European perspective (Czech view)

CESNET association, Praguemilan.sarek@cesnet.cz

EUROPE

Prague

Running eHealth projects

• MeDiMed (Metropolitan Digital Imaging System in Medicine) – http://www.telemedicinabrno.cz

• IZIP - Electronic Patient Health Account (EPHA)http://www.IZIP.cz, http://www.IZIP.info

• NETC@RDS (pilot of common EU Health Insurance Card (EHIC) ) - http://www.netcards-project.com/

• PIM (Product Information Management) – http://pim.emea.eu.int/

MeDiMedMetropolitan Digital Imaging System in

Medicine

Provided services

• Support of daily routines at the radiology departments

• Exchange of image information among hospitals (second opinion, long distance consultations, special applications, …)

• Support of teaching and research activities in the area of processing of medical image information

• Coordinated activities dealing with processing of medical image information• The main coordinator is the Masaryk University, Brno, Czech Republic• The necessary technology is mainly located at the Institute of Computer Science

of the Masaryk University• The project is opened for health-care institutions not only in the Czech Republic

• The MeDiMed project technology background consists of a set of dedicated PACS (Picture Archiving and Communication System) servers

• System of Routing modules and Image servers supports exchange of images

• Coordinated anonymisation and archiving of anonymous image studies supports additional teaching and research applications

Technology

The solution was from its start designed to serve as a reliable and accessible communication node as well as an educational and research centre available to any hospital or other healthcare institution, including medical faculties, interested in participating.

Supportive Network Infrastructure in the City of Brno

More than 100 km of optical cables plus a wireless connection

Interconnecting all major hospitals and healthcare institutions in the city of Brno

Metropolitan Academic Network operated by universities in the city of Brno

Computer network operated by the CESNET Association

Supportive Network Infrastructure in the Czech Republic

Mainfram

Mainfram

Primary PACS Servers

Secondary PACS servers

Mainfram

Mainfram

Mainfram

Mainfram

Logical Structure of MeDiMed SolutionHospital I

Hospital II

Private workrooms of radiologists(outside hospitals)

Teaching rooms; simulation of routine in radiology department

Hospital I: Healthcare institution where image information processing is 100% handled at the Metropolitan PACS centre

Hospital II: Healthcare institution co-operating in some way in the area of image information processing with Metropolitan PACS centre

Continuous arrows mean routine transmission, interrupted arrows depict update of information in the database of anonymous image studies for teaching and research purposes

Support of Research and Education

• Tailored Educational and Research PACS and its database of anonymous medical image studies is the necessary basis for medical training and additional educational and research applications.

• Images appropriate for teaching and research purposes are made anonymous (i.e. the personal data of the patient and other information that may disclose the identity of the patient is replaced with fictitious information or modified in such a way so as not to lose any relevant information but so as to prevent disclosure of the patient's identity) when sending into educational and research PACS.

• Data on the real patient obtained from several hospitals uses the same fictitious identity, thereby offering students a more complex view of the evolution of the patient's health.

Educational and Research PACS

• The whole integrated solution for support of teaching and research is certified, so it can form a part of an information system infrastructure of cooperating healthcare institutions.

• For every medical area there is a board of physicians responsible for correctness of incorporated information.

• Additional specialized aplications exploiting the database of anonymous image studies. Mainly accessible via educational portal.

• Hypertext document of the Case Study describing a given medical case and referencing the relevant anonymous medical images. Used especially for training purposes of medical students and young physicians.

• Human Tissue 3D Geometrical Biomodels, Application in Intervention Simulation. CT/MRI - sources of tissue geometry and structure information.

• …

MeDiMed benefitsThe huge potential of databases of medical image information in health care institutions can be reached by:

• Anonymisation of medical image information (elimination of the legal barrier preventing access to sensitive patient’s data).

• Coordinated assignment of fictitious identity (it offers a more complex view of the evolution of the patient’s health when beeing treated in different heathcare institutions).

• Building structured databases (sophisticated system of keywords, description of findings, …) of image information that can serve as a datasource for additional applications.

• The necessity of usage of standard technology also in the area of education and research.

 

System IZIPSystem IZIPElectronic Patient Health Account

(EPHA)

Current Status

25% of Health Care InstitutionsParticipate in the System IZIP

• 7 011 health care institutions in the Czech Republic participate in the system – 6, 664 Out-patient offices

2,948 GPs 3,716 specialists

– 220 pharmacies– 77 labs– 50 hospitals

0

200 000

400 000

600 000

800 000

1 000 000

1 200 000

1 400 000

1 600 000

1 800 000

2 000 000

II. -

III. 0

2VI.0

2IX

.02

XII.02

III.0

3VI.0

3IX

.03

XII.03

III.0

4VI.0

4IX

.04

XII.04

III.0

5VI.0

5IX

.05

num

ber

of m

edic

al r

ecor

ds Harmonized interfaces for directdata export from majorityof information systems used in

hospitals labs pharmacies out-patient offices

Figures to Sep. 05

7% of Czech Population HoldsElectronic Patient Health Account

(EPHA)- equals to 35% of Patients in CZ

0

2

4

6

8

10

2002-2003 2004 2005 2006 2007 2008

num

ber

of I

ZIP

clie

nts

in m

illio

ns

Testing phase

Routine phase

Funct. dev. phase

Public service phase Assoc. EHICphase

Ope

ning

for

all p

atie

nts

Reg

istr

atio

nof

all

patie

nts

Leg

al r

equi

rem

ents

for

the

who

le p

opu

latio

n

Voluntary period

0

10 000

20 000

30 000

40 000

50 000

60 000

tota

l nu

mb

er

of u

sers

0 1-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-44

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

-89

90

-94

95

+

age segment

users of IZIP

Dominant age segments 50 – 64 yrs a 20 – 35 yrs

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

0 1-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-44

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

-89

90

-94

95

+

age segment

% o

f a

ll p

op

ula

tion

Czech population uzers of IZIP

Harmonious population coverage

How is it working? See demo in English (or Czech

• http://www.IZIP.cz

• http://www.IZIP.info

Security of IZIP

Security of IZIP• The medical file belongs to the patient and is identified by an

identification number (birth registration number) and PIN. • Should a doctor wish to persuse a patient's medical file, they must

enter their access code and the patient's PIN - the patient can either tell the doctor the PIN or enter it themselves into the doctors computer.

• Should a patient decide not to tell a doctor a password or enter it into a computer, the doctor will not be able to read the medical file. They can however send enter the results of the examination into IZIP. The doctor can open a blank form, into which they write the results and send it to the patient's medical file. This is all without accessing the records written by other doctors.

NETC@RDS

• Pan-European initiatives to foster mobility & skills inside the E.U

• Since June 2004: common EU Health Insurance Card (EHIC) – ensures access to health care when abroad inside the EEA

• EHIC: Eye-readable document – minimum common denominator – only a temporary solution on the way forward to an e-EHIC

• But in 25 Member States + other EFTA countries – different levels of care entitlement, different levels of IT infrastructure

• Announced decision on long-term course – 2008+

• NETC@RDS challenge: to demonstrate potential of harmonising different solutions – by applying modern IT capabilities

NETC@RDS

• 20 partners from 10 Member-States : Austria, Czech Republic, Finland, France, Germany, Greece, Hungary, Italy, Slovak Republic and Slovenia + Estonia, Netherlands, Norway and Poland as observers

• All partners: not-for-profit institutions onbehalf national or regional health authorities

• Number of pilot sites: 70

• Time schedule: May 2004 – March 2006

• Possible extension till Oct 2006

• Budget: 5 M€ (50% e-TEN)

Slovenia

Austria

Germany

France

Italian Regions

EU standard

NETC@RDS

• Czech co-ordinator: MEDTEL – non-profit association

• Participation of CESNET: provider of Czech National Server and pilot infrastructure

• the first Czech pilot sites: from end of March 2006 at two hopitals near to Austrian and Slovak border (Hodonin and Znojmo)

PIM

(Product Information Management)

• system introduced by the EMEA in the first instance in December 2005.

• increasing the efficiency of the management and exchange of national product information

• improving the quality and consistency of the published product information.

EU Telematics

PIM

(Product Information Management)

• Czech pilot site: State Institute for Drug Control at Prague.

• Czech communication infrastructure: CESNET association in co-operation with PASNET academic network

Thank you for your attention.