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What the EU ehealth IoP Roadmap could bring to the Health future Michèle Thonnet French Ministry of Health. Reforming the H system : a necessity. demographic changes : ageing population increased prevalence of chronic diseases citizen expectations for high Q HC

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What the EU ehealth IoP Roadmap could bring to the Health futureMichèle ThonnetFrench Ministry of Health

EU eHealth interoperability Roadmap

reforming the h system a necessity
Reforming the H system : a necessity

demographic changes : ageing population

increased prevalence of chronic diseases

citizen expectations for high Q HC

increasing costs of research, equipments, examinations, treatment

quicker pandemia expansion

lack of staff ; shortage of HCP

mobility of citizens, patients, HCP, workers

mastering costs : crisis and ‘business’ model

its key expectations
ITs : Key expectations

Facilitate access, continuity of HC (mobility)

Improving Q of care, allowing real HC equity

Enhancing coordination, continuity of care security & safety

Facilitating collaboration between HCP, within/between HCPO

Improving homecare and adapted delivery services at PoC

Organising mutualisation and international standards usage

Facilitating research, L S experimentations and deployment

Decreasing the number of doubloning examinations

Mastering costs through innovative model(s)

multidisciplinary approach a necessity from research to citizen
Multidisciplinary approach :a necessity ; from research to citizen
  • efficient health (disease) management
  • prediction / prevention of diseases
  • remote monitoring and care
  • higher patient safety and citizen empowerment
  • shift from hospital to personal centered system
  • more personalized care solution- privacy issue
  • higher productivity of HC and professional interoperable standardised industry solutions
  • adapted legal framework

Actors … Stakeholders

Public authorities and

the organized civil society

  • a common objective, but own missions, agendas, vocabularies and constraints
  • different skills, needs and access to different to eHealth expertise


health in the eu treaty
Health in the EU Treaty
  • HEALTH is a national prerogative
    • subsidiarity is key
    • but challenges are the same in each M.S.
  • what could be done at EU level :
    • a volontarist collaboration between M.S.
    • supported by the E.C.
    • confirmed by the « eHealth action plan »
    • design through a dedicated organisation
    • declined on pragmatic priorities
a new era in legal and policy framework for eu cooperation on ehealth
a new era in legal and policy framework for EU Cooperation on eHealth

Communication on Quality critera for a web site

Communication on the eHAP

Recommendation on cross-border interoperability of electronic health record systems

Communication on telemedicine for the benefit of patients, healthcare systems and society

eHealth Standardisation Mandate 403


Council conclusion on safe and efficient healthcare through eHealth – December 2009

Proposal for a European Directive on patients’ rights in cross-border healthcare

2002-2010 a new Era

other eu current initiatives
other EU current initiatives
  • Health
    • Europe 2020: “Sustainable health”
  • Standardisation
    • Digital Agenda
    • Access
    • IT Standardisation
  • eHealth M.S. and stakeholders voluntary cooperation
    • epSOS


iop recommendation review
  • Interoperability is considered for the purpose of “integrated, connected and interoperable continuity of care for Europe”
ehealth interoperability

Jurisdiction # 1

Use Case A



Political / Legal






eHealth Interoperability

Jurisdiction # 2

Political / Legal

Use Case A




IOp Model, i2010 subgroup of eHealth; I2Health

a european collaborative initiative
A European Collaborative Initiative
  • How to answer to the civil society needs ?
  • How to balance cultural and legal norms ?
  • How to know and capitalise on  good practices ?
  • How to facilitate /accelerate pilots, adoption?
  • How to sustain initiatives & new models ?
  • How can countries coordinate efforts
  • And turn ideas into practice

CALLIOPE Network (with the support of EC-DG INFSO)

the need for an interoperability roadmap
The need for an Interoperability Roadmap
  • Each country or region is separately trying to solve the same problems.
  • Each country or region, organisation or division of the particular organisation lacks the resources and skills needed to boost innovation.
  • All countries will benefit from joint effort towards this.
target groups

E-health Community

Engagement through consultation


CALLIOPE in a nutshell

(June 2008 - December 2010)

To produce value for decision makers

  • A fully operable, open,trusted, co-operative multi-stakeholder environment
  • An analysis of Member States responses to the EC Interoperability Recommendation on EHR
  • Operational collaboration with relevant EU level projects

An EU eHealth Interoperability Roadmap, “the Roadmap“ to accelerate eHealth Deployment


The CALLIOPE Platform 1/2

Competence Centers

Health Authorities

June 2008

March 2010



The CALLIOPE co-operative working platform

  • Clear Governance
  • Efficient Supporting Structure
  • Outcome based management

Trust must be reinforced




Shared Values: openness and transparency, participation, quality, proportionality and coherence


though access to EU collective expertise and knowledge but also through appropriate conditions for this to be fully exploited


though shared ownership of the process, content and the outcome

The trilogy of Trust








the roadmap
The Roadmap
  • The needs
    • service innovations needed to focus on existing or anticipated health care system priorities
  • a vision
    • of where we wish to go and what solutions are needed to get there
  • a route for achieving the vision
    • to select and develop the right alternatives needed to create the right services


eu interoperability roadmap trusted
EU Interoperability RoadmapTRUSTED?


Principles, platform, level of Trust


Iterative approach, working methods


Content of the Roadmap


the process
The process

Most of the necessary knowledge exists

focus onidentifying, synthesizing, integrating, and diffusing this knowledge

taking into account the various facets

Organising this K along the value chain to reach the agreed target

epsos a highly political project
epSOS – a highly political project
  • Member State obligation to deliver the best possible medical treatment – at home or when travelling
  • Introducing a new dimension in national healthcare systems
  • Goal for the epSOS eHealth Project:
    • “to develop a practical eHealth framework and ICT infrastructure that will enable secure access to patient health information, particularly with respect to a basic patient summary and ePrescription, between European healthcare systems”
  • Main political objectives:
    • support patient mobilitynationally and in the EU
    • ensure that patient safety is guaranteed
    • increase efficiency and cost-effectivenessin cross-border care
the process26
The process

Roadmap versioned documents

Roadmap Consolidation workshops

CALLepSO workshops


X-border project consultations eID,semantics



Collaborative evolving process

Political priorities

1st stop Barcelona, March 2010!

Agreement and validation of way of work by the Secretaries of State

Stakeholder priorities

Reaching agreements through continuous bench-learning loop across concerned actors



provisional content
Provisional Content

High-level meeting on EU eHealth Governance-Barcelona








What: possible future actions at EU level

For what:

To accelerate ehealth deployment

Who: Health care community

How: Use Cases, alternatives, maturity and opportunities, building on what is shown to work

1st stop Barcelona validation

2nd step

December 2010

A proposal for a common

EU Roadmap for eHealth

EU interoperability Roadmap progress


recommendations and outlook
Recommendations and Outlook

Political priorities


provide concrete input to decision making

support of the eHealth high level governance process

towards secure unambiguous and portable electronic identification of eu citizens
Towards secure, unambiguous and portable electronic identification of EU citizens
  • Recommendations:
    • Cross border recognition of eID for healthcare purposes
    • A Common European Framework for eID Management is needed
      • One or many ID, role management …
      • Security, assurance levels, HP authorisation, …
    • European Governance for eID Management
towards an internal market for ehealth services technical interoperability
Towards an internal market for eHealth services – technical interoperability
  • Recommendations
    • Establishment of European-wide standards, interoperability testing and certification and accreditation schemes for eHealth
      • Review of national activities on standardisation, access and use of standards, take forward the CALLIOPE Recommendations on standardisation
    • Use cases prioritisation and prioritization of business areas coordination for standardization based on balanced proposals by stakeholders
    • Sharing of experience of best practices in standards use
towards a european wide infostructure semantic interoperability
Towards a European-wide infostructure – semantic interoperability
  • Recommendations
    • Consider semantic interoperability as an area for multinational collaboration
      • Develop a collaborative governance framework and support coordination work
    • Encourage the definition of standards for electronic medical data/documents to be shared across borders.
      • Address the challenges of multilingual semantic mapping

+ All Recommendations concerning technical interoperability apply also to semantic interoperability

legislation and regulation as facilitators legal and regulatory interoperability
Legislation and regulation as facilitators – Legal and regulatory interoperability
  • Recommendations
    • Agree – and review national legislation - on
      • A realistic and appropriate level of security for electronic processing and transfer of health related information
      • A shared policy on patient consent to electronic processing and cross border transfer of health data
      • A process for continuous improvement to reflect progress in technology, harmonisation of security, quality and safety practices
    • Adopt an EU information governance and a permanent coordination mechanism for cross-border transfer of health data
economic challenges of ehealth services
Economic challenges of eHealth services


Coordinate activity and resources

Support exchange of experiences with working on alternative co-operation models

Invest in human resources, skills, training …

Review legal and regulatory frameworks to accommodate market innovation and new models for reimbursement, funding and resource allocation for eHealth

monitoring progress
Monitoring progress


Building collaboratively a substantial body of knowledge and evidence at EU level

Considers the OECD model survey approach and indicators for adoption

Supports specific actions and a support mechanism to help MS to effectively share lessons learnt about benefits and costs of choosing one approach over another as well as about the incentive mechanisms and reimbursement system

together addressing open issues in the eu
Together addressing open issues in the EU


Elaborate – at the onset of the collaboration process – a two layered EU collaborative Governance based on current EU practice and the CALLIOPE experience

Consider the establishment of national multi-stakeholder platforms

main observations from calliope network
Main observations from CALLIOPE Network
  • For implementing eHealth interoperability, the Network supports the Member States key proposals to
    • Focus on high-level governance
    • Value exploring the concept of EU competence network
      • Including benchlearning processes, best practice repositories …
    • Operationalise stakeholder involvement and engagement
    • Consider interoperability as a process and emphasize the importance of its sustainability


iop rm critical success factors
IoP (RM) Critical Success Factors
  • Relevance: that IoP activities are seen as relevant to business objectives and current activities
  • Openness: that the IoP process is seen as an open and inclusive one
  • Engagement: that all parties are able to contribute to all stages of the process
  • Affordability: that the results are affordable, and demonstrating a clear return on investment
  • Sustainability: that the framework for development of IoP is sufficiently open and flexible to allow adaption and future development
adoption of a common working model
Adoption of a common working model

Sustainable Healthcare

Sharing Information and Knowledge for Better Health

eHealth Governance

eHealth Services

Common EU priorities

eHealth leadership, policy and strategy

EU & National Stake-holder collaboration

Electronic prescribing

Community services, AAL

Other national priorities

Knowledge management, etc.

Patient summaries

Chronic Care Management

Rare diseases

e.g., Data analysis & aggregation

Privacy, quality and safety policies

National priorities

Legislative and regulatory framework

Foundation eHealth infostructure

Clinical terminologies and classifications and codifications

Data structures and value setsEHR, EMR, PHR, other

Data interoperability and accessibility

Patient identification and patient data discovery

Fostering standards adoption

Market development, new business models, and incentives

HCP Authorization, authentication and rights management

Consent management and access control

Data and knowledge management tools

Data bases and Registries

Financing, Resource allocation and reimbursement models

Foundation ICT infrastructure

Mobile and fixed Electronic Communication Infrastructures

Access to ICT Networks, equipment and facilities

ICT processing and storage services

ICT Professional and technical support; Training

Monitoring, evaluation

brussels at eu parliament
Brussels, at EU Parliament
  • Crossing boundaries in eHealth: the CALLIOPE think-tank and collaborative platform

November 2010

To prepare the EU eHealth High Level Governance

directive on patients rights in cross border healthcare ehealth
Directive on patients rights in cross border Healthcare: eHealth

1. The Union shall support and facilitate cooperation and the exchange of information among Member States working within a voluntary network connecting national authorities responsible for eHealth designated by the Member States.

2. The objectives of the eHealth network shall be to:

  • (a) work towards delivering sustainable economic and social benefits of European eHealth systems and services and interoperable applications, with a view to achieving a high level of trust and security, enhancing continuity of care and ensuring access to safe and quality healthcare;
  • (b) draw up guidelines on ▌:
  • (i) a non-exhaustive list of data that are to be included in patients' summaries and that can be shared between health professionals to enable continuity of care and patient safety across borders, and
  • (ii) effective methods for enabling the use of medical information for public health and research;
  • (c) support Member States in developing common identification and authentication measures to facilitate transferability of data in cross-border healthcare.
european ehealth governance levels
European eHealth Governance levels
  • Policy level: to set out higher level political objectives, define common priorities and policy measures
  • Strategic level: to agree on concrete strategies for developing and implementing integrated, value adding eHealth servicesEstablishment and maintenance of an open platform for multi-stakeholder trusted dialogue
  • Operational level: deeper focus in areas such as ethics, security policies and services, EU infostructure, re-engineering of the standardisation process, maintaining links to national stakeholder groups, etc.
a further consolidated approach is needed
A further consolidated approach is needed…
  • Establish a European Governance to sustain an open and transparent process involving all three levels
  • Reach out to the national communities, i.e. beyond what CALLIOPE was able to achieve within its life span
  • Establish mechanisms to support MS in their implementation of the EU Roadmap
status quo
Status Quo
    • Ministries
    • Competence Centers
    • Users
    • Industry
  • Planned project start: January 2011
  • Involvement of High Level Representatives
  • Turning from project results (e.g. CALLIOPE RoadMap) to a MS driven aproach  the eHealth Governance Initiative
ehgi main objectives
eHGI Main Objectives

Provide to MS a consolidated approach and a strong political committment to governance at three levels (1) Policy (2) Strategy and (3) Operational

Provide to the MS, the EC and other relevant stakeholders a platform and “a think tank” for current and emerging challenges which could lead to a strong consolidated Roadmap of concrete actions and the description of potential future pilot projects and partnerships

Provide to the MS, the EC, the Competence Centres, the IT-Industry and to other relevant stakeholders a European eHealth Interoperability Framework

Provide to the EC, EPSCO Council and to other relevant stakeholders targeted support for activities requiring broad convergence across Europe, such as future LSP eHealth projects and common interoperable service solutions at MS level

thank you for your time
Thank you for your time