H. Stephen Lieber

1
Electronic Health Records Global Perspectives

• H. Stephen Lieber
• President CEO
• Healthcare Information and Management Systems
  Society (HIMSS)

2
HIMSS

• International not-for-profit, membership based
  organisation
• Offices in US, Belgium and Singapore
• Offer educational programs in North America,
  Europe, Asia and Middle East
• Over 23,000 HIT professionals, physicians,
  nurses, other healthcare executive members
• Primary source of education, professional
  development, tools and resources on e-Health, HIT
• Recognises best practices, leading hospitals and
  physician practices for adoption and use of HIT
• More at www.himss.org

3
Sound Familiar?

• The situation and challenges in (fill in the
  blank) are similar to other (fill in the
  continent) countries
• limited budget
• rising demand for healthcare services
• chronic disease management
• quality below expectations
• people in countryside with limited access to
  health care services

4
Core Comparisons

• Overview of each country examined
• National EHR Program
• - National IT/ICT status and strategy
• - National/Regional EHR Approach
• EHR Governance
• - Legal/Regulatory
• - Healthcare policy
• - EHR Financing

5
Core Comparisons (cont.)

• Technology
• Adoption
• Outcomes
• - Benefits
• - Implementation Experiences
• Next steps for each country

6
Funding

• Central Government
• Private Sector
• Central, Local and Private
• Central and Local

• -England, Germany,
• France, Netherlands,
• Sweden, South Africa,
• Denmark, New Zealand.
• -India, Israel, Japan, Singapore
• -Canada, Hong Kong, USA.
• -Australia

7
Governance Models
8
Standards and Interoperability
9
United Kingdom

• Regional and local organizations vary in their IT
  maturity and adoption of EHR/EMR systems
• Primary care has been, and continues to be, a
  leader in the adoption of EHR due to policy
  requirements and financial incentives
• Successful adoption has also been attributed to
  leadership by highly committed physician
  champions and carefully targeted communication,
  regulation, assistance and incentives on the part
  of the NHS

10
France

• Classic obstacles still being experienced
• lack of interoperability, incomplete
  standardization, insufficient training and
  inadequate provider support
• Start with clinical documents in use rather than
  fully structured data
• Need collaborative involvement of all
  stakeholders (patients, providers, vendors and
  government agencies) from beginning
• Need framework for national EHR early in the
  implementation process

11
Greece

• Goal allow the unimpeded flow of health
  information within the healthcare system in an
  absolutely secure manner, following the citizen
  in his/her interactions and contacts with the
  system
• The national EHR will include a subset of medical
  data for every citizen, easily accessible from
  various health care units
• Twister Project implement eHealth services in
  remote areas using a hybrid network with
  wireless, satellite, and terrestrial broadband
  segments

12
Turkey

• Significant benefits have been realized
• National Health Information Standards have been
  developed
• Agreements governing health data types and
  collection methods at the national and regional
  levels
• Agreements on data interchange standards between
  different health information systems
• Telemedicine programs implemented in selected
  rural and poor regional hospitals
• Decision Support System (DSS) has been added

13
Algeria

• In 2007, 66 of 69 countries in e-Readiness
• 10 of the population is considered to be
  internet users
• In 2006, 1.1 PCs per 100 person
• System aims to manage patient records, verify
  patient benefits, and simplify administration by
  reducing paperwork
• Designed to have three major applications
  teleconsultation, remote assistance of surgical
  acts and the sharing of health information

14
Estonia

• Service oriented nation-wide Health Information
  system
• All health service providers have own information
  systems and these connect to central Health
  Information System
• Document sending/receiving, Case
  beginning/closing messages, Summary queries,
  Document queries, Duplicate handling, Access
  services, Patient demographics, related person
  handling
• ID card system

15
Mongolia

• 10 of population PC users
• Pilots focused on distance treatment, diagnostic,
  monitoring
• Online system to allow medical professionals in
  remote areas to share patient information with
  medical professionals in urban centers and make
  internet-based diagnosis
• Bring together the best cardiological expertise
  in Mongolia, through a telemedicine network and
  website, for diagnostic purposes
• Health Sciences University of Mongolia and the
  University of Basel linkage to allow for remote
  pre-op, post-op diagnosis, therapy and knowledge
  sharing

16
Key Lessons

• Requires a commitment from high levels of
  government and private sector.
• Continuous communications at all levels.
• Data standards for Interoperability needs to be
  implemented.
• Physicians must be involved.
• Training is a essential piece that must be funded.