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Realising benefits from eHealth – European strategies and success cases –

Realising benefits from eHealth – European strategies and success cases –. Dr. Karl Stroetmann Communication & Technology Research Bonn, Germany. Bonn - Brussels. Epigraph.

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Realising benefits from eHealth – European strategies and success cases –

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  1. Realising benefits from eHealth– European strategies and success cases – Dr. Karl Stroetmann Communication & Technology Research Bonn, Germany Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  2. Bonn - Brussels Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  3. Epigraph "Too many of us spend our time worrying where technology is taking us, instead of working out the right way to go ourselves. We should not try to give computers the job of making our world a better place!“ David Golumbia, The Cultural Logic of Computation, 2009 Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  4. Outline • Health policy context • The promise of eHealth • Europe – a global leader in eHealth application • European benchmark cases • The Digital Agenda – a European eHealth vision Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  5. Hard facts facing public health policy makers (in 1970 !) • “Rising expectations and demands for healthcare • Rising costs of healthcare, especially hospital care • Demands for involvement of the consumer • The acceptability, availability & accessibility of healthcare, including ... a more convenient portal of entry into the system” Burney, J o School Health, V. 40 (1970), p. 3 Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  6. eHealth must be guided by health policy priorities eHealth cannot be instrumental in defining in what type of future health system we want to operate, BUT once a “better” health system paradigm has been established, eHealth can deliver much help and support Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  7. What eHealth can do: • Support and facilitate the realisation of clearly defined health policy and health system (sustainability) goals • Meet system needs and objectives, not that of individual interest groups (“The Commons” approach) • Enable new health delivery models and processes Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  8. WHO covereH IMPACT cover Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  9. Europe – a global leader in eHealth application • General practitioners (GPs) installed patient record systems: • USA: only 20-25% of offices • Europe/EU: • 80% have electronic medical data storage • 66% of all European GPs use them in a patient encounter, • Various EU Member States (Denmark, Estonia, Finland, UK) have 95% to 99% coverage Ashish K. Jha et al. (2006) HEALTH AFFAIRS, 11 October 2006 empirica/EC (2008). eHealth Indicators - use of ICT by primary care physicians Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  10. Europe – a global leader in eHealth application 12 EU Member States – as of 2011 about 25 (incl. CH, NO, TR) - cooperate in epSOS (European Patient Smart Open Services) project on cross-border transfer/sharing of • fully coded patient summary • fully coded ePrescribing data • translated into the respective language across multiple Member States Globally, the most ambitious and complex interoperability project ever Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  11. European benchmark cases and success stories Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  12. Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  13. Socio-economic impact of interoperable electronic health record and ePrescription systems in Europewww.ehr-impact.eu Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  14. “Small is beautiful”- theEmergency Care Summary (ECS) system of Scotland -adapted fromAlan HyslopeHealth Strategy, Scottish Government Health Directorates, Edinburgh, UK Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  15. NHS Scotland • Separate National Health Service (NHS) • ca. 5 million patients registered with 1050 general practices – GPs (family doctors) • All GPs have electronic patient record (EPR), connected to NHS broadband network • Out-of-hours GP and NHS 24 telephone service Slovakian eHealth Conference, Bratislava, 27th of May, 2010 15

  16. Decision in 2001 to implement an ECS • Allow GPs to keep their offices closed after 17 o’clock • A “useful summary” was therefore needed for new Out-Of-Hours Services (OOH) • Also to be used by Accident & Emergency Services (A&E), NHS24 (telephone helpline service), Ambulance Service • Patient safety = key driver • Decision to develop Emergency Care Summary, based on extract from GP EPRs • Simple dataset • ‘View only’ access by authorised users Slovakian eHealth Conference, Bratislava, 27th of May, 2010 16

  17. “Small” information content • Patient identity (address, telephone, CHI number, GP) • Allergies and adverse reactions to medications • Medication history • - Repeat prescriptions in past 12 months • - One-off prescriptions in past 30 days Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  18. System Overview NHS 24 Request & display A&E Ambulance ECSSystem OOH Check audit log GP Practice admin Health Board GP consultation TBD Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  19. Patient consultation & publicity campaign • Scottish Consumer Council • 8 patient focus groups held as part of planning, including people living with HIV and mental health problems • Letter to all GPs and Practice Managers • Leaflet sent to every household in Scotland, written by Scottish Consumer Council • Helpline dedicated to enquiries: Opt out, general enquiries, odd requests • Very few requests to view records • Very few opt outs Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  20. Implementation and progress • Successful pilot + evaluation in 2004 with 100K records in defined geographical area • National roll-out 2005/6 • Now 99%+ of population • 1800 patients have opted out (0.03% of all possible) • Over 4500 registered users • Use: • over 3.5 million accesses to date • c. 50k per week • steady increase Slovakian eHealth Conference, Bratislava, 27th of May, 2010 20

  21. Benefits from the ECS (I) Citizens Patient safety – medication-related in particular Some avoided admissions & referrals Time saving for patients fewer repeat questions at OOH, NHS24 and A&E More efficient consultation at NHS 24 – time & satisfaction Doctors & nurses Comfort to GPs patients are taken care of efficiently out of hours No manual writing of medication records Doctors’ and nurses’ life made easier Slovakian eHealth Conference, Bratislava, 27th of May, 2010 21

  22. Benefits from the ECS (II) Benefits to NHS Scotland Reduction in exposure to risk - better clinical governance Drugs are recorded correctly and fully Advice is based on better information Time savings – redeployment of resources: Fewer repeat questioning about medications by doctors and nurses at OOH and A&E Fewer calls to GPs by A&E pharmacists No manual input of medication lists at NHS24 - 1 min per call Avoided admissions & visits Avoided referrals by NHS24 to OOH and A&E Faster treatment and some avoided admission at A&E no overnight waiting for clarification with GP Slovakian eHealth Conference, Bratislava, 27th of May, 2010 22

  23. ECS – annual socio-economic performance Slovakian eHealth Conference, Bratislava, 27th of May, 2010 23

  24. ECS – cumulative socio-economic performance Slovakian eHealth Conference, Bratislava, 27th of May, 2010 24

  25. The integrated health information system of Andalusia, Spain adapted from Francisco Perez Torres Head of Information Systems Department Servicio Andaluz de Salud (SAS) Andalusia, Spain Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  26. Healthcare in Andalusia 26 • Spain: National Health System(universal coverage & free access, publicly funded by taxes) • Regional responsibility for health Andalusia since 1984 • 8.3 million population • In 2010 healthcare budget amounts to 9.80 billion EUR • 100% of primary care (1500 PHCs) and 72% of specialised care facilities are publicly owned (44 hospitals, 93% of all beds) Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  27. ASINGLE HEALTH RECORD Diraya´s objective Integrate the healthcare information of every citizen Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  28. Diraya: integrated healthcare in Andalusia Unique health record number for all citizens Regional EHR shared between - Primary care - Hospital outpatient specialised care - Hospital-based emergency care - Pharmacies (prescription database) - Hospital inpatient care: under implementation 28 Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  29. Diraya’s key elements 1 A SINGLE Health Record for each citizen 2 Unified ACCESS to all services KEYS 3 All relevant information STRUCTURED 4 Developed by the practitioners/users Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  30. Diraya Building blocks DATA ANALYSIS ePrescription RECETA XXI HEALTH RECORD Orders / CPOE Central Booking Citizens Data Base Maco Structured Resources Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  31. Diraya facts & figures More than 7.5 million EHRs with clinical data Connected: 795 primary healthcare centres (96% of inhabitants) 26 hospital organisations 3,500 pharmacies Users: Over 17,000 healthcare professionals 3,500 pharmacists 31 Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  32. Utilisation 2009 37.8 million primary care consultation sheets 2.7 million hospital emergency care episodes (76%) 790,000 hospital outpatient specialised care episodes (103,000 in march-2010: 25%) 93 million consultations scheduled through Diraya: Primary care: 82 million (5.6 million by internet) Specialised care: 11 million 70 million electronic prescriptions 89 million dispensing procedures 32 Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  33. 33 Number of dispensations accordingto type of prescription (2004-2009) Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  34. Costs and financing of Diraya • IT costs • 50% of overall costs • Organisational costs (non-IT costs) • Development, engagement, adaptation • Total value of socio-economic investment over 12 years: • 245 million EUR • Financed from the regional budget Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  35. Andalusia: annual socio-economic value of impact to society Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  36. Lessons learnt from Diraya Align the EHR and ePrescribing development with the regional government’s health strategy assure that booking and response times are guaranteed improve clinical management streamline healthcare processes rational drug usage …It’s not an IT project Alliances - collaborative model: Involve professionals in the inception of the system create useful tools for the clinical practice provide support to the staff(balance usability vs. regulation) agreement to assure a win-win with the Andalusian Council of Colleges of Pharmacists and with vendors Aim for a sensible balance: adding functionalities vs. improving ICT infrastructure - take risks Peer to peer training and support to professionals Analyse the information in the system & use feedback for improvement 36 Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  37. eHealth priority and activity fields mentioned in Member State policy documentspreliminary results Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  38. The future: A Digital Agenda for Europe (I) • Continued strong European support for eHealth solutions • Just published on 19.05.2010 - COM(2010) 245 • One of seven flagship initiatives of the Europe 2020 strategy for smart, sustainable and inclusive growth “To exploit the full potential of new eHealth services, the EU needs to remove legal and organisational barriers, particularly those to pan-European interoperability, and strengthen cooperation among Member States.” Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  39. A Digital Agenda for Europe (II) • Action Line 7 “ICT-enabled benefits for EU society” - Smart use of technology and exploitation of information to address the challenges facing society like climate change and the ageing population • there sub-objective 7.2. “Sustainable healthcare and ICT-based support for dignified and independent living” • Key Action 13: Undertake pilot actions to equip Europeans with secure online access to their medical health data by 2015 • Key Action 14: Propose a recommendation defining a minimum common set of patient data for interoperability of patient records to be accessed or exchanged electronically across Member States by 2012 Slovakian eHealth Conference, Bratislava, 27th of May, 2010

  40. Acknowledgement We thank the European Commission for financial and non-financial support !This presentation is part of various research supported by the European Commission, Directorate General Information Society and Media, Brussels. It reflects solely the views of its presenters. The European Community is not liable for any use that may be made of the information contained therein Slovakian eHealth Conference, Bratislava, 27th of May, 2010

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