of
  interoperability
• Define a working relationship with the different
  WGs Technical group, User/professional group,
  Industry group
• Facilitate the work of the WGs in relation with
  their national ministries (ICT, Health)
• Analyse the input from the different WGs and
  issue recommendations in the field of
  interoperability
• Assess the opportunity to transfer to regulatory
  fields (e.g. DG ENTR, DG SANCO) any
  recommendations formulated by the projects

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Hot spots

• Norwegian Centre for Telemedicine
• England (delivery problems identified)
  6.2billion procurement
• France Cards and ambitous EHR goals
• Nordic Countries Interoperabable regional
  infrastructures
• The New Member States
• And others

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The Paradigm ShiftThe Impact

• Healthcare Professionals
• Healthcare practices - changing roles
• Healthcare training
• Financial remuneration/rewards
• Healthcare vocation
• Patient
• Partners in the healthcare process

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The Ultimate Impact

• Distributed Hospital Service
• The Virtual Hospital
• Less bricks and beds,
• full staff in specialized functions
• Deconcentrated care
• The Informed and co-responsible patient

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Methods and technologies
User-needs investigation Decision-making
support Technology validation
assessment Security confidentiality
Grid technologies Data acquisition
systems Standardised vocabularies Data text
mining Knowledge representation Modelling
simulation
Clinical practice research




Genomic proteomic research



BI
MI




DB integration, management exploitation Algorith
ms for comparison prediction
Taken from BIOINFOMED white paper
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Understood that

• eHealth is a tool which should be used where
  appropriate

The aim is Health, not eHealth
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Thank you for Your attention