EHR: Visions and Strategies

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1 The 1 st International Meeting on the Electronic Health Record in Lisbon (26 November 2010) EHR: Visions and Strategies Prof. Dr. Georges De Moor EuroRec President Ghent, Belgium

2 Vision and Strategy: Presentation EuroRec Electronic Health Records: Trends General Recommendations regarding large scale implementations Example: the Belgian ehealth Platform Certification Georges De Moor, MD, PhD 2

3 The EuroRec Institute is a European independent not for profit organisation established in Its main mission is to promote as a federation of national ProRec centres (17 member countries and a number of applicants) the use of high quality Electronic Health Record systems (EHRs) in Europe*. * EuroRec therefore also supports certification by defining quality criteria and proposing quality labelling procedures.

4 Quality Criteria EuroRec has installed a central repository of indexed, validated and translated quality criteria and has developed tools that can be used to harmonise certification, product documentation and procurement specification of EHR systems. Existing criteria and tools are now being validated and tested in 25 Member States through the EHR Q TN Project with as other output also a unique inventory of all EHR vendors and other stakeholders in those countries. Certification will favour the harmonisation ofehr products: the EuroRec Seal

5 History of EuroRec s Research Projects MediRec (FP3) (94 95) (C.A.) Lisbon Declaration (Recommendation 9) ProRec (FP4) (96 98) (S.A.) Creation of first ProRec centres Widenet (FP5) (00 03) (A.M) Creation of EuroRec Q Rec (FP6) (05 08) (S.S.A.) Creation of Repository & Tools EHR Implement (FP6) (07 10) Strategic Recommendations EHR Q TN (FP7) (09 12) (T.N.) Dissemination/Implementation HITCH (FP7) (09 10) Interoperability Argos (FP7) (10 11) EU US Transatlantic Collaboration EHR 4 CR (IMI FP7) (11 14) Re use of EHR data for Clinical Research

6 Electronic Health Record All stakeholders across the world have recognised that the Electronic Health Record is: a key tool in the provision of safe, high quality and effective care ; and a critical factor for research. Georges De Moor, MD, PhD 6

7 Evolution In ehealth the technical landscape is moving fast and the boundaries between tertiary, secondary, primary care, homecare and even body settings are fading away leading to a continuum of care (cf. health and wellness). Georges De Moor, MD, PhD 7

8 EHR Trends Patient centered Longitudinal (life long) records Multi disciplinary and multi professional Structured and coded (cf. semantic interoperability) Intelligent (cf. decision support, clinical care pathways ) Transmural and virtual More sensitive content (e.g. genetic data) Personal Predictive/ Pre emptive Integrative Georges De Moor, MD, PhD 8

9 Looking at the full picture of an individual s health status (I. Iakovidis) Biosensors Biochips Environmental Data Genomic data Phenomic data Integrated Health Records

10 Use and Re Use of EHR data CARE Patient TRUST Clinician PHR EHR (EMR, EPR ) Privacy Enhancing Techniques Research Safety and Adverse Event Registers Knowledge Mgmt Platforms Decision Support Systems Health care Policy Support Marketing Billing

11 implement.eu EHR Implement has collected, analyzed and compared large scale Electronic Health Record implementations in a number of European countries (6) in order to provide best practice (and strategic) recommendations. In the past the political, social and organizational aspects that can ruin implementation have often been overlooked. Georges De Moor, MD, PhD 11

12 implement.eu Denmark (Connected Digital Health) England (NPfIT) France (GIP/DMP) Belgium (ehealth Platform) Ireland (ipms isoft) Slovenia (ezis) Georges De Moor, MD, PhD 12

13 General Recommendations (1) 1. You need a Vision and Strategy at three levels: Health (Quality, Efficiency, Equity ) e Health EHR Is there a consensus on the main goals to be reached? CAVE: Vision = Future = Changes! Georges De Moor, MD, PhD 13

14 General Recommendations (2) 2. You need Governance: In the case of a national plan you need strong government support preferably facilitated by: appropriate legislation; establishment of a formal governance structure (clear roles); a budget (do not underestimate costs for development, implementation, operation and maintenance).! but to be successful TRUST is key: thus early stakeholders engagement. Participative model: stakeholders (esp. the Healthcare Professionals) should be involved throughout the whole preparation and implementation processes! Georges De Moor, MD, PhD 14

15 General Recommendations (3) 3. You need a Realistic Implementation Plan: A flexible «stepby step» approach not dominated by pressure (e.g. political pressure): progressive, incremental not too ambitious Continuous evaluation as to allow for adaptation Find solutions for real needs and identify interesting business cases (cf. impact of quick wins on motivation, e.g. administrative simplifications) Georges De Moor, MD, PhD 15

16 General Recommendations (4) 4. Donot kill your own ehealth Market: Public Private Partnership should be made possible (do not re develop existing solutions) Respect existing successful local or regional initiatives regarding electronic health services Vendor selection should be submitted to the end users evaluation Georges De Moor, MD, PhD 16

17 General Recommendations (5) 5. Training and Education: Awareness should be raised Education and Training programmes should be established at an early stage (ICT for Health as part of the Medical Curriculum). Train the trainers (cf. Meaningful Use Programme in the US and the announced shortage in ehealth workforce (Health IT professionals)! Georges De Moor, MD, PhD 17

18 Example: the Belgian e Health Platform Cooperative platform for safe electronic data exchange offering a number of basic services in order to facilitate collaboration between all actors in Healthcare with the following basic infrastructure: Health PortalVAS VAS RIZIV- INAMI site VAS ehealth platform Portal MyCareNet VAS Healthcare institution software VAS Care provider software VAS Network Basic services ehealth platform ADS ADS ADS ADS ADS ADS Georges De Moor, MD, PhD 18

19 Belgian ehealth Platform (ctd) VAS = Value Added Service, is any service (e.g. electronic prescriptions) made available to patients or healthcare professionals. The VAS provider (public or private) can use the basic services (e.g. user and access management, PKI, date and time stamping, logging, web portal ) offered by the ehealth platform * ADS = Authentic Data Source, is a database containingreliable information (e.g. National Register of Physicians, Official Drug Database ) accessible via the ehealth platform * * The use of the ehealth platform is optional (not mandatory) * An independent Committee, part of the Belgian Data Protection Agency, controls the activities of the Platform * No central storage of personal health data Georges De Moor, MD, PhD 19

20 Belgian ehealth Platform and its Hubs Georges De Moor, MD, PhD 20

21 Belgian e Health Platform and its Hubs (ctd) Reference to the care provider(s) or care institution(s) where one or more electronic documents are available for a patient is, with the informed consent of the patient, stored in a local or regional reference directory (a so called "hub"). The Reference Directory managed by the ehealth platform (the so called "meta hub") only contains references to the hub(s) where references for a patient are stored. Georges De Moor, MD, PhD 21

22 Example: Exchange of Patient Data A 4: All data available Meta- Hub B C

23 Critical Success Factors (Belgian case) Trust: no hidden agenda (e.g. healthcare systems performance monitoring does not help in alleviating resistance of HC providers) Data quality: garbage in is garbage out Technical and Semantic Interoperability When the merging of data from several sources is needed, then the Unique Patient Identifier (i.e. the Belgian social security identification number) is being used Due respect of principles of Privacy Protection and Information Security Due respect and unrestricted application of Laws (e.g. Patient Rights, Privacy Protection, Healthcare Professional Secrecy...)

24 Certification: a powerful means New instruments Authority 4 New functions 3 1 Physicians Vendors 2 Pressure

25 Business cases for using EuroRec s quality criteria... A regional or national e Health programme wishing to implement quality labelling or certification as to ensure consistent EHR system functionality A purchaser wishing to procure an EHR system module (reducing his investment risk) A vendor/developer wishing to document his system or to upgrade with new funtionalities an EHR system (competitive advantage) Georges De Moor, MD, PhD 25

26 The EuroRec Annual Conference (May 2011, Budapest) The Re use of EHR data for Clinical Research : the Initiative (IMI and DG Research) The Trans Atlantic Project (DG RELEX)

27 Thanks for listening! Georges De Moor, MD, PhD 27

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