eHealth Projects in Germany - funded by eTEN – eMAC Meeting German Federal Ministry of Economics and Labour (BMWA) 2005-

1. Best-Practice for eTEN Projects eHealth Projects in Germany- funded by eTEN –eMAC MeetingGerman Federal Ministry of Economics and Labour (BMWA)2005-05-12, Berlin Reinhold A. Mainz Federal Ministry of Health and Social Security (BMGS) Project Group Telematics - Electronic Health Card Coordination for eEurope, EU action plans and programmes, international activities

2. eTEN Programme:Supporting market validation and implementation (of IST RTD results) Reinhold A. Mainz Federal Ministry of Health and Social Security (BMGS) Project Group Telematics - Electronic Health Card Coordination for eEurope, EU action plans and programmes, international activities

3. Objective Validation & deployment of public interest e-Services OrientationeEurope 2005 and beyond (iEurope 2010) * eTEN supports implementation(no R&D or infrastructure support) Themes eGov, eHealth, eLearning, eInclusion, Trust & Security, services for SME’s Procedure Calls for proposals * selecting the highest quality within the available budget Requirement - Trans-European dimension - practical service demonstrations bridge the gap between RTD and the marketplace: pragmatic, business, practical

4. Some examples of good-practice eHealth projects – funded by eTEN - with German partners • Mobilalarm • Netc@rds • I2-Health

5. MobilAlarm– A location-independent emergency service for older and disabled people Slides from: Dr. Karl & Dr. Veli Stroetmann empirica Institute for Communications- and Technology Research Oxfordstraße 2, 53111 Bonn, Tel.: +49 (228) 985 3044, email: Karl dot Stroetmann at empirica dot com

6. A Good Practice Case: The MobilAlarm Project Validating European Mobile Alarm Services for Inclusion and Independent Living • Supported by eTEN March 2004 - August 2005 • Testing an innovative alarm service for older, chronically ill and disabled people and all those concerned about safety while outside • Objective: prepare market role-out in EU

7. empirica Technologieforschung GmbH (Bonn, DE)Coordinator, private research & project consultancy Attendo Systems GmbH (Ismaning, DE) delivering device & service centre software Telehealth S.L. (Valencia, ES)Consultancy on ICT solutions for social services Fundación Andaluzia de Servicios Sociales (Seville, ES)public tele-assistance service provider Attendo Response Ltd. (Rotherham, UK) private response service provider Recontrol (Karlsruhe, DE)private response centre plus User Groups: Patients, Hospitals, Welfare, NGO, Police, ... Participants

8. Description The service will enable users to initiate an alarm call with a specifically designed device. On pressing the alarm buttons, a voice connection to a professional service centre is established. The device calculates location data by using the Global Positioning System (GPS) satellites and transmits the position to the service centre: the operator needs only one click for locating and mapping the user’s position on the screen. Service centre staff immediately calls people who can help.

9. Service • On pressing alarm buttons: GSM voice connection to service centre • Location data calculation through Global Positioning System (GPS) • User location shown on electronic map on operator‘s screen • People who can help alerted immediately (relatives, neighbours, doctors, rescue services)

10. Device • Specifically designed • Size: slightly smaller than common mobile phone • Weight: only 100 gram • Easy to handle: only five buttons • Two lateral alarm buttons for being pressed at once (simple but prevents false alarm) • Battery life of up to six days

11. Objectives The overriding objective of MobilAlarm is to test and evaluate the technical, organisational and economic characteristics of this trans-European tele-assistance service and to prepare its accelerated roll-out in Member States.

12. Methodology • Verification of regional user requirements & localisation of technology • Three test phases: • Internal tests with service centre employees • Small-scale pilot tests with real clients • Large-scale tests with about 40-100 clients in 3 markets Further tests with real customers will be conducted in the core stage of the project in spring 2005, allowing to adjust the device and service to particular user requirements. • Tests in Germany, UK, Spain • Development of Deployment Plan

13. Technical Challenge A current technical challenge is that the locating function cannot work when the device is shielded from a sufficient number of GPS satellites. This may be the case, for example, inside buildings, in urban “building canyons” and in dense forests. This problem of conventional GPS will be eased by a new technology named Assisted GPS (A-GPS). By being assisted through the mobile phone network, the device holders can be located even inside buildings and other shielded locations with an accuracy of five meters.

14. Important issues for consortium composition • Experienced project coordinator(proposal writing, contract negotiation, financial issues -> empirica) • Committed industry partner (-> Attendo) • All elements of the value system included (from device production to user groups) • Intermediary for language translation and management, if need be (-> Telehealth) • One partner with experience in an eTEN project

15. History • Attendo had business idea but not enough resources for market testing • Representatives from empirica and Attendo knew each other from conferences (networking like EHTEL (http://www.ehtel.org)) • Concrete project idea was developed, consortium formed (at least 2 independent partners in 2 Member States) • Proposal was written • After acceptance: number of partners reduced, workplan modified

16. Work packages • Management • Business and Deployment Plan • Requirements extension • Technical testing • Trials • Marketing -> typical work packages of an eTEN project

17. Important issues for day-to-day work • Administrative workload has to be considered • Deliverable writing takes much time and requires trained people • For most partners, an eTEN project is extra work => continuous professional project management indispensable

18. Dissemination MobilAlarm: eTEN project of the monthFebruary 2005

19. More information about MobilAlarm • Project website: http://www.mobilalarm-eu.org • Some project partners: http://www.empirica.com - http://www.attendo.de • e-mail: veli at empirica dot com

20. Netc@rds – Smart Card and Network Solutions for the Electronification of the European Health Insurance Card Slides from: Central Research Institute of Ambulatory Health Care in Germany (ZI), Herbert-Lewin-Platz 2, 10623 Berlin; email: rtavakolian@kbv.de; Tel.: +49-30-4005-2418

21. A Good Practice Case: The N E T C @ R D S Project Countries with participating contract partners: Finland Declaration of Accession: Denmark Slovenia Austria Slovakia France Czech Italy Hungary others welcome Greece

22. Setting the field • March 2002 • Basic decision of the European Council in Barcelona for a European Health Insurance Card (EHIC) • February 2003 • Proposal for gradual phasing of visual EHIC (2004) towards an electronic EHIC (2008) • October 2003 • Decisions No. 189, 190, 191, on introduction of the visual EHIC • June 2004 • Start of roll-out of the visual EHIC

23. Objectives of Netc@rds • Online verification of insurance data to prevent fraud and misuse • Fostering mobility of European citizens • Simplification of procedures for involved institutions: • Health insurance providers • Healthcare providers • Interstate clearance bodies • Integration of electronic data sets for EHIC into national cards • Contribution to interoperability of eHealth in Europe

24. Work items of Netc@rds • 1. Status survey and analysis on EHIC handling • 2. Technical proposal based on the NETC@RDS-cases • Proposal for electronic data storage on chip cards • Suggestions on interoperable infrastructure components • Demonstrator setup of a verification network • Automated optical data capture of conventional EHIC • Post-processing interface of EHIC data (XML Output file) • 3. Strategic proposal for eEHIC introduction

25. Prototype example of EHIC handling Patient arrives with EHIC Identity Check Passport or ID-Card Not available Fill-out form 80 or photocopy EHIC and ID Private payment Certify identity by physician Declare duration of intended stay by insured on form 81 Specify chosen insurance provider by insured on form 81 Treatment Sending forms immediately to chosen health insurance Archiving form copies for 2 years

26. Netc@rds-Cases1-4 Member State of Temporary Stay Home Country Member-State Case 1: dataset captured from chip card health insurancedata server Netc@rdsdataset Netc@rdsdataset Netc@rdsdataset Case 4: dataset captured from eye-readable medium (EHIC, paper) Netc@rdsdataet Case 2: dataset captured from chip card & server Case 3: dataset captured from server

27. eEHIC in process model viewpoint Access 1. Access / Data capture – the individual data must be available on the health care site completely and correctly 2. Identification – the concordance of the ID-data with the patient are verified 3. Verification – the entitlements rights of the person are checked Data capture Identification Verification An electronic European Health Insurance Card (eEHIC) is a process with the result of a trustworthy data set for entitlement at the healthcare provider. Trustworthy dataset

28. Health insurance chip cards available in the Netc@rds pilots France Germany Austria Slovenia Italy (Lombardia)

29. Summary • Online verification of entitlements rights • Replacement of paper forms • Contribution to interoperability • Interoperable dataset to foster electronic post-processing • Cost-effective extension to new card schemes • Simplified access to foreign healthcare systems • Fostering mobility of European citizens

30. More information about Netc@rds • Project website located in France: please use a search machine • Co-ordinator of the German project partners: http://www.zi-berlin.de • email: rtavakolian@kbv.de

31. I2-Health– A support action for an Interoperability Initiative for a European eHealth Area I2-Health

32. Policy background

33. eHealth services in Europe:Dynamic development driven by citizen demand Mobile citizens want to use eHealth services all other Europe • Cross-border health care / European-wide services • Services used at home shall be available while staying in other Member States / countries • Use of specialiced centres in Europe Systems (in Europe) must be interoperable

34. Political targets • Mobility of citizens • Cross border e-Health services • European-wide e-Health services • Information about health and possible treatment and care, including sufficient information to enable informed consent to treatment • European mechanisms to facilitate access to care in other Member States and information about them • Patient empowerment • Patient-centred care • Efficiency and quality of health systems

35. The challenge • The support of mobile citizens by european-wide or cross-border eHealth services is only possible if similar local services are interoperable to each other • aspects of interoperability are • legal and contractual framework, organizational agreements • technical connection of infrastructures like networks and middleware services • standardized technical protocols for secure data transmission and providing • agreements on structure, syntax, terminology, coding and presentation of data • definition of the semantic of data and the given context and its description by meta data

36. Co-operation in Europe on eHealth • Transparency about national developments gives chances to learn from others • Finalized developments can be used by others to avoid reinventing the wheel example: framework architecture / specification of the German card • Co-operation backed by agreements on the policy level:European Interoperability Initiative, driven by the health ministries

37. The EC eHealth Action Plan 2004Overview of actions withresponsibilityby the Member States: 2005 Develop a national or regional roadmap for e-Health • Deploying e-Health systems • Setting targets for interoperability • Setting targets for the use of electronic health records • Address issues such as reimbursement of e-Health services

38. The EC eHealth Action Plan 2004Overview of actions with responsibilityby the Member States: 2006 • Common approach to patient identifiers • Interoperability standards • Health data messages • Electronic health records • Support and boost investment in e-Health

39. Report of theHigh Level Group on Health Services and Medical Care 2004to the Council of the European Union • Interoperability is the corner stone supporting citizens mobility and patient centred care • Appropriate structures for cooperation on information and e-health must be implemented • The needed resources must be secured

40. eHealth Standardisation Focus GroupMain Recommendation (2005) Establish a platformwith a mandate and the necessary resources to facilitate co-operation between European Member States with support of the European Commission to promote e-Health interoperability for the mobile citizen

41. The Member States` Interoperability Initiativefor a European eHealth Area Initiated byGermany, Austria, France, Norway, Slovakia, The Netherlands supported bythe EC2004-06-01, Brussels Member States`ministries of healthInteroperability Initiative 41

42. The Member States` Interoperability Initiativefor a European eHealth Area:Supporting EC projects on the management level InformalSteering Committee:EHTEL Healthcare Authorities Governmental Group Member States`ministries of healthInteroperability Initiative I2-Health? 42

43. BilateralProjectD – Fcross borderhealth cards BilateralProjectePrescription /medication management BilateralProjectA – Dconnector BilateralProjectD – NLdocument WebSite ... The Member States` Interoperability Initiativefor a European eHealth Area:First supporting or proposed projects InformalSteering Committee Member States`ministries of healthInteroperability Initiative ... ERA eHealth CA TMA-Bridge I2-Health Netc@rds ++ 43

44. A Good Practice Case: The I2-Health project Interoperability Initiative for a European e-Health Area – Support Action I2-Health Support Action for the eTEN Programme Slides from: Dr. Karl & Dr. Veli Stroetmann empirica Institute for Communications- and Technology Research Oxfordstraße 2, 53111 Bonn, Tel.: +49 (228) 985 3044, email Karl dot Stroetmann at empirica dot com

45. Background • Interoperability of health information systems: • “Member States have expressed the need to support actions that cover the development of standards addressing the interoperability of diverse systems and services and • to explore in particular the possibilities of open source applications to achieve this objective. ... • The exchange of experience in the use of open standards and open source solutions among health administrations in Member States should be promoted.” • Communication from the European Commission (COM(2004)356) 30.4.2004 “e-Health – making healthcare better for European citizens: An action plan for a European e-Health Area” I2-Health

46. Project start: 1 February 2005 • Project duration: 24 month • Consortium: • empirica Institute for Communications- und Technology Research, Bonn, Germany (Coordinator) • Members to empirica: • Work Research Centre Ltd. (WRC), Dublin, Ireland • Central Research Institute of Ambulatory Health Care in the Federal Republic of Germany (ZI), Berlin, Germany • Technical University of Košice (TUK), Slovakia • European Health Telematics Association (EHTEL), Brussels, Belgium • Reports are given to: • (Informal) Steering Committee of Member State Healthcare Authorities I2-Health

47. Strategic goal • Initiate acoordination process for accelerating the deployment of e-health infrastructures and functional applications which are interoperable for trans-European use • thereby • Enabling cross-country, interoperable e-health applications • while • Safeguarding appropriate data security and privacy requirements. I2-Health

48. Objectives • Identify interoperability and connectivity issues and priorities, barriers and gaps, and solution approaches • Focus on fundamental interoperability issues (identification of actors, organisations, adequate measures to achieve interoperability, integration tests and certification) • Analyse similarly key topics relating to e-prescription and messaging • Develop a roadmap and concrete projects involving all relevant actors - guided by an open discussion process amongst Member State Healthcare Authorities and stakeholder groups I2-Health

49. WP2 Analysis of infrastructure concepts and building blocks, services and applications WP3 Identification management of actors, organisations and system components;fundamental interoperability issues, WP1 Conceptual Framework WP4 Workflow interoperability, prescribing and messaging WP5 Dissemination WP6 Management Workpackage overview and interrelationships I2-Health

50. Expected results • Report on European-level key e-health interoperability issues and activities needed to overcome barriers • Identification management e-health interoperability issues: gaps and needs analysis, and solution proposals • E-prescribing and messaging: gaps and needs analysis, and solution proposals to achieve interoperability of existing implementations • European e-health interoperability plan and roadmap: enabling the Interoperability Initiative • Policy level • Management level • Implemenation level I2-Health