???????????? ????? ?????? ???????????????

1
???????????? ????? ?????? ???????????????
???????? ? ??????????? ??????????? ???? ??
????????? ?????????????-???????????? ?????????? ?
??????????????? (e-Health) ? ??????????? ????
????????-(Modernizing our Healthcare Systems
the German and European Timetable for eHealth
and Health Cards)

• Dr. Gottfried T.W. Dietzel, LL.M.
• eHealth Consultancy Meckenheim/Bonn-Berlin,
  former EC-DG Sanco, Head of Telematics - BMG,
  Germany, Co-ordinator EHTEL Healthcare
  Authorities Group
• ??????? ?. - ??-???????? ???????????????
  ?????????? ??????????? ?????????? - EHTEL (????,
  ????????)

2
(No Transcript)
3
1. wrong medication (44)2. not treated
correct due to missing information (25)3.
wrong treatment or wrong surgery
(24)4. patients werent expected due to
agenda errors (18)
Categories of errors in NL (Beun-Nictiz)
4
Patient oriented Health Care in the Future
Networks
Patient Empowerment

• Internet based eLearning
• Individual Coaching and Health Education
• Access to own data (EPR)

Telematic Applications eHealth Transparency
Quality
Management
Cooperative Disease Management
Services, Products Treatment Procedures CME,
using eLearning
Sustainable
Finance System
Integrated seamless Care
New Approaches of Solidarity
Ó
5
Services and Applications of Health Telematics
6
Social Code Book V 67 Electronic
communication 68 Promotion EHR 290 PDC in
telematics
Plan
Release of e- cards Jan 2006
Legislation 2003
Evaluated, successful test stages 2005
Framework architecture/ specifications 2004
Milestones
Status
Release of e- cards 1 Q 2007
Legislation 2003
Framework architecture/ specifications 2004
Evaluated, successful test stages 1-3 Q 2006
7
Legislation concerning the electronic health card

• Patients rights and data protection are
  ensured by the law through
• informed consent
• read access rights
• access regulations (HPC/logging)
• prohibition of misuse of data
• prohibition of seizure

• The electronic health card with microprocessor
  chip has to be technically suitable for
• storing of patient data
• authentication
• encryption
• digital signature

8
Legislation - mandatory and voluntary part

• Mandatory part
• administrative data
• co-payment status
• electronic prescription
• European standards for use of medical services in
  other EU member states (E-111 form)

• Voluntary part
• drug documentation
• emergency medical data
• patient receipt
• electronic patient record
• patients own data storage area

9
Economic Effects I
The general view 20 40 of the services
provided in the health care system are data
collection and communication services. If they
are organized more efficiently (efficiency factor
2) this will lead to savings of 35 billion
Euro per year in Germany.

10
Economic Effects II
View of a priority area (electronic prescription
and medication management) The e-prescription
reduces the processing costs of every
prescription from 0,34 to 0,07. With 750
million prescriptions this means annual savings
of 183 million . 4 of the length of stays in
hospitals are going back to serious adverse
reactions of pharmaceuticals thus causing health
care spendings of 2,5 billion (in addition
there are also the economic costs). If
incompatibilities and undesired side-effects can
be reduced by interaction checks it will be
possible to save 1,25 billion per year within
the health-related budget (economic savings not
included).

11




Ensure that primary and secondary health care
providers have health telematics infrastructure
in place including regional networks




.
Best practice
in
electronic health services
in
Europe
identified and disseminated
benchmarking criteria set
Trailblazer for health cards
.
Establish a set of quality criteria for
health-related websites. Establish health
technology and data assessment networks.
12
(No Transcript)
13
A European health insurance card will replace
the forms currently required for receiving
medical care in a different member state - E 111
- (Decision by the European Council in
Barcelona). The Commission will support
the development of common concepts for - patient
identification - standardized architecture for
electronic patient records - the inclusion of
emergency patient data on the cards. (Decision
by the European Council in Sevilla, emphasized
again in the Commissions Communication on
eHealth of April 30, 2004 eHealth Action Plan)
14
European Health(Insurance)Card (Barcelona)
15
Evolution of EUROPEAN UNION RTD Programmes in
H E A L T H T E L E M A T I C S
FUTURE
PAST
10 years (2001-2011)
10 years (1991-2000)


to
from

KNOWLEDGE
INFORMATION






for Health
for HealthCare
for HealthCare
for Health




1989-1990
1990-1994
1994-1998
2002-2006
1998-2002
2006-2010
2010-2014
Information/Comm.
Information/Comm.
Technologies
Technologies
Bioinformatics /
Bioinformatics /
RESEARCH
RESEARCH
Genomics
Genomics
Neuro
and Social
Neuro
and Social
Sciences
Sciences
_at_
National and Regional Plans
National and Regional Plans
Inter-cooperation
Inter-cooperation
(EMEDIS/MEDA, EU-Canada
(EMEDIS/MEDA, EU-Canada
Telemedicine
Telemedicine
Group)
Group)
e
e
Europe / Health Online
Europe / Health Online
e
Health /
e
Commerce
e
Health /
e
Commerce
IMPLEMENTATION
IMPLEMENTATION
Ten Telecom
Ten Telecom
DG INFSO B1
16
Communication COM(2004) 356 final e-Health
making healthcare better for European citizens
An action plan for a European e-Health Area

• e-Health action plan main areas of activity
• Addressing common challenges selected examples
• Best practices collection (EC, 2005)
• National/regional roadmaps (MS, 2005)
• Common approaches for patient identifier (ECMS,
  2006)
• Interoperability standards for EHR and messaging
  (ECMS,2006)
• Boosting investments in eHealth (MS, 2007)
• Deployment of health information networks (MS,
  2004-2008)
• Including broadband, wireless, grids
• Legal framework, certification of qualifications
  (ECMS,2009)
• Many success stories presented at eHealth
  Ministerial Conferences and Exhibitions (2003,
  2004 2005) and related publications best
  practice studies http//www.ehealth2005.no/

17
eHealth Action Plan 1(Comm 356 paragr.
4.2.2.1.)

• By end 2006, Member States, in collaboration with
  the European Commission, should identify a common
  approach to patient identifiers. This should take
  account of best practices and developments in
  areas such as the European Health Insurance Card
  and identity management for European citizens.

18
eHealth Action Plan 2(Comm 356 paragr. 4.2.2.2.)

• By end 2006, Member States, in collaboration with
  the European Commission, should
• identify and outline interoperability standards
  for health data messages and electronic health
  records, taking into account best practices and
  relevant standardisation efforts.

19
eHealth Action Plan 3(Comm 356 paragraph 4.2.1.)

• By end 2005, each Member State is to develop a
  national or regional roadmap for e-health.
• This should focus on deploying e-Health systems,
  setting targets for interoperability and the use
  of electronic health records,and address issues
  such as the reimbursement of e-Health services.

20
Memberstates Activities (applications or
identification oriented)

• EPR orientation
• Great Britain

• Identification orientation
• Austria

• Card enabled networks orientation
• Slowenia
• France
• Germany
• Netherlands

21
Common Issues

• Streamlining/Institutionizing the still
  prevailing bumpy road (Russia) to ehealth Systems
• Interoperability
• Nationally prioritized Migration Concepts
  (starting with electronic prescription and drug
  management systems)
• European standards for the crossborder use of
  medical services (migration from E-111 forms and
  current eye visible cards to an advanced eHealth
  Card)

22
Lessons Learned General Experiences

• 1) Project duration usually longer than expected
• 2) Start with applications providing immediate
  benefits
• 3) Design intelligent update migration processes
• 4) Decision weakness of needed partners
  (Selbstverwaltung in Germany)
• 5) Conflict of interest of Payers and Healthcare
  Providers
• --gt Impact on System Architecture
• 6) Take customers with you immediately

23
Lessons Learned - Recommendations

• 1. Set Priorities right
• - have a vision, but start not only with new
  tools but with beneficial applications
  (ePrescription, medication management)
• - assure interoperability (consistency to
  ISO-standards, links to general telematic
  infrastructure/platform)
• 2. Design intelligent update migration processes
  (link cards to network solutions, go from drug
  documentation and discharge letters to Electronic
  Patient Record)
• 3. Advantages for patients must be immediately
  visible (assure patient orientation, not only
  financial benefits, design and promote acceptance
  programmes).

24
Thank you for listening to my visions regarding
the development and implementation of
eHealth eHealth_at_dietzel.net