washington, 16.02.2011, oecd-nsf1eu ehealth interoperability roadmap what the eu ehealth iop roadmap...
TRANSCRIPT
Washington, 16.02.2011, OECD-NSF 1EU eHealth interoperability Roadmap
What What the EUthe EU ehealth ehealth IoP IoP RoadmapRoadmap could bring to the could bring to the
Health futureHealth future
Michèle ThonnetMichèle ThonnetFrench Ministry of HealthFrench Ministry of Health
Reforming the H system : a Reforming the H system : a necessitynecessity • demographic changes : ageing population
• increased prevalence of chronic diseases • citizen expectations for high Q HC• increasing costs of research, equipments,
examinations, treatment• quicker pandemia expansion• lack of staff ; shortage of HCP• mobility of citizens, patients, HCP, workers• mastering costs : crisis and ‘business’
model
ITs : Key expectations ITs : Key expectations
• Facilitate access, continuity of HC (mobility)• Improving Q of care, allowing real HC equity • Enhancing coordination, continuity of care security & safety• Facilitating collaboration between HCP, within/between HCPO• Improving homecare and adapted delivery services at PoC• Organising mutualisation and international standards usage• Facilitating research, L S experimentations and deployment• Decreasing the number of doubloning examinations• Mastering costs through innovative model(s)
Multidisciplinary approach :a necessity ; from research to citizen
• efficient health (disease) management• prediction / prevention of diseases• remote monitoring and care• higher patient safety and citizen empowerment• shift from hospital to personal centered system• more personalized care solution- privacy issue• higher productivity of HC and professional
interoperable standardised industry solutions• adapted legal framework
Actors … Stakeholders
Public authorities and the organized civil society
– a common objective, but own missions, agendas, vocabularies and constraints
– different skills, needs and access to different to eHealth expertise
5
Health in the EU Treaty• HEALTH is a national prerogative
– subsidiarity is key– but challenges are the same in each M.S.
• what could be done at EU level :– a volontarist collaboration between M.S.– supported by the E.C.– confirmed by the « eHealth action plan »– design through a dedicated organisation– declined on pragmatic priorities
a new era in legal and policy framework
for EU Cooperation on eHealth• Communication on Quality critera for a web site• Communication on the eHAP• Recommendation on cross-border interoperability of
electronic health record systems• Communication on telemedicine for the benefit of
patients, healthcare systems and society• eHealth Standardisation Mandate 403
– ------------------------------------------------------------------------------------
• Council conclusion on safe and efficient healthcare through eHealth – December 2009
• Proposal for a European Directive on patients’ rights in cross-border healthcare
2002-2010 a new Era
other EU current initiatives• Health
– Europe 2020: “Sustainable health”• Standardisation
– Digital Agenda– Access– IT Standardisation
• eHealth M.S. and stakeholders voluntary cooperation– epSOS– CALLIOPE
8
eHR Modelling: an input for collaboration(2007)
11
IOp RECOMMENDATION REVIEW
– Interoperability is considered for the purpose of “integrated, connected and interoperable continuity of care for Europe”
12
Organisational
Semantic
Technical
Political / Legal
Jurisdiction # 2Jurisdiction # 1
Use Case A Use Case A
Organisational
Semantic
Technical
Political / LegalTop
Down
Bottom-up
IOp Model, i2010 subgroup of eHealth; I2Health
eHealth Interoperability
A European Collaborative Initiative
• How to answer to the civil society needs ? • How to balance cultural and legal norms ? • How to know and capitalise on good practices ?• How to facilitate /accelerate pilots, adoption?• How to sustain initiatives & new models ?
• How can countries coordinate efforts • And turn ideas into practice
CALLIOPE Network (with the support of EC-DG INFSO)
The need for an Interoperability Roadmap
• Each country or region is separately trying to solve the same problems.
• Each country or region, organisation or division of the particular organisation lacks the resources and skills needed to boost innovation.
• All countries will benefit from joint effort towards this.
14
15
TARGET GROUPS
Engagement through
consultation
(June 2008 - December 2010) To produce value for decision makers– A fully operable, open,trusted, co-operative multi-stakeholder environment – An analysis of Member States responses to the EC Interoperability Recommendation on EHR – Operational collaboration with relevant EU level projects
An EU eHealth Interoperability Roadmap, “the Roadmap“ to accelerate eHealth Deployment
CALLIOPE in a nutshell
The CALLIOPE Platform 1/2
June 2008
Malta
March 2010Competence Centers
Health Authorities
Structure
The CALLIOPE co-operative working platform
– Clear Governance– Efficient Supporting Structure– Outcome based management
Trust must be reinforced
18
GovernanceIntegrityShared Values: openness and transparency, participation, quality, proportionality and coherence
Competencethough access to EU collective expertise and knowledge but also through appropriate conditions for this to be fully exploited
Commitmentthough shared ownership of the process, content and
the outcome
1919
Th
e tr
ilog
y o
f T
rust
WHERE?FOR WHAT PUPROSE?
WHO BENEFITS?WHAT’S AT STAKE?
20
AN EU eHEALTH INTEROPERABILITY ROADMAP
The Roadmap• The needs
– service innovations needed to focus on existing or anticipated health care system priorities
• a vision – of where we wish to go and what solutions
are needed to get there
• a route for achieving the vision – to select and develop the right alternatives
needed to create the right services
21
EU Interoperability RoadmapTRUSTED?Structure
Principles, platform, level of Trust
Process Iterative approach, working methods
OutcomeContent of the Roadmap
22
The process•Most of the necessary knowledge exists
•focus on identifying, synthesizing, integrating, and diffusing this knowledge
• taking into account the various facets
•Organising this K along the value chain to reach the agreed target
epSOS – a highly political project
• Member State obligation to deliver the best possible medical treatment – at home or when travelling
• Introducing a new dimension in national healthcare systems
• Goal for the epSOS eHealth Project:– “to develop a practical eHealth framework and ICT infrastructure that
will enable secure access to patient health information, particularly with respect to a basic patient summary and ePrescription, between European healthcare systems”
• Main political objectives:
– support patient mobility nationally and in the EU– ensure that patient safety is guaranteed– increase efficiency and cost-effectiveness
in cross-border care
25
CALLIOPE and epSOS
Malta
26
Roadmap Consolidation workshops
CALLepSO workshops
Roadmap versioned documents
X-border project consultations eID,semantics
SDOs
The process
26
Reaching agreements through continuous bench-learning loop across concerned actors
27
Political priorities
Stakeholder priorities
Collaborative evolving process
27
1st stop Barcelona, March 2010!
Agreement and validation of way of
work by the Secretaries of State
28
CALLIOPE EU eHealth IOP Roadmap :
A common vision
Provisional Content
29High-level meeting on EU eHealth Governance-Barcelona
30
WHERE?FOR WHAT PUPROSE?
WHO BENEFITS?WHAT’S AT STAKE?
What: possible future actions at EU level
For what:
To accelerate ehealth deployment
Who: Health care community
How: Use Cases, alternatives, maturity and opportunities, building on what is shown to work
1st stop Barcelona validation
22ndnd step step
December 2010December 2010
AN EU eHEALTH INTEROPERABILITY ROADMAP
EU interoperability Roadmap progress
A proposal for a common EU Roadmap for eHealth
Recommendations and Outlook
• propositions • provide concrete input to decision
making • support of the eHealth high level
governance process
Political priorities
Towards secure, unambiguous and portable
electronic identification of EU citizens
• Recommendations: – Cross border recognition of eID for
healthcare purposes– A Common European Framework for eID
Management is needed • One or many ID, role management …• Security, assurance levels, HP authorisation, …
– European Governance for eID Management
32
Towards an internal market for eHealth services –
technical interoperability• Recommendations
– Establishment of European-wide standards, interoperability testing and certification and accreditation schemes for eHealth
• Review of national activities on standardisation, access and use of standards, take forward the CALLIOPE Recommendations on standardisation
– Use cases prioritisation and prioritization of business areas coordination for standardization based on balanced proposals by stakeholders
– Sharing of experience of best practices in standards use
33
Towards a European-wide infostructure –
semantic interoperability• Recommendations
– Consider semantic interoperability as an area for multinational collaboration
• Develop a collaborative governance framework and support coordination work
– Encourage the definition of standards for electronic medical data/documents to be shared across borders.
• Address the challenges of multilingual semantic mapping
+ All Recommendations concerning technical interoperability apply also to semantic interoperability
34
Legislation and regulation as facilitators –
Legal and regulatory interoperability
• Recommendations– Agree – and review national legislation - on
• A realistic and appropriate level of security for electronic processing and transfer of health related information
• A shared policy on patient consent to electronic processing and cross border transfer of health data
• A process for continuous improvement to reflect progress in technology, harmonisation of security, quality and safety practices
– Adopt an EU information governance and a permanent coordination mechanism for cross-border transfer of health data
35
Economic challenges of eHealth services
• Recommendations– Coordinate activity and resources– Support exchange of experiences with
working on alternative co-operation models– Invest in human resources, skills, training
…– Review legal and regulatory frameworks to
accommodate market innovation and new models for reimbursement, funding and resource allocation for eHealth
36
Monitoring progress
• Recommendations– Building collaboratively a substantial body of
knowledge and evidence at EU level – Considers the OECD model survey approach and
indicators for adoption– Supports specific actions and a support
mechanism to help MS to effectively share lessons learnt about benefits and costs of choosing one approach over another as well as about the incentive mechanisms and reimbursement system
37
Together addressing open issues in the EU
• Recommendations– Elaborate – at the onset of the
collaboration process – a two layered EU collaborative Governance based on current EU practice and the CALLIOPE experience
– Consider the establishment of national multi-stakeholder platforms
38
Main observations from CALLIOPE Network
• For implementing eHealth interoperability, the Network supports the Member States key proposals to
– Focus on high-level governance– Value exploring the concept of EU competence network
• Including benchlearning processes, best practice repositories …
– Operationalise stakeholder involvement and engagement
– Consider interoperability as a process and emphasize the importance of its sustainability
39
IoP (RM) Critical Success Factors
• Relevance: that IoP activities are seen as relevant to business objectives and current activities
• Openness: that the IoP process is seen as an open and inclusive one
• Engagement: that all parties are able to contribute to all stages of the process
• Affordability: that the results are affordable, and demonstrating a clear return on investment
• Sustainability: that the framework for development of IoP is sufficiently open and flexible to allow adaption and future development
40
Adoption of a common working model
Foundation eHealth infostructureFoundation eHealth infostructurePatient identification and patient data discovery
Data structures and value setsEHR, EMR, PHR, other
Clinical terminologies and classifications and codifications
Data and knowledge management tools
HCP Authorization, authentication and rights management
Consent management and access control
Data interoperability and accessibility
Data bases and Registries
eHealth Governance
eHealth Governance
Market development, new business models, and incentives
Privacy, quality and safety policies
Legislative and regulatory framework
Financing, Resource allocation and reimbursement models
eHealth leadership, policy and strategy
EU & National Stake-holder collaboration
Fostering standards adoption
Monitoring, evaluation
Patie
nt s
umm
arie
s
Elec
tron
ic p
resc
ribin
g
Chro
nic
Care
Man
agem
ent
Com
mun
ity s
ervi
ces,
AAL
Rare
dis
ease
s
Oth
er n
ation
al p
rioriti
es
e.g.
, Dat
a an
alys
is &
ag
greg
ation
Know
ledg
e m
anag
emen
t, et
c.Common EU priorities
National priorities
Foundation ICT infrastructureFoundation ICT infrastructureMobile and fixed Electronic Communication Infrastructures
ICT processing and storage services
ICT Professional and technical support; Training
Access to ICT Networks, equipment and facilities
Sustainable HealthcareSharing Information and
Knowledge for Better Health
41
TABLE I: IMPACTS PURSUED IMPACT OF THE CONVERGENCE PROCESS ON eHEALTH DEPLOYMENT
Engagement of EU Stakeholders through stimulating broad synergies Proof of Concept: Successful unprecedented multi-stakeholder formal collaboration on developing a key policy document (vs consultation only) Facilitation of adoption of outcomes of EU collaboration projects such as the epSOS specifications and the CALLIOPE eHealth Interoperability RoadmapAcceleration of the processes involving the organisation and management of governed multi-stakeholder environments in eHealth and beyond
EXPECTED IMPACT OF THE CALLIOPE OUTCOMES ON eHEALTH DEPLOYMENT
Towards better alignment of EU-national level actionsAcceleration of national eHealth deployment (by capitalizing on EU collaboration)Towards co-ordinated EU-national level innovation support action for eHealth deployment (though improved access and use of standards)
42
Convergence: Contributing factors
(By Z Kolitisi) 43
Broad Convergence
Working together
Roadmaping
Working with epSOS
Consensus building
Stakeholder Consultations
On boarding MS to epSOS
Standardization Liaison
Consultation with epSOS and other EU Initiatives
Trust
Collaborative environment
EC Recommendation Review
Dissemination
Dissemination
Open Sessions
Open Forum
Other dissemination activitiesStakeholder
Consultations
Bringing EU and the national/regional activities together
44
Brussels, at EU Parliament
– Crossing boundaries in eHealth: the CALLIOPE think-tank and collaborative platform
November 2010
To prepare the EU eHealth High Level Governance
Directive on patients rights in cross border Healthcare: eHealth1. The Union shall support and facilitate cooperation and the
exchange of information among Member States working within a voluntary network connecting national authorities responsible for eHealth designated by the Member States.
2. The objectives of the eHealth network shall be to:• (a) work towards delivering sustainable economic and social
benefits of European eHealth systems and services and interoperable applications, with a view to achieving a high level of trust and security, enhancing continuity of care and ensuring access to safe and quality healthcare;
• (b) draw up guidelines on ▌:• (i) a non-exhaustive list of data that are to be included in patients'
summaries and that can be shared between health professionals to enable continuity of care and patient safety across borders, and
• (ii) effective methods for enabling the use of medical information for public health and research;
• (c) support Member States in developing common identification and authentication measures to facilitate transferability of data in cross-border healthcare.
European eHealth Governance levels
Policy level: to set out higher level political objectives, define common priorities and policy measures
Strategic level: to agree on concrete agree on concrete strategiesstrategies for developing and implementing integrated, value adding eHealth servicesEstablishment and maintenance of an open platform for multi-stakeholder trusted dialogue
Operational level: deeper focus in areas such as ethics, security policies and services, EU infostructure, re-engineering of the standardisation process, maintaining links to national stakeholder groups, etc.
A further consolidated approach is needed…
• Establish a European Governance to sustain an open and transparent process involving all three levels
• Reach out to the national communities, i.e. beyond what CALLIOPE was able to achieve within its life span
• Establish mechanisms to support MS in their implementation of the EU Roadmap
48
Status Quo – Ministries– Competence Centers– Users– Industry
• Planned project start: January 2011• Involvement of High Level Representatives
• Turning from project results (e.g. CALLIOPE RoadMap) to a MS driven aproach the eHealth Governance Initiative
eHGI Main Objectives• Provide to MS a consolidated approach and a strong political committment to
governance at three levels (1) Policy (2) Strategy and (3) Operational
• Provide to the MS, the EC and other relevant stakeholders a platform and “a think tank” for current and emerging challenges which could lead to a strong consolidated Roadmap of concrete actions and the description of potential future pilot projects and partnerships
• Provide to the MS, the EC, the Competence Centres, the IT-Industry and to other relevant stakeholders a European eHealth Interoperability Framework
• Provide to the EC, EPSCO Council and to other relevant stakeholders targeted support for activities requiring broad convergence across Europe, such as future LSP eHealth projects and common interoperable service solutions at MS level
eHGI project structure
51
Thank you for your time