Continuity of care within and across borders

1. Continuity of care within and across borders Lăcrămioara STOICU-TIVADAR President, Romanian Society of Medical Informatics

2. Challenges for European Health Systems Demographic changes: more people will require prolonged care Increased prevalence of chronic diseases: substantial part of the overall healthcare costs Citizens’expectations and demands for high-quality care Inadequate safety standards and quality control: medical accidents Inefficiencies and staff shortages Reactive model of healthcare delivery: treatment after appearance of symptoms Rising healthcare costs: faster than the economic growth itself

3. EU • Costs Quality of care • EU 2020 Strategy  Sustainable growth • Strategy “to deliversustainable economic and social benefitsfrom adigital single market” • the EU could gain 4% of GDP by stimulating fast development of the digital single market by 2020*  • *Monti Report, Report to the President of the European Commission: A New Strategy for the Single Market at the Service of Europe’s Economy and Society

4. EU Increased life expectancy and the consequent increase in the prevalence of chronic illnesses pose serious challenges to the sustainability of the national health systems in Europe. 80 million senior citizens - population aged between 65 and 80 + years in Europe (EU-27) today a doubling of this figure forecasted by 2050 the life expectancy is rising on average by 2.5 years per decade and the number of aged over 80 is expected to grow by 180% by 2050 (Eurostat, 2010) e-Health - part of the solution, creating the basis for seamless care

5. Changes • in healthcare delivery • in how medical knowledge is managed & transferred in clinical practice • new care delivery models

6. eHealth actions in Digital Agenda for Europe 2.7.2. Sustainable healthcare and ICT-based support for dignified and independent living KA 13: Undertake pilot actions to equip Europeans with secure online access to their medical health data by 2015 and to achieve by 2020 widespread deployment of telemedicine services; KA14: Propose a recommendation defining a minimum common set of patient data for interoperability of patient records […] by 2012 Foster EU-wide standards, interoperability testing and certification of eHealth systems by 2015 through stakeholder dialogue

7. eHealth actions in Digital Agenda for Europe from

8. Focus on • Improved illness prevention/prediction and safety of care • Personalized healthcare (management and care) • Continuity of care – home care (outside the institution)

9. Strategic Research • Personal Health Systems • Patient Safety • Virtual Physiological Human

10. Is EU prepared for CC? http://ehealth-strategies.eu/

11. http://ehealth-strategies.eu/

12. Continuity of care- within borders - Continuity of care is the process by which the patient and the physician are cooperatively involved in ongoing health care management toward the goal of high quality, cost-effective medical care. the patient's experience of a 'continuous caring relationship' with an identified health care professional. for providers in vertically integrated systems of care is the delivery of a 'seamless service' through integration, coordination and the sharing of information between different providers.

13. Research to support continuity of care • Improved productivity of healthcare systems • better management of chronic diseases at the point of need • quicker transfer of knowledge to clinical practice • Continuous and personalised care solutions • participation of patients in care and prevention processes • respond to the needs of elderly people • Savings in lives and resources - focus on prevention and prediction of diseases • Higher patient safety - optimise medical interventions and prevent errors • New ICT-based environments for biomedical research and predictive medicine - push technology boundaries: grid computing, modelling& simulation • Industrial leadership • European eHealth and medical imaging/devices industry • attract pharmaceutical research back in Europe

14. Background • Healthcare organizations face critical barriers to data-drivenoranalytic care decisions: • siloed data, • large amounts of unstructured data • even paper-based records, • and a focus on using data primarily for business reporting rather than medical decisioning. • Data is not organized around patients across the continuum of care with specialties and practice areas keeping their data separate. • Claims data is often the only data managed effectively and electronic medical records are just beginning to become common. If analysis is being done it is almost certain to be financial analysis.

15. Background • the patient data is still a passive resource • rich, coherent, integrated picture of a patient • help identify patients at greater than average risk and to ensure earlier intervention. • recommended treatment plans can be compared with treatments received and the patients who need to complete additional treatments identified. • Risk factors can be identified for diseases and conditions.

16. ICT smart solutions and added value • a new, active diagnostic tool for medical professionals - algorithms that predict how likely a particular patient is to develop a disease • for expensive, chronic diseases like heart disease or diabetes, such predictions can be hugely valuable. • Adding a new tool to clinicians besides their own observations and on evidence-based guidelines: they can get automated assistance to prioritize or identify patients at risk of developing diseases or complications — keeping someone well not simply curing someone sick.

17. Solutions and added value • Algorithms can be developed based on the historical information to calculate the risks for a specific patient based on their information. • Taking all the historical data collected for a population, the risk factors can be identified and weighted. • Data mining can segment patients into different groups and then find the critical predictors for each group. • An algorithm that can be run automatically to give each patient a risk factor when they check in or when treatment is begun so the medical decisions can be driven effectively by that risk.

18. Solutions and added value • For every patient admitted for coronary artery bypass surgery, a risk assessment based on patient characteristics is conducted and compared to empirical facts. • The risk score that results gives the patient a statistically sound yardstick that describes the chances of mortality or possible complications during the medical treatment • Data-driven care decisions

19. Solutions and added value • Mayo Clinic • an additional algorithm to detect brain aneurysms in the processed images. • the algorithm predicts how likely it is that the images show a brain aneurism. • the solution generated a 95 percent accuracy rate in detecting aneurysms, compared with 70 percent for manual interpretation—a 25% improvement • added to the improved clarity of images, this represented a significant improvement in patient outcomes.

20. Solutions and added value • New born babies before term • The application ingests a constant stream of infant physiological data - heart rate and blood oxygen saturation level, along with related clinical information. • Predictive analytic models can be developed using data from any source. • Encapsulating the expertise—the intelligence—of physicians and nurses in this system allows it to focus precisely on the information needed to make better clinical decisions. • By detecting potentially life-threatening infections up to 24 hours earlier, the solution will deliver life-saving value and improve medical decisions in real time

21. Home care

22. Ambient Assisted Living (AAL) • An extension to home-care monitoring, in order to provide a better quality of life - the mobile solutions for chronic patients - were added to local existing applications • Devices and home appliances are made more accessible to persons with special needs (cognitive disabilities and older persons): • smart devices, • intuitive interaction between persons and devices • new technologies and standards

23. Interoperability remote delivery mechanism, proven capability to integrate with a wide variety of EMRs - a vey complex process to connect EMRs provides an end-to-end solution that can overcome the challenges of integrating the subscription-based model and scalable platform allows the flexibility to extend services over time to more practices, and connect with the broader community

24. Interoperability “Interoperability is the only technical problem in telehealth; the other challenges are not technical" Gerard Comyn, EC, DG ICT for Health easy connection between software applications and between software applications and devices wireless body or environmental sensors

25. Continuity of care - across borders • 28 February 2011 - the Council adopted a healthcare directive for both intra-European and “cross-border” applications • the legislation designed to strengthen patients’ rights substantially • The basic principle:patients are entitled to the same amount of reimbursement in the country that provides healthcare as they would receive in their native country.

26. Increased mobility of citizens and patients “Europe needs a shared medical record to ensure the continuity of care and to deliver a “seamless service” across borders, through the sharing of information, co-ordination and integration between different providers. Having one professional record and one patient record would lead to better continuity of care and decreased costs.” Continuity of care across borders Professor Eric Lepage, EPR Director for Assistance for Public Hospitals of Paris e-Health Week, Budapest 2011

27. Continuity of care across borders cooperation between member states in the field of healthcare has been strengthened in the field of e-health and through the development of a Europeannetwork which will bring together, on a voluntary basis, the national authoritiesresponsible for e-health; rare diseases, where the Commission willhave to support member states in cooperating in the field of diagnosis and treatmentcapacity;

28. Continuity of care across borders epSOS enables continuity of care across national borders 30,000 healthcare professionals 183 hospitals, 2,149 pharmacies 1,113 point-of- care or general practice clinics. (EH issue 02, 2010: ‘Crossing frontiers in e-health’)

29. e-Health Interoperability Assisted Ambient Living and Welness Medical imagistics Tissue engineering Data mining Augmented reality in healthcare Bioinformatics Mobile applications Personal healthcare systems Signal processing Education Romanian Society of Medical Informatics

30. SIMIMED HIS module TUC-N, Pixeldata SIMIMED HIS Server HIS Admin HIS DB (MS SQL Server 2008) Web Browser ASP.NET IIS WCF HTTPS HIS Client HTTPS Client Application ADO .NET TCP HL7 HL7 Datacenter module SIMIMED Datacenter HL7 HIS DB (MS SQL Server 2008) Web Browser Statistics HTTPS I I S ADO .NET TCP Web Browser Administration HTTPS • Besides the support for administrative tasks, SIMIMED application focused on clinical activity, a domain less exploited in the current existing hospital information systems. • Benefits • creating knowledge – based management and having decision support, as an indispensable tool for information management and also an efficient solution for quality improvement, removing errors and delays, and promote efficiency of all activities. • Implementing standards in the system helped reaching the previously set targets. Sistem integrat de management al informaţiilor medicale utilizând standardul HL7

31. Home care smart solution - TELEASIS Continuity of care Patient empowerment

32. ICT Solution Supporting Continuity of Care in Children Healthcare Services Mihaela Vida, PhD student Oana Lupșe, MSc student

33. Smarter clinical procedures • connecting medical databases to a medical decision system –Egadds - and creating a service for extracting the necessary information that is transferred based on HL7 CDA standard from multiple databases Valentin Gomoi, PhD student Mihaela Vida, PhD student

34. Optimizing clinical pathways for cardiology nursing A mobile EMR system will improve the legibility of clinical notes, will provide decision support for drug ordering, including allergy warning and drug incompatibilities. The system model proposed will supply a set of reminders to prescribe drugs or administrate them. Using a standard format for the lab results, will allow implementing the warnings for abnormal results. Romina Pintea, PhD student

35. Cell spreading on biocompatible materials studied by computer simulations Results of tissues engineering studies can be incorporated in patient‘s EHR for compatibility reasons Andreea Robu, PhD student

36. Regional Data mining The data from the information systems of the hospitals are first converted into XML format, according to HL7 CDA standard and they are then saved in a database through webservice calls. The centralized data are then transformed into ARFF format, and analyzed with the data miningprogram WEKA, in order to extract new knowledge. Raul Robu, PhD student

37. Education

38. Education – Master SIIS Domain: System engineering Faculty of Automation and Computers 3 semesters + 1 semester diploma project

39. SIIS • Electronical Healthcare Record • Bioinformatics • E-Health applications • Software project management in healthcare • Assisted decision in healthcare • Medical imagistics • Human-computer interaction in healthcare • Methods and communication in healthcare • Fundamentals of biological systems and medical informatics • Fundamentals of IT • Communication in healthcare networks • Data bases in healthcare • Software applications development in healthcare • Clinical systems • Medical equipments • Resources management in healthcare

40. Education – Master SIIS SIIS