H. Stephen LieberPresident & CEO

Healthcare Information and Management Systems Society (HIMSS)

Electronic Health Records Global Perspectives

HIMSS– International not-for-profit, membership based organisation

• Offices in US, Belgium and Singapore• Offer educational programs in North America, Europe,

Asia and Middle East– Over 23,000 HIT professionals, physicians, nurses, other

healthcare executive members– Primary source of education, professional development,

tools and resources on e-Health, HIT– Recognises best practices, leading hospitals and physician

practices for adoption and use of HIT– More at www.himss.org

Sound Familiar?

• The situation and challenges in (fill in the blank) are similar to other (fill in the continent) countries:

– limited budget– rising demand for healthcare services– chronic disease management– quality below expectations– people in countryside with limited access to health

care services

Core Comparisons

• Overview of each country examined

• National EHR Program- National IT/ICT status and strategy- National/Regional EHR Approach

• EHR Governance- Legal/Regulatory

- Healthcare policy - EHR Financing

Core Comparisons (cont.)

• Technology

• Adoption

• Outcomes- Benefits- Implementation Experiences

Next steps for each country

Funding

• Central Government

• Private Sector

• Central, Local and Private

• Central and Local

-England, Germany,France, Netherlands,Sweden, South Africa,Denmark, New Zealand.

-India, Israel, Japan, Singapore

-Canada, Hong Kong, USA.

-Australia

Governance Models

England, New ZealandCentralised

United StatesPrivate Sector

Germany, Denmark,

Hong Kong, Singapore

Distributed

CountriesGovernance Model

Standards and Interoperability

United States, IsraelMultiple Systems

England, United States, Singapore, New Zealand, Australia

Interoperability-Driven

England, South Africa, Singapore, Malaysia, New Zealand, Australia

International (such as HL7)

France, Sweden, Netherlands, Denmark,

New Zealand, Australia

Parochial Standards

United Kingdom

• Regional and local organizations vary in their IT maturity and adoption of EHR/EMR systems

• Primary care has been, and continues to be, a leader in the adoption of EHR due to policy requirements and financial incentives

• Successful adoption has also been attributed to leadership by highly committed physician champions and carefully targeted communication, regulation, assistance and incentives on the part of the NHS

France

• Classic obstacles still being experienced– lack of interoperability, incomplete standardization,

insufficient training and inadequate provider support• Start with clinical documents in use rather than fully

structured data• Need collaborative involvement of all stakeholders

(patients, providers, vendors and government agencies) from beginning

• Need framework for national EHR early in the implementation process

Greece

• Goal: allow the unimpeded flow of health information within the healthcare system in an absolutely secure manner, following the citizen in his/her interactions and contacts with the system

• The national EHR will include a subset of medical data for every citizen, easily accessible from various health care units

• Twister Project: implement eHealth services in remote areas using a hybrid network with wireless, satellite, and terrestrial broadband segments

Turkey

• Significant benefits have been realized:– National Health Information Standards have been

developed– Agreements governing health data types and

collection methods at the national and regional levels – Agreements on data interchange standards between

different health information systems– Telemedicine programs implemented in selected rural

and poor regional hospitals– Decision Support System (DSS) has been added

Algeria• In 2007, 66 of 69 countries in e-Readiness • 10% of the population is considered to be internet users• In 2006, 1.1 PCs per 100 person • System aims to manage patient records, verify patient

benefits, and simplify administration by reducing paperwork

• Designed to have three major applications: teleconsultation, remote assistance of surgical acts and the sharing of health information

Estonia

• Service oriented nation-wide Health Information system• All health service providers have own information

systems and these connect to central Health Information System

• Document sending/receiving, Case beginning/closing messages, Summary queries, Document queries, Duplicate handling, Access services, Patient demographics, related person handling

• ID card system

Mongolia• 10% of population PC users

• Pilots focused on distance treatment, diagnostic, monitoring

– Online system to allow medical professionals in remote areas to share patient information with medical professionals in urban centers and make internet-based diagnosis

– Bring together the best cardiological expertise in Mongolia, through a telemedicine network and website, for diagnostic purposes

– Health Sciences University of Mongolia and the University of Basel linkage to allow for remote pre-op, post-op diagnosis, therapy and knowledge sharing

Key Lessons

• Requires a commitment from high levels of government and private sector.

• Continuous communications at all levels.

• Data standards for Interoperability needs to be implemented.

• Physicians must be involved.

• Training is a essential piece that must be funded.