The future of (e)health in European Regions: A view by the Acting EU-Presidency

Transcription

1 1 Directorate-General for the Organization of Health Care Institutions The future of (e)health in European Regions: A view by the Acting EU-Presidency EHTEL 2010 SYMPOSIUM 23 November 2010 Luc Nicolas Health Telematics Unit

2 2 E-health: a project cycle?

3 3 Does it look like that?

4 4 Or rather like that? Wassily Kadinsky: Harmonie tranquille

5 5 E-health: a project cycle?

6 6 Key facts about the Belgian healthcare system: Healthcare Expenditure as % of GDP: 10.2% (OECD 2007) WHO Ranking of Healthcare systems: rank 21 Public sector healthcare expenditure as % of total healthcare expenditure: 75.1% (OECD 2007) Euro Health Consumer Index: rank 11 Belgians do have excellent access to healthcare services, and are one of the nations in Europe where patients have real freedom of choice where to seek care. However, medical results are not good enough to propel Belgium into the top 10 of Europe Dr. Arne Björnberg Euro Health Consumer Index Director

7 7 Organisation: Political/administrative unit responsible for primary healthcare Consumer Choice Financing Organisational and regulatory: the Federal Ministry of Health. Regarding preventive care (also part of primary care): the regional health authorities. Financially: the National Health Insurance Institute. Free choice and free access to primary care as well as to specialised and hospital care. There is a financial incentive to select one general practitioner as holder of your global medical record. Free compulsive social security system, mandatory to all inhabitants. Largely funded by contributions of the citizens with some taxed-based state contribution for the elderly and social vulnerable persons. Public or private providers Self employed primary care providers solely. No publicly employed primary care providers at all. Gatekeeping function of the GP Integrating health: initiatives for coordination Free access to specialists and hospitals. Limited financial incentive for the patient when referred to the specialist. Public hospitals (large minority) are financially supported by the local authorities of patient's residence. Deficits of those hospitals are covered by patient's local authorities. Limited initiatives for local coordination between primary care and hospital care.

8 EU27 EU27+2 BE 80 EU average Use of computers Use of the internet Use of broadband

9 9 DATA DIGITALIZATION % Digitalized Data in General Hospitals (2008) General Hospitals «Paperfull» More than 50% of Belgian Hospitals less than 50% digitalized data

10 10 PROBLEM DEFINITION

11 : All started with a recommendation

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13 13 The legacy Content (Ambulatory care) Network (Hospitals) Communication and Incentives Incentive of 800 /Y for each HCP using a labelled EHR: 20 millions + /Y

14 14 ACTH + ALTEM + ANATEM + MEDITEL + UMT + (ATMB)

15 15 E-Gov

16 PUSH Central DATA BANKS TOP DOWN TRUST NETWORKS INFRASTRUCTURE PULL SERVICES BOTTOM UP INFOSTRUCTURE

17 17 KEY PRINCIPLES : How to create «trust» Subsidiarity : Investment should take place at the most appropriate level giving priority to users needs, perceptions and cost-efficiency. Mutualisation : Available ressources are pooled together and distributed according to needs under the control of an agreed governance process. Transparency : All information is available and transparent for all. Decisions are always documented. Ownership: Health profesionals (and GPs in particular) are highly involved at all stages and own the system..

18 : Change of strategy SHIFTING TOWARDS A system to system policy -Centralised EHR versus federated EHR? -> Web services -Patient ID: Unique or different? -Security and legal certainty. S3 (Serveur des Soins de santé) is «given» as «food for thought» to local telematics associations.

19 : Federating to create an operational regional network.

20 20 7 YEARS PLAN 6 WORK GROUPS INVOLVING 100 STAKEHOLDERS: Creating trust Problem definition Agenda Policy adoption Implementation 2006: Technical and functional specifications approved 3 phases Creation of FRATEM asbl Pooled resources: /Y/Hosp Federal and regional limited support Basic federal services Authentic sources Privacy security Certification of systems Roll out : Opt in

21 2008 : CREATION OF THE EHEALTH PLATFORM

22 22 PRINCIPLES ADOPTED at FEDERAL LEVEL No central storage of personal healthcare data: Exchange from system to system is the main rule. Only central location service (with patient consent). Unrestricted application of law (privacy, secrecy, patients rights, free choice) with Special attention to information security and privacy protection Respect for and support of * existing local or regional initiatives * private initiatives regarding electronic service to healthcare actors Use of the ehealth platform is optional, not mandatory Platform is managed by the representatives of the various healthcare actors Federating rules (Consent, therpeutic relationship )

23 23 Users Basic Architecture Patients, healthcare providers Health Portal VAS VAS VAS RIZIV-INAMI site VAS VAS VAS and institutions ehealth platform Portal MyCareNet VAS VAS VAS Healthcare institution software VAS VAS VAS Care provider software VAS VAS VAS Network Basic services ehealth platform ADS ADS ADS ADS ADS ADS Suppliers

24 24 E_Health platform: Basic Services operational Coordination of electronic processes Web portal ( Integrated user and access management Logging management System for end-to-end encryption for communication of data to a recipient known at the time of the encryption for communication of data to a recipient not known at the time of the encryption Personal electronic mailbox for each healthcare supplier with limited features Electronic time stamping Coding and anonymisation

25 25 Exchange of patient data: now Remote files unknown

26 26 Exchange of patient data: Coming soon A 4: All data available Meta- Hub B C

27 27 25/6/

28 INTERREG IV STRAND A The Euregio Meuse-Rhin platform What? : Creation of areas of access organised for cross border health care Interhospital co-operation agreements Evaluation of the cover for the elderly Emergency services cross border Franco-Belgian Health Observatory Accessibility to information for patients and professionals via a website

29 INTERREG IV - STRAND A Cross Border co-operation Eligible regions

30 FRATEM & RSW : Looking back and forward SPF SANTE PUBLIQUE, SECURITE DE LA CHAINE ALIMENTAIRE ET ENVIRONNEMENT 30

31 31 IMPORTANT MILESTONES at regional level: February 2009 Privacy agreement approved by the National Order of Doctors. ->Establishment of surveillance and piloting comitees. 2010: External audit of security system: bluecrypt Creation of a function of mediator. Full opt in both for patients and health professionals. Designing a specific but phased integrated plan for integration of primary care actors with support of all circles of general parctice: -> Smooth links with Industry (Co-Gen: plug-in) -> Gradual Development of specific platform. DUPLICATION and FERTILISATION Helping other networks to be set up (Brussels) Helping to establish common rules and norms (With E-Health platform). Integrating the meta-hub in the picture Developing new functionalities (PACS,..)

32 32 Where are we now? Architecture based on Mutual Trust and web-services but.need of flexibility. Different standard used within hub(kmehr web-sevrices/ihe) Key services such as E-Prescription also developed with stakeholders. Limited Inclusion of «other stakeholders» (Nurses, kines, social workers) Discussion on patient access to data only starting. Co-existence of «shared EHR» under «Hub coverage». Encouraging industry to invest in web-based applications for individual HCP Different visions co-exist for ambulatory care platforms (HUBS_-Central regional- Per HCP- Private)-> Need for stocking validation criteria).

33 33 Where are we now? Federal strategy: -> Focusing on essentials (basic services, norms-rules-law and DB) and administrative simplification. -> Defining Semantic interoperability strategy. -> Integrating EPSOS -> Seeking cost-efficiency (No duplication of investment). -> Pushing innovative models (eg: Home hospitalisation).

34 What role for European regions? SERVICES! REhR: REGIONAL Electronic Health RECORD (Dynamic problems list) INTRA->EXTRA MURAL -> New definition of services Need to go beyond borders: Users needs. Need for gradual institutional (re)integration (Long term stability). But ALSO: - Subsidiarity «infrastructure» - Complementarity «infostructure». AND Training strategy. Involvement in Evaluation strategy. Funding: Looking for overall «routine financing plan» (Stop ad hoc financing). Towards «Meaningfull Use»? Link with reimbursement?

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36 TOP BOTTOM TOP BOTTOM TOP BOTTOM 1999: A simple telematics commission focusing on basic infostructure. 2005: Failure of a first «legal approach» to e-health Towards a «system to system» policy. 2008: A pragmatic approach for federal infrastructure making the best of previous invesment in E-Gov and social security. 2010: Basic infrastructure and services operational 2011: First regional services with added value 2013 on: Regional (re)consolidation?

37 TIME LINE: From Now to 120,00% 100,00% 80,00% 60,00% 40,00% 20,00% 0,00% HUBS "life" Sumehr E-prescription EHR (% diagnoctic coded)) PHR (patient access) E-HOSP Min criteria

38 E HEALTH IS ABOUT HEALTH Yes but HEALTH IS ABOUT HUMAN BEINGS.

39 39 Thanks for your kind attention! Useful links: