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Prof. Dr. Georges De Moor EuroRec President Ghent, Belgium

The 1 st International Meeting on the Electronic Health Record in Lisbon (26 November 2010) “EHR: Visions and Strategies”. Prof. Dr. Georges De Moor EuroRec President Ghent, Belgium. Vision and Strategy: Presentation. EuroRec Electronic Health Records: Trends

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Prof. Dr. Georges De Moor EuroRec President Ghent, Belgium

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  1. The 1st International Meeting on the Electronic Health Record in Lisbon (26 November 2010)“EHR: Visions and Strategies” Prof. Dr. Georges De Moor EuroRec President Ghent, Belgium

  2. Vision and Strategy: Presentation • EuroRec • Electronic Health Records: Trends • General Recommendations regarding large scale implementations • Example: the Belgian eHealth Platform • Certification

  3. The EuroRec Institute is a European independent not-for-profit organisation established in 2003. Its main mission is to promote - as a federation of national ProRec centres (17 member countries and a number of applicants) - the use of high-quality Electronic Health Record systems (EHRs) in Europe*. * EuroRec therefore also supports certification by defining quality criteria and proposing quality labelling procedures.

  4. Quality Criteria EuroRec has installed a central repository of +1700 indexed, validated and translated quality criteriaand has developed tools that can be used to harmonise certification, product documentation and procurement specification of EHR systems. Existing criteria and tools are now being validated and tested in 25 Member States through the EHR-Q-TN Project with as other output also a unique inventory of all EHR vendors and other stakeholders in those countries. Certification will favour the harmonisation of EHR products: the EuroRec Seal

  5. History of EuroRec’s Research Projects • MediRec (FP3) (94-95) (C.A.) Lisbon Declaration (Recommendation 9) • ProRec (FP4) (96-98) (S.A.) Creation of first ProRec centres • Widenet (FP5) (00-03) (A.M) Creation of EuroRec • Q-Rec (FP6) (05-08) (S.S.A.) Creation of Repository & Tools • EHR-Implement (FP6) (07-10) Strategic Recommendations • EHR-Q-TN (FP7) (09-12) (T.N.) Dissemination/Implementation • HITCH (FP7) (09-10) Interoperability • Argos (FP7) (10-11) EU-US Transatlantic Collaboration • EHR-4-CR (IMI FP7) (11-14) Re-use of EHR data for Clinical Research

  6. Electronic Health Record All stakeholders across the world have recognised that the Electronic Health Record is: • a key tool in the provision of safe, high quality and effective care ; • and a critical factor for research .

  7. Evolution In eHealth the technical landscape is moving fast and the boundaries between tertiary -, secondary-, primary care-, homecare- and even body-settings …are fading away… … leading to a continuum of care(cf. health and wellness).

  8. EHR Trends • Patient-centered • Longitudinal (life-long) records • Multi-disciplinary and multi-professional • Structured and coded (cf. semantic interoperability) • Intelligent (cf. decision support, clinical care pathways…) • Transmural and virtual • More sensitive content (e.g. genetic data) • Personal • Predictive/ Pre-emptive • Integrative

  9. Biosensors Biochips Environmental Data Genomic data Phenomic data Integrated Health Records Looking at the full picture of an individual’s health status (I. Iakovidis)

  10. Research Safety and Adverse Event Registers Marketing Knowledge Mgmt Platforms Health care Policy Support Decision Support Systems Use and Re-Use of EHR data CARE Patient TRUST Clinician PHR EHR (EMR, EPR…) Privacy Enhancing Techniques Billing

  11. http://www.ehr-implement.eu EHR-Implementhas collected, analyzed and compared data of large scale Electronic Health Record implementations in a number of European countries (6) in order to provide best practice (and strategic) recommendations. In the past the political, social and organizational aspects - that can ruin implementation - have often been overlooked.

  12. http://www.ehr-implement.eu Denmark(Connected Digital Health) England (NPfIT) France (GIP/DMP) Belgium (eHealth Platform) Ireland (iPMS-iSOFT) Slovenia (eZIS)

  13. General Recommendations (1) 1. You need a Vision and Strategyatthreelevels: - Health (Quality, Efficiency, Equity…) - e-Health - EHR Is there a consensus on the main goals to bereached? CAVE: Vision = Future = Changes !

  14. General Recommendations (2) 2. You needGovernance: In the case of a national plan youneedstronggovernment support preferablyfacilitated by: - appropriatelegislation; - establishment of a formalgovernance structure (clearroles); - a budget (do not underestimatecosts for development, implemen- tation, operation and maintenance). ! but to besuccessful… TRUSTiskey: thusearlystakeholders’ engagement. Participative model: stakeholders (esp. the HealthcareProfessionals) shouldbeinvolvedthroughout the wholepreparation and implementationprocesses!

  15. General Recommendations (3) 3. You needa RealisticImplementation Plan: - A flexible « step by step » approachnot dominated by pressure (e.g. political pressure): progressive, incremental…not tooambitious - Continuousevaluation as to allow for adaptation - Find solutions for real needs and identifyinteresting business cases (cf. impact of quick wins on motivation, e.g. administrative simplifications)

  16. General Recommendations (4) 4. DonotkillyourowneHealthMarket: - Public PrivatePartnershipshouldbe made possible (do not re-developexisting solutions) - Respect existing ‘successful’ local or regional initiatives regarding electronichealth services - Vendorselectionshouldbesubmitted to the end usersevaluation

  17. General Recommendations (5) 5. Training and Education: - Awarenessshouldberaised - Education and Training programmes shouldbeestablishedat an early stage (ICT for Health as part of the Medical Curriculum). - Train the trainers (cf. Meaningful Use Programme in the US and the announcedshortage in eHealthworkforce (Health IT professionals)!

  18. Health Portal VAS VAS VAS VAS Example: the Belgian e Health Platform Cooperative platform for safe electronic data exchange offering a number of basic servicesin order to facilitate collaboration between all actors in Healthcare with the following basic infrastructure: Care provider software Healthcare institution software VAS VAS VAS VAS RIZIV-INAMI site eHealth platformPortal MyCareNet VAS VAS VAS VAS VAS VAS VAS VAS VAS VAS VAS VAS Basic services eHealth platform Network ADS ADS ADS ADS ADS ADS

  19. Belgian eHealth Platform (ctd) VAS = Value Added Service, isany service (e.g. electronic prescriptions) made available to patients or healthcareprofessionals. The VAS provider (public or private) can use the basic services (e.g. user and access management, PKI, date and time stamping, logging, web portal…) offered by the eHealthplatform * ADS = Authentic Data Source, is a databasecontainingreliableinfor- mation (e.g. National Register of Physicians, Official Drug Database…) accessible via the eHealthplatform * * The use of the eHealthplatformisoptional (not mandatory) * An independentCommittee, part of the Belgian Data Protection Agency, controls the activities of the Platform * No central storage of personalhealth data

  20. Belgian eHealth Platform and its Hubs

  21. Belgian e-Health Platform and its Hubs (ctd) • Reference to the care provider(s) or care institution(s) where one or • more electronic documents are available for a patient is, with the • informed consent of the patient, stored in a local or regional • reference directory (a so-called "hub"). • The Reference Directory managed by the eHealth platform • (the so-called "meta-hub") only contains references to the hub(s) • where references for a patient are stored.

  22. Example: Exchange of Patient Data A 3: Fetch data from hub A 1: Where can we find data? Meta-Hub 2: In hub A and C 4:All data available 3: Fetch data from hub C C B

  23. Critical Success Factors (Belgian case) • Trust: no hidden agenda (e.g. healthcare systems performance monitoring does not help in alleviating resistance of HC providers) • Data quality: “garbage in is garbage out” • Technical and Semantic Interoperability • When the merging of data from several sources is needed, then the Unique Patient Identifier (i.e. the Belgian social security identification number) is being used • Due respect of principles of Privacy Protection and Information Security • Due respect and unrestricted application of Laws (e.g. Patient Rights, Privacy Protection, Healthcare Professional Secrecy...)

  24. Certification: a powerful means… New instruments Newfunctions 4 3 1 € 2 Pressure

  25. Business cases for using EuroRec’s quality criteria... • A regional or nationale-Health programmewishing to implement quality labelling or certification as to ensure consistent EHR system functionality • A purchaserwishing to procure an EHR system module (reducing his investment risk) • Avendor/developerwishing to document his system or to upgrade with new funtionalities an EHR system (competitive advantage)

  26. The EuroRec Annual Conference (May 2011, Budapest) “The Re-use of EHR data for Clinical Research”: the Initiative (IMI and DG Research)” ------------------------------------------------------------------------------ “The Trans-Atlantic Project (DG RELEX)”

  27. Thanks for listening! http://www.eurorec.org georges.demoor@ugent.be

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