EU eHealth Agenda

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Ilias Iakovidis

ICT for Health Unit

DG Information Society and Media

European Commission

WHO ARE WEICT for Health (eHealth) Unit, European Commission

Information Society and Media DG

Supported > 500 eHealth projects & pilots (> €1 Billion) since 1989 Current support (ca € 100 Mil/year)

Major focus in 90’s: Regional Health Information Networks,

Electronic Health Records, Homecare/telemedicine

Today’s focus:

I) Research- Personal health systems (wearable, portable monitoring)

- Patient safety (Clinical information systems for safer outcomes)

- Modelling and Simulation of diseases (Virtual Physiological Human)

II) Policy and support to deployment eHealth Action plan, Lead market initiative,

Recommendation on Interoperability, Deployment of telemedicine

Large Scale Pilots, certification of Electronic Health Record Systems

eHealth for SustainabilityeHealth for Sustainability

• Efficiency & productivity – to do more with less

• From ‘hospital-based’ to ‘patient-centred’ care

• From ‘late disease’ to ‘early health’

• Two main areas:

� Preventive medicine:

− Chronic disease management− Empowering the patient (training, monitoring ..)

� Predictive medicine:

− Molecular medicine

• eHealth for the economy – Lead Market sector

• Boario telecardiology:

� 35-47% reduction in hospital admissions (in various studies)

� 12% reduction in outpatient visits

• UK studies:

From ‘hospital-based’

to ‘patient-centred’ care

From ‘hospital-based’

to ‘patient-centred’ care

•� 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)

See EC Communication on Telemedicine COM(2008)689 final

ec.europa.eu/information_society/activities/health/policy/telemedicine/index_en.htm

eHealth worksOptimal results when eHealth tools when combined

with proper organisation and skills

• National and Regional Health information Networksimprove quality, efficiency, and will save next year € 80 Mil/year in Denmark (Medcom) and € 60 Mil/y in Czech republic (IZIP)

• ePrescription improves patient safety, saves € 70 Mil/y in Sweden

• Personal Health Systems and Telemonitoring can provide care at the point of need, reduce length of hospitalisation (by 20 -40% for heart patient in UK)

• Direct Online information Services such as NHS Direct online–empower patients, avoid unnecessary hospitalisation, support lifestyle choices, save € 110 Mil/year

www.good-ehealth.org www.eHealth-impact.org

http://www.epractice.eu

60

70

80

90

Using PC

Using electronic patien data storage

Routinely using PC in consultation

Internet access

Connecting with broadband

87.4%

80%

66.1%69%

62.5% 62.3%

55.2%

EU World Leader in deployment in primary care(EC Study 2007)

EU World Leader in deployment in primary care(EC Study 2007)

0

10

20

30

40

50Using decision support software forprescribing or diagnosis

Accessing other health institutions networks

Occasionally using PC to illustrate to patient

Regularly using PC to illustrate to patient

Exchanging administrative data withreimbursing organisations

Occasionally using Internet and electronichealth networks to provide telemonitoring tohome-patientsRoutinely using Internet and electronic healthnetworks to provide telemonitoring to home-patients

55.2%

44.4%

13.9%15.1%

2.7%0.9%

EU eHealth agendaPast R&D activities

Current policy and support to deployment

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Current policy and support to deployment

HospitalPharmacy

Health Centre

Emergency

Secure Networks

Towards eHealth Deployment: Step 1 Health Information Networks

Connecting providers: Messaging, EHR, HP tools, on line services

Towards eHealth Deployment: Step 1 Health Information Networks

Connecting providers: Messaging, EHR, HP tools, on line services

GP

Region 3

Home

mobile PC

Mobile, Wireless

&Broadband Region 2

Mobility

Region 1

Policy Action:2004 Communication and Action Plan

� Bringing the benefits of eHealth to EU citizens faster

(Quality of care, patient safety)

� Borderless European Health Information Space for

individual care, public health and research individual care, public health and research

� Increasing mobility of patients and professionals;

cross-boarder co-operations

� To facilitate growth and transparency of eHealth

Market; to decrease Market Fragmentation

•

Interoperability across borders

Linking basic information between patient summary systems or giving

access to physicians to patient summary in your home country

Interoperability across borders

Linking basic information between patient summary systems or giving

access to physicians to patient summary in your home country

Patient Summary 1Patient Summary 2

Direct access of physicians when legal

Country orRegion 3

Secure Networks

Country or Region 2

Mobility

Country or Region 1

Standardised exchange/access to common data sets

2008: Emphasis on Interoperability

• Support to projects, events, education on interoperability

• Mandate (M 403) given to CEN, CENELEC, ETSI to provide standards on (http://www.ehealth-interop.nen.nl)

1) patient and health practitioner identifiers;

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1) patient and health practitioner identifiers;

2) the patient summary;

3) an emergency data set.

• Launch of Large Scale Pilots on interoperability of emergency and medication data – CIP (7/08)

• Calls for proposals: � EHR certification (CIP June 08)

� Conformance testing (FP7-Call 4 Nov 08)

� PHS interoperability (FP7-Call 4 Nov 08)

EC Recommendation on Interoperability of cross border EHR

systems C(2008)3282

• Aims at enabling coordinated care by connecting

people, systems and services

• Provides Member States and relevant bodies

with basic principles to address the existing

challenges in implementing EHR interoperability

• Identifies different levels of actions:

� Political, Organisational, Technical, Semantic,

� Important issues: standardisation, certification,

conformance testing, education and awareness

Hospital

Pharmacy

Health CentreEmergency

Current R&D focus (since 1999 - )

Connecting individuals with Health Information Networks

Secure Networks

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Region 3

Home

mobile PC

Mobile, Wireless

&Broadband

Region 2

Mobility

Region 1

Secure Networks

A Communication on Telemedicine:October 2008

• Telemedicine experiences exist nation and Europe wide

• Increasing deployment due to:

� Technical reasons: Broadband, personal health systems

� Financial reasons: Moving patients from hospitals to home; � Financial reasons: Moving patients from hospitals to home;

solutions for chronic disease management

� Other reasons:

• Geographical, Patient empowerment, Involving family in

care process, Elderly people, Skill shortage

• Challenges: legal environment, reimbursement,

business models, evidence, acceptance, awareness,

technical

Competitiveness Innovation Programme Policy Support Programme (CIP ICT PSP)

• Large Scale Pilot (epSOS)

23 beneficiaries, 12 countries

6 national Ministries of Health

• Thematic Network on

eHealth Interoperability

(CALLIOPE)6 national Ministries of Health

15 Competence Centers

31 companies through IHE-Eur

11 Million EC funding

36 months

� 27 beneficiaries

� 30 months

� 500k EC funding

Implementation, support to policiesepSOS: Approach and Expected Outcome

• One large Scale Pilot

� Patient summary for unexpected care

� ePrescription/medication records

• With a common architecture• 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

Lead Market Initiative

1. Market fragmentation, lack of interoperability

4 main barriers to eHealth market development

1. Market fragmentation, lack of interoperability

2. Legal Uncertainty

3. Lack of availability and access to finance

4. Lack of procurement

The “future”: EC Research Activities

-Quality/Efficacy of Healthcare servicesQuality/Efficacy of Healthcare servicesQuality/Efficacy of Healthcare servicesQuality/Efficacy of Healthcare services

- Lifestyle: what we eat, drink, breath, … Lifestyle: what we eat, drink, breath, … Lifestyle: what we eat, drink, breath, … Lifestyle: what we eat, drink, breath, …

Factors determining a health statusof an individual & population

Factors determining a health statusof an individual & population

Exogenous

Health delivery system

- Lifestyle: what we eat, drink, breath, … Lifestyle: what we eat, drink, breath, … Lifestyle: what we eat, drink, breath, … Lifestyle: what we eat, drink, breath, … - Physical and social environment Physical and social environment Physical and social environment Physical and social environment

- Genetic “blueprint” /profile at birthGenetic “blueprint” /profile at birthGenetic “blueprint” /profile at birthGenetic “blueprint” /profile at birth- Acquired genetic changesAcquired genetic changesAcquired genetic changesAcquired genetic changes

Exogenous Determinants

(Nurture)

Endogenous Determinants

(Nature)

WHAT can ICT contribute

Environmental

Biosensors

Genomic data

Biochips

New and Future Activities

Towards full picture of individual’s health status

New and Future Activities

Towards full picture of individual’s health status

EnvironmentalData

Phenomic data

ICT Systems

Genomic data

The Virtual Physiological Human is a methodological and technological framework that once established will enable the investigation of the human body as a single complex system.

Based on the ideas of the International Physiome project

The Virtual Physiological Human (VPH) conceptThe Virtual Physiological Human (VPH) concept

The VPH research roadmap developed by project STEP in 2007:

www.europhysiome.org

- Personalised (patient-specific) healthcaresolutions

- Early diagnostics & predictive medicine

- Understanding diseases for the first timeacross several biological levels

Based on the IUPS Physiome Project

Genes Cellstructure-function

Tissuestructure

-function

Clinicalmedicine

Organstructure

-function

ProteinsLipids

Carbohydrates

mRNA

……

25,000genes

100,000+proteins

12 organsystems

1 body200+ celltypes

4 tissuetypes

Hunter, PJ and Borg, TK. Integration from proteins to organs: The Physiome Project. Nature Reviews Molec & Cell Biol. 4:237-243, 2003 (Peter Hunter 2007)

euHeart – Integrated Cardiac Care Using

Patient-Specific Cardiovascular Modelling

euHeart – Integrated Cardiac Care Using

Patient-Specific Cardiovascular Modelling

Development, personalization and validation of computational models of the heart to improve:

- Heart Failure- Coronary Artery Diseases

- Valves and Aorta

Shortcut to virtual_human_H_coronary_flow.mov.lnk

- Valves and Aorta - Resynchronization Therapy- Radiofrequency Ablation

Project coord.: Philips ResearchScientific coord.: Univ. of Oxford

17 partners (6 companies, 6 universities, 5 clinics)

Budget ~19M€ EC funding: ~14M€

INRIA

UOXF

Philips Research

ICT for Health Unit support for Research & development (FP7)

� Personalisation of Healthcare

• Personal health system

€ 72 Million (M) in 2007, (€ 63 M in 2009)

� Patient safety-avoiding medical errors

€ 30 M in 2007, (€ 30 M in 2009)

� Predictive Medicine – Virtual Human

• Modelling/simulation of diseases

€ 72 M in 2007, (€ 68 M in 2009)

Objective 5.3 –Virtual Physiological Human

(a) Patient-specific computer based models and simulation� Multiscale models and simulation of organs/systems targeting

specific clinical needs� Better understanding of the functioning of the organs and its

pathologies aiming at prediction/early diagnosis

(b) ICT tools, services and infrastructures for bio-medical

Budget: €63M FP7 ICT Call 6 Deadline April, 2010

(b) ICT tools, services and infrastructures for bio-medical researchers to support at least 2 of the 3 activities:

� Share data and knowledge

� Jointly develop and share models/simulators

� Create collaborative environments

(c) Support action on evaluation and assessment of VPH projects � Shared tools/infrastructure� Clinical achievements� Market potential / penetration

(d) Coordination or Support Actions in Biomedical Informatics� Sustaining cross-collaboration among different fields

Obj. 5.4 – International Cooperation on VPH

(a) Interoperability� Joint development of interfaces between scientific databases, web

services, mark-up languages, meta-data, ontologies

(b) Tools and services for global cooperation

� For modelling/simulation, curated models, interconnected libraries

Budget: €5M FP7 ICT Call 4 Deadline April 1, 2009

� For modelling/simulation, curated models, interconnected libraries and data repositories

(c) Contribution to global validation framework � Joint verification and validation of models wit reference to tools

developed for clinical applications.

Additional requirements:� Eligibility: Only on-going VPH related EU projects and to on-going

international projects that address one or more of the target outcomes a) b) c)

For further information

• INFSO H1 Policy site:http://ec.europa.eu/information_society/activities/h

ealth/index_en.htm

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• Research site:http://cordis.europa.eu/ist/health/index.html

• eHealth Task Force report:http://ec.europa.eu/information_society/activities/h

ealth/docs/lmi-report-final-2007dec.pdf

• Interactive Portal:http://www.epractice.eu