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Using eHealth to cross organizational, regional and national borders

Using eHealth to cross organizational, regional and national borders - Denmark and the Baltic Sea Region as an example Henning Voss, project manager Danish Centre for Health Telematics hvo@cfst.dk & www.cfst.dk Ester 3 Tallinn, 16 October 2006. HEALTH CARE IN DENMARK. Public:

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Using eHealth to cross organizational, regional and national borders

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  1. Using eHealth to cross organizational, regional and national borders - Denmark and the Baltic Sea Region as an example Henning Voss, project manager Danish Centre for Health Telematics hvo@cfst.dk & www.cfst.dk Ester 3 Tallinn, 16 October 2006

  2. HEALTH CARE IN DENMARK • Public: • No insurance companies • No private hospitals • Financed with income taxes • Decentralized organisation • GP private company with gatekeeper function

  3. MedComThe Danish Health Care Data Network FynComThe Funen Health Care Data Network Employees: 5 Employees: 12 International ProjectsCoCo, Wise, Picnic, ciTTis, Open ECG, Baltic eHealth etc. Employees: 5

  4. MedCom - the Danish Health Care Data Network What? Who? A non-profit co-operation between authorities, health care professionals and IT . vendors. Focus on cross-sectoral communication. Create a marked for electronic communication in the Danish Health Care Sector. • Ministry of Interior and Health • Association of County Councils • Ministry of Social Affairs • Association of Local Authorities • National Board of Health • Copenhagen Hospital Corporation • Copenhagen Local Authority • Frederiksberg Local Authority • Danish Pharmaceutical Association • Association of Danish Doctors • DanNet (Danish Telecom)

  5. Situation in 1992 Each GP needed hundreds of different paper based forms

  6. Communication flows in primary care

  7. MedCom Business Model • MedCom creates standard – e.g. eReferral • In cooperation with users, IT vendors and health authorities • MedCom validates standards in pilots • eMessages are integrated by participating SW vendors in their IT systems • MedCom disseminates standards into large scale • MedCom supports users and vendors • SW vendors sell eMessage modules to all their customers

  8. Implemented in most systems • Implemented in 100 IT-systems among 4.000 healthcare institutions: • All hospitals 100 pct. • All pharmacies 100 pct. • Almost all GPs 98 pct. • Most specialists 78 pct. • Many municipalities 48 pct.

  9. MedCom MedCom tools: EDI TOP-10 Danish Centre for Health Telematicss -

  10. MedCom tools:Test and Certification

  11. MedCom tools: Connectathons

  12. Benefits • 50 minutes saved per day in GP practice • Telephone call to hospitals reduced with 66% • Patient satisfaction: less waiting time • 2,3 € saved per message = 75 million €/year • Cost-benefit studies (with financial figures and in English): • MedCom eReferral as case (EC/ACCA, 2004) • MedCom in general (Gartner Group, 2006) • European Best practise projects (EC/Empirica, 2006)

  13. MedCom Lessons learned Danish Centre for Health Telematics • Commitment is needed: national - regional - local • Go for the high volumes & highest priorities • Create economic incentives • KISS – Keep It Simple, Stupid! • Don’t wait for “the perfect solution” • Close down bad projects! • Be patient with good projects!

  14. Beds with EHRActual & expected

  15. MedCom National EHR strategies Danish Centre for Health Telematics EHR that can share and reuse data Process model Terminology system Clinical guidelines Basic EHR (CEN/ENV 13606) SNOMED CT . ??? .

  16. MedCom Basic EHR Model Danish Centre for Health Telematics • Developed by National Board of Health • Compatible with CEN/ENV 13606 • Focuses on continuity of care  deals mainly with the clinical processes • Less focus on implementation  SW choose different strategies

  17. MedCom Basic EHR Model Danish Centre for Health Telematics

  18. A set of European “all-to-all” eDocuments Aim: Semantic standardization across borders. For Patient Summary, eMessages etc. Usable for different IT strategies (National “Switch Point”, “Spine”, “National patient index” etc.) Based on different standards (EDIFACT, HL7 W3C etc.) Additional: Standardized terminology (e.g. Snomed CT) to overcome language problems. Core eDocuments For true cross-border European communication!!! Core European eDocuments

  19. * * * * * * * * Core European eDocuments • Proposed by NCCs in EHTEL • MedCom - Denmark • Carelink - Sweden • KITH - Norway • STAKES - Finland • Gematik - Germany • NICTIZ - Netherlands • EDISANTE - France • MedTel/IZIP - Check Republic • And…Estonia???

  20. SNOMED CT • Covers • Human medical domain • Human odontology • Veterinary medicine • Concept-based • 350.000 concepts • 1.5 million relationships • For sale!

  21. The Int. Health Terminology Standards Development Organisation (SDO) • Buy the IPR to SNOMED CT • Develop and maintain SNOMED CT • Non-profit society • Open and transparent • Accountable to the member countries and other participants (vendors etc.) • One country – one vote • Payment according to GDI • Based in Denmark • Currently still negotiating with CAP • Into force from 2007

  22. National Release Centre SNOMED SDO National Release Centre National Release Centre Local/National Health Entities National Release Centre Shared technology environment enables collaboration New SNOMED Enterprise Model

  23. Confirmed: Australia Canada Denmark Lithuania New Zealand United Kingdom United States Discussion with: Netherlands Sweden Members of SDO What about Estonia?

  24. Baltic eHealth • empowering rural areas in the Baltic Sea Region

  25. Partners Facts: • Ten partners • Five countries • Start: 2004 • End: 2007 • Budget: 2 M€

  26. Healthcare and migration? The idea… Introduction of eHealth in Rural areas Better access to specialized healthcare Less out migration from rural areas

  27. 3 out of 4 doctors position cannot be permanently filled Av: 39 48 46 48 Healthcare and migration? Factors having great importance for choice of current settlement, % (n=1988) Rural healthcare under pressure: • Ageing population • Lack of specialists

  28. The idea… Introduction of eHealth in Rural areas Better access to specialized healthcare Less out migration from rural areas

  29. Literature study (subset) Radiology as a part of a comprehensive telemedicine and eHealth network in Northern Finland, Reponen J., Int J Circumpolar Health., 2004 Dec;63(4):429-35. Remote working: survey of attitudes to eHealth of doctors and nurses in rural general practices in the United Kingdom. Richards H, King G, Reid M, Selvaraj S, McNicol I, Brebner E, Godden D. Fam Pract. 2005 Feb;22(1):2-7. Information Technology in the Rural Setting: Challenges and More Challenges. Frisse ME, Metzger J., J Am Med Inform Assoc. 2004 Oct 18; Information technologies in Florida's rural hospitals: does system affiliation matter? Menachemi N, Burke D, Clawson A, Brooks RG., J Rural Health. 2005 Summer;21(3):263-8. High-tech rural clinics and hospitals in Japan: a comparison to the Japanese average. Matsumoto M, Okayama M, Inoue K, Kajii E., Aust J Rural Health. 2004 Oct;12(5):215-9. Cancer information needs in rural areas. Engelman KK, Perpich DL, Peterson SL, Hall MA, Ellerbeck EF, Stanton AL., J Health Commun. 2005 Apr-May;10(3):199-208 Patient safety-related information technology utilization in urban and rural hospitals. Brooks RG, Menachemi N, Burke D, Clawson A. J Med Syst. 2005 Apr;29(2):103-9 The promise of e-health--a Canadian perspective. Alvarez RC., World Hosp Health Serv. 2004;40(4):31-5.

  30. Aim: Provide tools to make use of eHealth easier The idea… Introduction of eHealth in Rural areas Better access to specialized healthcare Less out migration from rural areas

  31. Results • Tools that facilitate use of eHealth: • Cross border eHealth infrastructure • Guidelines on how to overcome barriers for eHealth • Best practise examples

  32. But why cross-border? • Most eHealth is regional/national, but the lack of specialists tend to be national problems. • Solutions: • Specialists cross borders • Patients cross borders • Services cross borders

  33. Vilnius Tallinn Denmark ??? Norway BHN Sweden eHealth Infrastructure

  34. Overcoming barriers for cross-border eHealth • Recognising a number of “barriers” that need to be dealt with: • Technological barriers • Organisational barriers • Economic barriers • Legal barriers

  35. Legal issues • Confidentiality, privacy and information security • Responsibility • Licensing • Patients’ Rights • Informed Consent • Contract issues

  36. eUltrasound pilot • Classical second opinion approach: • Mid-wives and doctors in Västerbotten • The Norwegian Centre for Fetal Medicine • First step – off-line consultation • Second step – on-line consultation

  37. eRadiology pilot • Lack of Radiologists in Funen hospital • Waiting lists and traveling to other hospitals. • Solution: • Images are taken in Funen • Reports are made in Vilnius and Tallinn • Start with conventional radiology • Multi-lingual standardized reporting schemes • Goal: From pilot to production (incl. business model)

  38. Cross-border eRadiology

  39. Cross-border eRadiology

  40. Acceptance of cross border remote reporting A: If I can get a faster treatment in Denmark, it is all right if a doctor in a foreign country does the reading of my X-rays B: ”I do not feel comfortable with having a doctor in a foreign country read my X-rays” 72 % agreed in statement A => high acceptance (n = 1988, Danish telephone survey, oct. 2005)

  41. Final conference: May 2007 in Stockholm

  42. Thank you for your attention! www.Baltic-eHealth.org hvo@cfst.dk Questions? Baltic eHealth is co-financed by the BSR Interreg III B programme

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