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e-Health: Huidige Status en Toekomstperspectieven

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

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e-Health: Huidige Status en Toekomstperspectieven

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  1. e-Health: Huidige Status en Toekomstperspectieven Prof Dr Georges De Moor Universiteit Gent Prof. Dr. G. De Moor (Gent, 09/03/2006)

  2. Health & eHealth: Main Objectives • Quality • Efficiency • Security • Safety • Equity of the Health(care) Services • cf. the Vision and Strategy in “Building Bridges” (1999) Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

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

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

  6. The e-Europe Action Plan (2005) E-Health identified as one of the EC priorities, with asdeadlines: • 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 Prof. Dr. G. De Moor (Gent, 09/03/2006)

  7. 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: General Definitions Prof. Dr. G. De Moor (Gent, 09/03/2006)

  8. Technical interoperability Organisational interoperability Functional interoperability Syntactic interoperability Semantic interoperability Political interoperability Legal interoperability Social interoperability Inter-standard interoperability Interoperability: Types Prof. Dr. G. De Moor (Gent, 09/03/2006)

  9. Basic Research Bio-Medical Informatics III HealthGrid Applied/ Industrial R&D 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 Prof. Dr. G. De Moor (Gent, 09/03/2006)

  10. 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 Prof. Dr. G. De Moor (Gent, 09/03/2006) Short time research Implementation Long time research

  11. 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 ) Examples of ongoing R&D or Deployment Projects Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

  13. ProRec CENTRES Centres Belgium Bulgaria Denmark France Italy Germany Ireland Romania Slovenia Spain Applicants Norway Greece Hungary Portugal Poland Sweden The Netherlands United Kingdom Slovakia “ Differences in languages, cultures and HC-delivery systems ” Prof. Dr. G. De Moor (Gent, 09/03/2006)

  14. EUROREC PROREC - CENTRES … (Complementarity / Languages) … Healthcare Authorities Users (Clinicians, Citizens) EHRs - Vendors Purchasers, Payers EUROREC: Organisation (Economy of scale / Synergy) Prof. Dr. G. De Moor (Gent, 09/03/2006)

  15. Administrative Records Medical Records Nursing Records Patient Health Diaries TRENDS in EHRs (1) EHRs become • transmural / virtual • multidisciplinary and interactive ! Integration with other health care software applications ...! Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

  17. 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 aSpecific Support Action (SSA)with EUR 1.3 million in EU funding. Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

  19. 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 internationalco-operation (eg. CCHIT in the US…) Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

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

  22. 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 andportability of the patient records no matter where the patients are located or are travelling... Prof. Dr. G. De Moor (Gent, 09/03/2006)

  23. Assay of the requirements amongst all stakeholders across Europe, covering both current and planned EHRs certification activities (Survey) 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) Prof. Dr. G. De Moor (Gent, 09/03/2006)

  24. QREC: Core Tasks (2) • Definition of a model (a common European Template) with harmonized guidelines and procedures for EHRs quality labelling and certification • Benchmarking processManualfor EHRs certification • Business Plan Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

  26. QREC: WP 3 WP 3 : Resources for EHR Interoperability T3.1 Register ofConformance 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 Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

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

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

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

  31. Use of Data • Who? Qualifications • What? Type of data • Why? Finality • “Importance of a legal framework” • “Importance of definitions (personal, sensitive, medical, social...)” Prof. Dr. G. De Moor (Gent, 09/03/2006)

  32. Identifiers • RRN • INSZ (RRN, KSZ) • PGIN (HEPI) • “Towards a comprehensive solution for the care settings: hospitals, ambulatory care, homecare…)” Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

  34. Research IDx Care TSPx TSx Administrative HEPI Int. Research TSP TSPy INSZ IDy TSP TSPz IDa Marketing IDz Primary and Secondary Uses Social/ Management Prof. Dr. G. De Moor (Gent, 09/03/2006)

  35. Microsoft’s Identity Meta-system interoperable architecture for digital identity connecting existing and future identity systems Infocards - Identity Selector providing a consistent user-experiencefor 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 Prof. Dr. G. De Moor (Gent, 09/03/2006)

  36. COPLINTHO: IBBT project (Vlaanderen) “Proof of Concept” project voor Interactieve eThuiszorg Start: 1 January 2005 End: 31 December 2006 eThuisZorg omgeving Prof. Dr. G. De Moor (Gent, 09/03/2006)

  37. Valorisation Project Markt Pre-valorisatie Concept Ontwerp Gebruiker Product Lab test Veld test Testprogramma Evaluatie-plan Prof. Dr. G. De Moor (Gent, 09/03/2006)

  38. COPLINTHO (IBBT): eHomeCare Services Applications Users • 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) • Nursesand 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 Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

  40. COPLINTHO: Individueel Netwerk voor Interactieve eThuiszorg Ziekenhuis (ZH) Huisarts (HA) Specialist (SPE) Breedband Netwerk Alarmcentrale (ALA) eThuisZorg omgeving Mantelzorger (MAZ) Prof. Dr. G. De Moor (Gent, 09/03/2006)

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

  42. Record Y • EHR locations • ... • Record X • EHR locations • ... GET Loc. EHR A GET EHR A • Requestor is B • B has access to REC A • B is Doc Flexibility • Record A • EHR locations • B is DOC A • C is trust person A Portal / Provider Doc. B Prof. Dr. G. De Moor (Gent, 09/03/2006)

  43. eHealth High Level Conference (Malaga, 10-12 May, 2006) (strategic/ political...) www.ehealthconference2006.org Prof. Dr. G. De Moor (Gent, 09/03/2006)

  44. Medical Informatics Europe (Maastricht, 27-30 August, 2006) (scientific/ academic...) www.mie2006.org Prof. Dr. G. De Moor (Gent, 09/03/2006)

  45. World of Health IT 2006 (Geneva, 10-13 October, 2006) (industrial...) www.eurorec.org Prof. Dr. G. De Moor (Gent, 09/03/2006)

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