marc lange thl-oper yhteistyöseminaari 26.-27.3.2014 oulu,peer review swot fi v05

Implementation of eHealth solutions in Europe – where does Finland stand?

Marc Lange, Secretary General

Competence Centre

Health Care Authorities

Industry

Health Care Delivery

Citizens/Patient Representative

InnovationAgency

InsurersSocial Care

Dissemination Organisation

European Health TELematics

A cross-(any)border and multidisciplinary collaboration forum

OPER cooperation seminar - Oulu 26 March 2014 2

Sustainable and large scale eHealth deployment

requires engagement and synergies

Our Activities


OPER cooperation seminar - Oulu 26 March 2014

Our platform enables an overview

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EHTEL Peer Review

One of the EHTELconnect services proposed by EHTEL to its members Objective: to assist organisations

• in self-benchmarking • their eHealth strategy / action plan / implementation • with similar communities

Ran for the first time in 2009 for the MoH of Sweden


Recommended by

in 2010

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Outcome of an EHTEL Peer Review

A two-day workshop • During which the programme/project managers from the

inviting organisation(s) • Present and discuss their eHealth programme and projects • Before an audience of “Peers”, member of the EHTEL

Network

A workshop report • Compiles the presentations and

the discussions among experts • Concludes with observations

organized in the form of a


The Peer Team

Multi-stakeholder • Consultancy organisations • Service delivery organisations • Public authorities • Industries

Multi-disciplinary • Physicians, pharmacists, economists, IT and Business

administration experts, experts in political science

European/international • Belgium, Denmark, Estonia, France, Germany, Israel,

Netherlands, Norway, Sweden, United Kingdom (England & Scotland).


Disclaimer

Overall, the presentations made were considered by the peer review experts to be comprehensive and detailed.

However, they could have been improved regarding two areas of focus.

• First, throughout the series of presentations, no precise “case studies” were discussed in any detail.

• Second, there were no presentations from senior clinicians or more local operational managers (such as domain experts and champions).


Scope: the eHealth National Architecture


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Foundation eHealth infostructure

Patient identification and patient data discovery

Data structures and value sets EHR, EMR, PHR, other

Clinical terminologies and classifications and codifications

Data and knowledge management tools

HCP Authorization, authentication and rights management

Consent management and access control

Data interoperability and accessibility

Data bases and Registries

eHealth Governance

Market development, new business models, and incentives

Privacy, quality and safety policies

Legislative and regulatory framework

Financing, Resource allocation and reimbursement models

eHealth leadership, policy and strategy

EU & National Stake-holder collaboration

Fostering standards adoption

Monitoring, evaluation

Sustainable Healthcare Sharing Information and Knowledge for

Better Health

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Foundation ICT infrastructure

Mobile and fixed Electronic Communication Infrastructures

ICT processing and storage services

ICT Professional and technical support; Training

Access to ICT Networks, equipment and facilities

26 March 2014 OPER cooperation seminar - Oulu

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Strengths (internal origin/helpful)

World-level benchmark

A strategic change management programme • It provides a compelling vision of integrated care • It is supported by an appropriate legislation to meet

• Societal and financial challenges and • The need to modernise the health and social care systems

Quality deployment process: • Early start, hence there is already a long experience • General overcoming of resistance to change (e.g. through

education)


Strengths (…)

Finland is sitting on a metaphorical "gold mine"

• The quantity, timeliness and quality of health data entered and collected from routine healthcare is impressive.

• Almost all records are “electronic from birth” • Today, the country has direct access to a source of valuable

information and resources


Weaknesses (internal origin/harmful)

The context of care: • New care pathways, chronic disease management,

patient empowerment are required for modernising the health and social care system.

Healthcare practitioners could have a more proactive role:

• They should act as coaches and guides to support health care improvement, working with "communities of patients" or "communities of providers".


Weaknesses (…)

Limited return-on-investment and benefits analysis:

• Because an infrastructure is mainly an enabler and requires services to deliver clinical and economic value

The policy behind the tools: • To focus on what the health system overall is attempting to

achieve


Opportunities (external origin/helpful)

Policy, governance and organisation • Invitation from Mr. Esko Aho

to seek for positive disruptive innovation in the Finnish health/social care system

• The creativity of the actors involved, which requires appropriate incentives to act

Leadership, business and benefits • Finland has a leadership position with regards to the

transformation of health and social care systems • Need for evidence on clinical effects of the changes to the

system and their measurement • Need for quantitative indicators e.g. on adverse events


http://eisri2013.wordpress.com/

Threats (external origin/harmful)

The demand for personal health data

• This may put the service provision under stress

Information is not knowledge • Risk of overload of information because of the volume of

collected data

The value and sensitivity of the data • This increases risks


Highlights

The eHealth infrastructure is there! • Technical building blocks • Legal framework • Issue: interoperability for system openness and agility • Challenge: an infrastructure does not deliver value,

it is only an enabler

eHealth and Telemedicine services will • Add value • Deliver benefits


A h

olis

tic

conc

ept

for

eHea

lth

Foundation eHealth infostructure

Patient identification and patient data discovery

Data structures and value sets EHR, EMR, PHR, other

Clinical terminologies and classifications and codifications

Data and knowledge management tools

HCP Authorization, authentication and rights management

Consent management and access control

Data interoperability and accessibility

Data bases and Registries

eHealth Governance

Market development, new business models, and incentives

Privacy, quality and safety policies

Legislative and regulatory framework

Financing, Resource allocation and reimbursement models

eHealth leadership, policy and strategy

EU & National Stake-holder collaboration

Fostering standards adoption

Monitoring, evaluation

Sustainable Healthcare Sharing Information and Knowledge for

Better Health

eHea

lth S

ervi

ces

Patie

nt su

mm

arie

s

Elec

tron

ic p

resc

ribin

g

Chro

nic

Care

Man

agem

ent

Com

mun

ity se

rvic

es, A

AL

Evid

ence

-bas

ed p

ublic

hea

lth

Popu

latio

n st

ratif

icat

ion

Tele

-con

sulta

tion

Tele

-dia

gnos

tic

Seco

nd o

pini

on

Tele

-med

ecin

e

Tele

-…

Foundation ICT infrastructure

Mobile and fixed Electronic Communication Infrastructures

ICT processing and storage services

ICT Professional and technical support; Training

Access to ICT Networks, equipment and facilities


Pat

ien

t su

mm

ary

ePre

scri

pti

on

Pat

ien

t ac

cess

Hea

lth

Car

e P

lan

Kan

Sa

Rem

ote

mon

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Hea

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coa

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…

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Developing eHealth and Telemedicine services

eHealth and Telemedicine services

• Medical components • Clinical evidence • Issue: the actual needs of health professionals and patients • Challenge: user adoption

This is about changing from • Data to services • Data collection to data integration in processes • Tools to process redesign / new care pathways



New Technology + Old System = New Old System

Patient’s home South Karelia Social and Health Care District (Eksote)

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3 2

4

HEALTH COACH

1

PATIENT

WEB PHR APPLICATION

GATEWAY

HOSPITAL SPECIALIST

GENERAL PRACTITIONER

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TELEMONITORING DEVICES

DATA TRANSMISSION DATA ACCESS THROUGH HOME CARE PORTAL ALARM MANAGEMENT

Tele-monitoring for Diabetes & CVD South Karelia ©


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The MAST model If the purposes of an assessment of telemedicine applications

are:

– To describe effectiveness and contribution to quality of care AND – To produce a basis for decision making The relevant assessment should be defined as: The assessment of telemedicine should be a multidisciplinary process that

summarizes and evaluates information about the medical, social, economic and ethical

issues related to the use of telemedicine in a systematic, unbiased, robust manner.

MAST Model for ASsessment of Telemedicine

26 March 2014 26

Multidisciplinary assessment (domains): 1. Health problem and characteristics of the application 2. Safety 3. Clinical effectiveness 4. Patient perspectives 5. Economic aspects 6. Organisational aspects 7. Socio-cultural, ethical and legal aspects

Transferability assessment:

• Cross-border

• Scalability

• Generalizability

Elements in MAST

26 March 2014 28

26 March 2014

A European Telemedicine Deployment Blueprint

OPER cooperation seminar - Oulu

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Testing of Service Routine Care Service

Small Scale Deployment

Large Scale Deployment

Hospital Group

Department

Department

HealthCare System

Piloted Service

Lessons learned from deployment inside an

organisation Local champions Limited constraints

(e.g. at legal level) Cost and benefit analysis …

Lessons learned from deployment across organisations

(for servicing the healthcare system) Institutional endorsement Legal constraints (if it is a D2P relationship) Need for robust methods Socio-economic analysis …

From pilot to routine care


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Identify the problem

Recognize the need for change

Explore

Search for a solution

Build Create, test and assess potential

impact

Apply and Monitor

From pilot to real life

Social Innovation Cycle

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Marc Lange Secretary general EHTEL Association 49/51, rue de Trèves B-1040 Brussels Belgium Tel: +32 (0)2 230 15 34 Fax: +32 (0)2 230 84 40 Mobile: +32 (0)475 27 71 45 [email protected] www.ehtel.eu

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Any questions?

marc lange thl-oper yhteistyöseminaari 26.-27.3.2014 oulu,peer review swot fi v05

Health & Medicine

health care improvement

quality of health data

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