ehealth Thought Leadership: A Way Forward EU ehealth Agenda

Transcription

1 ehealth Thought Leadership: A Way Forward Linklaters Brussels, 17 June 2009 EU ehealth Agenda Ilias Iakovidis Deputy Head of Unit, ICT for Health Unit, DG INFSO European COmmission 1 1

2 ehealth in EU Individual Member States' strategies 22 countries have explicit ehealth policy strategies 2 ec.europa.eu/information_society/activities/health/policy/index_en.htm

3 EU Wide Strategy 5. Telemedicine Communication - COM(2008)689 final 4. EC Recommendation on EHR Interoperability (2008) 3. Lead Market initiative for Europe (ehealth) 2. I2010 flagship initiative - ICT for Ageing Well 1. ehealth Action Plan - COM(2004)356 final 3 ec.europa.eu/information_society/activities/health/policy/index_en.htm

4 First step 3 Towards full full picture of of the the individual s s health health status status 2 Connecting individuals with with Health Health Information Networks 1 Linking all all the the points points of of care care Time 1990s Today 4

5 First step: Connectivity Linking all the points of care General Practitioners Health Authorities Hospitals Social Service Secure data networks Nursing Homes Labs Homecare 5

6 Prescriptions 80% Disch. Letters 81 % Lab. reports 95 % Estimated cumulative benefit by 2008: ~ 1.4 bil. Reimbursement = 95 % Referrals =80% 6 6

7 National Priorities: Preliminary Analysis Priorities in national ehealth Strategies # of Countries Examples Electronic Health Records EHR, EPR, Medical Records, Patient Summary, Emergency Data Set 17 DMP - Dossier Médical Personnel (FR) BEHR - Basic Structure for the EHR (DK) NHS Care Records Service / Spine (UK), Patient summary (SE, FI) SumEHR (BE), egp file (NL) Infrastructures & Networks Broadband communication networks and associated technology and basic services eprescription Management and implementation of eprescribing 12 MedCom the Danish Healthcare Data Nework (DK) Sjunet (SE) National Health Network (NO) National ehealth VPN (DE, AT) 16 Apotheket (SE) eprescription (DK, NL, SI) erezept (DE) 7

8 Wishes vs. Reality Number of EU Countries Complete EHR/interoperability National Priorities eprescription Priority (wish) Reality 8

9 ehealth use in Europe GPs engaging in patient data went up from 17% to 63%. Transfer of laboratory results (blood, ECG) from 11% to 54%. Transfer of administrative patient data to reimbursing organisations went up to 22% from 6% in Transfer of medical patient data increased from 8% to 28%. e-prescribing was done by about 3%, now by about 11%. A comparison with the 2007 results for all 27 EU Member States shows that the enlargement of the Union did not have much impact neither 9 positive nor negative on the developments in the past five years.

10 EC Recommendation on Interoperability of cross border EHR systems C(2008)3282 Aims at enabling coordinated care by connecting people, systems and services Provides Member States and relevant bodies with basic principles to address the existing challenges in implementing EHR interoperability Identifies different levels of actions: Political, Organisational, Technical, Semantic, 10 Important issues: standardisation, certification, conformance testing, education and awareness

11 Emphasis on Interoperability Support to projects, events, education on interoperability Mandate (M 403) given to CEN, CENELEC, ETSI to provide standards on ( 1) patient and health practitioner identifiers; 2) the patient summary; 3) an emergency data set. Launch of Large Scale Pilots on interoperability of emergency and medication data CIP (7/08) Calls for proposals: EHR certification (CIP June 08) Conformance testing (FP7-Call 4 Nov 08) 11 11

12 Competitiveness Innovation Programme Policy Support Programme (CIP ICT PSP) Large Scale Pilot (epsos) 23 beneficiaries, 12 countries 6 national Ministries of Health 15 Competence Centers 31 companies through IHE-Eur Thematic Network on ehealth Interoperability (CALLIOPE) 27 beneficiaries 30 months 500k EC funding 11 Million EC funding 12

13 Implementation, support to policies epsos: Approach and Expected Outcome One large Scale Pilot Patient summary for unexpected care eprescription/medication records With a common architecture Built on Member States solutions and users needs ( bottom up ) Thought as long lasting solution at European level Scalable and sustainable, adaptable to new situations 13

14 ehealth Market in EU POTENTIAL ehealth is currently the fastest growing industry of health sector, estimated at 20 Billion, 2% of Health expenditure Other EU markets: Pharma 205 Bill., Medical Technology 64 Bill. By 2010, a double digit growth rate of up to 11% is foreseen for ehealth, driven by a search for more productivity and performance (source: Datamonitor 2007 Trends to watch: Healthcare Technology). CHALLENGES Standardisation Interoperability B i d l & fi i EU Market fragmentation 14

15 Lead Market Initiative 4 main barriers to ehealth market development 1. Market fragmentation, lack of interoperability 2. Legal Uncertainty 3. Lack of availability and access to finance 4. Lack of procurement 15

16 Second step 3 Towards full full picture of of the the individual s s health health status status 2 Connecting individuals with with Health Health Information Networks 1 Linking all all the the points points of of care care Time 1990s Today 16

17 A Communication on Telemedicine: October 2008 Telemedicine experiences exist nation and Europe wide Increasing deployment due to: Technical reasons: Broadband, personal health systems Financial reasons: Moving patients from hospitals to home; solutions for chronic disease management Other reasons: Geographical, Patient empowerment, Involving family in care process, Elderly people, Skill shortage Challenges: legal environment, reimbursement, business models, evidence, acceptance, awareness, technical 17

18 CIP ICT-PSP Call ICT for patient-centered health service Proposed Funding Instruments: 1. Pilot A 7,5 M 2. Thematic Network 18

19 CIP ICT-PSP Call ICT for patient-centered health service Conditions and characteristics : To focus on at least one of the following chronic conditions: Cardiovascular Diseases (CVD); Chronic Obstructive Pulmonary Disease (COPD); Diabetes. To target 6 to 8 healthcare providers (regional, local healthcare authorities). Regional healthcare authorities should obtain endorsement from their corresponding national ministries to participate in the pilot. Support is focused on measuring the effectiveness and scaling up 19

20 Telemedicine Benefits Boario telecardiology: 35-47% reduction in hospital admissions (in various studies) 12% reduction in outpatient visits UK studies: Wireless Healthcare (2004): Early discharge from hospitals -> up to 85% reduction in weekly care costs Cost of telecare at home with 24 hours response = 1/3 of the cost of a nursing home place Potential of Mobile Monitoring in Germany Up to 1.5 billion/year savings through early patient discharge (Assuming 3 days less hospital stay for 20% of patients) 20

21 Connectivity: to patients homes 100 Patients' homes EU27 EU DK NL CZ SI LU SE BG DE MT FI EE SK PL AT UK BE IT NO IE IS ES LT FR RO EL CY LV HU PT Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April

22 The EU Strategy for ehealth 3 Towards full full picture of of the the individual s s health health status status 2 Connecting individuals with with Health Health Information Networks 1 Linking all all the the points points of of care care Time 1990s Today 22

23 Factors determining a health status of an individual & population -Quality/Efficacy of Healthcare services - Lifestyle: what we eat, drink, breath, - Physical and social environment - Genetic blueprint /profile at birth - Acquired genetic changes WHAT can ICT contribute Health delivery system Exogenous Determinants (Nurture) Endogenous Determinants (Nature) 23

24 III. Current R&D focus ( ) Towards full picture of individual s health status Biosensors Biochips Environmental Data Genomic data Phenomic data Integrated Health Records 24 24

25 ehealth works Optimal results when ehealth tools when combined with proper organisation and skills National and Regional Health information Networks improve quality, efficiency, and will save next year 80 Mil/year in Denmark (Medcom) and 60 Mil/y in Czech republic (IZIP) eprescription improves patient safety, saves 70 Mil/y in Sweden Personal Health Systems and Telemonitoring can provide care at the point of need, reduce length of hospitalisation (by 20-40% for heart patient in UK) Direct Online information Services such as NHS Direct online empower patients, avoid unnecessary hospitalisation, support lifestyle choices, save 110 Mil/year

26 ehealth works - does it? Is there a proof that specific ehealth application improves clinical (health) outcomes and/or is cost effective? Such proof to be -in large scale setting -using scientifically sound methods (such as the randomised clinical trials for drug testing) In other words, Can anybody get in trouble for NOT deploying ehealth solution today? Need for a commonly used set of assessment & evaluation 26 methodologies in order to pool evidence

27 ehealth Market in EU Potential ehealth is currently the fastest growing industry of health sector, estimated at 20 Billion, 2% of Health expenditure Other EU markets: Pharma 205 Bill., Medical Technology 64 Bill. By 2010, a double digit growth rate of up to 11% is foreseen for ehealth, driven by a search for more productivity and performance (source: Datamonitor 2007) Challenges Standardisation Interoperability Business model & financing 27

28 Lead Market Initiative 4 main barriers to ehealth market development 1. Market fragmentation, lack of interoperability 2. Legal Uncertainty 3. Lack of availability and access to finance 4. Lack of procurement 28

29 Annex 29 29

30 Terminology Computers process - data Humans interpret data and obtain - information ICT for Health solutions include products, systems and services for health authorities, professionals, patients and citizens that support improvements in health care (access, quality, efficacy/efficiency) as well in education and research. Synonyms: ehealth, Health Informatics, Health Telematics Telemedicine is a category of ehealth systems & services 30

31 ehealth (ICT for Health) 1. Clinical information systems a) Specialised tools for health professionals within care institutions b) Tools for primary care and/or for outside the care institutions 2. Telemedicine systems and services 3. Regional/national health information networks and distributed electronic health record systems and associated services 4. Secondary usage / non-clinical systems a) Health education and health promotion of patients/citizens b) Specialised systems for research, public health *Definition agreed with the ehealth Industry Stakholders Group reporting to the i2010 sub group on ehealth

32 Overall Health Strategy Sustainability of healthcare systems From late disease to early health From hospital-based to patient-centred Main areas for action: Preventive medicine Chronic disease management Empowering the patient (training, monitoring..) Personalised care Predictive medicine 32

33 Good ehealth study (Deloitte) Examined 600 e-health projects across Europe to ID best practice. Built a network of country correspondents Covered projects over past 15 years 50% of studies focused on administration and management systems Key theme of success was securing acceptance within an organisation patients and healthcare processionals Many successful projects based on extending solutions step-by-step 33

34 Good ehealth study (Deloitte) Key learnings: Training, training, training Involvement and commitment of higher management Quality involvement the central goal of e-health projects Break projects down into bite size achievable steps within a clear long-term vision Don t be afraid! Report - ehealth in Action 421 further examples at 34

35 Hospitals overview Hospitals in the EU seem well connected: 98% have internet access, 78% broadband Main applications: Hospital Information Systems administration eprescription & emedication (treatment support) imaging (diagnosis support) Integration of ehealth application components: lacking no ICT plans within the organisation lack of reliable providers (34%) no set standards 35 Based on ebusiness (Survey )

36 ehealth in EU situation on the ground GP Survey - 3 rd quarter interviews with GPs (max 318 inter./country); Coverage of 29 countries: EU27, Norway, Iceland; Sampling ensuring representativeness / country; Stratification by region to enable comparison between groups of similar regions using settlement types like metropolitan/urban/rural; Survey organisation: IPSOS 36

37 ehealth in EU Some Good News ehealth deployment in primary care (EC Study 2007) % Using PC Using electronic patien data storage % 66.1% 69% Routinely using PC in consultation Internet access % 62.3% Connecting with broadband % Using decision support software for prescribing or diagnosis % Accessing other health institutions networks Occasionally using PC to illustrate to patient Regularly using PC to illustrate to patient % 15.1% Exchanging administrative data with reimbursing organisations % 0.9% Occasionally using Internet and electronic health networks to provide telemonitoring to home-patients 37 Routinely using Internet and electronic health 37 networks to provide telemonitoring to homepatients

38 EU GPs using a computer during consultation, in % (EC Study 2007) % % FI UK EE NL NO DK IS IT BG BE SK FR DE ES EU27 HU PT CZ LU IE AT SE CY MT RO EL SI PL LT 38 3% LV Random samples of 6,789 GPs in 29 countries Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April 2008

39 Access to broadband in practices 100 Access to broadband in practices EU27 EU27+2 FI DK SE IS NL BE NO UK EE LU FR LV SI MT IT IE EL DE CZ AT ES HU LT PL PT CY BG SK RO 39 Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April 2008

40 Connectivity: to other GPs 100 Access to electronic systems of other health actors: GPs EU27 EU27+2 FI DK NL SE IS ES IT SI BE UK NO PT EE FR BG AT PL MT HU CZ IE LU DE EL SK LT CY RO LV Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April

41 Use: storage of medical patient data Store of identifiable patient data Diagnoses Medications Basic medical parameters Laboratory results Symptoms or the reasons for encounters Medical history Ordered examinations and results Vital signs measurements Treatment outcomes Radiological images EU27+2 EU27 41 Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April 2008

42 IT use among primary care physicians in seven countries 42

43 % GPs connected to secondary healthcare (hospitals and/or specialist) EU27 BE BG CZ DK DE EE EL ES FR IE IT CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE UK IS NO

44 Electronic exchange of data for at least one purpose % EU27 BE BG CZ DK DE EE EL ES FR IE IT CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE 44 UK IS NO

45 Connectivity: to specialists 100 Specialist practices EU27 EU27+2 DK FI NO BE NL SE AT ES SI FR EE IS DE UK CY BG MT LU PL HU CZ LT IT SK EL IE PT RO LV 45 Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April 2008

46 Connectivity: to hospitals 100 Hospitals EU27 EU27+2 DK NO FI NL BE UK IS SE EE AT ES IE PT IT MT LU FR HU SI CZ PL CY LT EL BG SK DE RO LV Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April

47 Connectivity: to health authorities 100 Health authorities EU27 EU27+2 EE DK UK LT IT PT FR IS SI ES PL NO IE AT MT FI BE SE BG RO NL LV CZ LU HU DE SK CY EL Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April

48 Link to insurers (reimbursers) 100 Admin data with reimbursers routinely EU27 EU27+2 DK NL UK FR PL LT AT NO IE SI CZ BG SE FI EE PT HU SK DE MT CY EL BE ES RO IT IS LV LU 48 Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April 2008

49 GP Attitudes towards ICT use in healthcare ICT improves the quality of healthcare services Agree strongly Agree somewhat EU27 EU27+2 BE BG CZ DK DE EE EL ES FR IE IT 1,6 1,6 1,5 1,5 1,5 1,4 1,4 1,4 1,3 1,3 1,1 1,0 0,7 CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE UK IS NO 1,7 1,7 1,6 1,7 1,7 1,5 1,4 1,4 1,4 1,5 1,5 1,4 1,4 1,3 1,2 1,2 1,2 0,9 Don't know Disagree somewhat Disagree strongly 49 Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April 2008

50 Networking: telemonitoring 100 Purpose of use of internet and electronic health networks: Telemonitoring routinely EU27 EU SE NL IS UK IE PT BG FI DE AT FR EL BE ES LV NO DK SK RO CZ EE IT CY LT LU HU MT PL SI Source: empirica: ICT and ehealth use among GPs in Europe 2007, Bonn April

51 For further information INFSO H1 Policy site: e-newsletter: Research site: DG ENTR LMI microsite: ehealth Task Force report: Interactive Portal: