iop-hd-de_03_schug-key-elements-2008-06-12.pdf
Key elements
for eHealth interoperability:
Useful results of the i2-Health project
Dr Stephan H Schug, MD, MPH
EHTEL Manager, Exec Committee Member
Update on eHealth Interoperability in Europe
- focus on electronic health records –
Satellite event of TELEMED 2008,
Heidelberg, 12 June 2008
eHealth Interoperability
Emerging eHealth applications might stop
at European borders
• Blocking cross-border communication
• Health ICT Market Fragmentation
Policy drivers for eHealth interoperability
• Citizen mobility
• Border regions
• Decisions of the European Court of Justice
• Health ICT Industry
• Pressure from stakeholder groups
Telemed 2008: EHTEL Satellite 3
Stephan Schug, EHTEL eHealth Interoperability in Europe
COM (2004)356: Eur. eHealth Area
By the end of 2006,
Member States together with EC should
identify and outline interoperability
standards for health data messages
and electronic health records, taking
into account best practices and relevant
standardisation efforts.
Telemed 2008: EHTEL Satellite 5
Stephan Schug, EHTEL eHealth Interoperability in Europe
i2-H Workplan Elements
Framework and generic elements
• Conceptual framework (WP1)
• Analysis of infrastructure concepts and building
blocks, services and applications (WP2)
eHealth issues for in-depth analysis
• Identification management of actors,
organisations and system components (WP3)
• Workflow Interoperability –
ePrescribing and Messaging (WP4)
Telemed 2008: EHTEL Satellite 8
Stephan Schug, EHTEL eHealth Interoperability in Europe
Framework: 4 action levels for
citizen-centred eHealth services:
Health policy: • Vision & strategies
• Processes & measures, incentives
cooperation
• Socio-economic (sustainable), legal
framework
• Accreditation and certification
Health service providers • Organisational structures and culture
(Organisational level): • Intra & inter-jurisdictional service processes
• Change management, behavioural change
collaboration
• Systems thinking, business process re-
engineering
Semantic • Terminologies, classifications
interoperation • Translation
Technical / functional • Technical standards
interoperation • Hardware and software connectivity
• User interfaces
Telemed 2008: EHTEL Satellite 9
Stephan Schug, EHTEL eHealth Interoperability in Europe
Interoperability / 4 action levels
Jurisdiction # 1 Jurisdiction # 2
Function A Function A
Interface; Mapping; Translation ...
Top-
Down Political / Legal Political / Legal
IOp Agreement
Organisational Organisational
Semantic Semantic
Bottom
-up Technical Technical
Telemed 2008: EHTEL Satellite 10
Stephan Schug, EHTEL eHealth Interoperability in Europe
WP3: Utilizing an Health eID
Trusted Third Party
Identity
Provider
Attribute RA, CA
Source
Grants access
Requester
Asks for service
Supplies ID (+ Auth.) data Decider
Telemed 2008: EHTEL Satellite 11
Stephan Schug, EHTEL eHealth Interoperability in Europe
WP3/ID-Management: One Example
Person or institution? Recognition professional Accounting, non-
Trust model ID mgmt. qualifications. Supervision. repudiation.
What What
Who What
are have
are are Electronic
you Health
you
you? you?
allowed? Records done?
Identifiers and Qualification, Why trust
numbering scheme role, affiliation your eID?
Telemed 2008: EHTEL Satellite 12
Stephan Schug, EHTEL eHealth Interoperability in Europe
ePrescribing benefits expected
Health policy focus: priority application for
several Member States
• improved patient safety
• patient empowerment
• considerable reduction in fraud
• cost savings
(5 bn transactions/year in EU25)
Telemed 2008: EHTEL Satellite 14
Stephan Schug, EHTEL eHealth Interoperability in Europe
Paper Based Prescription
Billing/Statistics
Pharmacy
Physician
Medicines
Health Insurance
Prescription Form / Payers
Patient
Telemed 2008: EHTEL Satellite 15
Stephan Schug, EHTEL eHealth Interoperability in Europe
Drug prescription errors
Prescription
Administration of drugs Medication safety
Pt information errors
Prescribing errors
Pt identification errors
Inefficiency of
Overdose
Diagnostic errors alert systems
Low dose
Allergy
Ignored Allergy Inappropriate timing Non withdrawal
Wrong preparation of drugs
Therapeutic plan Device errors
not updated (e.g. infusion pumps)
© Purcarea, 2006
Telemed 2008: EHTEL Satellite 16
Stephan Schug, EHTEL eHealth Interoperability in Europe
Reduce Medication ErrorsADE
I II III
Medication Errors Adverse Drug Events
I. Medication errors that do not result in patient harm
II. Medication errors that result in patient harm.
III. An adverse drug event that is not a result of a medication error.
ePrescribing & Medication Management: 17
management@ehtel.org Interoperability of medication workflows
ePrescribing: Group of Services
Electronic
Prescribing
Infrastructure,
Networked
Electronic Transmission
of Prescriptions
Electronic
Health
Records
Informed Prescribing Medication
w/Decision Support Records
Telemed 2008: EHTEL Satellite 18
Stephan Schug, EHTEL eHealth Interoperability in Europe
National Implementations
DK e-prescription: # / Month
Prescriptions
1992 2000 2006
Telemed 2008: EHTEL Satellite 19
Stephan Schug, EHTEL eHealth Interoperability in Europe
National Implementations
UK: Connecting for Health
Prescription Pricing
The Electronic Prescription Service Authority
ELECTRONIC
MESSAGING
Electronic copy Electronic copy Confirm what
Scanned Paper
of information on of information on has been
barcode Prescription
prescription prescription dispensed
Paper
GP prescription Patient Pharmacist
with barcode
Medicines etc
dispensed
Telemed 2008: EHTEL Satellite 21
Stephan Schug, EHTEL eHealth Interoperability in Europe
eRx Implementations EU
The
Denmark Sweden Germany Slovenia NHS Nether-
Engl. lands
Informed Implicit n/a System Implicit Plans Pilots
eRx with islands
Decision
Support
Electronic Fully Ca. Offline Plans Roll out In use for
Transfer of estab- 60 % Tests Phase 1 less then
Prescript. lished since (Barcode) 20 %
2007
Electronic National National Optional Roll Out Part of Roll out
Medication Database Database for on HIC Spine in
Record (09/2006) new eRx Patients (06/2006) 2008/09
Telemed 2008: EHTEL Satellite 22
Stephan Schug, EHTEL eHealth Interoperability in Europe
i2-Health Interoperability Approach
Patient information in digital form must be at least as
accessible and usable as paper based data
Meaningful exchange of medication data.
Legal base for issuing/dispensing
Political / Legal electronic prescriptions: National /
Cross-border / Internet-Pharmacies
Medication Forms and Logistics, Dis-
Organisational pensing, Reimbursement, Surveillance
Naming (Generic/Product),
Semantic Coding Schemes
Syntax (XML ..), Messaging Standards,
Technical Transportation, Networks, ..
Telemed 2008: EHTEL Satellite 23
Stephan Schug, EHTEL eHealth Interoperability in Europe
eRx Interoperability Issues
Organisational Interoperability
• Recognition of physicians autorisations (legal)
• Reimbursement claims; etc.
Semantic Interoperability
• Pharmaceutical nomenclature & classification
• Drug composition; branding etc.
• Instructions/Quantity (10-10-10 vs. qid; tid)
Telemed 2008: EHTEL Satellite 25
Stephan Schug, EHTEL eHealth Interoperability in Europe
i2-H Recommendations for the
Implementation of ePrescribing
Establish international standard formats for
interoperable electronic prescription
messages and interoperable medication
records (medication profiles)
Avoid a “digital Prescribing Babel”
by safeguarding the semantic
interoperability of all medication related
information (substances, dosage etc.)
Telemed 2008: EHTEL Satellite 27
Stephan Schug, EHTEL eHealth Interoperability in Europe
Core (e)Prescription Information
Prescription (of Medicines)
Trust
Identifier/DigSig
Identifier: Identifier/Status
Health Professional
Citizen/Patient Reimbursement
Medication Repeat Status Instructions
Rx 1 Med 1 Dose/TID 1
Rx 2 Med 2 Dose/TID 2
Rx N Med N Dose/TID N
Trust
Dispensation Information by Pharmacist Invoicing Information
Dispensation 1-N Reimbursement Claim
ePrescribing & Medication Management: 28
management@ehtel.org Interoperability of medication workflows
Jumping or Walking?
MS … MS … MS …
MS … MS …
MS 1
MS … Bilateral or multilateral
EU Basic agreement
Profiles
MS 2 MS …
MS … MS …
MS … MS 1 MS 2 MS …
“A flexible approach would allow for setting up bilateral or
multilateral agreements as well as using EU basic profiles”
Telemed 2008: EHTEL Satellite 29
Stephan Schug, EHTEL eHealth Interoperability in Europe
European Health Telematics Association
Focal Point for eHealth in Europe
• Improving awareness and value perception of
eHealth
• Information exchange and discussion Forum
for eHealth stakeholders
• Informing and advising EU institutions and
European organisations
• Collaborate with and adding value to existing
(potentially) eHealth related groups
• Participating in debates, key issues and
deployment approaches
Stephan Schug, EHTEL Telemed 2008: EHTEL Satellite p 30
eHealth Interoperability in Europe
EHTEL
Stakeholder Forum
for eHealth in Europe
Dr Stephan H Schug, MD MPH
Manager
EHTEL European Health Telematics Association
Direct Email: Stephan.Schug@ehtel.org
Liaison Office & Management Team: info@ehtel.org