realising benefits from ehealth – european strategies and success cases –

© Slovakian eHealth Conference, Bratislava, 27th of May, 2010 1

Realising benefits from eHealth

– European strategies and success cases –

Dr. Karl Stroetmann

Communication & Technology ResearchBonn, Germany


Bonn - Brussels


"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

Epigraph


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


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


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


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


WHO covereH IMPACT cover


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


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


European benchmark cases and success

stories


Socio-economic impact of interoperable electronic health record

and ePrescription systems in Europe

www.ehr-impact.eu


“Small is beautiful”- the Emergency Care Summary

(ECS) system of Scotland -adapted from

Alan HyslopeHealth Strategy, Scottish Government Health

Directorates, Edinburgh, UK


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

15


• 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

Decision in 2001 to implement an ECS

16


“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


System Overview

ECSSyste

m

Request & display

NHS 24

A&E

Ambulance

OOH

PracticeServer

GP consultation

Check audit log

HealthBoard

GP Practiceadmin

TBD


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


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

20


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

21


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

22


ECS – annual socio-economic performance

0

1.000.000

2.000.000

3.000.000

4.000.000

5.000.000

6.000.000

7.000.000

2002 2003 2004 2005 2006 2007 2008 2009 2010

₤

Present value of total annual costs Present value of annual benefits

23


ECS – cumulative socio-economic performance

0

5.000.000

10.000.000

15.000.000

20.000.000

25.000.000

30.000.000

35.000.000

40.000.000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

₤

Present value of cumulative costs Present value of cumulative benefits

24


The integrated health information system of Andalusia, Spain

adapted from

Francisco Perez TorresHead of Information Systems Department

Servicio Andaluz de Salud (SAS)Andalusia, Spain


26

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)


Integrate the healthcare information of every citizen

Diraya´s objective

A SINGLEHEALTHRECORD

A SINGLEHEALTHRECORD


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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


KEY

SDiraya’s key elements

A SINGLE Health Record for each citizen1

Unified ACCESS to all services 2

All relevant information STRUCTURED3

Developed by the practitioners/users4


Diraya Building blocks

HEALTH RECORD

DATA ANALYSIS

Citizens Data Base

Central Booking

Orders / CPOE

Maco Structured Resources

ePrescription RECETA XXI


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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


33

Number of dispensations accordingto type of prescription (2004-2009)

0,18 0,88

6,10

19,46

39,71

50,31

0

20.000.000

40.000.000

60.000.000

80.000.000

100.000.000

120.000.000

2004 2005 2006 2007 2008 2009

0,00

10,00

20,00

30,00

40,00

50,00

60,00

Recetas manuales Recetas impresas RXXI % Receta XXIManual prescript. Printed prescript.


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


Andalusia: annual socio-economic value of impact to society

0

25.000.000

50.000.000

75.000.000

100.000.000

125.000.000

150.000.000

175.000.000

200.000.000

225.000.000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

EU

R

Present value of total annual costs Present value of annual benefits


36

Lessons learnt from Diraya• Align the EHR and ePrescribing development with the regional

government’s health strategy– assure that booking and response times are guaranteed– improve clinical management– streamline healthcare processes– rational drug usage … It’s not an IT project

• Alliances - collaborative model: Involve professionals in the inception of the system

– 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


eHealth priority and activity fields mentioned in Member State policy documents

preliminary results

Reported eHealth activities Total 2007eH 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


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.”


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


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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