“e-Health, opportunities, threats and needs for SMEs” Dr. Jos Devlies OmegaSoft, Belgium.

“e-Health, opportunities, threats and needs for SMEs”

Dr. Jos Devlies

OmegaSoft, Belgium

eHealth Conference 2005 2

Outline of the presentation

• Some thoughts on SME’s and e-Health.

• Continuity of Care as driving concept.

• From proprietary EHR towards “Open e-Health”.

• Some thoughts on e-Learning in Healthcare.

• e-Content.

• Suggestions.


Small Medium Enterprises

• Officially defined, based on personnel, turn-over and “independence”.

• Increasingly important: 90-99% of enterprises, 40-60% of employment, 30-40% of turn-over.

• Is it reasonable to make a difference in e-Health… to keep using the “independence” criterion?

• What do they represent in e-Health?


Participants 5th Framework

Universities24%

Large23%

Public/non profit10%

Res. Centre17%

SME26%


Funding 5th Framework

Universities

23%

Large26%

SM Enterprise

23%

Research

Centre

18%

others

2%non profit

5%public

3%


e-Health: what?

• Hundreds of definitions of e-Health.• “The prime objective of the e-Health initiative is

to develop an infrastructure of user friendly, validated and interoperable systems for health education, disease prevention and medical care”

• “e-Health offers a wide range of services (information and applications) “delivered or enhanced through the Internet or related technologies”


… a new problem

?

… a never ending story ?


e-Health services• Professional Communication among Providers (Data Exchange)

• Logistics of Patient Management and Distributed Provision of Care

• Health System Administrative Transactions

• Business to Business Transactions

• Business to Consumer Transactions

• Biomedical Knowledge Management

• Electronic Health Record

• Clinical Care (Telemedicine)

• Health Information Delivery to the Public

• Distant Education of Health Professionals

• Consumer to Consumer Exchanges (Chat, Special-Interest Groups)


Some of the problem with eHealth?

• Healthcare is not just another profit oriented business…

• Nothing is simple in healthcare• Different stakeholder groups:

– Health(care) authorities and insurers– Healthcare professionals– Scientific authorities– e-Health industry

• Patients… to be represented by the authorities and/or the insurers


Role of the stakeholders

• Each of them should play his role and stick to that:– Authorities: regulatory framework– Users: select, validate and define how they want it– Science: define the guidelines & content– Industry: production and exploitation

=> Creation of National e-Health Institutes?


Focus on…

• e-Health services related to continuity of care

• e-Health services related to continuous professional development

C

C

C


Comprehensive Continuity of Care* – C³

Maturity of a service depends on – Healthcare framework:

• From capitation to fee for service or employment• Focus on primary care or not

– Regulatory framework– Appeal of the services– Willingness to pay => readiness to invest

• User pays when he has direct profit / savings• Who pays for the health added value?

* e-Ten C27778


Indicators for maturity

• Eagerness to invest• Risk evaluation• Importance given to the service by

– General Practitioners– Private specialists– Hospital managers and specialists– Pharmacists– Paramedics / Homecare– Patients


Baskets in B

E – IT

- ES

Cat. Service Belgium Italy Spain

NO Notification of Transfer 8,82 3,66 7,36NO Notification of Discharge 9,43 6,62 9,35NO Notification of Death 9,50 6,41 8,86NO Notification of Admission 9,38 6,49 7,67IM To be integrated in GP/Hospitals/Specialists/Pharm information sys. 5,06 3,68 4,53IM For internal hospital use 1,50 3,00 4,00IM Accessed by patient -0,35 -0,89 0,53IM Accessed by other hospitals 4,08 4,15 5,08IM Accessed by GP 6,85 5,77 6,30IL As v irtual referral letter to be integrated 7,53 5,37 7,50IL As a tool to improve cooperation between independent practices 7,73 4,73 7,79IL Accessed by physiotherapist -1,33 -0,84 -1,02 IL Accessed by Pharmacists 0,18 -1,48 1,46IL Accessed by patient -0,67 0,54 0,65IL Accessed by named colleague 5,67 5,89 4,57IL Accessed by indiv idual private specialists (secondary care) 5,85 3,85 6,21IL Accessed by hospital (secondary care) 4,69 4,19 4,79IL Accessed by home care -1,45 0,05 0,33IL Accessed by GP on duty 5,58 6,00 5,67IL Accessed by emergency serv ices 6,75 6,24 6,58EX Tech.invest.request 4,71 8,72 4,73EX Tech.invest.report 9,32 9,40 7,64EX Referrals 5,46 5,44 6,01EX Referral report 8,79 7,64 8,63EX Prescription serv ices (drugs) 4,53 6,64 6,11EX Lab results 9,67 9,73 8,80EX Lab requests 1,33 9,47 8,97EX Imaging requests 4,71 8,72 7,15EX Imaging reports 8,23 9,86 9,19EX Follow-up/Outcome reports 2,51 7,34 2,38EX Discharge summaries 8,28 7,15 9,02CO Reverse updating serv ices 4,25 2,75 5,50CO Direct access serv ices -3,25 -3,25 -0,43 CO Data reference serv ices 0,48 0,98 1,93CO Booking & scheduling serv ices 3,60 8,57 3,83ASP Practice analysis 0,23 1,77 2,79ASP Monitoring preventive care 3,33 4,19 4,79

The EHR at the centre of eHealth

and its evolution


Documenting EHRDocumenting EHR


Communicating EHRCommunicating EHR

Emergency Emergency dep.dep.

MedSERVEMedSERVE

HospitalHospital

LabLab

ImagingImaging

NursingNursing

GPGP

GPGP

SpecialistSpecialist

PharmacyPharmacy

• Addressed data (a => b)

• Syntax standards

• Semantics: metadata

• Fully securised

• Industrial exploitation

http://www.all-shred.com/bins.htm


““Open” EHROpen” EHR

On duty On duty serviceservice

Urgency Urgency servicesservices

MedSERVEMedSERVE

MedSHAREMedSHARE

HospitalHospital

LabLab

RadiologyRadiology NursingNursing

Cooperation of practicesCooperation of practices

GPGP

GPGP


PharmacyPharmacy

Kine/PhysioKine/PhysioPharmacyPharmacy




Three types of export files – Two kind of services

• Sumehr = Summary EHRAll EHR systems are able to export itIntended to be used in a “public” service: not

yet available

• MedShare Emergency EHR• MedShare Cooperative EHR

=>”Closed” groups• On duty services• Cooperation of independent practices


MedShare & Sumehr “snapshot”

• Patient identification • Allergens• Risk factors• History: diagnostic and treatment• Evaluation: active diagnosis & problems• Pregnancy related data• Medication (brand products / magisterial prep.)• Immunisation status• Patient’s care team


MedShare Cooperative Record• Patient identification • Allergens• Risk factors• History: diagnostic and treatment• Evaluation: active diagnosis & problems• Pregnancy related data• Medication (brand products / magisterial prep.)• Immunisation status• Patient’s care team

• Measurements (biometric data, lab results)• Reports (imaging, referrals, diagnostic

procedures)• Planning• Narrative textual data related to the three latest

consults


Evolution of e-Health services

=>From “Open EHR” towards “Open Services”–Network of service providers

–Single secured point of access


HealthLink ©

HealthLinkPortalInternet

PRIMARY CAREPHARMACY

HOMES

HOSPITALS

PATIENTS

CITIZENS

SOCIALINSURERS

PUBLICAUTHORITIES

INDUSTRYHealth

Content Providers

Service Providers

HealthLink (BiLAN)

(My)CareNet

S3/C3

Infohos/ACC

Medibridge/PcSol

UltraGenda

Other health applications

PRIMARY CAREPHARMACY

HOMES

By Belgacom


Open Issues to realise these “Open Services”

• Availability of a “eHealth backbone” for free

• Authentication services

• Authorisation services (management of health roles)

• Data Reference Services

• (Patient) Master Index Services


UrgencyUrgency

MedSERVEMedSERVE

HospitalHospital

LabLab

ImagingImaging

NursingNursing

GPGP

GPGP


PharmacyPharmacy

Th

e pro

-active EH

RT

he p

ro-active E

HR

Integrated Decision & Integrated Decision & Management SupportManagement Support

Distant Decision Support & Distant Decision Support & Management Web ServicesManagement Web Services



e-Health “Active EHR”

• Surveillance and warning services• Decision support excellence services• Evidence based care management

services

One big problem

Content!!

e-Health & e-Learning

The e-ProLearn projecte-Ten 27976


e-Prolearn was about…

• Continuous Professional Development• Definition of the learning needs “in the practice”:

context-sensitive learning linked to the EHR– Identification of the needs based in good practice

guidelines– Complete these needs through a domain specific

personal and professional assessment

• Provide learning material based on those needs only !!

• Measure impact of learning through changes in clinical behaviour in the practice


e-ProLearn problems

• Acceptance of e-Learning for professional accreditation is still very difficult to obtain

• Content:– Formalised Good Clinical Practice guidelines

to be used locally or through web services– Structured learning material: “Learning

Nuggets”

e-Content

some considerations


Content: both information & knowledge

• Information– “Narrative” content: opinions or consensus or the latest

trend in healthcare– Should be levelled: citizen and health professional– Targeted and structured in “nuggets” of information

• Knowledge – (Inter)active Content– To be used by information systems– Invest in

• professional consensus knowledge• formally standardised content

– Complete content with “centres of excellence” providing web based services to citizen and healthcare professionals


Content is “European”

• Science is by far the most important cross-boarder good we have.

• No sense in having different good practice guidelines in each of the E.U. countries

• e-Content can not be comprehensive at once: select domains the one after the other.>> Better to have one consensus well elaborated than

a mess of opinions.


Health Content

• Producing content is not a task for the e-Health industry

• Linking knowledge (content) to EHR is a task for industry– Direct interactive links– Through “ASP” services with centres of

excellence

• Two initiatives of the commission might give hope: Networks of Excellence & e-ContentPlus


e-ContentPlus• New programme 2005-2009

• “eContentplus has the overall aim to make digital content in Europe more accessible, usable and exploitable, facilitating the creation and diffusion of information and knowledge – in areas of public interest – at the Union level.”

• Budget 163 M€

• Not really focused on Healthcare this time


e-ContentPlus: action lines• Facilitating access to, use and exploitation of

digital content:– Improve cross-border use and exploitation of public

sector information– Encourage the use of “spatial data”– Open European knowledge pools of digital objects– Trans-European information infrastructure for

accessing and using high quality resources

• Improving quality and facilitating best practice for digital content

• Reinforcing co-operation and awareness


e-HealthContent• We need an e-Content focused on Healthcare

– Consensus building around evidence based medicine– Structuring content into computer usable knowledge– Support availability and use of e-HealthContent

through a functional integration in clinical systems

• Development of the content should be a joint effort of industry and “editors”

• Formalised content needs to be available to all “services providers”


Suggestions

• SMEs should focus and correctly evaluate the market maturity of a e-health service before starting to invest in it.

• All stakeholder should formally cooperate to create a profit enabling context for e-Health services. (eHealth institute).

• High performance e-Health backbone should be available to everyone with a single point of access.

• Appropriate authentication, authorisation, data reference services and master indexes services should be “available”

• Invest much more in content and in content driven services. => European e-HealthContent programme?

The future will be content driven, not technology driven!

The industry needs the authorities for that !!

“e-Health, opportunities, threats and needs for SMEs” Dr. Jos Devlies OmegaSoft, Belgium.

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