Creating an eHealth Infostructure for Mobile Citizens –

the Interoperability Initiative for a European eHealth Area

Dr. Karl A. Stroetmann, Dr. Veli N. Stroetmannwith Ramin Tavakolian & Marc Lange/Stephan Schug

Institute for Communications- and Technology ResearchBonn / Germany

karl@empirica.com

Third High-level Ministerial eHealth 2005 Conference, Tromsø, Norway, May 23-24, 2005

Contents

Why interoperability? Two examples

What is interoperability?

Policy drivers and policy statements

EU-level projects

Outlook: The European eHealth Interoperability Initiative (EU eHealth I2)

The need for interoperability – Full medical record

Alex Solomon grew up with hydrocephalus, a rare and life-threatening condition

"Whether or not a treating doctor has Alex's full medical record available can literally mean life or death“

Cynthia Solomon, his mother

She had to become "a walking filing cabinet of records on allergies, pituitary gland problems, brain scans and every piece of paper a doctor ever wrote about Alex's case”

Economist, April 30th 2005

Borderless ePrescribing Process?

Primary Care

CommunityPharmacy

Secondary Care

Prescriptions

Conversations

DispensingManagement

HealthcareFundingAgency

CostControl

Claims

Payments

QualityPrescriptionManagement

Patient

Medication

Budget Management

RiskManagement

ConcordanceSupport

Clinical DSS

Clinical DSS

Clinical DSS

Quality

PrescriptionRelay

Request

Request

eHealth interoperability domain

International / Multilingual aspects

Country BCountry A

Location level:- local

- regional

- national

Interoperability levels:- basic

- functional / syntactic- semantic

Clinical setting / GP office / Insurance / Pharmacy ...

Health system aspects:- security / privacy- financial / reimbursement- legal / regulatory- accreditation / licensing

Application entity 1

Human user

Application entity 2

Human user

Application entity 1

Human user

Application entity 2

Human user

Application entity 1

Human user

Application entity 2

Human user

"The solution is not merely to use computers, but to link the systems of doctors, hospitals,

laboratories, pharmacies and insurers"

Interoperability definition – A human user oriented perspective

In a multi-lingual context, particularly when considering cross-border health care, we should go beyond the technical level and include citizens (health professionals, patients, ...) as part of the interoperable system, i.e. we need an interface between the "separate application entity on each side" as defined by CEN and others, and the person (clinician, nurse, patient, ...) who inputs the information into the unit and the one who interprets and acts on the output at the other side.

We may be able to capture this by a wider definition of what "semantic interoperability" means, i.e. we would have to translate, e.g., concepts and terms as defined and modelled by terminology systems like SNOMED CT not only into the respective national language but also with respect to the medical culture and understanding in a given health system context.

General policy drivers

Mobility of citizens (demand)

Single European Market (supply)

Decisions of the European Court of Justice

Global competition

Pressure by stakeholder groups

Need for improved access for all, quality of services

Demographics

Cost pressure on systems

Specific policy drivers

The European Parliament "notes the importance of providing an efficient and secure method of exchanging patient records between Member States"Draft report on patient mobility and healthcare developments in the European Union, 20.12.2004

"Interoperability is the corner stone supporting citizens mobility and patient centred care"Report of the High Level Group on Health Services and Medical Care (to the Council of the EU), Dec. 2004

"Establish a platform with a mandate and the necessary resources to facilitate co-operation between European Member States with support of the European Commission to promote e-health interoperability for the mobile citizen." Report of the eHealth Standardisation Focus Group, Feb. 2005

"The high level e-Health forum ... will be able to set up working groups on specific topics, one of which should obviously be interoperability."Opinion of the Committee of the Regions on the Action Plan for a European eHealth Area, 22.03.2005

EU Support Action: The i2-Health project

Objectives

• identify interoperability and connectivity issues and priorities, barriers and gaps, and solution approaches

• focus on fundamental interoperability issues (identification of actors, organisations, adequate measures to achieve interoperability, integration tests and certification)

• analyse similarly key topics relating to e-prescription and messaging

• develop a roadmap and concrete projects involving all relevant actors - guided by an open discussion process amongst Member State Health Authorities

i2-health: Workplan Elements

• Generic elements– Conceptual framework (WP1)– Analysis of infrastructure concepts and building

blocks, services and applications (WP2)

• Specific subjects for in-depth analysis– Identification management of actors, organisations

and system components - fundamental interoperability issues (WP3)

– Workflow interoperability – e-prescribing and messaging (WP4)

Identity management of actors, organisations and system components - fundamental interoperability

issues

Analyse existing and planned patterns of identity management

Develop an integrated European approach for identity management

Identify crucial applications based on high-priority use-cases such as cross border messaging and prescription

Proposal for coordinated action to achieve minimum required interoperability

European pivots of identity management

Pan-European digital database of insurance providers

Electronic (!) European health (insurance) card with unique and reliable patient identification

Physicians as priority health professionals

European directives on mutual recognition of diplomas, certificates and other evidence of formal qualifications (e.g. 93/16 for physicians)

ePrescribing and Messaging – to critically review and discuss the state-of-the-art in

respect of e-prescribing and process-related messaging (like referral and discharge letters)

– to identify, collate and analyse use cases for applications with priority

– to develop, based on a needs and gaps analysis, a concrete procedure and work plan towards a pan-European solution

WP4: Workflow interoperability

Organisational interoperability– recognition of physicians authorisations (legal)– reimbursement claims; etc.

Semantic interoperability– pharmaceutical nomenclature & classification– drug composition; branding etc. – instructions/quantity (10-10-10 vs. qid; tid)

Technical interoperability– access to digital information – access to authorisation information; etc.

WP4: Interoperability Focus

ePrescribing: Implied Processes

Primary Care

CommunityPharmacy

Secondary Care

Prescriptions

Conversations

DispensingManagement

HealthcareFundingAgency

CostControl

Claims

Payments

QualityPrescriptionManagement

DrugWholesale

PharmaceuticalIndustry

StockControl

Stock

Stock

Patient

Medication

Budget Management

RiskManagement

ConcordanceSupport

Clinical DSS

Clinical DSS

Clinical DSS

Quality

CostNegotiation

Research

Research

Enrolment & Trial Management

PrescriptionRelay

Request

Request

Quality

9

Towards the Establishment of a European e-Health Research Area - eHealth ERA project

Strategic goals:• to coordinate national innovation-oriented eHealth RTD planning

and roadmapping,

• stimulate bilateral and multilateral joint activities and take steps towards further integration of RTD planning and results implementation across all Member States,

thereby

• establishing an effective European Research Area for eHealth,

• supporting the development of interoperable regional, national and trans-European eHealth infrastructures (Action Plan support).

The European eHealth Interoperability Initiative EU eHealth I2

(Preparatory Discussions on an initiative of the Member State Ministries of Health supported by the European Commission)

Goals will be

• to assure pan-European interoperability at all levels amongst eHealth infrastructures, services and applications developing at national and regional level,

thereby

• to further the development of a European market in borderless health services facilitated by eHealth applications

EU eHealth I2

European eHealth I nteroperability Initiative :

3 level approach

Policy level

Management level

Implementation level

EU eHealth I2

Management Team(European Interoperability

Agency?)

products

Certification Framework(Rules and Profiles)

industry productsproducts

Certification Framework(Rules and Profiles)

industry

NationaleHealth

competencecenters

implementationprojects

AdvisoryBoard

InteroperabilityStrategy

andOrganisation

Board

eHealth StakeholderForum

delegates

internationalactivities

rules for nomination

NationaleHealth

competencecenters

implementationprojects

AdvisoryBoard

InteroperabilityStrategy

andOrganisation

Board

eHealth StakeholderForum

delegates

internationalactivities

rules for nomination

I nteroperability Initiative for a European eHealth Area:

Management level

Thank you very much for your attention!

karl@empirica.com

Third High-level Ministerial eHealth 2005 Conference, Tromsø, Norway, May 23-24, 2005