dag voor de gezondheidszorg microsoft executive circle forum prof. dr. g. de moor (gent, 09/03/2006)...

Prof. Dr. G. De Moor (Gent, 09/03/2006)

Dag voor de Gezondheidszorg

Microsoft Executive Circle Forum

e-Health:

Huidige Status en

Toekomstperspectieven

Prof Dr Georges De Moor

Universiteit Gent




Health & eHealth: Main Objectives

– Quality– Efficiency– Security – Safety– Equity of the Health(care) Services

cf. the Vision and Strategy in “Building Bridges” (1999)




Historical Background

– Commissie Telematica-Standaarden (3 Mei 1999) (15 December 2005) www.health-telematics.be

– BeHealth project en platform (23 Dec 2004) www.health-telematics.be/behealth

– ‘FOD Volksgezondheid’- projecten “ …a step by step approach…”

Future?

– Wetsontwerp Verwerking Gezondheidsgegevens– Sectoraal Comité Gezondheidszorg van de CBPL (!)




Projects / Activities

– RIM2, ELODIS, CODENTAL, KINELECTRICS, HEPI-GO, FLOW (Alfa, Beta, Gamma), BePrescript, KMEHR Love, KMEHR Live, BeHEALTH, THESAURUS, KMEHR Lab, HEPI-Gone, HISABEL, KMEHR+, REGISTERS

Working Groups

– DATA, SECURITY, MESSAGES, ARCHIVES, BeHealth, NURSING, LABELLING




“Patient-centered Care, Continuity of Care, Individualized Care, Mobility, ...”

ICT for Health

– C = Communication (across boundaries)• Exchange of data• Linkage of data

– Interoperability (cf. eHealth Action Plan CEC/EU)• Standardisation• Health Personal Identifiers, Summary- and

Emergency- Health Records…(cfr. verwijzings-repertoria…)




The e-Europe Action Plan (2005)

– By the end of 2005: EU member states must define national and regional e-health strategies (deployment of e-health systems, use of electronic health records, interoperability and re-imbursement of e-health services)

– By the end of 2006: identification of interoperability standards for health data messages, electronic health records, taking into account best practices and relevant standardisation efforts

– By the end of 2009: EU member states and the EC will set the baseline for standardised provision of e-health services in clinical and administrative settings

E-Health identified as one of the EC priorities, with as deadlines:




Interoperability: General Definitions

• ISO 2002:12 : Interoperability refers to the ability of two or more systems (computers, communication devices, networks, software and other information technology components) to interact with one another and exchange information according to a prescribed method in order to achieve predictable results

• CEN/ISSS 2005 : Interoperability is a state which exists between two application entities when, with regard to a specific task, one application entity can accept data from the other and perform that task in an appropriate and satisfactory manner without the need for extra operator intervention

• NAHIT (US) : Interoperability is the ability of different information technology systems, software applications and networks to communicate, to exchange data accurately, effectively and consistently, and to use the information that has been exchanged (March 09,2005)




Interoperability: Types

• Technical interoperability• Organisational interoperability• Functional interoperability• Syntactic interoperability• Semantic interoperability• Political interoperability• Legal interoperability• Social interoperability• Inter-standard interoperability




EHR & interoperability

Bio-Medical Informatics

HealthGrid

Deployment

Applied/Industrial R&D

Basic Research

Decision Support Systems

Support to eHealth “Action Plan”

Health Info Networks & Services

Personal Health Systems (Wearables)

General issues:EHR, Security, Interoperability

I

II

III

Time




Implementation

I

eHealth ERAeHealth ERA

I2HEALTHI2HEALTH

Certification EHRQREC

Certification EHRQREC

Interoperability

TMA BridgeInteroperability

TMA Bridge

RIDEInteroperability

RIDEInteroperability

SHARE Healthgrid

SHARE Healthgrid

SYMBIOMATICSBMI ERA Pilot

SYMBIOMATICSBMI ERA Pilot

STEPVH CA

INFOBIOMEDINFOBIOMED

BIOPATTERNBIOPATTERNSEMANTIC MININGSEMANTIC MINING

Semantic HealthInteroperabilitySemantic HealthInteroperability

II III

Short time research Long time research




Examples of ongoing R&D or Deployment Projects

• At European level: QREC (http://www.eurorec.org )

• At Belgian level: HEPI-GO (http://www.health-telematics.be )

• At Regional level: COPLINTHO (https://coplintho.ibbt.be )




EuroRec

– The « European Institute for Health Records »

– A not-for-profit organization, established April 16, 2003

– Mission: the promotion of high quality Electronic Health Record systems (EHRs) in Europe

– Federation of national ProRec centres in Europe




ProRec CENTRES

Centres

BelgiumBulgariaDenmarkFranceItalyGermanyIrelandRomaniaSloveniaSpain

Applicants

NorwayGreeceHungaryPortugalPolandSwedenThe NetherlandsUnited KingdomSlovakia

“ Differences in languages, cultures and HC-delivery systems ”




EUROREC: Organisation

PROREC - CENTRES … (Complementarity / Languages)

(Economy of scale / Synergy)

EUROREC

Healthcare

Authorities

…

Users

(Clinicians, Citizens)

EHRs -

Vendors

Purchasers,

Payers




TRENDS in EHRs (1)

– transmural / virtual– multidisciplinary and interactive

AdministrativeRecords

Patient Health Diaries

MedicalRecords

NursingRecords

! Integration with other health care software applications ...!

EHRs become




TRENDS in EHRs (2)

-Medical and Bio-Medical data

-Security: Privacy Enhancing Techniques-Semantic Interoperability: Ontology based approaches-Added value of EHRs: eg. Decision Support Systems-Grid Technology: HealthGrid

“The PHENOMES will meet the GENOMES in the EHRs of the Future”




QREC: FP6-IST4

Results of the 4th Information Society Technology (IST4)

Call for Proposals under the EU’s 6th Research

Framework Programme (FP6):

– 276 new research projects

– With EUR 1 billion in EU funding

QREC-project on « Quality Labelling and Certification of EHR systems in Europe » is a Specific Support Action (SSA) with EUR 1.3 million in EU funding.




QREC: Main Objectives

To develop formal methods and to create a mechanism for the quality labelling and certification of EHR systemsin Europe, in primary- and in acute hospital-care settings

EuroRec Institute is coordinating partner QREC has 12 partners and 2 subcontractors




EUROREC: GOALS

– Support to ProRec centres

– Inform users of current trends in EHRs and express their needs

– Help public authorities to define and implement strategies

– Defend the EHRs-industry (ROI)

– Promote research, education and development in EHRs

– Foster international co-operation (eg. CCHIT in the US…)




QREC: ORIGIN

Several EU-member states (Belgium, Denmark, UK, Germany, …) have already proceeded with quality labelling and certification schemes, but they differ in scope, in legal framework under which they operate, in policies, in organization, in the choice of quality conformance criteria for benchmarking and testing…

These differences represent a risk of further market fragmentation: harmonization efforts should help to avoid this!




Benefits for the Stakeholders

Industry

Quality Labelling / Certification

Market & R.O.I.

Quality and Safety Efficientie and Cost Savings

Clinicians, Patients,

Public Health

Health Authorities




EHRs Certification: Expected Impacts

– to reduce EHRs investment risk for buyers/purchasers

– to foster availability, accessibility, inter-operability and portability of the patient records no matter where the patients are located or are travelling...

– to stimulate confidence and increased investment in EHRs

– to guarantee better return on investment (ROI) for vendors– to induce cost savings in healthcare

– to improve the quality of care and safety of patients

– to encourage patients to play a greater role in managing their own health information

– to provide valuable population health information




QREC: Core Tasks (1)

1. Study of current EHRs « Quality Labelling andCertification » -systems: (State-of-the-Art Report)

2. Assay of the requirements amongst all stakeholders across Europe, covering both current and planned EHRs certification activities (Survey)

3. In-depth analysis of the ways to classify and profile EHR systems (Profiling and Indexing)

4. Comparison of various possible EHR certification systems (Methodology)




QREC: Core Tasks (2)

5. Definition of a model (a common European Template) with harmonized guidelines and procedures for EHRs quality labelling and certification

6. Benchmarking process Manual for EHRs certification

7. Business Plan




QREC: Main WorkPackages

WP 1: Consortium Management, Project Co-ordinationand Quality Assurance

WP 2 : EHR systems Quality Labelling and Certification Development

WP 3 : Resources for EHR Interoperability

WP 4 : Benchmarking Services

WP 5 : Communication and Dissemination Activities




QREC: WP 3

WP 3 : Resources for EHR Interoperability

T3.1 Register of Conformance Criteria and GuidanceDocuments

T3.2 Inventory and Register of EHR Archetypes andGuidelines for their Use

T3.3 Register of Health Coding Systems in Use in EuropeT3.4 Inventory of Relevant Standards for EHR systemsT3.5 Register of XML Schemas and Open Source

Components for EHR systems




Definitions

Archetype (in eHealth):

A uniquely identified, reusable and formal expression of a specific health concept,

expressed by means of an Archetype Definition Language and composed of descriptive data, constraint rules and ontological definitions.

Archetypes can be specializations of other archetypes.




QREC: WP 3/ T3.3

T3.3 Registration of Health Coding Systems in Use in Europe

Implementation of the European Standard EN 1068

EuroRec has been appointed as the Registration Authorityand has been mandated by CEN/BT and /TC 251




QREC: Concrete Results

The Quality Labelling system will act as a filter, enabling:

Potential buyers to identify their needs, requirements (includingContexts of Use, EHRs modules,…) and to find TEST PLANS with APPROPRIATE SCENARIOS and CRITERIA against which a number of existing EHRs will be tested;

Vendors to check their own systems in order to get a quality label or certification.




The HEPI-GO project: “a Proof of Concept Project”

Start: 1 Dec.2005

End : 1 Jul. 2006

– Het Persoonlijk Gezondheids- Identificatienummer

– Situering in juridisch kader– Voorstel van cryptografische omzettingsmethode– Voorstel van implementatiemodel– Testen op kleine schaal (pilots)




Use of Data

– Who? Qualifications– What? Type of data– Why? Finality

“Importance of a legal framework”

“Importance of definitions (personal, sensitive, medical, social...)”




Identifiers

– RRN– INSZ (RRN, KSZ)– PGIN (HEPI)

“Towards a comprehensive solution for the care settings: hospitals, ambulatory care, homecare…)”




Choice of Identifiers: a selection of criteria

ref. ASTM “Standard Guide for Properties of a Universal Healthcare Identifier”

– Unique (collision free)– Permanent (from cradle to grave and beyond)– Meaningless– Processable– Accessible– Governed– Usable (automated and manual)– ...




Primary and Secondary Uses

INSZ

Research

Administrative HEPI

IDx

IDy

IDz

TSPTSPy

TSPz

Care

Marketing

Int. Research

TSx

TSP

IDa

TSPx

Social/

Management




• Microsoft’s Identity Meta-system

– interoperable architecture for digital identity

– connecting existing and future identity systems

• Infocards - Identity Selector

– providing a consistent user-experience for Identity Management

• Innovative approaches for dealing with sensitive data (e.g. Health) in a service oriented environment, require complex Identity and Credential management. The end-user experience offered by “Infocards” could facilitate the adoption of such new approaches.

INFOCARDS




COPLINTHO: IBBT project (Vlaanderen)

“Proof of Concept” project voor Interactieve eThuiszorg

eThuisZorg omgeving

Start: 1 January 2005End: 31 December 2006




Valorisation

Project Markt

Concept Ontwerp Gebruiker

Lab test Veld test

Testprogramma

Evaluatie-plan

Product

Pre-valorisatie




COPLINTHO (IBBT): eHomeCare Services

– e-Scheduling

– e-Work-planning

– e-Record keeping and exchange

– e-Prescription (and medication folders)

– e-Learning

– e-Entertainment

– e-Alarming

– e-Monitoring, Telemetry

– e-Decision support

– Voice and Video communication

– (e-Medicine)

Users

– Nurses and other Care-Givers– Patients

• chronically ill (diabetics,…)• palliative patients • post-hospital discharge• revalidation/ rehabilitation• pregnant (at risk)

– Healthy citizens (prevention)– Disabled and Elderly– General Practitioners– Medical Specialists

Applications

Data, voice and video




Legal Issues




COPLINTHO: Individueel Netwerk voor Interactieve eThuiszorg

eThuisZorg omgeving

Alarmcentrale (ALA)

Mantelzorger (MAZ)

Ziekenhuis (ZH)

Specialist (SPE)Huisarts (HA)

Breedband Netwerk




Clusters

InteractievePatienten

Terminal (IPT)PC

IDTv

Patient @ Home Cluster

Coplintho Broker Cluster

CM

SDR

SEMPMS

PMSC

FPS

MSF

QMAS

WSQMAS

WSQMAS

WS

GatewayCoplintho Broker Facade

Gateway

Family Cluster

PC

GSM

Resource constrained

device




Flexibility

WS

WS

WS

CREDENTIAL

MANAGER

WS

WS

WS

WS

monitor

QoS

SERVER

GET L

oc. E

HR A

Record A• EHR locations• B is DOC A• C is trust person A

Portal /Provider

Doc. B

WS

WS

WS

Record X• EHR locations• ...

WS

WS

WS Record Y• EHR locations• ...

GET EHR A

• Requestor is B• B has access to REC A• B is Doc




eHealth High Level Conference

(Malaga, 10-12 May, 2006)

(strategic/ political...)

www.ehealthconference2006.org




Medical Informatics Europe

(Maastricht, 27-30 August, 2006)

(scientific/ academic...)

www.mie2006.org




World of Health IT 2006

(Geneva, 10-13 October, 2006)

(industrial...)

www.eurorec.org

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