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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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slide1
e-Health:

Huidige Status en

Toekomstperspectieven

Prof Dr Georges De Moor

Universiteit Gent

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

slide2
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)

slide3
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)

slide4
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)

slide5
“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)

slide6
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)

interoperability general definitions
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)

interoperability types
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)

slide9
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)

slide10
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

examples of ongoing r d or deployment projects
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)

slide12
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)

slide13
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)

slide14
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)

slide15
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)

slide16
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)

slide17
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)

slide18
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)

slide19
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)

slide20
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)

slide21
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)

slide22
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)

slide23
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)

slide24
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)

slide25
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)

slide26
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)

slide27
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)

slide28
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)

slide29
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)

slide30
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)

slide31
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)

slide32
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)

slide33
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)

slide34
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)

slide35
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)

slide36
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)

slide37
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)

slide38
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)

slide39
Legal Issues

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

slide40
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)

slide41
Clusters

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

slide42
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)

slide43
eHealth High Level Conference

(Malaga, 10-12 May, 2006)

(strategic/ political...)

www.ehealthconference2006.org

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

slide44
Medical Informatics Europe

(Maastricht, 27-30 August, 2006)

(scientific/ academic...)

www.mie2006.org

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

slide45
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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