e health demystified
TRANSCRIPT
E-HEALTH DEMYSTIFIED: AN E-GOVERNMENT SHOWCASE
Mario Kovacˇ , University of ZagrebPresented By Syed Ali Raza
What is E-Health Refers to incorporating information and
ICT into: Healthcare products, services, and
processes Organizational and governmental
infrastructures that can improve patient-citizens’ health and well-being
Increases efficiency and productivity in healthcare delivery
Trends Healthcare costs could double
among EU member states by 2060 If trends over the past 3 decades
continue,Healthcare costs in US will climb as
much as 7 percent annually for the foreseeable future
What E-Health could do to save this cost
Internationally, the telemedicine market topped with US$13.8 billion in 2012
Expected to grow at a 16.9 % compound annual rate, to US$35.1 billion in 2018.
Internet Trends Pew Research Health Online 2013 study:
81 % of US adults having regular Internet access,
59 % of those studied had used the Internet to look online for health information during the previous year.
7 in 10 track a health indicator for themselves or a loved one
21 percent use some form of technology to track health data
Barrier in Implementing E-Health At government levels is the failure to
consider the need for interoperability among systems and services
INTEROPERABILITY
Enables health information and medical expertise to be exchanged among
clinicians, patients, and others.
Stakeholders
Stakeholders (contd..) Clinicians
Require access to detailed health records in order to manage healthcare
Patients To exercise individual, informed autonomy over their
healthcare They want direct access to multiorganizational healthcare
records (possibly integrated to their PHR) Private providers, national and regional
health services Need real-time, fine-grained business intelligence
regarding healthcare costs, quality, and outcomes.
Interoperability framework
Legal interoperability Focuses on aligning legislation so that information
exchange conforms to established legal procedure Most important are directives:
To protect personal data To provide a community framework for electronic
signatures To establish patients’ rights in cross-border healthcare Regulations on data protection, on e-IDs and on
medical devices; Recommendations regarding e-health interoperability
and telemedicine
Organizational interoperability Focuses on coordinating processes of
organizations to realize mutually agreed upon goals.
Governments ultimately occupy the highest stakeholder level
International standardization bodies are important partners in this process.
Instantiation and support for cross-border licensing and certification of quality also play an important role
Semantic interoperability Aims to establish precision in the
meaning of exchanged information For this aim, Systems are developed
for Concept representations Clinical models that assemble data items EHR information models Provenance context
Challenge is “multiple standards”
Technical interoperability Aims to address technical coherence
among connected information systems and services
Such as interoperable identification and authentication
epSOS (European Patients Smart Open Services)
Focuses on improving medical treatment for EU citizens traveling outside their home countries
Provides individual patient data electronically to health professionals within the pilot program
Primary services to facilitate cross-border interoperability are: a patient summary e-prescriptions
epSOS IHE profiles and CDA Security policy is based on ISO/IEC TR
13335 specifications epSOS deliverables, components, and
pilot infrastructure are also used in other projects: e-SENS STORK Trillium Bridge project
ACHIEVING E-HEALTH INTEROPERABILITY: KEY PRINCIPLES
The Croatian Central Healthcare Information System (CEZIH)
Currently Connecting more than 2,300 general practitioner offices
250 pediatric care facilities and 250 women’s health clinics
2,000 dental offices, 150 locations providing medical care specifically for
school children, 120 laboratories and 1,300 pharmacies 1,100 specialist outpatient care facilities Offers functionalities to facilitate data exchange among
more than 60 hospitals; This framework includes over 60 ICT vendors providing
software and services.
Interoperability achievements For semantic interoperability,
All software vendors use HL7 message specifications to develop functionalities for data communication.
Technical interoperability addressed: By enforcing the use of Web services, establishing
HL7 Version 2 and Version 3 as compatibility standards
Use of common public key infrastructure with X509 certificates
Patient information can only be accessed using smart cards, and all messages are digitally signed
Interoperability achievements (contd..)
Legal interoperability Comprehensive legislation being done to support
interoperability and new service integration Patient centricity
e-prescription for patients with both short-term conditions and chronic diseases
e-referral to biochemistry laboratories automatic insurance status validation medical summary following patient Immunization side-effects reports
Interoperability achievements (contd..)
Overall interoperability has been verified against thousands of sample use cases executed in: common testing environments production environments
Success Indicators On average, it processes over 50 million e-
prescriptions yearly, 15 million e-referrals, and 48 million practitioners’ reports.
E-referrals have significantly reduced patient travel: 15,000 people per day
E-prescription has reduced thousands of prescribing errors.
e-referral and e-prescription services can potentially reduce equivalent CO2 emissions by up to 15,000 metric tons per year
Lesson Learned Required documents for legal interoperability, while
similar in complexity, will likely take longer to pass as national legislation
Organizational change will definitely be significantly greater and more complex due to a larger stakeholder pool
Semantic issues will differ little; good practices in smaller systems can be replicated in larger ones
Clients access the central system through the Internet using regional government–provided X509 certificates for authentication
The necessary requirements within regions meet epSOS specifications