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EC eHealth activities
in Policy, Deployment and Research
Gérard Comyn
Former head of the ICT for Health Unit
DG INFSO
Vice President of CATEL
Slovakia, 27/5/2010
Challenges for European Health Systems
• Pressure on healthcare systems Citizens’ expectations for high-quality care Demographic changes
more people will require prolonged care Increased prevalence of chronic diseases
substantial part of the overall healthcare costs Medical accidents Staff shortages Reactive model of healthcare delivery
after appearance of symptoms Rising healthcare costs
faster than the economic growth itself
• How to offer high-quality & affordable care?
••• 3
Examples of eHealth solutions
1. Clinical information systems
a) Specialised tools for health professionals within care institutions
b) Tools for primary care and/or for outside the care institutions
2. Telemedicine systems and services
3. Regional/national health information networks
electronic health record systems and associated services
4. Secondary usage / non-clinical systems
a) Health education and health promotion of patients/citizens
b) Specialised systems for research, public health
*Definition agreed with the eHealth Industry Stakholders Group reporting to the i2010 sub group on eHealth
Overall eHealth Policy
• eHealth in support of: Improved productivity of healthcare systems
higher quality care at the point of need
better health information processing
Continuous and more personalised care solutions respond to the needs of elderly people
informed & responsible participation of patients and informal carers
Prevention and prediction of diseases save lives and avoid costly treatments
Higher patient safety optimise medical interventions and prevent errors
Support to mobility of patient timely access to vital information at the point of need
Health sector in EU
• Employs 9.3 % of workforce, > 15 M people (retail 13.0 M,
business services 13.3m)
• Health expenditure > 8,5 % of GDP, growth at 4% a year
(faster than EU economic growth), potential to reach 16% of
GDP in EU by 2020 (Healthcast 2020, PWC)
• Health care is information intensive sector but ICT
penetration is low compare to other sectors.
• There is great potential for benefits for individuals, society
and economy when ICT, leadership and skills come together
• eHealth is currently the fastest growing industry of health sector,
estimated at € 15-20 Billion, ~2% of Health expenditure
Other EU markets: Pharma € 205 Bill., Medical Technology € 64 Bill.
• By 2010, a double digit growth rate of up to 11% is foreseen for
eHealth, driven by a search for more productivity and performance
(source: Datamonitor 2007 – Trends to watch: Healthcare Technology).
CHALLENGES
• Standardisation
• Interoperability
• Business model & financing
eHealth Market in EU
EU Market fragmentation
Main Instruments to address these challenges
o Policy Instruments– Directives, recommendations, communications,
staff working papers ..
o Deployment, support to policies: Competitiveness and Innovation Programme (CIP)– Large Scale Pilots, Thematic Networks
o Research (Framework Programme)– Integrated Projects, STREPs ..
Secure
data
networks
SocialService
General
Practitioners
Homecare
Hospitals
Nursing
Homes
Health
Authorities
Labs
First step in eHealth services deployment:
Connectivity- linking all the points of care
Country or
Region 3
Secure Networks
Country or
Region 2
Mobility
Country or
Region 1
Interoperability across bordersLinking basic information between patient summary systems or giving access to physicians to patient summary in your home country
Patient Summary 1Patient Summary 2
Standardised exchange/access of minimum common data
Direct access of physicians when legal
EC Response
1. Research and development since 1989 (among the first
international funding agencies focusing on eHealth)
2. Support to deployment and coordination with some Member
States (1996-)- example: Medcom, Denmark
3. Policy document and proactive coordination of eHealth
deployments ( eHealth Action plan 2004 -)
4. Large Scale Pilot – epSOS on cross border interoperability of
patient summaries and prescriptions (2008)
5. EC Recommendation on Interoperability (2008)
Interoperability : why?
• Lack of interoperability is detrimental to– the patients (leads to lack of information,
medical errors, limited patient mobility)– health professionals (difficult access to
health records)– health managers (lack of economic analysis)– researchers (reduced availability of medical
data) – industry, in particular to small- and medium-
sized enterprises (reduced market shares).
EC Recommendation on Interoperability of cross border EHR
systems C(2008)3282
• Aims at enabling coordinated care by connecting people, systems and services
• Provides Member States and relevant bodies with basic principles to address the existing challenges in implementing EHR interoperability
• Identifies different levels of actions:
– Political, Organisational, Technical, Semantic,
– Important issues: standardisation, certification, conformance testing, education and awareness
EC and Member States cooperation in eHealth deployment
• Large Scale Pilot on cross border interoperability (epSOS = Smart Open Services for European patients)
– 12 EU member states, € 22m, 2008-2011
– Cross-border services – safe treatment for citizens when in another MS
• European Patient Summary (emergency treatment, unplanned care)
• ePrescription across the EU (continuity of care)
• EU Interoperability Network CALLIOPE
– Community building, exchange of experience
– All member states
Implementation, support to policiesepSOS: Approach and Expected Outcome
• One large Scale Pilot
– Patient summary for unexpected care
– ePrescription/medication records
• With a common architecture
• Built on Member States’ solutions and users’ needs (‘bottom up’)
• Thought as long lasting solution at European level
• Scalable and sustainable, adaptable to new situations
International CooperationWHAT and WHY
• Exchange of best practices
– engaging health professionals
– disseminating to public
– realistic procurements – what can be delivered and how fast
• Interoperability
– why: safety, efficacy, continuity of care, defragmentation of global market: competition better quality at lower price
– What: converging standards, interoperability testing, certification
• Benchmarking/ assessment of benefits
• Re-use of health data for public health, education and research
EU-US cooperating ongoing with ONC – Office of National Coordinator on the above issues
Region 3
Hospital
Home
Pharmacy
Health Centre
mobile PC
Mobile,
Wireless&
Broadband
Emergency
Region 2
Mobility
Region 1
Step 2
Connecting individuals with Health Information Networks
Health monitoring, access to health information
Secure Networks
EC RESPONSE to Step 2
• R&D on personal health systems (wearable, portable) since 1999
• Communication on Telemedicine (2008)
• Large Scale Pilot– Renewing for Health, start January 2010
• Special actions on procurement and financing
• ―Staff working paper‖ ( EC official document) on legal framework
(to be issued in 2010) that shows
– what are the relevant EU directives and regulations (i.e. that
telemedicine is ―legal‖)
– not all national legislations are adopted accordingly
Personal Health Systems and Telemedicine:
Sensors for multi-parametric monitoring
Hospital
Health / call
Centre
Data processing & analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [%
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-0.5
0
0.5
Ris
k [-
-]
t [sec]
Positive VVS Risk
Other data:
clinical, images,
lab, genomics
Intelligent
analysis
Support to diagnosis
decision & treatment
Treatment,Rehabilitation
Medical
expertise
Data communication and feedback
Catedra Sanitas Madrid 11/11/2009 ••• 19
Personal Health Systems (PHS) characteristics
Realised as: Wearable, implantable, portable systems Integration of various components and technologies
e.g., sensors, implants, signal processing algorithms, user interfaces, mobile and wireless communications
Used by the patient or healthy individual Coupled with telemedicine platforms to provide personalised services
Non-/minimally-invasive monitoring and management Remote & continuous health status monitoring and disease
management Personalised medical advice, recommendations & treatment Available at anytime and location beyond hospitals
MYHEART
AMON
Telemedicine for the benefit of patients, healthcare systems and society
Commission Communication COM (2008) 689, 4.11.2008
• Why telemedicine?– Improve quality of life of patients– Better care : closer monitoring -earlier detection
and diagnosis of diseases– Increased accessibility to health
services/professionals in remote, scarcely populated areas
– Empowered patients in managing their health conditions
– « Moving patients from hospital to home »– Improving efficiency and timeliness of
healthcare service provision
• Boario telecardiology:
35-47% reduction in hospital admissions (in various studies)
12% reduction in outpatient visits
• UK studies:
Wireless Healthcare (2004): Early discharge from hospitals ->
up to 85% reduction in weekly care costs
Cost of telecare at home with 24 hours response = 1/3 of the cost of a
nursing home place
• Potential of Mobile Monitoring in Germany
Up to €1.5 billion/year savings through early patient discharge
(Assuming 3 days less hospital stay for 20% of patients)
Telemedicine Benefits
The Communication on Telemedicine:October 2008
• Telemedicine experiences exist nation and Europe wide
• Increasing deployment due to:
– Technical reasons: Broadband, personal health systems
– Financial reasons: Moving patients from hospitals to home;
solutions for chronic disease management
– Other reasons:
• Geographical, Patient empowerment, Involving family in
care process, Elderly people, Skill shortage
• Challenges: legal environment, reimbursement,
business models, evidence, acceptance, awareness,
technical
Mr. X, 70 years Diagnosed with chronic heart
failure
• Needs close monitoring of clinical symptoms
• To prevent/anticipate acute adverse episodes
Daily telemonitoring of weight and dyspnoea at home allows– closer monitoring,
– More adapted care,
– Earlier warning in case of acute episode
Photo credit: ESA
Mrs Y, 40 yearsLives in a Northern Sweden
Diabetes
• Diabetes, needs regular eye checks (retinography)
Teleophthalmology performed in the neighbouring town, eye scans sent to capital and interpreted by a specialist
– Better care, – better territorial cohesion, – better quality of life
photo credit: microsoft
Hospital Zstruggles with peaks in activity in
radiology
• During peaks, radiologists are lacking for interpretation of radiographs
Teleradiology allows remote interpretation of radiographs and may thus
– Reduce delays
– Optimise resources
– Allows 24/7 service
Photo credit: Ramic medical imaging
Photo credit: virtual cancer centre
Objective of the Telemedicine Communication
• Enabling patients, healthcare systems and society to take the maximum benefit from Telemedicine solutions
• Support Member States in integrating telemedicine services in their healthcare systems
• Provide a consistent approach towards Telemedicine in Europe
Building confidence and acceptance of telemedicine
services
• Building confidence and acceptance on telemedicine services
– Measure and document impact of telemedicine, improve quality of studies
– Support large scale telemedicine use, and innovative and sustainable procurement/funding schemes
– Involve health professionals and patients in telemedicine
– Defining Member States needs
– collection of good practice on deployment of telemedicine in Member States
Bringing legal clarity
• Bringing legal clarity
– Member States to share information on current /future national legislative frameworks relevant to telemedicine
– + adapt national legal framework to allow telemedicine to be used
– Analysis of the European legal framework applicable to telemedicine services
Solving technical issues and facilitating market
development
• Facilitating market development
– industry and international standardisation bodies to propose a plan to achieve interoperability in telemedicine
– Commission in cooperation with Member States to issue a strategy on conformance testing of interoperability, functionality and security of telemonitoring systems
Integrated Health Records
Environmental
Data
Biosensors
Phenomic data
Genomic data
Biochips
Step 3
Seeing the full picture of individual’s health status
-Quality/Efficacy of Healthcare services
- Lifestyle: what we eat, drink, breath, …
- Physical and social environment
- Genetic “blueprint” /profile at birth
- Acquired genetic changes
WHY Step 3?Factors determining a health statusof an individual & population
Exogenous Determinants(Nurture)
Endogenous Determinants(Nature)
Health delivery system
ICT contribute to all factors!
New Options for Disease
Management
Diseaseprogression
Mortality& costs
Geneticpredis-position
First cellmutations
asympto-maticdisease
Diseased cells release biologicalmarkers
First symptoms/manifestation
Diseaseproliferation
Environmental trigger
Currentapproach
In vitromarkers
Diagnostic (anatomic) imaging, biopsies
symptomsdiagnosis
• Non-personalizedmedication
• Chemotherapy• Radiotherapy• Surgery
Followup
Molecular ImagingMolecular Imaging
MolecularMedicineapproach
Molecular Therapy
Molecular Therapy
DNAscreens
Proteinscreens
Monitor TreatmentMonitor Treatment
EarlierPersonalizedIntegratedEfficient
Philips Presentation
The Virtual Physiological Human is a methodological and technological framework that once established will enable the investigation of the human body as a single complex system.
The VPH research roadmap developed by project STEP in 2007:
www.europhysiome.org
- Personalised (patient-specific) healthcaresolutions
- Early diagnostics & predictive medicine
- Understanding diseases for the first timeacross several biological levels
EC DG INFSO Response to Step 3
The Virtual Physiological Human (VPH)
International cooperation for VPH
• Modelling the physiology of the human being is an
international Challenge (e.g. Physiome project)
• Many issues such as the huge volume of data to
manage, multiple formats used to store the data,
the interoperability of models and applications,
and the standardisation are not limited to Europe.
• Clear need to exchange experiences and
expertises to address this ―super Challenge‖
– Strong Cooperation with NIH http://www.nibib.nih.gov/Funding/MultiscaleModeling, http://www.cancer.gov/
and in particular in IMAG group activities http://www.imagwiki.org/mediawiki/
– Weaker cooperation with Japan and China
– Call for proposals to invite International organizations to our VPH projects (5 new contracts start now with partners from US, NZ)
– Current call on VPH is open and encourages INCO partners
– The call in 2012 will have dedicated budget to INCO partners
Conferences with participation of US and EU projects
– ICT-BIO 2006 and 2008
– IMAG symposium: http://www.siam.org/meetings/ls08/index.php
– Healthgrid conferences
VPH International Cooperation What we have done so far
• Council conclusions on safe and efficient healthcare through
eHealth – adopted by EPSCO Council on Dec 1st 2009
– Strong commitment of Member States with specific action plan on
governance, deployments, legal issues and interoperability
• eHealth Governance Initiative - State secretaries of Ministries
of health agreed to cooperate on eHealth (10/2009)
– State Secretary level MS collaborative platform supported by DG
INFSO and DG SANCO
Increased cooperation between MS and with ECon eHealth DEPLOYMENT
National Priorities: Preliminary Analysis
Priorities in national eHealth Strategies
# of Countries
Examples
Electronic Health Records
EHR, EPR, Medical Records,
Patient Summary,
Emergency Data Set
17 DMP - Dossier Médical Personnel (FR)
BEHR - Basic Structure for the EHR (DK)
NHS Care Records Service / Spine (UK),
Patient summary (SE, FI)
SumEHR (BE),
eGP file (NL)
Infrastructures & Networks
Broadband communication networks and associated technology and basic services
12 MedCom – the Danish Healthcare Data Nework (DK)
Sjunet (SE)
National Health Network (NO)
National eHealth VPN (DE, AT)
ePrescription
Management and implementation of ePrescribing
16 Apotheket (SE)
ePrescription (DK, NL, SI)
eRezept (DE)
http://www.ehealth-era.org/
eHealth worksOptimal results when eHealth tools when combined
with proper organisation and skills
• National and Regional Health information Networks improve quality, efficiency, and will save next year € 80 Mil/year in Denmark (Medcom)
• ePrescription improves patient safety, saves € 70 Mil/y in Sweden
• Personal Health Systems and Telemonitoring can provide care at the point of need, reduce length of hospitalisation (by 20 - 40% for heart patient in UK)
• Direct Online information Services such as NHS Direct online–empower patients, avoid unnecessary hospitalisation, support lifestyle choices, save € 110 Mil/year
www.good-ehealth.org www.eHealth-impact.org
http://www.epractice.eu
eHealth use in Europe 2002 - 2007
• GPs engaging in patient data went up from 17% to 63%.
• Transfer of laboratory results (blood, ECG) from 11% to 54%.
• Transfer of administrative patient data to reimbursing organisations went up to 22% from 6% in 2002.
• Transfer of medical patient data increased from 8% to 28%.
• e-Prescribing was done by about 3%, now by about 11%.
• A comparison with the 2007 results for all 27 EU Member States shows that the enlargement of the Union did not have much impact — neither positive nor negative — on the developments in the past five years.
••• 400
10
20
30
40
50
60
70
80
90
Using PC
Using electronic patien data storage
Routinely using PC in consultation
Internet access
Connecting with broadband
Using decision support software for
prescribing or diagnosis
Accessing other health institutions networks
Occasionally using PC to illustrate to patient
Regularly using PC to illustrate to patient
Exchanging administrative data with
reimbursing organisations
Occasionally using Internet and electronic
health networks to provide telemonitoring to
home-patientsRoutinely using Internet and electronic health
networks to provide telemonitoring to home-
patients
87.4%
80%
66.1%69%
62.5%62.3%
55.2%
44.4%
13.9%15.1%
2.7%
0.9%
eHealth in EU – Some Good NewseHealth deployment in primary care (EC Study 2007)
Conclusions
• On going deployment of eHealth at national, European and international level
• Structured initiatives of cooperation:
– At international level
– eHealth governance at European level
• Number of problems still to be solved (interoperability, legal framework, involvement of health professionals ..)
http://ec.europa.eu/information_society/activities/health/index_en.htm
Thank you !
