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Realising benefits from eHealth
– European strategies and success cases –
Dr. Karl Stroetmann
Communication & Technology Research
Bonn, Germany
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Bonn - Brussels
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Epigraph
"Too many of us spend our time worrying
where technology is taking us, instead of
working out the right way to go ourselves.
We should not try to give computers the job
of making our world a better place!“
David Golumbia, The Cultural Logic of Computation, 2009
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Outline
• Health policy context
• The promise of eHealth
• Europe – a global leader in eHealth
application
• European benchmark cases
• The Digital Agenda – a European
eHealth vision
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Hard facts facing public health
policy makers (in 1970 !)
• “Rising expectations and demands for
healthcare
• Rising costs of healthcare, especially
hospital care
• Demands for involvement of the consumer
• The acceptability, availability & accessibility
of healthcare, including ... a more
convenient portal of entry into the system”
Burney, J o School Health, V. 40 (1970), p. 3
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eHealth must be guided by health
policy priorities
eHealth cannot be instrumental in
defining in what type of future health
system we want to operate,
BUT
once a “better” health system paradigm
has been established, eHealth can
deliver much help and support
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What eHealth can do:
• Support and facilitate the realisation of
clearly defined health policy and health
system (sustainability) goals
• Meet system needs and objectives, not that
of individual interest groups (“The
Commons” approach)
• Enable new health delivery models and
processes
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WHO cover
eH IMPACT cover
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Europe – a global leader in eHealth
application
• General practitioners (GPs) installed patient record
systems:
– USA: only 20-25% of offices
– Europe/EU:
• 80% have electronic medical data storage
• 66% of all European GPs use them in a patient
encounter,
• Various EU Member States (Denmark, Estonia,
Finland, UK) have 95% to 99% coverage
Ashish K. Jha et al. (2006) HEALTH AFFAIRS, 11 October 2006
empirica/EC (2008). eHealth Indicators - use of ICT by primary care physicians
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Europe – a global leader in eHealth
application
12 EU Member States – as of 2011 about 25
(incl. CH, NO, TR) - cooperate in epSOS
(European Patient Smart Open Services)
project on cross-border transfer/sharing of
– fully coded patient summary
– fully coded ePrescribing data
– translated into the respective language across
multiple Member States
Globally, the most ambitious and
complex interoperability project ever
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European benchmark
cases and success
stories
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Socio-economic impact
of interoperable electronic health record
and ePrescription systems in Europe
www.ehr-impact.eu
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“Small is beautiful”
- the Emergency Care Summary
(ECS) system of Scotland adapted from
Alan Hyslop
eHealth Strategy, Scottish Government Health
Directorates, Edinburgh, UK
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NHS Scotland
• Separate National Health Service (NHS)
• ca. 5 million patients registered with 1050 general
practices – GPs (family doctors)
• All GPs have electronic patient record (EPR),
connected to NHS broadband network
• Out-of-hours GP and NHS 24 telephone service
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Decision in 2001 to implement an ECS
• Allow GPs to keep their offices closed after 17 o’clock
• A “useful summary” was therefore needed for new
Out-Of-Hours Services (OOH)
• Also to be used by Accident & Emergency Services
(A&E), NHS24 (telephone helpline service),
Ambulance Service
• Patient safety = key driver
• Decision to develop Emergency Care Summary,
based on extract from GP EPRs
• Simple dataset
• ‘View only’ access by authorised users
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“Small” information content
• Patient identity (address, telephone, CHI
number, GP)
• Allergies and adverse reactions to medications
• Medication history
- Repeat prescriptions in past 12 months
- One-off prescriptions in past 30 days
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System Overview
Request &
display
A&E
GP
consultation
ECS
System
GP Practice
admin
©
NHS
24
Check
audit log
Health
Board
Slovakian eHealth Conference, Bratislava, 27th of May, 2010
Ambulance
OOH
TBD
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Patient consultation & publicity campaign
• Scottish Consumer Council
• 8 patient focus groups held as part of
planning, including people living with HIV and
mental health problems
• Letter to all GPs and Practice Managers
• Leaflet sent to every household in Scotland,
written by Scottish Consumer Council
• Helpline dedicated to enquiries: Opt out,
general enquiries, odd requests
• Very few requests to view records
• Very few opt outs
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Implementation and progress
• Successful pilot + evaluation in 2004 with 100K records
in defined geographical area
• National roll-out 2005/6
• Now 99%+ of population
• 1800 patients have opted out (0.03% of all possible)
• Over 4500 registered users
• Use:
– over 3.5 million accesses to date
– c. 50k per week
– steady increase
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Benefits from the ECS (I)
Citizens
– Patient safety – medication-related in particular
– Some avoided admissions & referrals
– Time saving for patients
• fewer repeat questions at OOH, NHS24 and A&E
– More efficient consultation at NHS 24 – time & satisfaction
Doctors & nurses
– Comfort to GPs
• patients are taken care of efficiently out of hours
– No manual writing of medication records
– Doctors’ and nurses’ life made easier
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Benefits from the ECS (II)
Benefits to NHS Scotland
– Reduction in exposure to risk - better clinical governance
• Drugs are recorded correctly and fully
• Advice is based on better information
– Time savings – redeployment of resources:
• Fewer repeat questioning about medications by doctors and
nurses at OOH and A&E
• Fewer calls to GPs by A&E pharmacists
• No manual input of medication lists at NHS24 - 1 min per call
– Avoided admissions & visits
• Avoided referrals by NHS24 to OOH and A&E
• Faster treatment and some avoided admission at A&E
– no overnight waiting for clarification with GP
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7.000.000
ECS – annual socio-economic performance
6.000.000
5.000.000
4.000.000
₤
3.000.000
2.000.000
1.000.000
0
2002
2003
2004
2005
2006
Present value of total annual costs
©
2007
2008
2009
2010
Present value of annual benefits
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ECS
–
cumulative
socio-economic
performance
40.000.000
35.000.000
30.000.000
25.000.000
₤ 20.000.000
15.000.000
10.000.000
5.000.000
0
2002
2003
2004
2005
2006
Present value of cumulative costs
©
2007
2008
2009
2010
2011
2012
Present value of cumulative benefits
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The integrated health information system of
Andalusia, Spain
adapted from
Francisco Perez Torres
Head of Information Systems Department
Servicio Andaluz de Salud (SAS)
Andalusia, Spain
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Healthcare in Andalusia
• Spain: National Health System
(universal coverage & free access, publicly
funded by taxes)
• Regional responsibility for health
Andalusia since 1984
• 8.3 million population
• In 2010 healthcare budget amounts
to 9.80 billion EUR
• 100% of primary care (1500 PHCs)
and 72% of specialised care
facilities are publicly owned (44
hospitals, 93% of all beds)
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Diraya´s objective
Integrate the healthcare information of
every citizen
A
SINGLE
HEALTH
RECORD
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Diraya: integrated healthcare in
Andalusia
• Unique health record number for all citizens
• Regional EHR shared between
- Primary care
- Hospital outpatient specialised care
- Hospital-based emergency care
- Pharmacies (prescription database)
- Hospital inpatient care: under implementation
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Diraya’s key elements
A SINGLE Health Record for each citizen
2
Unified ACCESS to all services
3
All relevant information STRUCTURED
4
Developed by the practitioners/users
KEYS
1
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Diraya
Building blocks
DATA
ANALYSIS
ePrescription
RECETA XXI
HEALTH
RECORD
Central
Booking
Maco
©
Orders /
CPOE
Citizens Data Base
Structured
Resources
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Diraya facts & figures
• More than 7.5 million EHRs with clinical data
• Connected:
– 795 primary healthcare centres (96% of inhabitants)
– 26 hospital organisations
– 3,500 pharmacies
• Users:
– Over 17,000 healthcare professionals
– 3,500 pharmacists
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Utilisation 2009
• 37.8 million primary care consultation sheets
• 2.7 million hospital emergency care episodes (76%)
• 790,000 hospital outpatient specialised care
episodes (103,000 in march-2010: 25%)
• 93 million consultations scheduled through Diraya:
– Primary care: 82 million (5.6 million by internet)
– Specialised care: 11 million
• 70 million electronic prescriptions
• 89 million dispensing procedures
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Number of dispensations according
to type of prescription (2004-2009)
120.000.000
60,00
50,31
100.000.000
80.000.000
50,00
40,00
39,71
60.000.000
30,00
40.000.000
20,00
19,46
20.000.000
10,00
6,10
0
0,18
2004
0,88
2005
Recetas
manuales
Manual prescript.
©
0,00
2006
2007
Recetasprescript.
impresas
Printed
2008
RXXI
2009
% Receta XXI
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Costs and financing of Diraya
• IT costs
– 50% of overall costs
• Organisational costs (non-IT costs)
– Development, engagement, adaptation
• Total value of socio-economic investment
over 12 years:
– 245 million EUR
• Financed from the regional budget
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Andalusia: annual socio-economic value
of impact to society
225.000.000
200.000.000
175.000.000
EUR
150.000.000
125.000.000
100.000.000
75.000.000
50.000.000
25.000.000
0
1999
2000
2001
2002
2003
2004
Present value of total annual costs
©
2005
2006
2007
2008
2009
2010
Present value of annual benefits
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Lessons learnt from Diraya
•
Align the EHR and ePrescribing development with the regional
government’s health strategy
–
–
–
–
•
Alliances - collaborative model: Involve professionals in the
inception of the system
–
–
–
•
•
•
©
assure that booking and response times are guaranteed
improve clinical management
streamline healthcare processes
rational drug usage … It’s not an IT project
create useful tools for the clinical practice
provide support to the staff (balance usability vs. regulation)
agreement to assure a win-win with the Andalusian Council of
Colleges of Pharmacists and with vendors
Aim for a sensible balance: adding functionalities vs. improving
ICT infrastructure - take risks
Peer to peer training and support to professionals
Analyse the information in the system & use feedback for
improvement
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eHealth priority and activity fields
mentioned in Member State policy documents
preliminary results
Reported eHealth activities
©
Total 2007
eH ERA
Total 2010
eH Strategies
DELTA
EHR/Patient summary
27
27
+0
Standards (technical and
semantic)
19
25
+6
ePrescription
16
18
+2
Citizen card
22
23
+1
Professional card
7
10
+3
Patient ID
24
26
+2
Professional ID
13
17
+4
Telemedicine
23
27
+4
Evaluation
5
13
+8
Legal Activities
14
18
+4
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The future: A Digital Agenda for Europe (I)
• Continued strong European support for eHealth
solutions
• Just published on 19.05.2010 - COM(2010) 245
• One of seven flagship initiatives of the Europe 2020
strategy for smart, sustainable and inclusive growth
“To exploit the full potential of new eHealth services, the
EU needs to remove legal and organisational barriers,
particularly those to pan-European interoperability, and
strengthen cooperation among Member States.”
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A Digital Agenda for Europe (II)
•
•
•
©
Action Line 7 “ICT-enabled benefits for EU society” Smart use of technology and exploitation of information
to address the challenges facing society like climate
change and the ageing population
– there sub-objective 7.2. “Sustainable healthcare and
ICT-based support for dignified and independent living”
Key Action 13: Undertake pilot actions to equip
Europeans with secure online access to their medical
health data by 2015
Key Action 14: Propose a recommendation defining a
minimum common set of patient data for
interoperability of patient records to be accessed or
exchanged electronically across Member States by
2012
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Acknowledgement
We thank the European Commission for financial and
non-financial support !
This presentation is part of various research
supported by the European Commission, Directorate
General Information Society and Media, Brussels. It
reflects solely the views of its presenters. The
European Community is not liable for any use that
may be made of the information contained therein
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