Transcript Slide 1

Health IT Trends & Marketing Conference 2005
« QUALITY LABELLING and CERTIFICATION of
ELECTRONIC HEALTH RECORD systems (EHRs) in
EUROPE »
Georges J.E. DE MOOR, M.D., Ph.D.
(EUROREC)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EuroRec
– The « European Institute for Health Records »
– A non-for-profit organization, established April 16, 2003
– Mission: the promotion of high quality Electronic Health
Record systems (EHRs) in Europe in Primary and Acute
Hospital - care settings
– Federation of national ProRec centres in Europe
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
ProRec CENTRES
Applicants
Centres
Belgium
Bulgaria
Denmark
France
Italy
Germany
Ireland
Romania
Slovenia
Spain
Norway
Greece
Hungary
Portugal
Poland
Sweden
The Netherlands
United Kingdom
Slovakia
“ Differences in languages, cultures and HC-delivery systems ”
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
HISTORY of EU-PROJECTS (1)
PROREC
: Promotion Strategy for the European HC Record
(CEU, FP4, HC 1110,1996-1998)
WIDENET
QREC
: Offering World-Wide Services through an
International Network of Health Record
centres (CEU, FP5,IST-14203, 2000-2003)
: Quality Labelling and Certification of
Electronic Health Record systems in
Europe (CEU, FP6, IST-27360, 2005-2008)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
Other EU-PROJECTS
– « Feasibility Study on Certification of EHRs in Europe »
2005-2006) (CEU, DG Enterprise)
– RIDE, « A Roadmap for Interoperability of eHealth
Systems with emphasis on Semantic Interoperability »
(2005-2008) (CEU, DG Information Society)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
HISTORY of EU-PROJECTS (2)
PROREC
First PROREC centres established and
cooperation between all stakeholders
WIDENET
QREC
{
Extension of the PROREC network
(additional PROREC centres created)
Establishment of EUROREC (June 14, 2003)
{
Harmonisation of EHRs-Certification
Delivery of EuroRec Services
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
European Conferences on Electronic Health Records
1997, Paris
1998, Rotterdam
1999, Sevilla
2001, Aix-en-Provence
2002, Berlin
2003, Dublin
2004, Brussels
2005, Copenhagen
PROREC
WIDENET
QREC
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EUROREC: GOALS
– Support to ProRec centres
– Inform users of current trends in EHRs and express
their needs
– Help public authorities to define and implement strategies
– Defend the EHRs-industry (ROI)
– Promote research, education and development in EHRs
– Foster international co-operation
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EUROREC’s wish to liaise: e.g. with the US
– Standards :
– ANSI-HISB (Healthcare Informatics Standards Board)
– HL7 (CDA / Care Record Summaries)
– ASTM E31.28 Electronic Health Record SC (Continuity of Care Record)
- Certification :
- CCHIT (Certification Commission for Healthcare Information Technology)
- NAHIT (National Alliance for Healthcare Information Technology)
- AHIC (American Health Information Community)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EUROREC: ORGANIZATION (1)
EUROREC
(Economy of scale / Synergy)
PROREC - CENTRES
Users
(Clinicians, Citizens)
EHRs Vendors
…
(Complementarity / Languages)
Purchasers,
Payers
…
Healthcare
Authorities
“Think European (or Globally), but act locally”
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EUROREC: ORGANIZATION (2)
President
: Georges De Moor
(Belgium)
Secretary General
: François Mennerat
(France)
Vice-President (1)
: Rolf Engelbrecht
(Germany)
Vice-President (2)
: Kieran Hickey
(Ireland)
Treasurer
: Louis Schilders
(Belgium)
Deputy-Treasurer
: Knut Bernstein
(Denmark)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EUROREC: FUNDING
– Membership fees
– Annual conferences
– Services (cf. business plan)
– E.C. projects funded: CERTFE, QREC, RIDE,...
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EHRs: TRENDS (1)
EMR
EPR:
– transmural
– virtual
– multidisciplinary
Administrative
Records
Medical
Records
Nursing
Records
Patient Health
Diaries
! Integration with other health care software applications ...!
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EHR: TRENDS (2)
-Medical and Bio-Medical data
-Security: Privacy Enhancing Techniques
-Semantic interoperability: Ontologies
-Added value of EHRs: Decision Support Systems
-TeleHealth
-GRID Technology: HealthGrid
“PHENOTYPE will meet GENOTYPE in future EHRs”
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: FP6-IST4
Results of the 4th Information Society Technology (IST4)
Call for proposals under the EU’s 6th Research
Framework Programme (FP6):
– 276 new research projects
– With EUR 1 billion in EU funding
QREC-project on « Quality Labelling and Certification of
EHR systems in Europe » is a Specific Support Action (SSA)
with EUR 1.3 million in EU funding.
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: ORIGIN
Several EU-member states (Belgium, Denmark, UK,
Germany, …) have already proceeded with quality labelling
and certification schemes, but they differ in scope, in legal
framework under which they operate, in policies, in
organization, in the choice of quality conformance criteria
for benchmarking and testing…
These differences could represent a risk of further market
fragmentation: harmonization efforts should counter this!
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: Main Objective
To develop formal methods and to create a mechanism
for the certification of EHR systems in Europe
EuroRec Institute is coordinating partner
QREC has 12 partners and 2 subcontractors
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC PARTNERS
EuroRec
ProRec-IE, Ireland
ProRec-FR, France
ProRec-BE, Belgium
MEDIQ, Denmark
ProRec-DE, Germany
RAMIT, Belgium
UCL, U.K.
ProRec-SI, Slovenia
ProRec-BG, Bulgaria
ProRec-RO, Romania
TNO, The Netherlands
ECOR, Germany
Empirica, Germany
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EHRs Certification: EXPECTED IMPACT
– to reduce EHRs investment risk for buyers
– to stimulate confidence and increased investment in EHRs
– to guarantee better return on investment (ROI) for vendors
– cost savings in healthcare
– improvement in quality of care and safety of patients
– to encourage patients to play a greater role in managing
their own health information
– to provide valuable population health information
– to foster availability, accesibility, interoperability and
portability of the patient records no matter where the
patients are located or travelling
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
Stakeholders / Benefits
INDUSTRY
OPENS UP the MARKET & REDUCES RISKS
Standards / Certification
QUALITY & SAFETY
CLINICIANS, PATIENTS,
PUBLIC HEALTH
EFFICIENCY & COST SAVINGS
HEALTH AUTHORITIES
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EHR- Interoperability and - Standards
- CEN EN 13606: EHRCOM:2004, Message based standard
- GEHR/ OpenEHR: Archetype concept based
- ISO/ TC215’s EHR- related standards
- HL7 Version 3: RIM and CDA based message protocols
- ACR-NEMA’s DICOM standard
- IHE’s XDS Integration Profile , eb- XML based
- JAPAN’s MML, Medical Mark-up Language
“All these standards vary in scope and content: complementarity ?”
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EN 13606: Five Parts
- 1. Reference Model (stable since 2004)
- 2. Archetype Interchange Specification (*)
- 3. Reference Archetypes and Terms Lists
- 4. Security Features
- 5. Exchange Models
(*) EN 13606 has adopted the OpenEHR archetype methodology
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EHRcom (EN 13606): Basic Building Blocks
- 1. EHR: the EHR for one person
- 2. Folders: high level organisation e.g. per episode, per clin.specialty
- 3. Compositions: a clinical care session,encounter or document
- 4. Sections: clinical heading reflecting workflow & consultation process
- 5. Entries: clinical statement about observations,evaluations,instructions
- 6. Clusters: nested multi-part data structures
- 7. Elements: leaf nodes with single data values, e.g. body weight
- 8. Data values: instance values,e.g. coded terms, measurements with units
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
ISO/ TC 215’s EHR Related Standards
– ISO TR 18307:2001 Interoperability and compatibility in messaging and
communication standards (a list of fundamental principles and objectives)
– ISO TS 18308:2004 Requirements for an Electronic Health Record
Architecture (EHRA) (a list of requirements, not the architecture)
– ISO TR 20514 EHR, definition, scope and content (a pragmatic
categorization of Electronic Health Records)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
Definitions (1)
Electronic Health Record (EHR)
Repository of information regarding the health status of a
subject of care, in computer processable form.
(ISO TR 20514:2004)
The EHR is the primary source of data and information in Health
Information Networks (HINs)
Goals:
- Supporting continuing, efficient and high quality integrated healthcare
- Ability to share patient health information between authorized users
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
Definitions (1’)
Electronic Health Record (EHR)
The structural organisation of the EHR needs to be appro-
priate to the needs of clinicians.
Flexibility of data entry and support of narratives are major reasons for
the retention of paper records by many clinicians.
Answer:
- The EHR must not be prescriptive about this: it needs to accomodate
both.
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
Definitions (2)
Archetype (in eHealth):
A uniquely identified, reusable and formal expression of a
specific health concept.
Expressed by means of an Archetype Definition Language
and composed of descriptive data, constraint rules and
ontological definitions.
Archetypes can be specializations of other archetypes.
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EHRs Certification: the case of Belgium
– Early 1998: PROREC Belgium develops a quality
labelling system for EHRs in ambulatory setting
(333 Quality Criteria defined)
– Belgian Ministry of Public Health and Social Affairs
establishes a national Health Telematics Committee,
and implements the EHRs certification process in
Belgium (May 3,1999):
– the conformance criteria list is reduced in size (100)
– the certification is a voluntary one, but is
incentivized by legislation and budgets: GPs are
actually paid to use certified systems (about 1.5 KEURO per physician per year)
– The conformance testing (initially organized on a yearly
basis) is being conducted (since 2005) on a permanent basis
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: Coordination with Health Authorities
The coordination with healthcare authorities will be done
through the collaboration with the eHealth ERA consortium
and its European Health Care Authorities (HCA) Ministries
Group that is co-ordinating with the national e-Health
roadmap activities within the EU-Framework Programme.
Both platforms (EuroRec and eHealth ERA) will follow the
necessary bottom-up and top-down approaches for the
adequate assessment of needs and for the optimal choice of
methods for EHRs certification in Europe.
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: Core Tasks (1)
1. Study of current EHRs « Quality Labelling and
Certification » -systems
(State-of-the-Art Report)
2. Assay of the requirements amongst all stakeholders across
Europe, covering both current and planned EHRs
certification activities
(Survey)
3. In-depth analysis of the ways to classify and profile EHR systems
(based on “functional profiles” and other aspects)
4. Comparison of various possible EHR certification systems
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: Core Tasks (2)
5. Definition of a model (a common European template) with
harmonized guidelines and procedures for EHRs certification
6. Benchmarking process manual for EHRs certification
7. Business plan for EHRs certification (cf. sustainability of
services)
(Extra: harmonization of terms and concepts ( an iterative
process) to be used, resulting in a
general glossary)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: Main WorkPackages
WP 1: Consortium Management, Project Co-ordination
and Quality Assurance
WP 2 : EHR systems Quality Labelling and Certification
Development
WP 3 : Resources for EHR Interoperability
WP 4 : Benchmarking Services
WP 5 : Communication and Dissemination Activities
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: WP 1
WP 1 : Consortium Management, Project Co-ordination
and Quality Assurance
T1.1
T1.2
T1.3
Consortium Management
Project Co-ordination
Quality Assurance
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: WP 2
WP 2 : EHR systems Quality Labelling and Certification
Development
T2.1
T2.2
T2.3
T2.4
T2.5
T2.6
State of the Art Report on existing EHR
Certification Schemas
Pan-European Requirements Assay
Labelling Terminology and Functional Profiles for
EHRs to be certified
Comparison and Harmonisation of Certification
Guidelines and Procedures
Model Certification Guidelines and Procedures
including Legal Issues
Plan for Validation of Guidelines
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: WP 3
WP 3 : Resources for EHR Interoperability
T3.1
T3.2
T3.3
T3.4
T3.5
Register of Conformance Criteria and Guidance
Documents
Inventory and Register of EHR Archetypes and
Guidelines for their Use
Register of Health Coding Systems in Use in Europe
Inventory of Relevant Standards for EHR systems
Register of XML Schemas and Open Source
Components for EHR systems
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: WP 3/ T3.3
T3.3
Registration of Health Coding Systems in Use in Europe
Implementation of the European Standard EN 1068
EuroRec has applied to act as a Registration Authority
and has been mandated by CEN/TC 251
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: WP 4
WP 4 : Benchmarking Services
T4.1
T4.2
Benchmarking Services Manual for Quality
Labelling and Certification of EHRs
Business Plan (for new certification related services)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
QREC: WP 5
WP 5 : Communication and Dissemination Activities
T5.1
T5.2
T5.3
T5.4
EHR Tutorials
Project Website Development and Maintenance
Liaison
Conferences
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EUROREC: Communication and Dissemination (1)
Fostering a harmonised implementation of high quality EHRs will require
promotion, awareness and educational actions, hence :
– EuroRec Website and associated services based on
trustworthy resources (to help purchasers, vendors
and end-users)
– Tutorials on EHRs and Certification
– Workshops and Annual Conferences:
– Liaison (with US, Canada, Japan, Australia…)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EUROREC’s wish to liaise (example: with the US)
– Standards :
– ANSI-HISB (Healthcare Informatics Standards Board)
– HL7 (CDA / Care Record Summaries)
– ASTM E31.28 Electronic Health Record SC (Continuity of Care Record)
- Certification :
- CCHIT (Certification Commission for Healthcare Information Technology)
- NAHIT (National Alliance for Healthcare Information Technology)
- AHIC (American Health Information Community)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
Harmonization Efforts
CEN/ TC 251 EHRCOM
Convergence
OpenEHR Archetypes
HL7 CDA, RMIM...
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
Global Health IT Standards Summit 2005
Global Health Information Technolgy Standards Summit
(ISO/TC 215)
19-20 September 2005, Hamamatsu City, Japan
ISO, CEN, HL7...
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
EUROREC (QREC): Communication and Dissemination (2)
– Annual Conferences:
– Eurorec 2005 Conference (in Denmark)
– EuroRec 2006 Conference (in Bulgaria)
– EuroRec 2007 Conference and Global EHRs
Certification Summit (in Slovenia)
– Eurorec 2008 Conference (in Romania)
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
http://www.eurorec.org
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
http://www.eurorec.org
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
http://www.eurorec.org
Prof. Dr. Georges De Moor, August 23, 2005 / Boston
Health IT Trends & Marketing Conference 2005
Thanks for listening!
http://www.eurorec.org
[email protected]
Prof. Dr. Georges De Moor, August 23, 2005 / Boston