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

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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

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• 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

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eHR Modelling: an input for collaboration(2007)

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IOp RECOMMENDATION REVIEW

– Interoperability is considered for the purpose of “integrated, connected and interoperable continuity of care for Europe”

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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.

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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

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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

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WHERE?FOR WHAT PUPROSE?

WHO BENEFITS?WHAT’S AT STAKE?

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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

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EU Interoperability RoadmapTRUSTED?Structure

Principles, platform, level of Trust

Process Iterative approach, working methods

OutcomeContent of the Roadmap

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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

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CALLIOPE and epSOS

Malta

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Roadmap Consolidation workshops

CALLepSO workshops

Roadmap versioned documents

X-border project consultations eID,semantics

SDOs

The process

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Reaching agreements through continuous bench-learning loop across concerned actors

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Political priorities

Stakeholder priorities

Collaborative evolving process

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1st stop Barcelona, March 2010!

Agreement and validation of way of

work by the Secretaries of State

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CALLIOPE EU eHealth IOP Roadmap :

A common vision

Provisional Content

29High-level meeting on EU eHealth Governance-Barcelona

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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

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Thank you for your time

michele.thonnet@sante.gouv.fr