Regional Health Information Network of Crete - HYGEIAnet

1. Regional Health Information Network of Crete - HYGEIAnet Stelios C. Orphanoudakis Institute of Computer Science FORTH and Department of Computer Science University of Crete Heraklion, Crete, Greece

2. the healthcare environment is changing • Population mobility and continuity of care • Care to the point of need (incl. Home Care) • Distant monitoring of health status • Intermittent hospital • Personal health management enabled by wellness pathways • Evidence-based medicine • Increasing role of genomic data and bioinformatics • Emphasis on the creation and consistent use of a life-long (active) I-EHR Technology is taking on a leading role Stelios C. Orphanoudakis

3. Best practice, as determined by experts on the basis of outcomes, requires integrating individual clinical expertise with the best available external evidence from extensive clinical trials. However, finding, interpreting and applying the results of the thousands of clinical trials reported in published research literature, is a major problem.1 The result is an inefficient transfer of evidence from the research world to the clinic. “there is an enormous ‘voltage drop’ from what is known in medical science to what the average patient receives for medical care.”2 information and knowledge transfer 1 T.C. Rindfleisch, D.L. Brutlag, Directions for clinical research and genomic research into the next decade: implications for Informatics, J. Am. Med. Inform. Assoc. 5 (5) (1998) 404-411 Sep/Oct 2 L. Weed, Clinical judgment revisited, Methods Inf. Med. 38 (1999) 279-286 Stelios C. Orphanoudakis

4. the challenge to date remains ... • Comprehensive • Comprehensible • Compatible how to make eHealth services • Available • Affordable • Accountable A A A C C C Stelios C. Orphanoudakis

5. priorities for the 21st century Today, dominant trends in healthcare include the movement towards shared or integrated care, in which the single doctor-patient relationship is giving way to one in which an individual’s healthcare is the responsibility of a team of professionals across all levels of the healthcare system. These trends necessitate the development of: • Regional Health Information Networks (RHINs) • Life-long (active) integrated electronic health record (I-EHR) • Synchronous and Asynchronous Collaboration Services • Novel eHealth Services Stelios C. Orphanoudakis

6. Region of Crete • Population of ~600,000 • Large number of isolated communities in remote locations • Population more than doubles during the summer period • Accidents more than triple during the summer period • 42% of accidents involve tourists • The Healthcare System of Crete includes all levels of the hierarchy • The Venizelion General Hospital and EKAB-Crete offer medical services to other islands in the South Aegean A model for the design and implementation of RHINs Stelios C. Orphanoudakis

7. An infrastructure that provides shared resources for health care agents and patients enabling information to flow in an appropriately structured, identifiable (unambiguous) and secure fashion. The Principles… Implementation based on a modular and scalable architecture component-based SW promotion of interoperability use of open standards evolution from the current infrastructure, while adding new capabilities provision of high quality services HII – Health Information Infrastructure Stelios C. Orphanoudakis

8. diverse set of mobile, wireless and terrestrial communications Stelios C. Orphanoudakis

9. diverse, heterogeneous applications and services Pre-hospital Emergency Care Integrated Electronic Health Record Hospital Care Venizeleion Telematic Services Home Care Primary Care Stelios C. Orphanoudakis

10. Caller - Dispatcher GPS - GIS Medical Doctor Health Emergency Coordination Center Patient/ Consumer pre-hospital health emergency management (EKAB-Crete) Mobile Units Stelios C. Orphanoudakis

11. complementarity and continuity of effort INTERREG II Deployment of HYGEIAnet on Crete Services ISTs HEALTHNET I.H.I.S. R&D Stelios C. Orphanoudakis

12. achieving critical mass • Diffusion of innovation is a gradual and often difficult process, and requires effective management of change • The rate of adoption of innovative solutions is influenced by many social, cultural, economic, organizational, and political factors • Education, training, and continuous technical support is a key success factor All available evidence indicates that a critical mass has been achieved on Crete Stelios C. Orphanoudakis

13. benefits • benefits are to be assessed regularly until steady-state is achieved • in HYGEIAnet, measurable benefits have been observed regarding • the cost to benefit ratio • access to care • quality of care • creation of a critical mass and momentum Stelios C. Orphanoudakis

14. conclusions • a vision and long term strategy • adequate investment and continuity of effort • empowerment of users • effective management of complexity • effective management of change • resolution of medico-legal issues • medical liability • reimbursement The development and deployment of next-generation RHINs and innovative eHealth services requires: Stelios C. Orphanoudakis