1. Dr. H. Karanikas
eHealth in the Public Sector
The example of the Electronic Health Record for Primary Health Care
Dr Haralampos Karanikas
eHealth & IT Consultant, Athens Medical Society
eHealth Researcher at NKUA
2. Dr. H. Karanikas
HALF of EU enterprises
provide mobile devices for
business use
276.5 million EUR
turnover
of EU B2C eCommerce (2012)
14% of EU SMEs
selling online
29% of EU
enterprises
use e-Invoices
28% EU enterprises
use Social media
38% EU venture capital
DIGITAL BUSINESS
Digital revolution
“Do or Die”
72% of EU individuals
uses INTERNET regularly
900 000 estimated
demand/supply gap by 2020
150 Million
subscriptions
fixed Broadband
130 mobile
subscriptions
per 100 people
ICT drives 1/3rd
EU GDP growth
1995-2007
2.4%
of workforce
+ 4.1%
yearly employment growth
ICT professionals
55%
work outside ICT sector
7% of GDP
Size of the
digital
economy
6% of
Gov't
R&D
17% of
business
R&D
by ICT
sector
ICT
sector
4.4%
ICT in
Other Sectors
17% EU patents
3. Dr. H. Karanikas
eHealth
eHealth is the provision of health services,
supported by electronic means.
It includes health information networks,
electronic health records, telemedicine,
tele-care, chronic disease management, and
systems for monitoring, supporting patients
and their families.
Internet is an effective means by which in an economic
way one can retrieve anywhere, anytime medical
information.
The "patient" is "consumer” of electronic health
services and requires a more active role in their health
management.
4. Dr. H. Karanikas
IT Applications - Data
In healthcare we are beginning to realize that the real value is not in the IT
infrastructure, but to the data. Good data is the "key" to improve health outcomes,
better chronic disease management and better management of population health
overall.
These data must be kept and be accessible for the entire life of the citizen.
This brings many challenges for current computer systems, as they have not been
designed so that data "survive" outside applications. When we have a change of
application (usually every 7-10 years), it is not unusual to get lost historical data and to
have a fresh start with the new system.
Thus, it becomes clear that the storage of health data should be independent of the
application (and therefore independent of the supplier).
This has already happened in the imaging data, PACS systems. We believe that the same
thing should happen with all clinical data.
5. Dr. H. Karanikas
Big data in health
The most commonly accepted definition, Gartner (the 3 Vs)
“Big data is high-volume, high-velocity and high-variety information assets that
demand cost-effective, innovative forms of information processing for enhanced
insight and decision making.”
to put together multiple sources of information,
coming through many different channels,
to ignore what is not important,
to work under time constraints,
support analysts and end users
The key issue is to utilize all of these together using innovative technology, serving
the needs of users
Includes large data from multiple sources, such as biological, clinical, and
environmental information relating to the health status of individuals and can only
be dealt with by new technologies for large-scale storage, integration and analytics.
6. Dr. H. Karanikas
Strategy Documents 1/2
• Development and operation of ESY.net, KEN-
DRG, ePrescription, ERP part of the hospital IT
systems etc
7. Dr. H. Karanikas
Strategy Documents 2/2
• Εxpanded primary care network. Coordinated
and integrated care, using e-governance and new
technology.
• EOPYY play a vital role to ensure universal
access to care by cost-effective purchasing of
health services.
• Τhe development of the Greek DRG system
8. Dr. H. Karanikas
• IDIKA is one the main institutional partners of MoH for strengthening eHealth
• The establishment of Ministries for Digital Policy and Telecommunications and
Administrative Reconstruction ( includes eHealth and eGovernment Health)
• Establishment and operation of the National eHealth Council
– National Standard of Electronic health record for the citizen,
– National Interoperability Framework,
– National Contact Point for European citizens (cross-border healthcare)
– Integration of Electronic referrals and prescribing.
• Ongoing to establish the Electronic Health Care Network
Current eHealth priorities 1/2
9. Dr. H. Karanikas
• IDIKA to be the national central node of eHealth services with other European
agencies.
• Continue upgrading ePrescription with Medical Prescribing protocols,
contraindications, SPCs filters.
• Develop Patient Registers based on ePrescription.
• EHR for PHC, Patient Consent, eRDV
• “Health Atlas” (www.healthaltas.gov.gr) information database concerning health
professionals, health services etc.
• eGovNow since the beginning of 2017 will interconnect hospitals.
• New ESPA
– «Integrated Information System for the Support of Primary Health Care» (IDIKA)
– «Unified registries and code lists for Ministry of Health»
Current eHealth priorities 2/2
10. Dr. H. Karanikas
IDIKA
ePrescription
electronic Appointments
Patient Summary (PS)
Electronic Health Record
Patient Consent
Register of Chronic disease
Prescription guidelines (with the coordination of Athens Medical Society)
EOPYY
E-DAPY
Notices
Insured Health Record
Central monitoring announcements for hospitalization
eDAPY for materials and special diet formulation
Disease Registries (Hepatitis C, Chronic Myelogenous Leukemia)
Main eHealth stakeholders
11. Dr. H. Karanikas
Ministry of Health (MoH)
Integrated Hospital Information Systems (13 projects for Health Care Regions HCR)
ΒΙ MoH
National Telemedicine Network (2nd HCR - EKEPY)
a. Tele-diagnosis – Tele-consulting, b. Distance Learning, c. Telemedicine in emergency cases, and d.
Tele-psychiatry.
Medical instruments with which it is equipped a typical Telemedicine unit include: Otoscope,
Dermatoscops, Ophthalmoscope, High resolution examination camera, stethoscope, vital signs
measurement device, cardiograph
EDET
Cloud for health applications
Blood registry
EOF, EKAPTY, KEELPNO, EPY etc
Main eHealth stakeholders
12. Dr. H. Karanikas
Avoiding incorrect prescribing problems - control 5 points
– right medicine
– correct dose
– proper patient
– Timing
– Proper administration route
ePrescription:
– «creation, sending, execution and monitoring of pharmacological treatments
based by electronic means» [Miller et al, 2005].
– ability to send error-free, accurate and understandable prescriptions
electronically from the healthcare provider to the pharmacy.
Example: ePrescription
13. Dr. H. Karanikas
The implementation of an integrated electronic prescribing system was established by the law
– 3892/2010 (ΦΕΚ Α΄ 189/04.11.2010) Electronic, entry and execution, of prescriptions and orders for
medical tests.
• In conjunction with the data protection law 2472/1997 (ΦΕΚ Α'50 10.4.1997)
13
Total
9.000.000 persons
43.000 doctors
11.900 pharmacies
Per month
5.500.000 medicines'
prescriptions (99%)
2.000.000 referrals of
diagnostic tests (92%)
3.000.000 persons
The ePrescription System
14. Dr. H. Karanikas
14
– Directives 2011/24/EU, 2012/52/EU
– GUIDELINES ON MINIMUM/NONEXHAUSTIVE PATIENT SUMMARY DATASET FOR
ELECTRONIC EXCHANGE IN ACCORDANCE WITH THE CROSS-BORDER DIRECTIVE
2011/24/EU
• Status: Adopted by eHealth Network, Date: 19 November 2013
– GUIDELINES ON ePRESCRIPTIONS DATASET FOR ELECTRONIC EXCHANGE UNDER
CROSS-BORDER DIRECTIVE 2011/24/EU
• Status: Adopted by eHealth Network, Date: 18 Nov 2014
• non-binding guidelines on electronic prescriptions
• Minimum technical requirements for cross-border ePrescriptions
• Minimum technical requirements with regard to data security
• Storage periods, Organisation of dispensations
• Minimum requirements for ePrescriptions with regards to their content
• Legal background, Evaluation and quality assurance
• etc
– Patient Registries Guidelines (Adopted by eHealth Network, November 2015)
EU Guidelines
16. Dr. H. Karanikas
Registry holders and Member States:
• to improve registry quality and interoperability between registries and their data sources by
following and implementing the PARENT Guidelines
• to demonstrate the importance of registry data for evidence-based policy making and to
encourage data use and re-use via means of collaborative research studies and publication of
results
• to increase patients' awareness of the importance of high-quality registry data and
encourage their involvement in the generation and use of data
• to share the national legislations, plans and strategies concerning the areas of registries,
eHealth/Electronic Health Records, Rare Diseases, HTA and potentially European Reference
Network.
eHealth Network recommends
17. Dr. H. Karanikas
Primary Health Care (PHC) – Electronic Health Record (EHR)
• Consistent use of an EHR for PHC does not ensure successful use for improving the
quality of health care.
• Continuing efforts to encourage the adoption and meaningful use of EHR in
primary care should focus and ensure that the use manages to improve care.
• In an outpatient setting, a medical record covers the entire life of the patient
(citizen), is not an episode of care (such as hospital stay). So we should have an
EHR from which we can create reports in time. In the absence of continuity of
care, continuity of information is necessary to optimize healthcare.
• Support for integrating EHR to user workflows.
• Can improve care, when, for example, reminders in conjunction with the regular
health check and vaccinations, as common tools support health personnel.
19. Dr. H. Karanikas
It covers the majority of diagnoses occur in primary care.
Easy to use.
Collaborates with other encodings.
Continually evolve and be accepted.
Coding for PHC
25. Dr. H. Karanikas
Concluding remarks
• Redefining roles of stakeholders and optimum utilization of existing nationwide
applications
• Clarifying the role of IDIKA and relationship with EOPYY
• Interoperability Standards - Certification of IT resources
• Open data – Open Systems
26. Dr. H. Karanikas
On going work
Athens Medical Society has developed a Health Portal dedicated to Health
professionals. Includes eLearning, medical knowledge base, Health Journal
and other services.
http://www.mednet.gr/ - http://www.e-healthnet.gr/
Athens Medical Society & ΕΕΜΕΠΥ is leading or participate on the following
on going actions:
– Developing Diagnostic protocols in a machine processable format for the ePrescription
system.
– Developing Patient Registries.
– Developing and incorporating to Protocols system a Drug Summary subsystem, including
drug specific information such as Drug Interactions, Allergies etc
– Application of Clinical guidelines to NHS hospitals (Pilot stage).
– A national committee has been established to set up the framework and coordinate all
actions for the application of Therapeutic Protocols.
27. Dr. H. Karanikas
Synergies are needed …
... to regain the advantage of the relation of health 'needs' with
health data and thus improve the quality of health care.
… clear, feasible plan followed up until the end.
Thanks …
h.karanikas@gmail.com
Dr. Haralampos Karanikas
eHealth Consultant
Editor's Notes
a framework for building detailed clinical models used to hold semantically interoperable data.
For this reason, we have built our Think! Clinical so that it stores data in a clinical data repository we call Think!EHR Platform using a standard called openEHR ( www.openEHR.org ). It provides a framework for building detailed clinical models used to hold semantically interoperable data. The standard has been in academic use for more than ten years, but it lacked adequate tools, commercial products and large real-world deployments.Our goal is to change this. While continuously improving the performance and toolset of our platform, we are involved in several large deployments:• Our Think!Clinical product provides the Ljubljana Children’s hospital a single patient view, enabling nurses and physicians to take better care of their patients. All clinical data including medical device data is managed by our Think!EHR health data platform so users can rely on consistent and timely information. Several processes were transformed, including lab and radiology orders, but perhaps the most significant is Medication Prescribing and Administration as it is a key component of patient safety.• Slovenia’s National eHealth backbone runs on our Think!EHR Platform, enabling exchange of documents and structured health data between the country’s 120 healthcare providers. It also enables centralised eHealth applications managing Immunisations, Prescriptions, Referrals and Patient Summaries at the national level.• Moscow City has built a city-wide EHR using Think!EHR Platform to manage all clinical data for 12 million inhabitants. By providing a health data platform to participating vendors, Moscow City ensured all data from newly developed applications is open, pre-integrated and thus interoperable. Such interoperability is often an afterthought, resulting in high costs of integration of proprietary data. And, as new applications come and go, the data will remain stable and available for the lifetime of the patient. (see video: https://www.youtube.com/watch?v=K0lmDlksHnY)• Unimed, a Brazilian insurer and health service provider with 19 million customers is using Think!EHR Platform to aggregate all clinical data from their seven hospitals in Sao Paolo. This provides them with a single patient view across the group, but also enables them to build new applications, like the patient portal once for all facilities.• Cambio, the largest hospital information system provider in Sweden, is deploying Think!EHR Platform for clinical decision support. By normalizing clinical data using our platform, they can roll out the same application across their customer base, significantly reducing integration costs and time to market.• Signed partner contracts with major HIS providers like Cambio (27% of the Swedish market), DIPS (85% of Norwegian hospitals) and Critical Software (Portugal and Brazil)
the falling cost of whole genome sequencing, and the rise in collection of diverse personal data, means that we are on the cusp of having ‘big data’ that can be used to track the health of individuals and populations in more detail than ever before. The different types of personal data being collected include physiological data (e.g. online blood sugar monitoring), behaviour (e.g. movement tracking), disease, prescription history, and clinical outcomes.
The proposed definition reads as follows: The term 'big data in health' encompasses high-volume, high-diversity biological, clinical, environmental and lifestyle information collected from an individual or cohort in relation to their health and wellness status, at one or several time points. Big data may come from various kinds of sources, including genomics, metabolomics and proteomics measurements and derived data, clinical trials, EHRs, patient registries, insurance claims, mobile applications, environmental monitoring, or behavioral and socioeconomic indicators. Big data in health is used to improve the efficiency and effectiveness of prediction and prevention strategies, or of medical interventions, which often requires the use of innovative tools and methods.
Τα δεδομένα μας ικανοποιούν τις 4 “V” προκλήσεις : Volume (Όγκος), Velocity (Ταχύτητα), Variety (Ποικιλία ), και Veracity (βεβαιότητα ή ακριβή στοιχεία), καθώς επίσης και τη πρόκληση “D” Distribution of Data Sources (Κατανομή των πηγών δεδομένων) που αποτελούν την εποχή «μεγάλων δεδομένων».
Η δημιουργία των Υπουργείων Ψηφιακής Πολιτικής και Τηλεπικοινωνιών και Διοικητικής Ανασυγκρότησης (Ηλεκτρονική Υγεία και η Ηλεκτρονική Διακυβέρνηση στην Υγεία)
E-prescribing is meant to reduce the risks associated with traditional prescription script writing.
Είναι επίσης ένας από τους σημαντικότερους λόγους για την ώθηση στην ανάπτυξη ηλεκτρονικών ιατρικών αρχείων.
Electronic prescribing should be seen as an important step in improving patient care, with an eye toward moving to implementation of a complete EHR system.
Οι παραπάνω οδηγίες μπορεί να αναφέρονται σε διασυνοριακή περίθαλψη …. αλλά βασική χρησιμότητα είναι εντός χώρας… ασε που λόγω χαμηλής διαλειτουργικότητας το διασυνοριακό μας βολεύει….
A secondary focus of the guidelines is to provide material for each Member State to use, if they wish, for reference at national level.
There is a particular issue regarding the identification of medicinal products. The
European Medicines Agency (EMA) has suggested the use of the inventory of medicines
established under the legal obligations laid down in Article 57 (2) of Regulation (EU) No
1235/2010 of the European Parliament and of the Council of 15 December 2010
amending, as regards pharmacovigilance of medicinal products for human use,
Regulation (EC) No 726/2004 laying down Community procedures for the authorisation
and supervision of medicinal products for human and veterinary use and establishing a
European Medicines Agency (“pharmacovigilance legislation of 2010”)13: the so-called
‘Article 57 database’. Member States will work with the EMA and the European
Commission to explore this issue.
Big data may come from various kinds of sources, including genomics, metabolomics and proteomics measurements and derived data, clinical trials, EHRs, patient registries, insurance claims, mobile applications, environmental monitoring, or behavioral and socioeconomic indicators.
Σχόλια για
Interoperability
αξία των data (και ειδικά το evidence-based policy making κόντρα στα οριζόντια μέτρα)
Citizen engagement (mobile)
Short term synergies
I am saying registry holders because in order to achieve interoperable systems we need “interoperable humans” sharing a common interests.
PARENT target audience are all Patient Registries across diseases and medical cases.
REA: Relative Effectiveness Assessment