eHealth

What is at Stake ?

Gérard Comyn

Vice-President CATEL

Former Head of „ICT for Health‟ Unit

DG INFSO

European Commission

••• 2

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

••• 4

eHealth grew in Europe 2002 - 2007

GPs using electronic patient data rose : 17% to 63%.

Lab. results Transfer (blood, ECG) from 11% to 54%.

Administrative data transferred to reimbursing organisations rose: 6% to

22%

Medical data transfer rose: 8% to 28%.

e-Prescribing rose: 3% to 11%.

A comparison with the 2007 results for all 27 EU Member States shows

that the enlargement of the Union had negligible impact on the

developments over the past five years.

••• 5

The roadmap for eHealth

Time

1990s Today

Linking all the points of care 1

Connecting individuals

with Health Information Networks2

Towards full picture of the

individual‟s health status3

••• 6

Step 1

Linking all the points of care

Connecting individuals

with Health Information Networks

Towards full picture of the

individual‟s health status

Time

1990s Today

1

2

3

••• 7

Patients

Frail persons

Continuity of care enabled by eHealth

SocialService

General

Practitioners

Homecare

Hospitals

Nursing

Homes

Health

Authorities

Prevention

Rehabilitation

Diagnosis

&

Care

Healthy citizens

Labs

••• 8

Secure data

networks

and

interoperable

applications

SocialService

General

Practitioners

Homecare

Hospitals

Nursing

Homes

Health

Authorities

Labs

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

ICT for Health – Gérard Comyn – MIE 2009, Sarajevo ••• 10

Large Scale Pilot on

cross-border eHealth interoperability

“epSOS – Smart Open Services for

European Patients”

Patient Summary for EU Citizens

ePrescribing for EU Citizens

••• 11

Implementation, support to policies

epSOS: 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

••• 12

Competitiveness Innovation Programme

Policy Support Programme (CIP ICT PSP)

Large Scale Pilot (epSOS)

23 beneficiaries, 12 countries

6 national Ministries of Health

15 Competence Centers

31 companies through IHE-Eur

11 Million EC funding

36 months

Thematic Network on eHealth

Interoperability (CALLIOPE)

27 beneficiaries

30 months

500k EC funding

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).

Aim: guidelines for national and cross-border interoperability of

EHR systems

Scope: incl. also patient summaries, emergency data sets,

medication records / ePrescription

Actions at four levels:

(1) political

(2) organisational

(3) technical

(4) semantic

Monitoring, evaluation & awareness rising

Compliance with national & EU laws

Recommendation on cross-border

interoperability of EHR systems

JO L 190 du 18.7.2008, p. 37–43

IMPORTANT TO REMEMBER

Interoperability of EHR systems cannot go at the expenses of the

privacy, data security and confidentiality

First priority – guarantee the fundamental rights and freedoms – then

interoperability

Requirement – a close cooperation with the national supervisors for

personal data protection (They must be involved in the process of

development and deployment of EHR systems)

••• 16

Step 2

Linking all the points of care

Connecting individuals

with Health Information Networks

Towards full picture of the

individual‟s health status

Time

1990s Today

1

2

3

Sensors for multi-parametric

monitoring

Hospital

Health / call

Centre

Data communication and feedback

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

Telemedicine: the bigger picture

EHRs

••• 18

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

••• 19

PHS presented also as

m-health or p-health

EMH

EMH Core

System

Patient

Unit

s

Mobile

Networks

GPRS/

UMTS

- Objective Vital Values

- Subjective Diary Data

- Messaging

Patient Feedback Loop in Real-Time

Doctor

Wireless Health

Broker & Service

Provider

Hospital

Source: Rainer Herzog, Ericsson, presented at the Personal Health Systems conference, Brussels, 12-13 February 2007

Moving to “pHealth”

• Enrich information

from surrounding environment, activities, emotions, genetic …

• Account for measurements in non-clinically controlled environments

give “context” to a value, i.e. under which conditions it was measured

• Adapt to specific characteristics of the individual

we are all different from each other

a blood pressure level may be high for person X but normal for person Y

• Consider all the above in:

reducing false alarms

medical decision making

providing services

• PHS research moves in this direction

… but we are not quite there yet

••• 21

Telemedicine for the benefit of patients,

healthcare systems and society

Commission Communication COM (2008) 689, 4.11.2008

Building confidence and acceptance of

telemedicine services

Bringing legal clarity

Solving technical issues and facilitating market

development

Workshop Legal Aspects of

Telemedicine – key findings

Licensing/registration/accreditation

B2B – clear, no license required

B2C – uncertainty – MS may impose specific requirements

Suggestion for a directive setting the limit for MS intervention

Accreditation – need for a harmonised accreditation of a telemedicine act at EU level? –suggestion to draft European level guidelines

Reimbursement

MS to work out at national level what kind of TM services to reimburse

How? – either by separate nomenclature for TM services or by recognising that certain interventions have TM aspects within their conduct (RPM for diabetes management)

Sufficient evidence and sound business cases of TM are necessary

Liability

EU level consumer protection legislation applicable to telemedicine

Local legislation on liability

Hospital liability - MS level – may be different

In some MS it is clear that for any service received in a hospital, the hospital can be sued regardless if the professional is self-employed or employed by the hospital

Suggestion to harmonise no fault liability for this at EU level

Data protection

Good legal basis for handling personal data within a telemedicine service

Patients’ right to know what happens to the data, who has access to it and for what purposes –basis for patients’ confidence

Telemedicine - Why?

An expanding market

TM market: high potential for growth and jobs in the EU (Lead Market Initiative)

Telemedicine market 2007

€ 4.7 billion

Telemedicine market 2012

€11.2

billion

Est. annual

Growth Rate

19%

Source: Telemedicine; Opportunities For Medical and Electronic Providers. BCC Research, 2007

••• 24

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

••• 25

Conclusions on Telemedecine

What Telemedecine is ..

A new organisation of Healthcare

A support to the Healthcare professionals

A personalised support to patients

A way to help facing new challenges (in particular

Chronic disease management and demographic

change)

What Telemedecine is not ..

A solution to lack of competent healthcare professionals

A solution to financial problems (a risk to see only the

business case)

••• 26

Conclusions on Telemedecine

At European Level

M-health: A perspective for patient mobility

Standards/interoperability still to be developed

Legal context: Some activities well defined (e.g.

teleradiology)

To be complemented by access to EHRs Europe-

wide

World-wide

No guarantee on professionals’ competence

No guarantee on protextion of personal data

••• 27

Step 3

Linking all the points of care

Connecting individuals

with Health Information Networks

Towards full picture of the

individual‟s health status

Time

1990s Today

1

2

3

New Options for

Disease Management

Currentapproach

In vitromarkers

Diagnostic (anatomic) imaging, biopsies

symptomsdiagnosis

• Non-personalizedmedication

• Chemotherapy• Radiotherapy• Surgery

Followup

Molecular Imaging

MolecularMedicineapproach

Molecular Therapy

DNAscreens

Proteinscreens

Monitor Treatment

EarlierPersonalizedIntegratedEfficient

Diseaseprogression

Mortality& costs

Geneticpredis-position

First cellmutations

asympto-maticdisease

Diseased cells release biologicalmarkers

First symptoms/manifestation

Diseaseproliferation

Environmental trigger

Philips Presentation

••• 29

Step 3 – Towards full picture of individual‟s

health status

Biochips

Environmental

Data

Phenomic data

ICT Systems

Biosensors

Genomic data

healthcare

naturenurture

Three major factors

(determinants) affecting

health status

••• 30

Computational Models of the Human Body

Reproduce Anatomical and Functional

properties of physiological systems at various

scales

molecules, proteins, cells, tissues,

organs, systems, body, etc.

Integrate Geometry, Physics, Chemistry,

Physiology…

Help understand normal or pathological

evolutions :

systems : cardio-vascular, Central

Nervous, Digestive, Reproductive, etc.INRIA in silico electro-

mechanical cardiac model

nano

micro

meso

macro

ATP

sarcomeres

fibers

organ N. Ayache, INRIA

ICT at crossroads with Life sciences

Brussels, October 12, 2004

Catedra Sanitas Madrid 11/11/2009 ••• 32••• 32

Empirica- IPTS study

••• 33

Conclusions

eHealth recognised as a strategic area by member states

Problems still to be improved

Business models

Reengineering of healthcare systems

Confidentiality

Liability

Involvement of professionals

New models, new actors, new markets

Increased role of the patient

••• 34

gerard.comyn@gmail.com

http://ec.europa.eu/information_society/activities/health/policy/telemedicine

http://www.epractice.eu

Disclaimer:

The views developed in this presentation are those of the author and do not reflect

necessarily the official position of the European Commission on the subject matter

Merci!