EHR Workshop
Brussels 11 -12 October 2007
Introduction to the
Workshop on Primary and
secondary use of EHR
Ilias Iakovidis
Deputy Head - ICT for Health
DG Information Society and Media
EU Commission
EHR Workshop
Brussels 11 -12 October 2007
• Welcome
• EU eHealth Agenda
• EHR – situation on the ground
• Why this workshop
ICT for Health Unit
Information Society and Media DG
European Commission
•
European Union –ICT for health office established in 1989 ,
supported to date over 400 project, worth more than €1 Billion
•
The vision (since 1994): “eHealth enabled Citizen-centred care”
or equivalently “eHealth enabled Continuity of care”
•
Major focus in 90’s: Regional Health Information Networks,
Electronic Health Records, Homecare/telemedicine
•
Today’s focus –
• Support to deployment of R&D results of 90’s
• R&D in Personal health systems, Patient safety,
modelling and simulation of human physiology
(disease simulator)
eHealth Vision of EC (since 1994):
Enable Continuity of care/Patient centered care
Through all the stages
Across all the points of care
HOSPITAL
Prevention
Diagnosis
Care
Rehabilitation
PHYSICIAN
HEALTH AUTHORITIES
HEALTH
INSURANCES
PHARMACY
How: Sharing information
LABORATORIES
Tools: Electronic health records
Regional health information networks
Link the healthcare institutions and
provide applications to for health professionals
(R&D Focus 1991-2001)
Health Centre
Emergency
Hospital
Pharmacy
Secure Networks
Region 3
Mobile,
Wireless
mobile PC
&
Broadband
Region 2
Region 1
Home
Mobility
Link the people with the health
Infrastructure/services (EC R&D focus since 01)
Health Centre
Emergency
Hospital
Pharmacy
Secure Networks
Region 3
Mobile,
Wireless
mobile PC
&
Broadband
Region 2
Region 1
Home
Mobility
Current R&D focus: Towards full picture of individual’s
health status (Molecular Medicine)
Biochips
Biosensors
Environmental
Data
Genomic data
Phenomic data
Integrated Health Records
Support to Deployment:
eHealth Action plan: COM(2004) 356 final
‘
Main areas of activity
•
•
•
•
•
•
National/regional roadmaps
Common approaches for patient identifier
Interoperability standards for EHR and messaging
Boosting investments in eHealth
Certification and labeling
Legal framework, certification of qualifications
• Yearly Ministerial conferences & exhibitions (next in
Malaga, Spain 10-12 May, 2006)
• World of Health IT yearly conference
Support to Deployment of eHealth
Priority for EU
•
DG INFSO ( + DG ENTR, SANCO, RTD, MARKT, COMP)
• CIP Porgramme - pilots
• Lead Market initiative ( follow up of AHO report)
• ASP 2008 – Chronic Disease Management
•
DG SANCO
• Initiative on health services
• Initiative on Eu Health strategy
•
DG JLS
• Privacy of data in Electronic Health Records
Hospitals 2004: EHR
systems
Hospital EPR systems - Installed base - 2004
100%
80%
60%
40%
20%
Medical document management
Order communication
Computer based storage of electronic patient records
Knowledge Support Systems
EU
FI
N
DK
SW
NO
CH
AU
NL
BE
ES
IT
EI
RE
UK
/
FR
DE
0%
(Hospitals in Germany)
Medical Records – Medical Document Management Systems
(France)
(Hospitals in France)
Main Storage Medium in Medical Records Library
Main Storage Medium in Medical Records Library
(Italy)
Hospitals in Italy
IT use among primary care physicians
in seven countries
www.medcom.dk
Prescriptions
80%
Disch. Letters
81 %
Lab. reports
95 %
Estimated cumulative
benefit by 2008: ~ € 1.4 bil.
Reimbursement
Referrals
13290 = 95 %
40113 =80%
EHR related activities
around the World
Accenture, 2007
Canada – Infoway set
up to design and
procure National EHR
- $1.2 billion of
government backing
USA - ONCHIT
promoting NHIN and
RHIO’s. Government
has invested $140
million to date.
EHR Maturity
High
Medium
Mexico: No
EHR but aim
for HL7
Integration
Low
Considering
EHR
Data N/A or
No EHR
Presence
Chile: PACS in
Santiago
University
Hospital Q2
2004.
Denmark
: National
EHR for
January
2006.
England:
Connecting
for Health£6 billion
until 2010.
Netherlands:
88% of GPs
have an EHR
France: EHR
Mandatory by
2007.
Sweden:
Developing a
National EHR –
Germany: EHealth card by
January 2006.
China: Plans to
develop a
national EHR
Hong Kong:
Territory wide
Patient Master
Index
Singapore:
EMR system
tender
expected Q1
2005
Australia:
Malaysia:
Brazil:
HealthConnect is
Lifetime
Health
National Health
developing a
Record (LRH)
Card Project.
National
by 2010
st
Information
Argentina: 1
Network.
adoption of a
New
Zealand:
digital
South Africa:
National EHR system
radiography
No EHR – but
in place.
solution- 2004. infrastructure
being developed.
TOP standards
HINE Survey (2004)
Information standards meant to prevail - EU - 2003
0
5
10
15
20
25
30
HL7
33
XML/Web
27
12
DICOM
Snomed CT
ISO
35
11
7
•
HL7, SNOMED CT, XML and DICOM are the favourites. Three
countries reported not having decided yet.
•
All pointed out how critical is the usage of international
accepted standards.
•
All requested more cooperation with health professionals
(clinically oriented) to tackle semantic interoperability.
•
IHE initiative mentioned three times as major interoperability
initiative (clinicians/vendors)
Hospitals 2004: Standards
Integration standards - 2004 (Europe)
100%
90%
80%
70,4%
71,3%
70%
63,7%
64,9%
60%
50%
40%
30%
20%
7,4%
10%
8,2%
0%
HL7
HISA
Currently
Next 5 years
DICOM
Hospitals 2004: Standards
Integration standards - 2004 (Europe)
100%
90%
80%
70%
60%
HL7
50%
HISA
40%
DICOM
30%
20%
10%
EU
N
FI
DK
SW
NO
CH
AT
NL
BE
ES
IT
EI
RE
UK
/
FR
DE
0%
Why this workshop (1/2)
i) patient care - Primary purpose of EHR
i) clinical research - Secondary usage of EHR data (other areas
include public health, management, health system research)
Patient care and clinical research need each other - and have
potential for greater synergy:
- Assisting each other in better performance/quality
- Faster translation of R&D into practice
- Learning from advances in information handling, knowledge
representation
But still are “different worlds” w.r.t. data modeling, knowledge
representation and storage and communication standards,
legal framework ..
• in pharma limited experience with clinical care (e.g. HIS, EHR, RIS/PACS,
LIS, HL7, ICD, SNOMED…)
• In clinical care limited experience with clinical research (e.g. EDC,
validation, ICH, MedDRA ..)
Why this workshop (2/2)
This workshop focuses on 3 specific topics of interest to
Pharmaceutical industry where such synergy could be achieved
1) patient recruitment in clinical research,
2) electronic data capture (EDC) during clinical trials and
3) safety monitoring.
3 areas chosen where concrete recommendations could be achieved:
A)Interaction model between actors of i) and ii)
B) Practical solutions for interoperability between systems of i) and ii)
C) Specific legal requirements regarding secondary use of EHR
What do we want to achieve & how ?
•
Practical recommendations rather than ususal
and universally known “diagnosis of problems”
• focus on the 3 priority areas
• Working workshop with limited competent people rather
than formal communication event … we expect each
participant to actively contribute
•
While the topics are primarily of Pharma
interest they should meet concerns of different
stakeholders and identify win-win situations
• Clarify topics within the agenda
• Provide pre-workshop material for reading (decision left
for each of work stream co-chair)
Structure of the workshop
•
•
Start and finish with a plenary
•
Special attention should be devoted to practical
suggestions such as
•
organisational issues for better adoption/use of EHRs,
seamless and legal extraction of data for research,
supporting the clinical research so it adds ( does not
compete) with care processes, tracking post marketing
experience to improve patient safety, …
•
Technical issues: terminologies, ontologies, standards,
privacy enhancing technologies
Three parallel streams to end up with Practical
recommendations to be captured and reported on
Friday afternoon
Organizing Committee
•
•
•
•
European Commission:
• Ilias Iakovidis (ICT for Health),
with the support of Veli Stroetmann (empirica research)
European Federation for Pharma Industry
Association (EFPIA):
• Isabelle de Zegher (Novartis),
• Jean Samuel (Pfizer),
• Mats Sundgren (Astra Zeneca),
• Bernard Ferre (EFPIA)
Clinical Care: G. de Moor (Eurorec)
IT Vendors:
• G. Zhalmann (Siemens),
• P. Wilson (CISCO)
Interoperability
•
Concept with vast scope and many facets
•
Many research groups working for decades
•
Many international efforts with US, CA, and AUS
•
Major technical aspects are common with other areas
But the semantic interoperability has to be done by the
domain experts
EC funds several projects on Semantic interoperability
such as Semantic Health and RIDE
Interoperability
“Interoperability means the ability of
information and communication technology
systems and of the business processes they
support to exchange data and to enable the
sharing of information and knowledge”.
Recommendation by EC to be published in 2008
Please review and update ( e.g. pg 10!)
ICT for Patient Safety
•
Description of the upcoming projects
Conclusions & Practical
considerations
•
Coffee, lunch, timing
•
Permission to use presentation & written material
•
Focus and small concrete step rather than “boiling the
ocean”
•
To find more on ICT for Health / eHealth?
• Policy site:
http://europa.eu.int/information_society/activities/health/index_en.htm
• eHealth R&D Newsletter (monthly issues):
http://europa.eu.int/information_society/activities/health/research/
newsletter/index_en.htm
Thank you
ilias.iakovidis@ec.europa.eu