The EuroRec Institute: Structure, Activities and new Services

1. The EuroRec Institute:Structure, Activitiesand new Services Dr. François MENNERAT EuroRec ProRec-France

2. European initiatives for e-HealthThe basis • Facilitate interoperability to the benefit of the "Mobile European Citizen" • Develop the market of applications • Out of the national niches Sofia, Bulgariya

3. European initiatives for e-HealthThe basis • Principle of free circulation of persons, services and assets • Established as early as the first version (Rome Treaty I, 1957) of the Treaties instituting the European Community, now the European Union • Article 8A paragraph 1 (“Citizenship”, later modified according to the Maastricht Treaty) • « Every citizen of the Union shall have the right to move and reside freely within the territory of the Member States… » • Articles 48 to 51 (“Workers”) et 52 à 58 (“Right of establishment”)  Free circulation of patients and professionals Sofia, Bulgariya

4. Introduction to EuroRecThe European Institute for Health Records www.eurorec.org

5. The EuroRec Institute • European Institute for Health Records • Non-profit organisation • founded in 2002 as their Federation by the (then) established ProRec centres(Belgium, Spain, France, and Bulgaria) • registered in 2003 according to the French law • Active at the European level with respect to the "subsidiarity principle" • Bound to become self-sustainable Sofia, Bulgariya

6. The EuroRec Institute • Becomes a mainstay of a persistent action of the European Commission services • Directorate General XIIInow InfSo - "Information Society and Media" • via successive R&D Framework programmes • towards extensive development, implementation and use of interoperable EHR systems • MEDIREC, PROREC, WIDENET projects, and currently Q-REC Sofia, Bulgariya

7. Where it all started • A series of statements • depicting an unsatisfying situation • possibly still partially valid today in several countries Sofia, Bulgariya

8. Where it all started • Vendors take usually little care of customers’ actual needs • Developers often unaware of current standards and technical specifications • Most users unable to formulate their requirements • Users often presumptuous with regard to their technical competence • Users tend to exaggerate local specificity • Users reluctant to spend significant time for education Sofia, Bulgariya

9. Where it all started • Public authorities with poor or no implementation strategy • Public authorities often unaware of technical or functional constraints • Public authorities often unaware of market constraints • National markets too small for acceptable return on investment etc. Sofia, Bulgariya

10. A gradually developing initiative (1) MEDIREC • 3rd FPR&D • AIM programme "Advanced Informatics in Medicine" • 18 months Concerted Action (1994-1995) • 25 partners from 14 countries • "The Lisbon Declaration" • at the Final AIM Conference (December 1994) Sofia, Bulgariya

11. The Lisbon Declaration • 10 consistent recommendationsto the Members States and the Commission • Recommendation 9 • The effective co-operation between all interested parties including users, professionals, authorities, industry, standardisation bodies and others • at a European level and through a process of managed convergence towards European EHRs • would benefit from the set-up of an appropriate structure based on existing organisations that could promote that mission Sofia, Bulgariya

12. A gradually developing initiative (2) PROREC(Promotion Strategy for Quality European Health Records) • 4th FPR&D • "Health Telematics" programme • 36 months Support Action1996-1998 • 5 partners from 5 countries • Practical implementation of item 9 of the Lisbon Declaration Sofia, Bulgariya

13. Main achievements of the PROREC project • Foundation of 3 ProRec Centres • Belgium, Spain, France • Postponement of the planned UK centre • Preliminary contacts in Hungary, The Netherlands, Germany, Italy Sofia, Bulgariya

14. ProRec centres: the structures • Registered non-profit organisations • Established at the national level • Gathering in a balanced way • solution providers • users • Developing contacts with all other stakeholders(public authorities, etc.) Sofia, Bulgariya

15. ProRec centres: objectives • Identify, try and help solve • issues opposing or slowing down • the process of widely implementing and using • high quality EHRs • secure, comprehensive, communicable, interoperable • at the national level,as well as throughout Europe Sofia, Bulgariya

16. Rationale behind ProRec centres • Take account of local specificity • Act at ground level ("Bottom-Up") • think European (the mobile citizen, the market), • act locally (the needs) • Bring together and involve field actors: • those who actually use EHRs as their professional tool, • together with those who provide the expected solutions Sofia, Bulgariya

17. A gradually developing initiative (3) WIDENET • 5th FPR&D • IST programme ("Information Society Technology”) • 36 months Accompanying Measure (2000-2003) • 12 partners from 10 countries • Enlarging and strengthening the network Sofia, Bulgariya

18. Main achievements of the WIDENET project • 7 new ProRec Centres • Slovenia, Germany, Italy, Ireland, • Bulgaria, Denmark, Romania • And, as a keystone, the foundation of the European Institute for Health Records(The EuroRec Institute) Sofia, Bulgariya

19. The EuroRec Institute • A non-profit organisation • Founded by established ProRec centres(Belgium, Spain, France, and Bulgaria) • Developing activities at the European level(subsidiarity principle) • Bound to become self-sustainable Sofia, Bulgariya

20. The network of ProRec centres • Promotion of quality European Health Records • Formally established and officially registered • Belgium, Spain, France, Slovenia, Germany, Italy, Ireland, Bulgaria, Denmark, Romania • At different development stages • Norway, Cyprus, Greece, The Netherlands, Slovakia, United Kingdom, Portugal, Hungary, Poland, Sweden, etc. Sofia, Bulgariya

21. Established • Setting up • Mature contacts • First contacts Lessons learnt in the health care sector The network of ProRec centres Sofia, Bulgariya

22. 1997, Paris 1998, Rotterdam 1999, Sevilla 2001, Aix-en-Provence 2002, Berlin 2003, Dublin 2004, Bruxelles/Brussel 2006, Genève10 October 2006 European Conferences on Electronic Health Records(EUROREC conferences) Sofia, Bulgariya

23. Current and future activities:The Q-REC project European Quality Labelling and Certification of Electronic Health Records (EHR) Systems IST – 27370 - SSA

24. Overall objectives • Foster Quality of EHR Systems (EHRS) • To the benefit of patients • Support Interoperability of EHRS in Europe • To the benefit of citizens • Facilitate the emergence and consolidation of a European market of medical software Sofia, Bulgariya

25. The scope of Q-REC • does include • neither national projects • nor general issues regarding interoperability • is restricted to interoperability between EHR Systems • Emphasis on conformity testing and certification Sofia, Bulgariya

26. Liaison • In the U.S. with CCHIT (Certification Communication for Healthcare Information Technology) • As well as with other initiatives in Europe and the U.S. Sofia, Bulgariya

27. WP3 - Resources for EHR Interoperability • T3.1 Register of Conformance Criteria and Guidance Documents • T3.2 Inventory and Register of EHR Archetypes and Guidelines for their Use • T3.3 Register of Health Coding Systems in Use in Europe • implementing the European standard EN 1068 "Health Informatics - Registration of coding systems" • T3.4 Inventory of Relevant Standards for EHR systems • T3.5 Register of XML Schemas and Open Source Components for EHR systems Sofia, Bulgariya

28. Other projects • EuroRec is member of the RIDE project • "A Roadmap for Interoperability of eHealth Systems in Support of COM 356 with Special Emphasis on Semantic Interoperability" • EuroRec is member of the EHR-Implement project • Meant to examine political, social and organisational factors influencing large scale EHR implementations, and to identify best practices Sofia, Bulgariya

29. Conclusion • EuroRec is playing the role assigned by the services of the European Commission • To facilitate and support the extensive development, implementation and use of interoperable EHR systems throughout Europe • By providing an increasing number of services to suppliers, users, and public authorities Sofia, Bulgariya

30. Introduction to CEN / TC 251Health Informatics www.centc251.org

31. CENwww.cenorm.be • CEN – Comité européen de normalisation (European Committee for Standardisation) • Founded in 1961 by the National Standards Bodies in the European Economic Community and EFTA countries • To contribute to the objectives of the European Union and European Economic Area with voluntary technical standards • Over 350 Technical Committees (TCs) Sofia, Bulgariya

32. CEN’s remit • Promote • free trade • Lift undesirable barriers hidden behind permanent reference to national standards • safety of workers and consumers • interoperability of networks • environmental protection • exploitation of R&D programmes • and public procurement Sofia, Bulgariya

33. CEN’s Structure • Members • National Standards Bodies (NSBs) • Currently 29 (since 2004) • Associates • Chemical industry, Construction industry, Consumers, Environment, Machine tools, Medical technology, Small and medium-sized enterprises, Trade unions • Affiliates • The NSBs of Central and Eastern European countries which can become members of the Union, and therefore become full National Members of CEN • The most important criterion to be met is the adoption of European Standards as national standards Sofia, Bulgariya

34. Legal Framework • Directive 83/189/EEC, revised into Directive 98/34/EC, then amended into Directive 98/48/EC • Differing from international (ISO) ones, once published by CEN, European standards (EN) ipso facto become National Standards • European standards and documents are not retailed by CEN but by NSBs • Once a work item is addressed by CEN, no competing or overlapping work item can be addressed at national level • Therefore the Commission and all NSBs shall be informed of any new subjects decided by a NSB and the drafts be circulated • Following, national laws apply with regard to the use of standards in procurement Sofia, Bulgariya

35. A sample of outstanding European Standards for Health Informatics • EN 14822 « General Purpose Components » (GPICs – 3 parts + 1 TS) • EN 14720 « Service request and report messages - Basic services including referral and discharge » • EN 13606 « Electronic Health Record Communication » (EHRcom – 5 Parts) • EN 13940 « System of concepts to support Continuity of Care – Part 1: Basic concepts» (CONTsys)  • etc. Sofia, Bulgariya

36. as well as for your questions ! Thank you for your attention… www.eurorec.org Sofia, Bulgariya