Notable e-health developments Desarollo de e-salud (from building blocks to effective systems) ‏

1. Notable e-health developments Desarollo de e-salud (from building blocks to effective systems)‏ Marc Nyssen, Ronald Buyl, Koen Thomeer, Frederik Questier, Gustave Karara, Frank Verbeke Vrije Universiteit Brussel Faculty of Medicine and Farmacy Biostatistics and Medical Informatics Department

2. Overview • What is E-health?? • Technical building blocks • Professional context • Legal context • Win-win situations • Examples • Perspectives

3. What is E-health?? • ICT in healthcare • Mostly: [I][i]nternet • Healthcare telematics • Medical records • Telemedicine • Digital imaging • In fact: re-organising healthcare

4. What is E-health?? Purposes • Improving the quality of health care • Costs reduction • To reduce errors • To reduce or eliminate falsifications • To reduce the required manpower • Guide towards “best known practice”

5. Technical building blocks • Connectivity • Security and en encryption • Authentication • Databases (certified sources and others)‏ • XML applications • Naming systems/ defining terms, codes, ... • Sources/portals

6. Supporting sources • Legal framework and privacy legislation • Organisation of the state • Social sector organisation • State (Ministry of social affairs) • Private sector (health insurance) • Nomenclatures (onthologies) • Related standards (WHO, CEN, ISO, ...)

7. Connectivity: OK but not enough Interoperability: the ALT model (HITCH project)

8. Security and encryption Available systems • Practical considerations: • Paper: readable but (often) not accessible • Electronic: leakages can become disasters! • PKI (public key infrastructure)‏ • Asymmetric encryption systems • Patient identification separate from medical data • Well managed medical identification-”number”

9. Authentication Who is who? • More subtle: Who can announce with some “credibility” the identity-or role of an individual • In the medical world • Identities (patient/care-provider)‏ • Role leads to access permissions • Belgium: E-id central, no separate medical ID will be introduced

10. Databases Relational- and other models • “standard technology” • SQL: rather transmissible • Internet linkages from databases: great • Data storage: no acute problem • Cheap storage but: long term = 30years!

11. XML applications XML: “self describing documents” • Large consensus: XML solves EDI • Not only “document” also “application” • Control- and processing tools • From text to meaningful data object • Ontologies are under development

12. Naming systems What exactly are we talking about? • ontology: precise definition of terms • MeSH (Medical Subject Headers)‏ • BabelMeSH • Nomenclature systems • classifications: ICPC (primary care), ICD (diseases) WHO, Snomed • Medication databases BCFI/ Delphi

13. Professional context Team- versus individual approach in medicine • Medical record • Terminology • Guidelines and clinical pathways • The patients involvement

14. Notable examples • International scene (Europe) • Electronic medical records • Open MRS • OpenClinic • Eb@le-sante Project in DRC • Ehealth platform • Electronic medical prescriptions and summary records (EpSos)

15. Notable examples • Denmark: EMP fully rolled-out • UK: NHS major effort including electronic prescriptions • Netherlands:central switch for health traffic, linking hospitals and individual health workers:ABORTED

16. International benchmarks

17. Perspectives Study: ”eHealth is Worth it” (Empirica) (The economic benefits of implemented eHealth solutions at ten European sites)‏

18. Perspectives Recent developments in Europe • European roadmap • epSOS: transnational prescription and summary records • Renewing Health project: large scale evaluation of telemedicine application (randomized clinical trials)

19. electronic medical records • Purpose: register the health state and history of the individual patient • Cornerstone of good health care! • Tool for communication between team members • Patient-centric health care! • Proven to be more effective than the written paper-based record!

20. electronic medical records (2)‏ • To be effective: structure required • Different registration methods exist • POMR (Problem Oriented Medical Registration)‏ • Health care element • Approach • Service(s)‏ • (in contrast to HL7 RIM!!!)‏

21. EMRs in developing countries‏ Statement: Africa cannot manage paper!

22. EMRs in developing countries‏ Statement 2: Double work is NOT the solution

23. electronic medical records (3)‏ Open MRS • Free software • Client-server based • Strong underlying data model • Originally: “vertical” registration of diseases • Also: medical record • Very successful in developing world

24. electronic medical records (5) OpenClinic GA • Free software (on SourceForge) • Complete medical/clinical record • Fully coded (ICD-ICPC) • Patient identification (strong) • Administrative support + invoicing (full) • Reimbursements (Universal Coverage?) • Reporting (ministry/WHO format) • Network features • Distance support • Controlled web-reporting (global health barometer)

25. OpenClinic worldwide

26. Eb@lé-santé project in DRC Standard Eb@lé-santésite setting:

27. Eb@lé-santé, results via OpenClinic's global health barometer Results:via “Open Clinic” global health barometer

28. Eb@lé-santé Results:via “Open Clinic” global health barometer

29. Global Health Barometer http://www.globalhealthbarometer.net/

30. Global Health Barometer http://www.globalhealthbarometer.net/

31. Global Health Barometer

32. Global Health Barometer

33. National eHealth infrastructures

34. Scheme eHealth platform eHealth-platform in Belgium : • No medical data kept by the state, only meta-data ! • Free offering of basic services (secure communication) • User and access management according to laws and rules • Offering authentic sources to additional services • Secure encrypted mailboxes for all health workers (patients later)

35. Scheme eHealth platform:

36. Scheme eHealth platform: Basic service • A service realized and offered by eHealth-platform, that can be used by an added value offerer, to realize his added value service Service with added value (DTW)‏ • A service, offered to patients and/or health care workers • The instance, responsible for the development and offering of the added-valus service, can make use of the basic services as developed and offered by the eHealth-platform

37. Schema eHealth platform: validated authentic source (GAB)‏ • A database offering information, on which eHealth-platform relies • The manager of this database is responsible for the availability ant the organisation and quality of the information offered

38. eHealth platform: basic services Portal site (https://www.ehealth.fgov.be), with amongst others: 1. a search engine 2. integrated users- and access management 3. a content management system 4. managing logins 5. personal electronic mailbox for each health care worker 6. time stamping 7. coding and anonimising service 8. system for end-to-end encryption

39. Examples: EMP Medical prescriptions: • Central in medical treatments • Often hand-written • In USA yearly +- 7000 deaths • Fraud, theft, forging • Over-medication ?? • No added value possible when on paper

40. Examples: EMP Electronic Medical Prescription: • Avoid erroneous interpretation • Possibly: concurrently with paper • Avoiding fraud, theft, forging • Over-medication can be discovered • Diverse added values possible, requiring law changes

41. Patiënt-ID-number + PrescriptionID-number

43. Recip-e roll-out: created by day

44. Recip-e roll-out: delivered by day

45. Recip-e roll-out: cumulative/day

46. Recip-e roll-out: uptake vs. time (s)

47. Recip-e roll-out: time (s) in pharmacy

48. epSOS Purpose: • Pilot to interchange Electronic prescriptions and summary records in Europe • 26? partners • Via national contact points • Full picture: legal, organisational, technical

49. epSOS

50. mHealth developments Mobile technology in support of Public Health at different levels • Patient level • Provider level • System level • Integrating patient – provider - system