eHealth Thought Leadership: A Way Forward Brussels, …content.linklaters.com/pdfs/insights/ehealth/03.pdf · eHealth Thought Leadership: A Way Forward Brussels, 17 June 2009 ...

••• 1••• 1

EU eHealth Agenda

Ilias Iakovidis

Deputy Head of Unit,

ICT for Health Unit, DG INFSO

European COmmission

eHealth Thought Leadership: A Way ForwardBrussels, 17 June 2009

Linklaters

••• 2

Individual Member States' strategies

22 countries have explicit

eHealth policy strategies

www.ehealth-era.org

eHealth in EU

ec.europa.eu/information_society/activities/health/policy/index_en.htm

••• 3

EU Wide StrategyEU Wide Strategy

1. eHealth Action Plan - COM(2004)356 final

2. I2010 flagship initiative - ICT for Ageing Well

3. Lead Market initiative for Europe (eHealth)

4. EC Recommendation on EHR Interoperability (2008)

5. Telemedicine Communication -COM(2008)689 final

ec.europa.eu/information_society/activities/health/policy/index_en.htm

••• 4

First step

Linking all the points of care Linking all the points of care Linking all the points of care

Connecting individuals with Health Information Networks

Connecting individuals Connecting individuals with Health Information Networkswith Health Information Networks

Towards full picture of the individual’s health status

Towards full picture of the Towards full picture of the individualindividual’’s health statuss health status

TimeTime

1990s1990s TodayToday

111

222

333

••• 5

Secure Secure data data

networksnetworks

SocialService

General General PractitionersPractitioners

Homecare

Hospitals

NursingHomes

HealthHealthAuthoritiesAuthorities

Labs

First step: ConnectivityLinking all the points of care

••• 6••• 6

Prescriptions

80%

Disch. Letters

81 %

Lab. reports

95 %

Reimbursement13290 = 95 %

Referrals40113 =80%

www.medcom.dk

Estimated cumulative benefit by 2008: ~ € 1.4 bil.

••• 7

National Priorities: Preliminary Analysis Priorities in national eHealth Strategies

# of Countries

Examples

Electronic Health RecordsEHR, 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)

ePrescriptionManagement and implementation of ePrescribing

16 Apotheket (SE)

ePrescription (DK, NL, SI)

eRezept (DE)

http://www.ehealth-era.org/

••• 8

Wishes vs. Reality

0

2

4

6

8

10

12

14

16

18

CompleteEHR/interoperability

Priority (wish)Reality

Number of EU Countries

National Priorities

ePrescription

••• 9

eHealth use in Europe 2002 - 2007

• GPs engaging in patient data went up from 17% to 63%.

• Transfer of laboratory results (blood, ECG) from 11% to 54%.

• Transfer of administrative patient data to reimbursing organisations went up to 22% from 6% in 2002.

• Transfer of medical patient data increased from 8% to 28%.

• e-Prescribing was done by about 3%, now by about 11%.

• A comparison with the 2007 results for all 27 EU Member States shows that the enlargement of the Union did not have much impact — neither positive nor negative — on the developments in the past five years.

••• 10

EC Recommendation on Interoperability of cross border EHR systems C(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

••• 11••• 11

Emphasis on Interoperability

• Support to projects, events, education on interoperability

• Mandate (M 403) given to CEN, CENELEC, ETSI to provide standards on (http://www.ehealth-interop.nen.nl)

1) patient and health practitioner identifiers;2) the patient summary;3) an emergency data set.

• Launch of Large Scale Pilots on interoperability of emergency and medication data – CIP (7/08)

• Calls for proposals: EHR certification (CIP June 08) Conformance testing (FP7-Call 4 Nov 08)

••• 12

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

• Thematic Network on eHealth Interoperability (CALLIOPE)

– 27 beneficiaries

– 30 months

– 500k EC funding

••• 13

Implementation, support to policiesepSOS: Approach and Expected Outcome

• One large Scale Pilot Patient summary for unexpected careePrescription/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

••• 14

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 – Trends to watch: Healthcare Technology).

CHALLENGES • Standardisation

• Interoperability

B i d l & fi i

eHealth Market in EU

EU Market fragmentation

••• 15

Lead Market Initiative

1. Market fragmentation, lack of interoperability

2. Legal Uncertainty

3. Lack of availability and access to finance

4. Lack of procurement

4 main barriers to eHealth market development

••• 16

Second step






TimeTime


111

222

333

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A Communication on Telemedicine:October 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

••• 18

• Proposed Funding Instruments:

7,5 M€

CIP ICT-PSP Call 3 2009CIP ICT-PSP Call 3 2009

2. Thematic Network

1. Pilot A

ICT for patient-centered health service

••• 19

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

CIP ICT-PSP Call 3 2009


CIP ICT-PSP Call 3 2009


••• 20

• Boario telecardiology:

35-47% reduction in hospital admissions (in various studies)

12% reduction in outpatient visits

• UK studies:

Wireless Healthcare (2004): Early discharge from hospitals ->

up to 85% reduction in weekly care costs

Cost of telecare at home with 24 hours response = 1/3 of the cost of a nursing home place

• Potential of Mobile Monitoring in Germany

Up to €1.5 billion/year savings through early patient discharge

(Assuming 3 days less hospital stay for 20% of patients)

Telemedicine Benefits

••• 21

Connectivity: to patients’ homes

Patients' homes

5 4 4 3 3 2 2 2 2 2 2 1 1 1 1 0 0 0 0 0 0 0 01 132 2

45

6930

10

20

30

40

50

60

70

80

90

100

EU27

EU

27+2 DK NL

CZ SI

LU SE

BG DE

MT FI EE

SK PL

AT

UK

BE IT NO IE IS ES LT FR RO EL

CY LV HU PT

Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008

••• 22

The EU Strategy for eHealth






TimeTime


111

222

333

••• 23

-Quality/Efficacy of Healthcare services

- Lifestyle: what we eat, drink, breath, …- Physical and social environment

- Genetic “blueprint” /profile at birth- Acquired genetic changes

Factors determining a health statusof an individual & population

Factors determining a health statusof an individual & population

Exogenous Determinants

(Nurture)

Endogenous Determinants

(Nature)

Health delivery system

WHAT can ICT contribute

••• 24••• 24

EnvironmentalData

Phenomic data

Integrated Health Records

Biosensors

Genomic data

Biochips

III. Current R&D focus (2004 - )Towards full picture of individual’s health status

••• 25

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

••• 26

Is there a proof that specific eHealth application improves clinical (health) outcomes and/or is cost effective?

Such proof to be -in large scale setting-using scientifically sound methods (such as the randomised clinical trials for drug testing)

In other words,

Can anybody get in “trouble” for NOT deploying eHealth solution today?

Need for a commonly used set of assessment & evaluation methodologies in order to pool evidence

eHealth works -does it?

••• 27

eHealth Market in EU

• PotentialeHealth is currently the fastest growing industry of health sector, estimated at € 20 Billion, 2% of Health expenditureOther EU markets: Pharma € 205 Bill.,

Medical Technology € 64 Bill.By 2010, a double digit growth rate of up to 11% is foreseen foreHealth, driven by a search for more productivity and performance (source: Datamonitor 2007)

• Challenges Standardisation Interoperability Business model & financing

••• 28

Lead Market Initiative

1. Market fragmentation, lack of interoperability

2. Legal Uncertainty

3. Lack of availability and access to finance

4. Lack of procurement

4 main barriers to eHealth market development

••• 29••• 29

AnnexAnnexAnnex

••• 30

TerminologyTerminology

• 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

••• 31••• 31

eHealth (ICT for Health)eHealth (ICT for Health)

1. Clinical information systemsa) 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 networksand distributed electronic health record systems and associated services

4. Secondary usage / non-clinical systemsa) Health education and health promotion of patients/citizens b) Specialised systems for research, public health

*Definition agreed with the eHealth Industry Stakholders Group reporting to the i2010 sub group on eHealth

••• 32

Overall Health Strategy

• Sustainability of healthcare systems

• From ‘late disease’ to ‘early health’

• From ‘hospital-based’ to ‘patient-centred’

• Main areas for action:Preventive medicine

• Chronic disease management

• Empowering the patient (training, monitoring ..)

Personalised care

Predictive medicine

••• 33

Good eHealth study (Deloitte)

• Examined 600 e-health projects across Europe to ID best practice. Built a network of country correspondents

• Covered projects over past 15 years• 50% of studies focused on administration and

management systems • Key theme of success was securing acceptance within

an organisation – patients and healthcare processionals

• Many successful projects based on extending solutions step-by-step

••• 34

• Key learnings:– Training, training, training– Involvement and commitment of higher management– Quality involvement the central goal of e-health projects – Break projects down into bite size achievable steps within a

clear long-term vision– Don’t be afraid!– www.good-ehealth.org– Report - eHealth in Action– 421 further examples atwww.epractice.eu

Good eHealth study (Deloitte)

••• 35••• 35

Hospitals – overview

• Hospitals in the EU seem well connected: 98% have internet access, 78% broadband

• Main applications: Hospital Information SystemsadministrationePrescription & eMedication (treatment support)imaging (diagnosis support)

• Integration of eHealth application components: lackingno ICT plans within the organisationlack of reliable providers (34%)no set standards

Based on eBusiness W@tch (Survey 2006)

••• 36

eHealth in EU – situation on the ground

GP Survey - 3rd quarter 2007

• 6789 interviews with GPs (max 318 inter./country);

• Coverage of 29 countries: EU27, Norway, Iceland;

• Sampling ensuring representativeness / country;

• Stratification by region to enable comparison between

groups of similar regions using settlement types like

metropolitan/urban/rural;

• Survey organisation: IPSOS

••• 37••• 370

10

20

30

40

50

60

70

80

90Using PC

Using electronic patien data storage

Routinely using PC in consultation

Internet access

Connecting with broadband

Using decision support software forprescribing or diagnosis

Accessing other health institutions networks

Occasionally using PC to illustrate to patient

Regularly using PC to illustrate to patient

Exchanging administrative data withreimbursing organisations

Occasionally using Internet and electronichealth networks to provide telemonitoring tohome-patientsRoutinely using Internet and electronic healthnetworks to provide telemonitoring to home-patients

87.4%

80%

66.1%69%

62.5% 62.3%

55.2%

44.4%

13.9%15.1%

2.7%0.9%

eHealth in EU – Some Good NewseHealth deployment in primary care (EC Study 2007)

••• 38

EU GPs using a computer during consultation, in %(EC Study 2007)

EU GPs using a computer during consultation, in %(EC Study 2007)


100%

66%

3%

Random samples of 6,789 GPs in 29 countries

94 93 9284

7673 72

66 65 6459

5447

3227

21 20 18

11 8 3

66

5956

77

10095 94

72

81

0102030405060708090

100

FI UK EE NL

NO DK IS IT BG BE

SK FR DE ES

EU27 HU PT CZ

LU IE AT

SE CY

MT

RO EL SI PL LT LV

••• 39

Access to broadband in practicesAccess to broadband in practices


Access to broadband in practices

91 88 8682

73 72

6258

5451 49

4439 37 36 36 33 32 32 32

23

155

4440

74

48 48

93

59

80

0

10

20

30

40

50

60

70

80

90

100

EU27

EU

27+2 FI DK

SE IS NL

BE

NO UK

EE LU FR LV SI

MT IT IE EL

DE

CZ

AT

ES

HU LT PL

PT

CY

BG SK

RO

••• 40

Connectivity: to other GPsConnectivity: to other GPs


Access to electronic systems of other health actors: GPs

62 59

51 50

3225 25

21 2115

11 11 10 9 7 6 6 5 5 5 4 4 011 10

34

21 21

68

22

35

0

10

20

30

40

50

60

70

80

90

100

EU

27E

U27

+2 FI DK NL

SE IS ES IT SI

BE

UK

NO PT

EE FR BG AT PL

MT

HU CZ IE LU DE EL

SK LT CY

RO LV

••• 41

Use: storage of medical patient dataUse: storage of medical patient data

Store of identifiable patient data

35

67

75

76

77

79

81

85

91

92

35

67

76

77

77

79

81

85

92

92

0 20 40 60 80 100

Radiological images

Treatment outcomes

Vital signs measurements

Ordered examinations and results

Medical history

Symptoms or the reasons for encounters

Laboratory results

Basic medical parameters

Medications

Diagnoses

EU27+2 EU27


••• 42

IT use among primary care physicians in seven countries

IT use among primary care physicians in seven countries

••• 430

10

20

30

40

50

60

70

80

90

100

EU27 BE BG CZ DK DE EE EL ES FR IE IT CY LV LT LU HU MT NL AT PL PT RO SISK FISE UK IS NO

% GPs connected to secondary healthcare(hospitals and/or specialist)

% GPs connected to secondary healthcare(hospitals and/or specialist)

••• 44

Electronic exchange of data for at least one purpose

Electronic exchange of data for at least one purpose

0

10

20

30

40

50

60

70

80

90

100

EU27 BE BG CZ DK DE EE EL ES FR IE IT CY LV LT LU HU MT NL AT PL PT RO SISK FISE UK IS NO

%

••• 45

Connectivity: to specialistsConnectivity: to specialists


Specialist practices

64

44 43

33

17 16 1410 8 7 7 7 6 5 5 4 3 3 3 3 3 1 07 6

2011 12

70

11

29

0

10

20

30

40

50

60

70

80

90

100E

U27

EU

27+2 DK FI NO BE NL

SE AT ES SI FR EE IS DE

UK

CY

BG MT LU PL

HU CZ LT IT SK EL IE PT RO LV

••• 46

Connectivity: to hospitalsConnectivity: to hospitals


Hospitals

75 73 72

61

44

32 31

2319

14 13 11 9 8 7 6 5 4 4 4 4 0 010 10

47

20 21

76

24

51

0

10

20

30

40

50

60

70

80

90

100

EU

27E

U27

+2 DK

NO FI NL

BE

UK IS SE

EE AT

ES IE PT IT MT

LU FR HU SI

CZ PL

CY LT EL

BG SK

DE

RO LV

••• 47

Connectivity: to health authoritiesConnectivity: to health authorities


Health authorities

64

51

29

2116 15 13 13 13 11 11 11

7 7 7 5 5 5 4 4 3 3 110 9

1817 17

78

1318

0

10

20

30

40

50

60

70

80

90

100E

U27

EU

27+2 EE

DK

UK LT IT PT

FR IS SI

ES PL

NO IE AT

MT FI BE

SE

BG

RO NL

LV CZ

LU HU

DE

SK

CY EL

••• 48Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008

Link to insurers (reimbursers)Link to insurers (reimbursers)

Admin data with reimbursers routinely

45 43

2623

1915 14

10 8 8 5 5 4 3 3 3 3 2 2 1 1 0 05 4

1915 15

48

13

21

0

10

20

30

40

50

60

70

80

90

100E

U27

EU

27+2 DK NL

UK

FR PL LT AT

NO IE SI

CZ

BG SE FI EE PT

HU SK

DE

MT

CY EL

BE

ES

RO IT IS LV LU

••• 49

GP Attitudes towards ICT use in healthcareGP Attitudes towards ICT use in healthcare

ICT improves the quality of healthcare services

1,6

1,1

1,4

0,7

1,4

1,61,5

1,0

1,5 1,51,6

1,2

1,5

1,3 1,2

1,7

1,4

0,9

1,4

1,7 1,7

1,4 1,5 1,4 1,41,5

1,2

1,7

1,41,31,3

EU27

EU27

+2

BE

BG CZ

DK

DE

EE EL

ES FR IE IT CY

LV LT LU HU

MT

NL

AT

PL PT

RO

SI

SK FI SE UK

IS NO

Agree strongly

Agree somewhat

Disagree somewhat

Disagreestrongly

Don't know


••• 50

Purpose of use of internet and electronic health networks: Telemonitoring routinely

3 3 2 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 00 011 1

9 110

10

20

30

40

50

60

70

80

90

100

EU

27

EU

27+2 SE NL IS UK IE PT

BG FI DE AT

FR EL

BE

ES LV NO

DK

SK

RO CZ

EE IT CY LT LU HU

MT

PL SI


Networking: telemonitoring

••• 51

••• 51

For further information

• INFSO H1 Policy site:http://ec.europa.eu/information_society/activities/health/index_en.htm

• e-Newsletter:http://ec.europa.eu/information_society/activities/health/newsletter/index_en.htm

• Research site:http://cordis.europa.eu/ist/health/index.html

• DG ENTR LMI microsite:http://ec.europa.eu/enterprise/leadmarket/leadmarket.htm

• eHealth Task Force report:http://ec.europa.eu/information_society/activities/health/docs/lmi-report-final-2007dec.pdf• Interactive Portal:http://www.epractice.eu

eHealth Thought Leadership: A Way Forward Brussels, …content.linklaters.com/pdfs/insights/ehealth/03.pdf · eHealth Thought Leadership: A Way Forward Brussels, 17 June 2009 ...

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