What the EU ehealth IoP
Roadmap could bring to the
Health future
Michèle Thonnet
French Ministry of Health
EU eHealth interoperability Roadmap
Washington, 16.02.2011, OECD-NSF
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Reforming the H system : a necessity
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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
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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
• 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
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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
2002-2010 a new Era
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
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• Council conclusion on safe and efficient healthcare through
eHealth – December 2009
• Proposal for a European Directive on patients’ rights in crossborder healthcare
other EU current initiatives
• Health
– Europe 2020: “Sustainable health”
• Standardisation
– Digital Agenda
– Access
– IT Standardisation
• eHealth M.S. and stakeholders voluntary cooperation
– epSOS
– CALLIOPE
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eHR Modelling: an input for
collaboration(2007)
IOp RECOMMENDATION REVIEW
– Interoperability is considered for the
purpose of “integrated, connected and
interoperable continuity of care for
Europe”
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eHealth Interoperability
Jurisdiction # 1
Use Case A
Top
Down
Bottom
-up
Jurisdiction # 2
Use Case A
Political / Legal
Political / Legal
Organisational
Organisational
Semantic
Semantic
Technical
Technical
IOp Model, i2010 subgroup of eHealth; I2Health
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A European Collaborative Initiative
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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
• 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.
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TARGET GROUPS
Decision
makers
Engagement
through
consultation
Opinion
leaders
Stakeholder
Organsiations
E-health Community
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CALLIOPE in a nutshell
(June 2008 - December 2010)
To produce value for decision makers
– A fully operable, open,trusted, co-operative multistakeholder 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
March 2010
Competence Centers
June 2008
Health Authorities
Malta
Structure
The CALLIOPE co-operative working
platform
– Clear Governance
– Efficient Supporting Structure
– Outcome based management
Trust must be reinforced
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The trilogy of Trust
Governance
Integrity
Shared Values: openness and transparency, participation,
quality, proportionality and coherence
Competence
though access to EU collective expertise and knowledge but
also through appropriate conditions for this to be fully
exploited
Commitment
though shared ownership of the process, content and the
outcome
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AN EU eHEALTH INTEROPERABILITY ROADMAP
WHERE?
FOR WHAT PUPROSE?
WHO BENEFITS?
WHAT’S AT STAKE?
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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
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EU Interoperability Roadmap
TRUSTED?
Structure
Principles, platform, level of Trust
Process
Iterative approach, working methods
Outcome
Content of the Roadmap
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The process
•Most of the necessary knowledge exists
•focus on identifying, 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
• Member State obligation to deliver the best possible medical treatment – at
home or when travelling
• Introducing a new dimension in national healthcare systems
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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 mobility nationally and in the EU
– ensure that patient safety is guaranteed
– increase efficiency and cost-effectiveness
in cross-border care
CALLIOPE and epSOS
Malta
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The process
Roadmap versioned
documents
Roadmap Consolidation workshops
SDOs
CALLepSO workshops
X-border project
consultations eID,semantics
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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 benchlearning loop across concerned actors
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CALLIOPE EU eHealth IOP Roadmap :
A common vision
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Provisional Content
High-level meeting on EU eHealth Governance-Barcelona
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AN EU eHEALTH INTEROPERABILITY ROADMAP
What: possible future actions at EU level
For what:
To accelerate ehealth deployment
Who: Health care community
WHERE?
FOR WHAT PUPROSE?
WHO BENEFITS?
WHAT’S AT STAKE?
How: Use Cases, alternatives, maturity
and opportunities, building on what is
shown to work
1st stop Barcelona validation
2nd step
December 2010
EU interoperability Roadmap progress
A proposal for a common
EU Roadmap for eHealth
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Recommendations and Outlook
• propositions
• provide concrete input to decision
making
• support of the eHealth high level
governance process
Political priorities
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
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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
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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
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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
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Economic challenges of eHealth services
• Recommendations
– 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
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Monitoring progress
• Recommendations
– 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
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Together addressing
open issues in the EU
• Recommendations
– 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 multistakeholder platforms
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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
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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
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Adoption of a common
Sustainable Healthcare
Sharing Information and Knowledge
working model
for Better Health
eHealth
eHealth
leadership,
Governance
e.g., Data analysis &
aggregation
Knowledge management, etc.
Other national priorities
Rare diseases
Community services, AAL
Chronic Care Management
Electronic prescribing
Patient summaries
eHealth Services
Common EU priorities
policy and strategy
EU & National Stakeholder collaboration
Privacy, quality and
safety policies
National priorities
Foundation eHealth infostructure
Patient
identification and
patient data
discovery
HCP Authorization,
authentication and
rights management
Clinical
terminologies and
classifications and
codifications
Consent
management and
access control
Data structures and
value sets
EHR, EMR, PHR,
other
Data and
knowledge
management tools
Data
interoperability and
accessibility
Data bases and
Registries
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
Legislative and
regulatory
framework
Fostering standards
adoption
Market
development, new
business models, and
incentives
Financing, Resource
allocation and
reimbursement
models
Monitoring,
evaluation
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TABLE I: IMPACTS
PURSUED IMPACT OF THE CONVERGENCE PROCESS ON eHEALTH DEPLOYMENT
 Engagement of EU Stakeholders through stimulating broad synergies
 Proof of Concept:
Successful unprecedented multi-stakeholder formal
collaboration on developing a key policy document (vs consultation only)
 Facilitation of adoption of outcomes of EU collaboration projects such as the
epSOS specifications and the CALLIOPE eHealth Interoperability Roadmap
 Acceleration of the processes involving the organisation and management of
governed multi-stakeholder environments in eHealth and beyond
EXPECTED IMPACT OF THE CALLIOPE OUTCOMES ON eHEALTH DEPLOYMENT
 Towards better alignment of EU-national level actions
 Acceleration of national eHealth deployment (by capitalizing on EU
collaboration)
 Towards co-ordinated EU-national level innovation support action for eHealth
deployment (though improved access and use of standards)
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Convergence: Contributing factors
Working together
Working with epSOS
Collaborative
environment
Dissemination
Stakeholder
Consultations
On boarding MS
to epSOS
Trust
Broad Convergence
Other dissemination activities
Stakeholder
Consultations
Open Forum
Open Sessions
Consensus building
EC Recommendation Review
Standardization Liaison
Consultation with epSOS
and other EU Initiatives
Dissemination
Roadmaping
(By Z Kolitisi)
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Bringing EU and the national/regional activities
together
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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
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
 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 services
Establishment 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…
• 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
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Status Quo
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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
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Provide to MS a consolidated approach and a strong political committment to
governance at three levels (1) Policy (2) Strategy and (3) Operational
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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
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Provide to the MS, the EC, the Competence Centres, the IT-Industry and to other
relevant stakeholders a European eHealth Interoperability Framework
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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
eHGI project structure
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Thank you for your time
michele.thonnet@sante.gouv.fr