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Dr. H. Karanikas
eHealth in the Public Sector The example of the Electronic Health Record for Primary Health Care
Dr Haralampos KaranikaseHealth & IT Consultant, Athens Medical SocietyeHealth Researcher at NKUA
Dr. H. Karanikas
HALF of EU enterprises provide mobile devices for business use276.5 million EUR
turnoverof EU B2C eCommerce (2012)
14% of EU SMEs selling online
29% of EU enterprises use e-Invoices
28% EU enterprises use Social media
38% EU venture capital
DIGITAL BUSINESS
Digital revolution “Do or Die”
72% of EU individuals uses INTERNET regularly
900 000 estimated demand/supply gap by 2020
150 Million subscriptionsfixed Broadband
130 mobile subscriptions per 100 people
ICT drives 1/3rd EU GDP growth 1995-2007
2.4% of workforce
+ 4.1% yearly employment growth
ICT professionals
55% work outside ICT sector
7% of GDP Size of the digital economy
6% of
Gov't R&D
17% of business R&Dby ICT sector
ICT sector 4.4%
ICT in Other Sectors
17% EU patents
Dr. H. Karanikas
eHealth
eHealth is the provision of health services, supported by electronic means.
It includes health information networks, electronic health records, telemedicine, tele-care, chronic disease management, and systems for monitoring, supporting patients and their families.
Internet is an effective means by which in an economic way one can retrieve anywhere, anytime medical information.
The "patient" is "consumer” of electronic health services and requires a more active role in their health management.
Dr. H. Karanikas
IT Applications - Data
In healthcare we are beginning to realize that the real value is not in the IT infrastructure, but to the data. Good data is the "key" to improve health outcomes, better chronic disease management and better management of population health overall.
These data must be kept and be accessible for the entire life of the citizen.
This brings many challenges for current computer systems, as they have not been designed so that data "survive" outside applications. When we have a change of application (usually every 7-10 years), it is not unusual to get lost historical data and to have a fresh start with the new system.
Thus, it becomes clear that the storage of health data should be independent of the application (and therefore independent of the supplier).
This has already happened in the imaging data, PACS systems. We believe that the same thing should happen with all clinical data.
Dr. H. Karanikas
Big data in healthThe most commonly accepted definition, Gartner (the 3 Vs)“Big data is high-volume, high-velocity and high-variety information assets that demand cost-effective, innovative forms of information processing for enhanced insight and decision making.”
to put together multiple sources of information, coming through many different channels,
to ignore what is not important, to work under time constraints,
support analysts and end users
The key issue is to utilize all of these together using innovative technology, serving the needs of users
Includes large data from multiple sources, such as biological, clinical, and environmental information relating to the health status of individuals and can only be dealt with by new technologies for large-scale storage, integration and analytics.
Dr. H. Karanikas
Strategy Documents 1/2
• Development and operation of ESY.net, KEN-DRG, ePrescription, ERP part of the hospital IT systems etc
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Strategy Documents 2/2
• Εxpanded primary care network. Coordinated and integrated care, using e-governance and new technology.
• EOPYY play a vital role to ensure universal access to care by cost-effective purchasing of health services.
• Τhe development of the Greek DRG system
Dr. H. Karanikas
• IDIKA is one the main institutional partners of MoH for strengthening eHealth• The establishment of Ministries for Digital Policy and Telecommunications and
Administrative Reconstruction ( includes eHealth and eGovernment Health)
• Establishment and operation of the National eHealth Council– National Standard of Electronic health record for the citizen,– National Interoperability Framework, – National Contact Point for European citizens (cross-border healthcare) – Integration of Electronic referrals and prescribing.
• Ongoing to establish the Electronic Health Care Network
Current eHealth priorities 1/2
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• IDIKA to be the national central node of eHealth services with other European agencies.
• Continue upgrading ePrescription with Medical Prescribing protocols, contraindications, SPCs filters.
• Develop Patient Registers based on ePrescription.• EHR for PHC, Patient Consent, eRDV• “Health Atlas” (www.healthaltas.gov.gr) information database concerning health
professionals, health services etc. • eGovNow since the beginning of 2017 will interconnect hospitals.
• New ESPA– «Integrated Information System for the Support of Primary Health Care» (IDIKA)– «Unified registries and code lists for Ministry of Health»
Current eHealth priorities 2/2
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IDIKA ePrescription
electronic Appointments
Patient Summary (PS)
Electronic Health Record
Patient Consent
Register of Chronic disease
Prescription guidelines (with the coordination of Athens Medical Society)
EOPYY E-DAPY
Notices
Insured Health Record
Central monitoring announcements for hospitalization
eDAPY for materials and special diet formulation
Disease Registries (Hepatitis C, Chronic Myelogenous Leukemia)
Main eHealth stakeholders
Dr. H. Karanikas
Ministry of Health (MoH) Integrated Hospital Information Systems (13 projects for Health Care Regions HCR)
ΒΙ MoH
National Telemedicine Network (2nd HCR - EKEPY) a. Tele-diagnosis – Tele-consulting, b. Distance Learning, c. Telemedicine in emergency cases, and d.
Tele-psychiatry.
Medical instruments with which it is equipped a typical Telemedicine unit include: Otoscope, Dermatoscops, Ophthalmoscope, High resolution examination camera, stethoscope, vital signs measurement device, cardiograph
EDET Cloud for health applications
Blood registry
EOF, EKAPTY, KEELPNO, EPY etc
Main eHealth stakeholders
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Avoiding incorrect prescribing problems - control 5 points– right medicine– correct dose– proper patient– Timing– Proper administration route
ePrescription: – «creation, sending, execution and monitoring of pharmacological treatments
based by electronic means» [Miller et al, 2005].– ability to send error-free, accurate and understandable prescriptions
electronically from the healthcare provider to the pharmacy.
Example: ePrescription
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The implementation of an integrated electronic prescribing system was established by the law– 3892/2010 (ΦΕΚ Α΄ 189/04.11.2010) Electronic, entry and execution, of prescriptions and orders for
medical tests.• In conjunction with the data protection law 2472/1997 (ΦΕΚ Α'50 10.4.1997)
13
Total 9.000.000 persons 43.000 doctors 11.900 pharmacies
Per month 5.500.000 medicines'
prescriptions (99%) 2.000.000 referrals of
diagnostic tests (92%) 3.000.000 persons
The ePrescription System
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– Directives 2011/24/EU, 2012/52/EU– GUIDELINES ON MINIMUM/NONEXHAUSTIVE PATIENT SUMMARY DATASET FOR
ELECTRONIC EXCHANGE IN ACCORDANCE WITH THE CROSS-BORDER DIRECTIVE 2011/24/EU• Status: Adopted by eHealth Network, Date: 19 November 2013
– GUIDELINES ON ePRESCRIPTIONS DATASET FOR ELECTRONIC EXCHANGE UNDER CROSS-BORDER DIRECTIVE 2011/24/EU• Status: Adopted by eHealth Network, Date: 18 Nov 2014• non-binding guidelines on electronic prescriptions • Minimum technical requirements for cross-border ePrescriptions• Minimum technical requirements with regard to data security• Storage periods, Organisation of dispensations • Minimum requirements for ePrescriptions with regards to their content• Legal background, Evaluation and quality assurance • etc
– Patient Registries Guidelines (Adopted by eHealth Network, November 2015)
EU Guidelines
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Guidelines Adopted - EU eHealth network
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Registry holders and Member States:• to improve registry quality and interoperability between registries and their data sources by
following and implementing the PARENT Guidelines• to demonstrate the importance of registry data for evidence-based policy making and to
encourage data use and re-use via means of collaborative research studies and publication of results
• to increase patients' awareness of the importance of high-quality registry data and encourage their involvement in the generation and use of data
• to share the national legislations, plans and strategies concerning the areas of registries, eHealth/Electronic Health Records, Rare Diseases, HTA and potentially European Reference Network.
eHealth Network recommends
Dr. H. Karanikas
Primary Health Care (PHC) – Electronic Health Record (EHR)
• Consistent use of an EHR for PHC does not ensure successful use for improving the quality of health care.
• Continuing efforts to encourage the adoption and meaningful use of EHR in primary care should focus and ensure that the use manages to improve care.
• In an outpatient setting, a medical record covers the entire life of the patient (citizen), is not an episode of care (such as hospital stay). So we should have an EHR from which we can create reports in time. In the absence of continuity of care, continuity of information is necessary to optimize healthcare.
• Support for integrating EHR to user workflows.• Can improve care, when, for example, reminders in conjunction with the regular
health check and vaccinations, as common tools support health personnel.
Dr. H. Karanikas
Building the EHR for the PHC
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It covers the majority of diagnoses occur in primary care. Easy to use. Collaborates with other encodings. Continually evolve and be accepted.
Coding for PHC
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Access to EHR: ePrescription - Visit
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Initial screen
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Diagnoses
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Medications
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Dynamic diagrams
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Concluding remarks
• Redefining roles of stakeholders and optimum utilization of existing nationwide applications
• Clarifying the role of IDIKA and relationship with EOPYY• Interoperability Standards - Certification of IT resources• Open data – Open Systems
Dr. H. Karanikas
On going work
Athens Medical Society has developed a Health Portal dedicated to Health professionals. Includes eLearning, medical knowledge base, Health Journal and other services.
http://www.mednet.gr/ - http://www.e-healthnet.gr/
Athens Medical Society & ΕΕΜΕΠΥ is leading or participate on the following on going actions:– Developing Diagnostic protocols in a machine processable format for the ePrescription
system. – Developing Patient Registries.– Developing and incorporating to Protocols system a Drug Summary subsystem, including
drug specific information such as Drug Interactions, Allergies etc – Application of Clinical guidelines to NHS hospitals (Pilot stage). – A national committee has been established to set up the framework and coordinate all
actions for the application of Therapeutic Protocols.
Dr. H. Karanikas
Synergies are needed …
... to regain the advantage of the relation of health 'needs' with health data and thus improve the quality of health care.
… clear, feasible plan followed up until the end.
Thanks …
Dr. Haralampos KaranikaseHealth Consultant
