ict for health by dipak kalra
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Extended National ICT Research Directors Forum meetingon European Large Scale Actions (ELSA)
ICT for Health
Dr Dipak KalraUniversity College London
d.kalra@chime.ucl.ac.uk
on behalf of an panel of experts convened to consider ELSA priorities for ICT solutions for sustainable health
Dr Dipak KalraUniversity College London
d.kalra@chime.ucl.ac.uk
on behalf of an panel of experts convened to consider ELSA priorities for ICT solutions for sustainable health
European health systems: priorities and challenges
• Growing expectations for equity of access, quality and efficiency, patient empowerment and engagement
• Rising incidence of chronic diseases and increased complexity of their treatment
• age related: dementia, cancer
• lifestyle related: diabetes, asthma, obesity, ischaemic heart disease
• Growing expectations and concerns about patient safety
• Need for better integration across wellness, health care, public health, occupational health and social care
• Demographic change
• ageing population is driving up demand for health services
• adverse health worker to patient ratio
• Societal pressure for demonstrable protection of privacy
Priorities for reliable state-of-the-art healthcare to all
• focus on prevention and support of patient self-care and life style management
• foster translation and utilisation of research results into clinical practice
• improve chronic disease management: knowledge driven, longitudinal, across care boundaries, patient involving
• focus on (close to) home and ambulatory health services
• achieve better integration with between healthcare services, social care and wellness services
• improve skills shortage: case based and population based e-learning, advanced simulations and modelling
Jennings, Miller, Materna 1997
Point of care delivery
Continuing care (within the institution)
Long-term shared care (regional
national, global)
TeachingResearch
Clinical trials
explicit consent
EducationResearch
EpidemiologyData mining
de-identified
+/- consent
Public healthHealth care
managementClinical audit
implied consent
A pan-European Health Infostructure
Citizen in the community
Social careOccupational
healthSchool health
WellnessFitness
Complementary health
real-time knowledge directed carerapid bench to bed translation
Our present-day approach to these challenges
Implications and opportunities for ICT in health
• Manage increasingly complex clinical care
• Connect multiple locations of care delivery
• Support team-based care
• Deliver evidence-based health care
• Improve safety
• reduce errors and inequalities
• reduce duplication and delay
• Improve cost effectiveness of health services
• Enrich population health management and prevention
• Empower and involve citizens
• Protect patient privacy
• Better inform and exploit bio-science research
Electronic Health Record - EHR 2.0
Date: 1.7.94
WhittingtonHospital
Healthcare Record
John Smith DoB: 12.5.46
Clinical trials,functional genomics,
public health databasesEHR repositories
Clinical devices,instruments
Clinical applications
Decision support, knowledge managementand analysis components
Mobile devices
Personnel registers,security services
Social computing:forums, wikis and blogs
Integrating information
Centring services on
citizens
Creating and using knowledge
Examples of Health ICT research enabled by the Framework Programme
• Comprehensive electronic records (EHR)
• requirements, information architectures, clinical data standards, terminology systems, security - now published as international standards
• BUT now needing to be validated against large scale challenges
• standardised clinical meaning across diverse communities of practice
• cross-border confidentiality protection and de-identification
• pan-European quality assured and certified eHealth interoperability solutions
• Virtual Physiological Human (VPH)
• sophisticated modelling of how body systems and organs behave in health and in disease, to help optimise treatment decisions
• BUT now needing to be refined through
• linkage with real electronic health records, and real-world clinical data quality
• safety testing for real clinical decisions in varied care settings
• Personal Health Systems (PHS)
• wearable and implanted and near patient monitors, communicating with a central repository: integrating and alerting whenever needed
• BUT now needing to
• integrate with holistic EHR data
• safely advise on patients with multiple diseases and using multi-vendor PHS products
Digital Me
Source: Peter Coveney, UCL
Principles for a successful approach
• To focus on a very concrete societal need which can be addressed by user and experience driven R&D, innovation and large scale demonstrators leading to wide deployment
• Special effort to engage payers, clinicians and patients at every stage in addition to the other (more committed) stakeholders.
• Major milestone: European infostructure on top of national eHealth infrastructures (not their duplication!)
• Focus on few applications demonstrating the benefits of such infostructure and open the way for regional/national/international developments
• Provision of visible and useful milestones, at regular intervals
Examples of objectives of an ELSA on eHealth
• Improve the quality and effectiveness of clinical shared care and facilitate cross border care
• Provide “the right information, in the right place, at the right time” to health providers and patients while securing the citizens right to privacy
• Bring into the equation other data relevant to our health beyond medical information (lifestyle, environment)
• Improve the way clinical research is performed and facilitate faster translation into clinical practice
Emphasising translation
• The EU Health Telematics Framework Programmes have inspired some of the best health informatics research on the planet
• But, it has proved difficult for some of the research to be refined and validated at the scale needed for national or European adoption
• potential impact has not been realised yet
• market potential is as yet under-recognised
• societal gains and cost savings remain a missed opportunity
• It is now vital to capitalise on proof of concept and SME level Health ICT research
• ELSA’s have the potential to provide large scale validation, evidence of what works well, and how to turn research results into products and daily experience
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