ELECTRONIC HEALTH RECORDS .an essential application of

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ELECTRONIC HEALTH RECORDS .an essential
application of
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MAIN
FOCUS
Strengthening of primary health care
Time saving
Cost-effective
Improves quality and patient safety
Reduces professional isolation
Takes specialties to primary health care
Improves outreach of education
-taking basic health solutions to countries
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MAIN
SOME
FOCUS
FOCUS
Strengthening of primary health care
Strengthening of secondary health care
Time saving
Cost-effective
LITTLE
Improves quality and patient safety
FOCUS
Reduces professional isolation
Takes specialties to primary health care
Home care
Improves outreach of education
-taking basic health solutions to countries
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e-Health for health-care delivery
QUALITY AND SAFETY Standards for patient care
information systems Standards for telematics
services
POLICY National coordination of e-health
services E-health for emergencies Adequate
resources
-taking basic health solutions to countries
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e-Health for health-care delivery
ACCESS Connectivity Software and hardware
standards
USE Appropriate technical use of e-health
services Store and forward image
exchange Tele-consultation E-learning
-taking basic health solutions to countries
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REQUIREMENTS
WHO PRODUCTS
-taking basic health solutions to countries
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SUCCESS CRITERIA FOR COUNTRIES

• Potential constraints to the use of e-HCD should
  be identified
• and addressed systematically
• lack of proper needs assessment
• lack of vision, strategy and national plans
• lack of information and awareness about e-HCD
  applications
• computer illiteracy
• insufficient resources to meet costs
• limited expertise in medical informatics
• weak information and telecommunications
  infrastructures
• absence of legislative, ethical and
  constitutional frameworks

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SPECIFIC RECOMMENDATIONS

• Assume the leadership role of in support of
  e-health activities in countries
• Prepare a draft list of success and
  sustainability factors
• Work with partners
• Conduct proper needs assessment
• Create a framework or methodology for assessment
• Country work should be based on a combination
  (matrix) of countrys expressed needs and
  situation and WHO partnership on eHealthHCD
  priorities

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• contribute to the establishment of comprehensive
  systems
• ensure the quality and safety of products and
  services
• develop mechanisms to promote universal and
  equitable access to health technologies
• formulate guidance on the rational, appropriate
  and cost-effective use of health technologies
• provide advice on possible sources of financial
  support
• develop relevant support products in the form of
  norms,
• standards, specifications, guidelines and
  training material

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Information and Communication Technologies in
the WHO European Region
52 countries
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SWEDEN OBJECTIVES
Support Hospitals and their services (financial
incentives to provide access to remote
areas) support PC connection to the www Support
local authorities with no real capacity to
develop the systems on their own support
patients and relatives in their own
environment, Support partnership with governments.
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NORWAY strategy
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-         Canada At federal level, national
information for e-health guidelines provincial
implementation. -         Barcelona Home care
support to citizens and families. -        
Baltic countries closing hospital facilities and
supporting primary care. -         RUS, Ankladesh
region being supported by NOR.
-         Canada At federal level, national
information for e-health guidelines provincial
implementation. -         Barcelona Home care
support to citizens and families. -        
Baltic countries closing hospital facilities and
supporting primary care. -         RUS, Ankladesh
region being supported by NOR.
-         Canada At federal level, national
information for e-health guidelines provincial
implementation. -         Barcelona Home care
support to citizens and families. -        
Baltic countries closing hospital facilities and
supporting primary care. -         RUS, Ankladesh
region being supported by NOR.
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E-Health in the Americas

• Current Status, trends and greatest challenges.

WHO, FEB 2004
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eHealth

• It became an international issue in many forum.
• It combines .
• Information Technology
• Electronics and Communications Engineering
• Medicine
• Education
• Biomedical Engineering
• Health Services Managment
• It is the result of the technological electronic
  developments applied to Health Care.
• Every field claims their part and no general
  consensus has been reached. There are enough
  pilot proyects, but we need urgently to evaluate
  cost benefit, effectiveness, appropiatness and
  readiness

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United States of America

• 60 total population has access to the Internet
• 86 adult Internet users access to research on
  health care or specific diseases
• Most e-Health companies have consumer-oriented
  portals
• Federal agencies with regulatory authority over
  eHealth
• Federal Trade Commission (FTC)
• Food and Drug Administration (FDA). 
• Non-governmental organizations have roles in
  e-Health issues
• Research and policy analysis
• Quality oversight
• Standards development
• Information dissemination
• American Telemedicine Association ATA.

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Canada

• Clarify coverage by distinguishing between direct
  and ancillary health services
• Provide stable, predictable and long-term funding
• Address immediate issues through targeted funding
• Rural and Remote Access
• to improve timely access to care in rural and
  remote areas
• Diagnostic Services
• to improve wait times for diagnostic services
• Primary Health Care Transfer
• to support efforts to remove obstacles to
  renewing primary health care delivery
• Home Care Transfer
• to provide a foundation for an eventual national
  home care strategy
• Catastrophic Drug Transfer
• to allow provincial drug programs to expand and
  improve coverage for their residents

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in the Americas

• Canada
• and the
• United States of America

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Application Samples
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e-Health in the Americas

• Latin America

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Critical Issues

• Health issues and costs obstacles to social
  economic development
• Inefficient allocation of scarce resources
• Mortality rates still high, low life expectancy
• Epidemiologic transitions
• Unequal access to basic health services
• Patient transfers / long waiting lineser niv
• Lack of coordination within health entities
• Low budgets / inefficient resource distribution
• Technology gaps
• digital, communications, transport,
• Cultural gaps

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Health Reform Process

• Diverse models, unique to each country
• Common trends
• Universalization of health services
• Administrative descentralization
• Involvement of other sectors
• private, education, labour, etc.
• Primary-care / people-centred health models
• Focus on quality and accountability
• Moving from reactive to proactive approach

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Succesful practices in Latin America

• Cuba, very good digital information
• Argentina, excellent hospital information
  systems
• Costa Rica, Telemedicine at the CCSS.
• eHealth platforms in Chile, Colombia, Cuba,
  Dominican Republic, México and Ecuador.
• Universities developing Health Care Software for
  all.
• And many more documented in the booke-Health in
  LA
• Mexico. Telemedicine systems at ISSSTE, 6 years
  ago, now new developments in universities and
  public health services.

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MexicoActual Hospital Infraestructureof the
Health Ministry
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Health Care Ministry Goals of 2000-2006

• Provide Health Services with
• Equity
• Quality
• Financial support for patients
• By Popular insurance to all open population
• 45 mill of the lowest income, more marginality
  and less infrastructure.

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Mexico strategic lines 2004-2006

• E Health portal
• Comunitary Health Centers for internet
• Develop the National Telemedicine System
• 10 National institutes of Health
• 16 states with 9 nodes of telemedicine each
• Share and use all the infrastructure available
• Public, and Social Health Sectors,
• Universities private and public
• Special fundings and ONG Institutions
• Later on develop latin american liasons and
  coordination
• Develop the standards for radiology, clinical
  lab, HIS,

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Regarding information

• E Health portal
• Designed to provide information to
• Patients
• Chronic
• New detected
• General Public
• Children, women, old, general adults
• Health Providers
• Health Professionals
• Nurses
• Doctors
• Technicians
• Administrators
• Engineers

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Mexicos eHealth
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Electronic Medical Record approved august 2003

• Mexican Official Standard 168 allows use of
  electronic devices for medical records
• Accessible
• Confidential
• Secure

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• 5. Stablish the models to develop internal
  networks for imaging patient data.

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8. Proposals and models for hospital networks
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Review standards

• Develop HL7 specifications that will enable
  healthcare information systems to exchange,
  manage and integrate clinical and administrative
  data according the legal and regulatory issues in
  Mexico.
• DICOM
• IEEE EMBS
• CID

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Security concerns - Driving the demand for
solutions
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Knowing who you are dealing with remains a major
concern for e-health services on the Internet
but in e-health, it is important to Know if you
are dealing with a dog.
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Some E-health Security Threats

• Knowing that the person behind the computer (or
  IT equipment) is a real doctor and/or an
  authorized medical personnel.
• Being sure of the source/origin of medical
  information transmitted via the Internet.
• Access control to sensitive medical information
  (e.g. computerized patient records).
• Ensuring that e-health transactions can be bound
  to authorized medical personnel/institution (e.g.
  for remote diagnostics and medical advice).
• Securing the transmission of sensitive health
  information between connected collaborating
  medical institutions (e.g. in e-health networks).
• Making sure that medical records can only be
  modified by authorized personnel

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General Security and Trust Requirements

• Confidentiality
• Information accessed only by those authorized
• Data Integrity
• No information added, changed, or taken out
• Authentication
• Parties are who they pretend to be
• Non-repudiation
• Originator cannot deny origin
• Access Control/Authorization
• Originator cannot deny origin
• Infrastructure of trust
• Automating the checking of identities

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E-Health Security Requirements

• Authentication Establishing the Identities of
  all parties to an e-health transaction
• Access Control Making sure only authorized
  personnel/patient can access medical records.
• Non-repudiation E-health transactions must be
  binding.
• Data confidentiality Only the intended
  recipient of an e-health transaction or data
  should be able to view the content.
• Data Integrity Unauthorized modification of
  medical data must be detected.

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Landscape in security in E-

• Technology shifts in E- environment
• Ubiquitous computing (95 / 5)
• Mobile devices wearable computing
• Wireless communications
• Peer to peer applications
• Global wide area communications
• Multimedia high bandwidth applications
• Nano technology
• Complexity shifts in E- environment
• Complexity of identification, authentication
  access control
• dynamic staff, contractors, visitors, and
  collaborators turnover
• Complexity of managing information security risks
  in the distributed and autonomous global
  infrastructure
• Reliance shift in E- environment
• High demand for business continuity against
  failures and accidents in E-

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Landscape in security in E-

• Paradigm shifts in E- environment
• Unbounded System
• No unified administrative control
• No global visibility
• Un-trusted insiders
• Lack of complete timely information
• Open, highly distributed systems
• Unknown participants
• Unknown perimeters
• Unknown software components

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Landscape in security in E-

• Threats with increasing impact in E- based
  society
• Exposure misuse of confidential private
  information
• Identify theft
• Modification of critical data
• Denial of services Spam messages
• System compromise base for launching attacks
  against other systems
• Financial fraud
• Industrial espionage
• Legal loss liability on the Internet
• Loss of reputation user-confidence
  Embarrassment
• Utility (e.g. electric grid power) failure and
  natural disaster
• Terrorism
• through
• Disclosure, modification, loss/destruction and
  interruption of information resources services

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Trends in Security Incidents Reported at CERT
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Trends in Security Vulnerabilities Reported at
CERT
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Why E-health security?

• E-health uses ICT, like other E- Security
  threats exists for
• Administration
• Hospital information system
• Telemedicine
• Medical records database DNA analysis
  databanks
• Medical instruments, devices robots (tests, CT,
  surgery)
• Emergency room
• Home care monitoring
• Education
• Pharmaceutical information system prescription
  drug network
• Health information on the Internet
• Health insurance system
• Need to protect CIA credibility of ICT
  infrastructure information
• Need to protect human life, privacy, dignity,
  quality of life, social well being

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Existing efforts

• International
• ISO TC215 WG4 Health Informatics Security
• ISO standards ISO/IEC17799
• IMIA WG04 Data Protection in Health Information
  Processing
• USA
• HIPAA Final Rule (20 Feb 2003)
• SEI SSE-CMM Capability Maturity Model
• NIST 800 series
• EU Asia Pacific
• E-government projects

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WHOs view

• Information security assurance program
• Risk assessment monitoring
• Policies, procedures, standards, guidelines, best
  practices development compliance
• Protection methods architecture
• Awareness training
• Information security organization

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Goals

• To achieve
• Security
• Confidentiality, Integrity and Availability
• Assurance
• Business continuity, disaster recovery, quality
  of services
• Survivability
• Survivability is the capability of a system to
  full-fill its mission, in a timely manner, in the
  presence of attacks, failures, or accidents,
  CERT Coordination Centre, IEEE

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Benefits

• No such standards exists today
• WHO initiatives
• Services to countries
• Manageable project
• Learning experience
• Establish better relationship
• Better understanding of problems
• Best awareness program
• Improve information security in E-health for
  countries

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CONTACTS Dr. Steffen Groth groths_at_who.int Ms.
Irma Velazquez velazquezi_at_who.int www.who.int/eh
t/ehealthHCD
-taking basic health solutions to countries