Ilias Iakovidis PhD

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EU eHeath Agenda

• Ilias Iakovidis PhD
• Deputy Head, "ICT for Health Unit
• Information Society Media DG
• European Commission

http//europa.eu.int/information_society/activitie
s/health/index_en.htm
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eHealth for Sustainability

• Efficiency productivity to do more with less
• From hospital-based to patient-centred care
• From late disease to early health
• Two main areas
• Preventive medicine
• Chronic disease management
• Empowering the patient (training, monitoring ..)
• Predictive medicine
• Molecular medicine
• eHealth for the economy Lead Market sector

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EU World Leader in deployment in primary care
(EC Study 2007)
87.4
80
69
66.1
62.5
62.3
55.2
44.4
15.1
13.9
2.7
0.9
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GPs Electronic exchange of patient data by
purpose (selected countries)
Lab results from laboratories Admin data to reimbursers Medical data to care providers / professionals Admin data to other care providers Prescription to pharmacies Medical data cross border
EU27 39.8 15.1 10.3 9.7 6.3 0.7
BE 73.5 2.5 12.9 12.9 1.6 0.9
BG 5.3 9.7 3.4 5.8 2.4 1.0
DK 96.2 47.9 73.6 74.0 97.3 1.9
EE 39.3 5.3 1.3 1.3 0.7 0.0
NL 83.8 45.4 26.0 27.5 71.0 4.7
FI 90.0 7.6 54.8 20.8 0.4 0.4
SE 82.4 8.2 13.1 15.7 80.9 1.5
UK 84.9 43.2 26.5 31.5 5.1 0.4
NO 88.2 18.6 34.8 25.5 2.9 0.5
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008
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National Priorities Preliminary Analysis
Priorities in national eHealth Strategies of Countries Examples
Electronic Health Records EHR, EPR, Medical Records, Patient Summary, Emergency Data Set 17 DMP - Dossier Médical Personnel (FR) BEHR - Basic Structure for the EHR (DK) NHS Care Records Service / Spine (UK), Patient summary (SE, FI) SumEHR (BE), eGP file (NL)
Infrastructures Networks Broadband communication networks and associated technology and basic services 12 MedCom the Danish Healthcare Data Nework (DK) Sjunet (SE) National Health Network (NO) National eHealth VPN (DE, AT)
ePrescription Management and implementation of ePrescribing 16 Apotheket (SE) ePrescription (DK, NL, SI) eRezept (DE)
http//www.ehealth-era.org/
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Wishes vs. Reality
Number of EU Countries
ePrescription
National Priorities
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eHealth worksOptimal results when eHealth tools
when combined with proper organisation and skills

• National and Regional Health information Networks
  improve quality, efficiency, and will save next
  year 80 Mil/year in Denmark (Medcom) and 60
  Mil/y in Czech republic (IZIP)
• ePrescription improves patient safety, saves 70
  Mil/y in Sweden
• Personal Health Systems and Telemonitoring can
  provide care at the point of need, reduce length
  of hospitalisation (by 20 - 40 for heart patient
  in UK)
• Direct Online information Services such as NHS
  Direct online empower patients, avoid
  unnecessary hospitalisation, support lifestyle
  choices, save 110 Mil/year

www.good-ehealth.org
www.eHealth-impact.org
http//www.epractice.eu
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Ideas for ActionCommission, National/Regional
authorities, Health Professionals associations,
Industry

• Collect and promote the evidence of eHealth
  benefits
• Demonstrate Scalability of solutions focusing on
  the interoperability, reliability, speed and
  security (privacy enhancing technologies).
• Create conditions for global market development
  and innovation e.g.
• Business models, user incentives, skills
  development
• legal and regulatory framework
• financing and procurement - towards innovation
  friendly eHealth market

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EU eHealth agendaPast RD activities Current
policy and support to deployment
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eHealth in European Commission

• DG INFSO eHealth research, policy and support to
  deployment
• Directive on Information society services,
  Communication, Recommendation on Interoperability
  
• DG SANCO Information to patients / citizens
  (portals)
• Directive on patients rights (Art 16 on
  eHealth)
• White paper on health strategy, patient safety
  Communication
• DG ENTR
• -Pharmaceuticals Innovation and Legislation
• Lead Market Initiative, standardisation
• DG JLS EC/45/96 on Privacy protection, WP 131 on
  EHR (Art 29)
• DG MARKT Professional recognition, e-commerce
  directive
• DG RTD IMI, Clinical research, System Biology

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Towards eHealth Deployment Step 1 Health
Information Networks Connecting providers
Messaging, EHR, HP tools, on line services
Emergency
Hospital
GP
Pharmacy
Health Centre
Secure Networks
Region 3
Mobile, Wireless Broadband
mobile PC
Region 2
Region 1
Mobility
Home
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www.medcom.dk
Estimated cumulative benefit by 2008 1.4
bil.
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Competitiveness Innovation Programme Policy
Support Programme (CIP ICT PSP)

• Large Scale Pilot (epSOS)
• 23 beneficiaries, 12 countries
• 6 national Ministries of Health
• 15 Competence Centers
• 31 companies through IHE-Eur
• 11 Million EC funding
• 36 months

• Thematic Network on eHealth Interoperability
  (CALLIOPE)
• 27 beneficiaries
• 30 months
• 500k EC funding

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Implementation, support to policies epSOS
Approach and Expected Outcome

• One large Scale Pilot
• Patient summary for unexpected care
• ePrescription/medication records
• With a common architecture
• Built on Member States solutions and users
  needs (bottom up)
• Thought as long lasting solution at European
  level
• Scalable and sustainable, adaptable to new
  situations

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Interoperability across bordersLinking basic
information between patient summary systems or
giving access to physicians to patient summary in
your home country
Direct access of physicians when legal
Patient Summary 1
Patient Summary 2
Secure Networks
Country or Region 2
Country or Region 3
Country or Region 1
Mobility
Standardised exchange/access to common data sets
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EC Recommendation on Interoperability of cross
border electronic health record systems
COM(2008)3282

• Aims at enabling coordinated care by connecting
  people, systems and services
• Provides Member States and relevant bodies with
  basic principles to address the existing
  challenges in implementing EHR interoperability
• Identifies different levels of actions
• Political, Organisational, Technical, Semantic,
• Important issues standardisation, certification,
  conformance testing, education and awareness
• Need for concerted action among all Member States!

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A Communication on TelemedicineOctober 2008

• Telemedicine experiences exist nation and Europe
  wide
• Increasing deployment due to
• Technical reasons Broadband, personal health
  systems
• Financial reasons Moving patients from hospitals
  to home solutions for chronic disease management
• Other reasons
• Geographical, Patient empowerment, Involving
  family in care process, Elderly people, Skill
  shortage
• Challenges legal environment, reimbursement,
  business models, evidence, acceptance, awareness,
  technical

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EU Wide Strategy
5. Telemedicine Communication - COM(2008)689 final
4. EC Recommendation on EHR Interoperability
(2008)
3. Lead Market initiative for Europe (eHealth)
2. I2010 flagship initiative - ICT for Ageing Well
1. eHealth Action Plan - COM(2004)356 final
ec.europa.eu/information_society/activities/health
/policy/index_en.htm
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eHealth Market in EU

• Potential
• eHealth is currently the fastest growing industry
  of health sector, estimated at 20 Billion, 2
  of Health expenditure
• Other EU markets Pharma 205 Bill.,
  Medical Technology 64 Bill.
• By 2010, a double digit growth rate of up to 11
  is foreseen for eHealth, driven by a search for
  more productivity and performance (source
  Datamonitor 2007)
• Challenges
• Standardisation
• Interoperability
• Business model financing

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Lead Market Initiative
4 main barriers to eHealth market development

1. Market fragmentation, lack of interoperability
2. Legal Uncertainty
3. Lack of availability and access to finance
4. Lack of procurement

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CIP ICT-PSP Call 3 2009
ICT for patient-centered health service

• Proposed Funding Instruments

1. Pilot A
2. Thematic Network
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CIP ICT-PSP Call 3 2009 ICT for patient-centered
health service

• Conditions and characteristics
• To focus on at least one of the following chronic
  conditions Cardiovascular Diseases (CVD)
  Chronic Obstructive Pulmonary Disease (COPD)
  Diabetes.
• To target 6 to 8 healthcare providers (regional,
  local healthcare authorities). Regional
  healthcare authorities should obtain endorsement
  from their corresponding national ministries to
  participate in the pilot.
• Support is focused on measuring the effectiveness
  and scaling up

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EU eHealth agenda Next steps
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Factors determining a health status of an
individual population
? Quality/Efficacy of Healthcare services ?
Lifestyle what we eat, drink, breath, ?
Physical and social environment ? Genetic
blueprint /profile at birth ? Acquired genetic
changes ICT important tool for all
factors! (not only health delivery systems)
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Towards eHealth Deployment Step 2 Connecting
individuals with providers/Health Information
Networks
GP
Pharmacy
Hospital
Emergency
Health Centre
Secure Networks
Region 3
Mobile, Wireless Broadband
mobile PC
Region 2
Region 1
Mobility
Home
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Towards eHealth Deployment Step 3 Seeing the
full picture of individuals health status
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New Options for Disease Management
Philips Presentation
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ICT for Health Unit support for Research
development (FP7)

• Personalisation of Healthcare
• Personal health system
• 72 Million (M) in 2007, ( 63 M in 2009)
• Patient safety-avoiding medical errors
• 30 M in 2007, ( 30 M in 2009)
• Predictive Medicine Virtual Human
• Modelling/simulation of diseases
• 72 M in 2007, ( 68 M in 2009)

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Annex
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Terminology

• Computers process - data
• Humans interpret data and obtain - information
• ICT for Health solutions include products,
  systems and services for health authorities,
  professionals, patients and citizens that support
  improvements in health care (access, quality,
  efficacy/efficiency) as well in education and
  research.
• Synonyms eHealth, Health Informatics, Health
  Telematics
• Telemedicine is a category of eHealth systems
  services

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eHealth (ICT for Health)

• 1. Clinical information systems
• a) Specialised tools for health professionals
  within care institutions
• b) Tools for primary care and/or for outside the
  care institutions
• 2. Telemedicine systems and services
• 3. Regional/national health information networks
• and distributed electronic health record systems
  and associated services
• 4. Secondary usage / non-clinical systems
• a) Health education and health promotion of
  patients/citizens
• b) Specialised systems for research, public
  health

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Definition agreed with the eHealth Industry
Stakholders Group reporting to the i2010 sub
group on eHealth
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EU GPs using a computer during consultation, in
(EC Study 2007)
100
Random samples of 6,789 GPs in 29 countries
66
3
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008
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Access to broadband in practices
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008
34
Connectivity to other GPs
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008
35
Use storage of medical patient data
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008
36
IT use among primary care physicians in seven
countries
37
GPs connected to secondary healthcare(hospitals
and/or specialist)
38
Electronic exchange of data for at least one
purpose
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Connectivity to specialists
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008
40
Connectivity to hospitals
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008
41
Connectivity to health authorities
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008
42
Link to insurers (reimbursers)
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008
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GP Attitudes towards ICT use in healthcare
Source empirica ICT and eHealth use among GPs
in Europe 2007, Bonn April 2008