Transcript Slide 1

Current and Future Initiatives of EuroRec
Past, Current and Future Initiatives
of EuroRec
Prof. Dr. Georges DE MOOR
EuroRec President
Georges De Moor, MD, PhD
Amstelveen, 8 oktober, 2009
Current and Future Initiatives of EuroRec
EuroRec is an independent
organisation established in 2003.
not-for-profit
Its main mission is to promote - as a federation of
national ProRec centres (15 member countries and 7
new applicants) - the use of high quality Electronic
Health Record systems (EHRs) in Europe.
It therefore also supports certification by defining
quality criteria.
Georges De Moor, MD, 2PhD
Sarajevo, September 1, 2009
Current and Future Initiatives of EuroRec
Organisational Issues:
- Adapt EuroRec’s Articles of Association (General Assembly Meeting,Nov.2009, Dublin)
- Redefine EuroRec’s Global Business Plan
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Current and Future Initiatives of EuroRec
International Liaison:
DG INFSO
BT and TC 251
TC 215
IHTSDO
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Current and Future Initiatives of EuroRec
Trends in Health Systems
The Old World
The New World
Provider-focused
Patient and family-focused
Illness
Wellness
Site-of-care
Continuum of care
Episode Management
Disease Management
Supply Management
Demand Management
Solitary Decision Making
Collaborative EBM
Efficiency
Effectiveness
General care
Specialized care
(from UHN, Toronto)
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Current and Future Initiatives of EuroRec
The care settings as starting points…
In eHealth the technical landscape is so fast moving that the
boundaries between tertiary, secondary and primary care
settings, homecare settings and even body settings are fading
away…
… leading to a continuum of care (cf. health and wellness).
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Current and Future Initiatives of EuroRec
Electronic Health Record (EHR)
All stakeholders across the world have recognized that the Electronic
Health Record is:
-a key tool in the provision of safe, high quality and effective care ;
-and a critical factor for clinical research .
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Current and Future Initiatives of EuroRec
Trends in Electronic Health Record systems (EHR s)
• Patient-centered (gatekeeper?) and longitudinal (life-long) records
• Multi-disciplinary / multi-professional
• Transmural and virtual
• Structured and coded (cf. semantic interoperability)
• Intelligent (cf. decision support)
• Personalised
• Predictive
• More sensitive content (e.g. genetic data)
• Integrative
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Seeing the full picture of an individual’s health status (I. Iakovidis)
Biosensors
Biochips
Environmental
Data
Genomic data
Phenomic data
Integrated Health Records
Current and Future Initiatives of EuroRec
History of EU funded EuroRec Projects
- MediRec
(FP3) (94-95) (C.A.)
Lisbon Declaration (Recom. 9)
- ProRec
(FP4) (96-98) (S.A.)
Creation of first ProRec centres
- Widenet
(FP5) (00-03) (A.M)
Creation of EuroRec
- QRec
(FP6) (05-08) (S.S.A.) Creation of Repository & Tools
- EHR-Implement
(FP6) (07-10)
Strategic Recommendations
- EHR-Q-TN
(FP7) (09-12) (T.N.)
Dissemination/Implementation
- HITCH
(FP7) (09-10)
Interoperability
- (Argos
(FP7) (10-11)
EU-US Collaboration)
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Current and Future Initiatives of EuroRec
Q-REC Rationale (Why Certification is Essential)
- To assure the quality of EHR systems: operability and patient safety!
- Sharing of information requires a quality assessment of EHR products with a
view to ensuring interoperability with other systems (users)
- Certification of EHRs is essential for both the buyers and the suppliers to
ensure that EHR systems are robust enough to deliver the anticipated benefits.
(EHR systems and related product quality (data portability and interoperability)
are otherwise difficult to judge!)
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Current and Future Initiatives of EuroRec
QREC: Origin
Several EU-member states (Belgium, Denmark, UK, Ireland,France …) have
already proceeded since many years with (EHRs-) quality labelling and/or
certification (more often in primary care) but these differ in scope, in legal
framework under which they operate, in policies and organisation, and
perhaps most importantly in the quality and conformance criteria used
for benchmarking …
These differences represent a richness but also a
risk: therefore harmonisation efforts should help to
avoid further market fragmentation in Europe
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Current and Future Initiatives of EuroRec
A few business cases for the quality criteria...
• An e-Health programme wishing to implement quality labelling or
certification as to ensure consistent EHR system functionality regionally
or nationally
• A purchaser wishing to procure an EHR system module
• A vendor/developer wishing to document his system or to (re-) develop
an EHR system module or wishing to interface a given module of his
system across multi-vendor systems
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A growing number of strategic eHealth projects
already are, or become certification-dependent, e.g.:
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•
•
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Administrative simplification
Electronic billing
Care pathways and disease management projects
Electronic prescription
Interaction with validated databases
Secure medical data exchange (summary records!)
Interoperability, operability and portability
...
Current and Future Initiatives of EuroRec
EuroRec Repository Flow
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Typology of Indexes
Multiple indexing of each statement to maximise the likelihood of finding
all relevant statements when searching via the indices
Business Functions (50 in 8 subcategories)
Care Settings (18 in 3 subcategories)
Component Types (18 in 4 subcategories)
•A0 EHR data (record) management
•A2 Administrative services
•A00 EHR data entry
•A20 Appointments and scheduling
•A01 EHR data analysis
•A21 Patient consents, authorisations, directives
•A02 EHR data content
•A22 Patient demographic services
•A03 EHR data structure
•A23 Certificates and related reporting services
•A04 EHR data display
•A24 Patient financial and insurance services
•A05 EHR data export/import
•A3 Care Supportive services
•A09 EHR generic data attributes
•A30 Supportive care service requests (orders)
•A1 Clinical functions
Business
Functions
service
reporting
(results)
Health
care enterprises
•B0 Generic or ubiquitous •A31 Supportive care•B1
•C3
Directory services
•C0 EHRS functional component
•A10 Clinical: medication management
•A32
Laboratory
services
•B10 Long-term care
(institution)
•B01 Regional healthcare network
•C30
Directory: patients
•C1
EHRS distribution)
infrastructure component
(specific
•A11 Clinical: long-term illness management
•A33 Imaging services•B11 General practice
•C31 Directory: personnel
•C10 EHRS Interoperability component
•B02 Virtual or telehealth
•A12 Clinical: health needs assessment
•A34 Diagnostic and therapeutic
services
(other):
•B12 Secondary
care
•C32(hospital)
Directory: equipment
ECG/EEG etc.
•C11
Security
management
component
Personal health
•A13 Clinical: care planning and care•B03
pathways
•B13
Tertiary
care
centre
(specialist
hospital)
•C33
Directory:
health
service directories
•A35 Pharmacy services
•A14 shared care
•B04 Community •C2
and Knowledge
home care resources
•B14 Domain specific
•C34 Directory: service resources
•A4 Analysis
and reporting
•C20 Knowledge:
terminology
•A15 Clinical: alerts, reminders and •B05
decision
support
Health,
wellness
and prevention
•B15
Profession
specific
•C35 Third parties
•A40 Screening
•C21
Knowledge:
ontology and preventive health
•A16 Clinical: workflow and task management
•B06 Occupational
health
•B2 Secondary uses
•C4 Profiling or authoring tool
•A41 Care
setting reports
•C22 Knowledge:
archetype
•A17 Clinical: patient screening and •B07
preventive
services
Publiccare
health
•B20 Research and
knowledge
discovery
•C5
Documentation,
support etc.
•C23 Knowledge: template
Care Settings
Component Types
•C24 Knowledge: data set
•C25 Knowledge: guideline
•C26 Knowledge: algorithm
•B21 Education •C6 EHR system functional component
•B22 Health service and planning
EuroRec Statements
EuroRec Languages
(non-exhaustive list)
• English (default language)
• Bulgarian
• Danish
• Dutch
• French
• German
• Italian
• Romanian
• Slovakian
• Slovenian
• Serbian
Multilingual: statement 2265
Current and Future Initiatives of EuroRec
Georges De Moor, MD, PhD
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Current and Future Initiatives of EuroRec
Q-REC Approach
EuroRec has installed a central repository of 1500 « validated » quality
criteria and other relevant materials and has developed tools that can be
used to harmonise certification, product documentation and procurement
specification of EHR systems.
EuroRec does not impose particular certification approaches or specific
criteria on any interested party but wishes to foster, via appropriate
channels, the progressive adoption of consistent and comparable
approaches to EHR system quality labelling. EuroRec could therefor be
considered as a service provider.
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How to Manage Certification?
EuroRec has Multiple Options:
1. Authority: Government (or mandated subcontr.) vs. Non Gov.
2. Self-certification by Industry (also an option!)
3. National based vs. Pan European (or joint, cf. specific/generic)
4. Mandatory vs. voluntary (with or without incentives)
5. Formal audit/testing vs. self-assessment (or pre-test assessment)
6. Scoring/rating scheme: pass/fail or more graded approach
7. Scheme review rate (1,2,…n year cycles)
8. Quality Assurance vs. Quality Improvement focus
Certification: a powerful weapon…
New instruments
Authority
4
New functions
3
Physicians
1
€
Vendors
2
Pressure
Current and Future Initiatives of EuroRec
- In the US: increased momentum via Obama’s stimulus plan: Meaningful
Use standards that HHS is developing under the American Recovery and
Reinvestment Act (ARRA);
- Meaningful Use: incentive payment from Medicare and Medicaid for
physicians and hospitals using EHRs;
- Terms for Meaningful Use under development;
- Certification ! CCHIT is already starting 2 new certification programs with
an eye toward helping providers earn federal subsidies starting in 2011!
(criteria and test scripts published…) (incremental inspection program…).
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Unveiling the EuroRec Seal
• To have a “base” level set of functions
that can be accredited across Europe.
• This will greatly appeal to the supplier industry and allow for more early
stage accreditation of systems across national boundaries.
• Harmonisation of the certification will favour harmonisation of products.
• Develop a strong, growing and profitable EHR supplier industry that can be
competitive globally.
Current and Future Initiatives of EuroRec
History of EU funded Projects
- MediRec
(FP3) (94-95) (C.A.)
Lisbon Declaration (Recom. 9)
- ProRec
(FP4) (96-98) (S.A.)
Creation of first ProRec centres
- Widenet
(FP5) (00-03) (A.M)
Creation of EuroRec
- QRec
(FP6) (05-08) (S.S.A.) Creation of Repository & Tools
- EHR-Implement
(FP6) (07-10)
Strategic Recommendations
- EHR-Q-TN
(FP7) (09-12) (T.N.)
Dissemination/Implementation
- HITCH
(FP7) (09-10)
Interoperability
- Argos
(FP7) (10-11)
EU US Collaboration
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Current and Future Initiatives of EuroRec
EHR-Implement is collecting, analyzing and comparing broad scale
Electronic Health Record implementations in European countries in order
to provide best practice and strategic recommendations.
In the past political, social and organizational aspects that can ruin
implementation have been overlooked.
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Current and Future Initiatives of EuroRec
EHR-QTN is a Thematic Network project that prepares the health
community across Europe (including also most Eastern European
countries) for systematic and comparable quality assurance and
certification of Electronic Health Record systems and other eHealth products.
The project fits with objective 1.6 of the 2nd Call for Proposals for
the CIP-ICT PSP program: “Improving certification of e-Health
products”
EuroRec is offering its repository of quality criteria and its tools to
facilitate the deployment of such certifications throughout Europe.
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Current and Future Initiatives of EuroRec
United Kingdom
Austria
Belgium
Spain
Bulgaria
Slovenia
EHR-QTN
Croatia
Slovakia
Cyprus
Serbia
28 Partners
24 Countries
Czech Republic
Romania
Portugal
Denmark
Poland
Estonia
Norway
France
Germany
Netherlands
Luxembourg
Greece
Italy
Hungary
Ireland
Georges De Moor, MD,29PhD
Sarajevo, September 1, 2009
Current and Future Initiatives of EuroRec
EHR Q TN Activities
1.
Validate and customise the EuroRec criteria (with a focus on on eprescription and patient summaries) in 25 countries
Database of stakeholders (esp. EHRs vendors,incl.SMEs)
Inventory of legal issues regarding certification
Annual EHR-QTN International Conferences
In each of the 25 countries one workshop per year on:
2.
3.
4.
5.
•
•
•
Validation of EuroRec Repository and Criteria (Y1)
Tools for certification, product documentation & procurement (Y2)
Procedures for EHR Quality Labelling and Certification (Y3)
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Current and Future Initiatives of EuroRec
HITCH
Healthcare Interoperability Testing and
Conformance Harmonization
Establish a deployable process for the Interoperability Conformance Testing of
information systems in the field of Healthcare.
…where two different worlds interact with each other in a common project:
- Technical Conformance Testing of Interoperability
, ,and
- Quality Labelling and Certification
! CEN/CENELEC/ETSI
M403 – eHealth Interoperabillity / Phaze 2
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Current and Future Initiatives of EuroRec
Other New Areas of Interest of EuroRec
- Semantic Interoperability: the EHR-content, ontologies, archetypes, templates, terminologies
- Personal Health Records: and their interaction with Professional Health Records
- Re-use of Electronic Health Record data: for research, clinical trials (and vice-versa! )
- EHRs and Pre-emptive care: genetic data to manage individual risk for potential diseases
- Certification of other (EHR-related) systems: widening EuroRec’s scope
- Collaboration at global level: e.g. between the EU and the US
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Current and Future Initiatives of EuroRec
Value of Clinical Archetypes (D. Kalra)
• Empowerment of healthcare professionals
– enable clinical data sets and structures to be shared
• Provide target knowledge representations for use by guidelines and
care pathway systems
• Decision support of physicians and intelligent coaching of patients
• EHR entries identify the Archetypes used when the data were created,
and/or to which they map
– aids future interpretation, analysis, computation
– contributes towards semantic interoperability
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Current and Future Initiatives of EuroRec
Archetypes / Detailed Clinical Models
- to identify high quality archetypes which will have been developed
elsewhere and to make them available to a broader community
- to organize the involvement of clinicians via their official and authoritative
associations (part of the 500 million Euro ELSA; to start a major experimental and clinically
driven project for clinical content quality assurance embracing archetypes and terminology)
- to develop formal methods of validating the design and content of
archetypes
- to develop a formal process of verification and certification for archetypes
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Current and Future Initiatives of EuroRec
Re-use of (medical) data
Patient
Clinician
TRUST
EHR (EMR, EPR…)
PHR
Privacy Enhancing Techniques
Clinical Trials
& Research
Billing
Safety and
Adverse
Event
Registers
Georges De Moor, MD, PhD
Marketing
Knowledge
Mgmt
Platforms
Decision
Support
Systems
35
Healthcare
Management
Amstelveen, 8 oktober, 2009
Current and Future Initiatives of EuroRec
Georges De Moor, MD, PhD
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Current and Future Initiatives of EuroRec
Pilot Projects: “Transatlantic Methods for Handling Global Challenges in the
European Union and United States”
RELEX/C1/2009/PP
The general objective of the pilot projects is to promote mutual understanding
and learning among EU and US policy researchers and policymakers on a
number of challenges with a global dimension.
EuroRec’s main interest:
Comparative assessment of the EU and US approaches in the target
area:
“e-Health: interoperability and certification of Electronic Health
Records”
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EuroRec is at your service !
1. Developing & maintaining a central repository with quality criteria
2. Developing tools: certification, procurement and product doc.
3. Providing guidance and assistance to all stakeholders
4. Assisting Authorities in introducing / adopting certification
5. Training and accreditation of surveyors (European level)
6. Set-up of certification session (incl. scenario scripting/operations)
7. Validation of clinical archetypes (clinical models)
8. Continous & total Q.A. of processes and procedures
Some Conclusions
• Certification is a powerful weapon: use it!
• Continuity of certification should be guaranteed (this is for the matter
credibility)
• Efficiency: do not (re-)invent the wheel
• Take advantage of the growing EuroRec repository and of the broadening
certification scope (e.g. Certification of “EHRs in other settings” and of other
eHealth applications)
• Align choices & strategies with European and International ones
(cf. standards, clinical models and coding systems ...)
• Professionalize the certification procedures
• Build a long term, incremental and consistent certification roadmap which is
in harmony with your overall healthcare strategy
• ...EuroRec is your partner and is at your service !
Current and Future Initiatives of EuroRec
Thanks for listening!
http://www.eurorec.org
[email protected]
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Amstelveen, 8 oktober, 2009