EU ehealth Agenda. Ilias Iakovidis. ICT for Health Unit DG Information Society and Media European Commission

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1 EU ehealth Agenda Ilias Iakovidis ICT for Health Unit DG Information Society and Media European Commission 1

2 WHO ARE WE ICT for Health (ehealth) Unit, European Commission Information Society and Media DG Supported > 500 ehealth projects & pilots (> 1 Billion) since 1989 Current support (ca 100 Mil/year) Major focus in 90 s: Regional Health Information Networks, Electronic Health Records, Homecare/telemedicine Today s focus: I) Research - Personal health systems (wearable, portable monitoring) - Patient safety (Clinical information systems for safer outcomes) - Modelling and Simulation of diseases (Virtual Physiological Human) II) Policy and support to deployment ehealth Action plan, Lead market initiative, Recommendation on Interoperability, Deployment of telemedicine Large Scale Pilots, certification of Electronic Health Record Systems

3 ehealth for Sustainability Efficiency & productivity to do more with less From hospital-based to patient-centred care From late disease to early health Two main areas: Preventive medicine: Chronic disease management Empowering the patient (training, monitoring..) Predictive medicine: Molecular medicine ehealth for the economy Lead Market sector

4 From hospital-based to patient-centred care 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) See EC Communication on Telemedicine COM(2008)689 final ec.europa.eu/information_society/activities/health/policy/telemedicine/index_en.htm

5 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

6 EU World Leader in 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 % 44.4% 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 Routinely using Internet and electronic health networks to provide telemonitoring to homepatients

7 EU ehealth agenda Past R&D activities Current policy and support to deployment 7

8 Towards ehealth Deployment: Step 1 Health Information Networks Connecting providers: Messaging, EHR, HP tools, on line services Pharmacy GP Hospital Emergency Health Centre Secure Networks mobile PC Mobile, Wireless & Broadband Region 2 Region 3 Region 1 Home Mobility

9 Policy Action: 2004 Communication and Action Plan Bringing the benefits of ehealth to EU citizens faster (Quality of care, patient safety) Borderless European Health Information Space for individual care, public health and research Increasing mobility of patients and professionals; cross-boarder co-operations To facilitate growth and transparency of ehealth Market; to decrease Market Fragmentation

10 Interoperability across borders Linking basic information between patient summary systems or giving access to physicians to patient summary in your home country Direct access of physicians when legal Patient Summary 1 Patient Summary 2 Secure Networks Country or Region 1 Country or Region 2 Country or Region 3 Standardised exchange/access to common data sets Mobility

11 2008: 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) PHS interoperability (FP7-Call 4 Nov 08) 11

12 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, Important issues: standardisation, certification, conformance testing, education and awareness

13 Current R&D focus (since ) Connecting individuals with Health Information Networks Health Centre Hospital Emergency Pharmacy Secure Networks mobile PC Mobile, Wireless & Broadband Region 2 Region 3 Region 1 Home Mobility 13

14 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

15 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 36 months

16 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

17 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

18 The future : EC Research Activities

19 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 Health delivery system Exogenous Determinants (Nurture) Endogenous Determinants (Nature) WHAT can ICT contribute

20 New and Future Activities Towards full picture of individual s health status Biosensors Biochips Environmental Data Genomic data Phenomic data ICT Systems

21 The Virtual Physiological Human (VPH) concept Based on the ideas of the International Physiome project The Virtual Physiological Human is a methodological and technological framework that once established will enable the investigation of the human body as a single complex system. The VPH research roadmap developed by project STEP in 2007: - Personalised (patient-specific) healthcare solutions - Early diagnostics & predictive medicine - Understanding diseases for the first time across several biological levels

22 Based on the IUPS Physiome Project Genes mrna Proteins Lipids Carbohydrates Cell structure -function Tissue structure -function Organ structure -function Clinical medicine 25,000 genes 100,000+ proteins 200+ cell types 4 tissue types 12 organ systems 1 body Hunter, PJ and Borg, TK. Integration from proteins to organs: The Physiome Project. Nature Reviews Molec & Cell Biol. 4: , 2003 (Peter Hunter 2007)

23 euheart Integrated Cardiac Care Using Patient-Specific Cardiovascular Modelling Development, personalization and validation of computational models of the heart to improve: - Heart Failure - Coronary Artery Diseases - Valves and Aorta - Resynchronization Therapy - Radiofrequency Ablation Shortcut to virtual_human_h_coronary_flow.mov.lnk Project coord.: Philips Research Scientific coord.: Univ. of Oxford 17 partners (6 companies, 6 universities, 5 clinics) Budget ~19M EC funding: ~14M Philips Research INRIA UOXF

24 ICT for Health Unit support for Research & development (FP7) Personalisation of Healthcare Personal health system 72 Million (M) in 2007, ( 63 M in 2009) Patient safety-avoiding medical errors 30 M in 2007, ( 30 M in 2009) Predictive Medicine Virtual Human Modelling/simulation of diseases 72 M in 2007, ( 68 M in 2009)

25 Objective 5.3 Virtual Physiological Human Budget: 63M FP7 ICT Call 6 Deadline April, 2010 (a) Patient-specific computer based models and simulation Multiscale models and simulation of organs/systems targeting specific clinical needs Better understanding of the functioning of the organs and its pathologies aiming at prediction/early diagnosis (b) ICT tools, services and infrastructures for bio-medical researchers to support at least 2 of the 3 activities: Share data and knowledge Jointly develop and share models/simulators Create collaborative environments (c) Support action on evaluation and assessment of VPH projects Shared tools/infrastructure Clinical achievements Market potential / penetration (d) Coordination or Support Actions in Biomedical Informatics Sustaining cross-collaboration among different fields

26 Obj. 5.4 International Cooperation on VPH Budget: 5M FP7 ICT Call 4 Deadline April 1, 2009 (a) Interoperability Joint development of interfaces between scientific databases, web services, mark-up languages, meta-data, ontologies (b) Tools and services for global cooperation For modelling/simulation, curated models, interconnected libraries and data repositories (c) Contribution to global validation framework Joint verification and validation of models wit reference to tools developed for clinical applications. Additional requirements: Eligibility: Only on-going VPH related EU projects and to on-going international projects that address one or more of the target outcomes a) b) c)

27 For further information INFSO H1 Policy site: ealth/index_en.htm Research site: ehealth Task Force report: ealth/docs/lmi-report-final-2007dec.pdf Interactive Portal: 27