eHealth:

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e-Health Huidige Status en Toekomstperspectieve
n
Prof Dr Georges De Moor Universiteit Gent
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• Health eHealth Main Objectives
• Quality
• Efficiency
• Security
• Safety
• Equity of the Health(care) Services
• cf. the Vision and Strategy in Building Bridges
  (1999)

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• 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 (!)

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• 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

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• 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)

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The e-Europe Action Plan (2005)
E-Health identified as one of the EC priorities,
with as deadlines

• 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

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Interoperability General Definitions

• ISO 200212 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)

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Interoperability Types

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

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Basic Research
Bio-Medical Informatics
III
HealthGrid
Applied/ Industrial RD
Decision Support Systems
II
Personal Health Systems (Wearables)
General issues EHR, Security, Interoperability
Health Info Networks Services
I
EHR interoperability
Support to eHealth Action Plan
Deployment
Time
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eHealth ERA
III
II
I
SYMBIOMATICSBMI ERA Pilot
I2HEALTH
SHARE Healthgrid
Certification EHR QREC
STEPVH CA
Semantic Health Interoperability
RIDE Interoperability
Interoperability TMA Bridge
INFOBIOMED
BIOPATTERN
SEMANTIC MINING
Short time research
Implementation
Long time research
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Examples of ongoing RD or Deployment Projects

• At European level QREC (http//www.eurorec.org )
• At Belgian level HEPI-GO (http//www.health-telem
  atics.be )
• At Regional level COPLINTHO (https//coplintho.ib
  bt.be )

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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

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ProRec CENTRES
Centres Belgium Bulgaria Denmark France Italy Germ
any Ireland Romania Slovenia Spain
Applicants Norway Greece Hungary Portugal Poland S
weden The Netherlands United Kingdom Slovakia
Differences in languages, cultures and
HC-delivery systems
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EUROREC Organisation
(Economy of scale / Synergy)
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TRENDS in EHRs (1)
EHRs become

• transmural / virtual
• multidisciplinary and interactive

! Integration with other health care software
applications ...!
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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
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QREC FP6-IST4

• Results of the 4th Information Society Technology
  (IST4)
• Call for Proposals under the EUs 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.
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QREC Main Objectives
To develop formal methods and to create a
mechanism for the quality labelling and
certification of EHR systems in Europe, in
primary- and in acute hospital-care settings
EuroRec Institute is coordinating partner QREC
has 12 partners and 2 subcontractors
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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)

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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!
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Benefits for the Stakeholders
Industry
Market R.O.I.
Quality Labelling / Certification
Quality and Safety
Efficientie and Cost Savings
Clinicians, Patients, Public Health
Health Authorities
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EHRs Certification Expected Impacts

• to reduce EHRs investment risk for
  buyers/purchasers

• 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

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

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QREC Core Tasks (1)

• Study of current EHRs  Quality Labelling
  andCertification  -systems (State-of-the-Art
  Report)

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

• Comparison of various possible EHR certification
  systems (Methodology)

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QREC Core Tasks (2)

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

• Benchmarking process Manual for EHRs
  certification
• Business Plan

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QREC Main WorkPackages
WP 1 Consortium Management, Project
Co-ordination and 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
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QREC WP 3
WP 3 Resources for EHR Interoperability
T3.1 Register of Conformance Criteria and
Guidance Documents T3.2 Inventory and Register
of EHR Archetypes and Guidelines for their
Use T3.3 Register of Health Coding Systems in Use
in Europe T3.4 Inventory of Relevant Standards
for EHR systems T3.5 Register of XML Schemas and
Open Source Components for EHR systems
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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.
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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 Authority and has been mandated by
CEN/BT and /TC 251
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QREC Concrete Results
The Quality Labelling system will act as a
filter, enabling Potential buyers to identify
their needs, requirements (including Contexts 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.
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• 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)

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• Use of Data
• Who? Qualifications
• What? Type of data
• Why? Finality
• Importance of a legal framework
• Importance of definitions (personal, sensitive,
  medical, social...)

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• Identifiers
• RRN
• INSZ (RRN, KSZ)
• PGIN (HEPI)
• Towards a comprehensive solution for the care
  settings hospitals, ambulatory care, homecare)

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• 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)
• ...

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Primary and Secondary Uses
Social/
Management
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INFOCARDS

• Microsofts 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.

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COPLINTHO IBBT project (Vlaanderen) Proof of
Concept project voor Interactieve eThuiszorg
Start 1 January 2005 End 31 December 2006
eThuisZorg omgeving
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Valorisation
Project
Markt
Pre-valorisatie
Concept
Ontwerp
Gebruiker
Product
Lab test
Veld test
Testprogramma
Evaluatie-plan
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COPLINTHO (IBBT) eHomeCare Services
Users
Applications

• 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)

• 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

Data, voice and video
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Legal Issues
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COPLINTHO Individueel Netwerk voor Interactieve
eThuiszorg
Ziekenhuis (ZH)
Huisarts (HA)
Specialist (SPE)
Breedband Netwerk
Alarmcentrale (ALA)
eThuisZorg omgeving
Mantelzorger (MAZ)
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Clusters
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Flexibility

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

Portal / Provider
Doc. B
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eHealth High Level Conference (Malaga, 10-12
May, 2006) (strategic/ political...) www.ehealth
conference2006.org
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Medical Informatics Europe (Maastricht, 27-30
August, 2006) (scientific/ academic...) www.mie2
006.org
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World of Health IT 2006 (Geneva, 10-13 October,
2006) (industrial...) www.eurorec.org