ech campus leadership summit: ilias lakovidis
TRANSCRIPT
Ilias Iakovidis PhDDeputy Head, "ICT for Health“ Unit
Information Society & Media DGEuropean Commission
http://europa.eu.int/information_society/activities/health/index_en.htm
Empowering patients through e-health
Empowering patients through e-health
European Connected Health Leadership SummitBelfast 6-7 May, 2009
Health sector in EU
• Employs 9.3 % of workforce, > 15 M people (retail 13.0 M, business services 13.3m)
• Health expenditure > 8,5 % of GDP, growth at 4% a year (faster than EU economic growth), potential to reach 16% of GDP in EU by 2020 (Healthcast 2020, PWC)
• Health care is information intensive sector but ICT penetration is low compare to other sectors.
• There is great potential for benefits for individuals, society and economy when ICT, leadership and skills come together
••• 3
eHealth (ICT for Health)eHealth (ICT for Health)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 networks
and 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
eHealth for SustainabilitySome examples
• 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
eHealth works:Efficiency and productivity
• 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
• 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
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
Region 3
Hospital
Home
Pharmacy
Health Centre
mobile PC
Mobile, Wireless
&Broadband
Emergency
Secure Networks
Region 2
Mobility
Region 1
Step 1 (past EU R&D activities) Health Information Networks
Connecting providers: Messaging, EHR
GP
0
10
20
30
40
50
60
70
80
90
Using 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%
EU World Leader in deployment in primary care (EC Study 2007)
IT use among primary care physicians in seven countries
EU GPs using a computer during consultation, in % (EC Study 2007)
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
100%
66%
3%
Random samples of 6,789 GPs in 29 countries
94 93 92
84
7673 72
66 65 6459
54
47
3227
21 20 18
118 3
66
5956
77
10095 94
72
81
0
10
20
30
40
50
60
70
80
90
100
FI
UK
EE
NL
NO
DK IS IT
BG
BE
SK
FR
DE
ES
EU
27
HU
PT
CZ
LU IE AT
SE
CY
MT
RO EL SI
PL
LT
LV
GPs: Electronic exchange of patient data by purpose (selected countries)
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
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
Country orRegion 3
Secure Networks
Country or Region 2
Interoperability across bordersLinking basic information between patient summary
systems or giving access to physicians to patient summary in your home country
Mobility
Country or Region 1
Patient Summary 1Patient Summary 2
Standardised exchange/access to common data sets
Direct access of physicians when legal
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!
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)
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
Region 3
Hospital
Home
Pharmacy
Health Centre
mobile PC
Mobile, Wireless
&Broadband
Emergency
Secure Networks
Region 2
Step 2:Current EU activitiesConnecting individuals with providers/Health
Information Networks
Mobility
Region 1
GP
• 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)
From ‘hospital-based’ to ‘patient-centred’ careFrom ‘hospital-based’
to ‘patient-centred’ care
See EC Communication on Telemedicine COM(2008)689 finalec.europa.eu/information_society/activities/health/policy/telemedicine/index_en.htm
Integrated Health Records
EnvironmentalData
Biosensors
Phenomic data
Genomic data
Biochips
Step 3: The full picture of individual’s health status
Step 3: The full picture of individual’s health status
New Options for Disease Management
New Options for Disease Management
Diseaseprogression
Mortality& costs
Geneticpredis-position
First cellmutations
asympto-maticdisease
Diseased cells release biologicalmarkers
First symptoms/manifestation
Diseaseproliferation
Environmental trigger
Currentapproach
In vitromarkers
Diagnostic (anatomic) imaging, biopsies
symptomsdiagnosis
•Non-personalizedmedication
•Chemotherapy•Radiotherapy•Surgery
Followup
Molecular ImagingMolecular Imaging
MolecularMedicineapproach
Molecular Therapy
Molecular Therapy
DNAscreens
Proteinscreens
Monitor TreatmentMonitor Treatment
EarlierPersonalizedIntegratedEfficient
Philips Presentation
EU Wide eHealth Policy and support to deployment
EU Wide eHealth Policy and support to deployment
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
EU Wide 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)
ConclusionsConclusions
• ICT has shown impact on sustainability but this impact needs to scale. patients need to take more active role in health & care
and use ICT in their health/wellness management (changing consumer behavior pattern)
stronger focus but health delivery system on prevention and early diagnosis,
• ICT has great potential in: enabling novel approaches for personalised medicine
(cross-disciplinary and multi-stakeholder research)
fostering global research (International effort)
••• 22
For further informationFor further information
• INFSO H1 Policy site:
http://ec.europa.eu/information_society/activities/health/index_en.htm
• Research site:http://cordis.europa.eu/ist/health/index.html
• Interactive Portal:http://www.epractice.eu
••• 23
AnnexAnnex
EU GPs using a computer during consultation, in % (EC Study 2007)
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
100%
66%
3%
Random samples of 6,789 GPs in 29 countries
94 93 92
84
7673 72
66 65 6459
54
47
3227
21 20 18
118 3
66
5956
77
10095 94
72
81
0
10
20
30
40
50
60
70
80
90
100
FI
UK
EE
NL
NO
DK IS IT
BG
BE
SK
FR
DE
ES
EU
27
HU
PT
CZ
LU IE AT
SE
CY
MT
RO EL SI
PL
LT
LV
Access to broadband in practices
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
Access to broadband in practices
9188 86
82
73 72
6258
5451 49
4439 37 36 36
33 32 32 32
23
15
5
4440
74
48 48
93
59
80
0
10
20
30
40
50
60
70
80
90
100
EU
27
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
Connectivity: to other GPs
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
Access to electronic systems of other health actors: GPs
6259
51 50
32
25 2521 21
1511 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
27
EU
27+
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
Use: 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
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
0
10
20
30
40
50
60
70
80
90
100
% GPs connected to secondary healthcare(hospitals and/or specialist)
Electronic exchange of data for at least one purpose
0
10
20
30
40
50
60
70
80
90
100
%
Connectivity: to specialists
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
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
20
11 12
70
11
29
0
10
20
30
40
50
60
70
80
90
100
EU
27
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
Connectivity: to hospitals
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
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
27
EU
27+
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
Connectivity: to health authorities
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
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
100
EU
27
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
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008
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
100
EU
27
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
GP 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 1,41,4
1,5
1,2
1,7
1,41,31,3
EU
27
EU
27+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
Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008