Ilias Iakovidis PhD Deputy Head, " ICT for Health “ Unit Information Society & Media DG European Commission Empowering patients through e-health http://europa.eu.int/information_society/activities/health/index_en.htm European Connected Health Leadership Summit Belfast 6-7 May, 2009

Health sector in EU Employs 9.3 % of workforce, > 15 M people (retail 13.0 M, business services 13.3m) Health expenditure > 8,5 % of GDP, growth at 4% a year (faster than EU economic growth), potential to reach 16% of GDP in EU by 2020 (Healthcast 2020, PWC) Health care is information intensive sector but ICT penetration is low compare to other sectors. There is great potential for benefits for individuals, society and economy when ICT, leadership and skills come together

Employs 9.3 % of workforce, > 15 M people (retail 13.0 M, business services 13.3m)

Health expenditure > 8,5 % of GDP, growth at 4% a year (faster than EU economic growth), potential to reach 16% of GDP in EU by 2020 (Healthcast 2020, PWC)

Health care is information intensive sector but ICT penetration is low compare to other sectors.

There is great potential for benefits for individuals, society and economy when ICT, leadership and skills come together

eHealth (ICT for Health) 1. Clinical information systems a) Specialised tools for health professionals within care institutions b) Tools for primary care and/or for outside the care institutions 2. Telemedicine systems and services 3. Regional/national health information networks and distributed electronic health record systems and associated services 4. Secondary usage / non-clinical systems a) Health education and health promotion of patients/citizens b) Specialised systems for research, public health ••• *Definition agreed with the eHealth Industry Stakholders Group reporting to the i2010 sub group on eHealth

1. Clinical information systems

a) Specialised tools for health professionals within care institutions

b) Tools for primary care and/or for outside the care institutions

2. Telemedicine systems and services

3. Regional/national health information networks

and distributed electronic health record systems and associated services

4. Secondary usage / non-clinical systems

a) Health education and health promotion of patients/citizens

b) Specialised systems for research, public health

eHealth for Sustainability Some examples Efficiency & productivity – to do more with less From ‘hospital-based’ to ‘patient-centred’ care From ‘late disease’ to ‘early health’ Two main areas: Preventive medicine Chronic disease management Empowering the patient (training, monitoring ..) Predictive medicine Molecular medicine eHealth for the economy – Lead Market sector

Efficiency & productivity – to do more with less

From ‘hospital-based’ to ‘patient-centred’ care

From ‘late disease’ to ‘early health’

Two main areas:

Preventive medicine

Chronic disease management

Empowering the patient (training, monitoring ..)

Predictive medicine

Molecular medicine

eHealth for the economy – Lead Market sector

eHealth works: Efficiency and productivity National and Regional Health information Networks improve quality, efficiency, and will save next year € 80 Mil/year in Denmark (Medcom) and € 60 Mil/y in Czech republic (IZIP) ePrescription improves patient safety, saves € 70 Mil/y in Sweden Direct Online information Services such as NHS Direct online– empower patients, avoid unnecessary hospitalisation, support lifestyle choices, save € 110 Mil/year www.good-ehealth.org www.eHealth-impact.org http://www.epractice.eu

National and Regional Health information Networks improve quality, efficiency, and will save next year € 80 Mil/year in Denmark (Medcom) and € 60 Mil/y in Czech republic (IZIP)

ePrescription improves patient safety, saves € 70 Mil/y in Sweden

Direct Online information Services such as NHS Direct online– empower patients, avoid unnecessary hospitalisation, support lifestyle choices, save € 110 Mil/year

eHealth Market in EU Potential eHealth is currently the fastest growing industry of health sector, estimated at € 20 Billion, 2% of Health expenditure Other EU markets: Pharma € 205 Bill., Medical Technology € 64 Bill. By 2010, a double digit growth rate of up to 11% is foreseen for eHealth, driven by a search for more productivity and performance (source: Datamonitor 2007) Challenges Standardisation Interoperability Business model & financing

Potential

eHealth is currently the fastest growing industry of health sector, estimated at € 20 Billion, 2% of Health expenditure

Other EU markets: Pharma € 205 Bill., Medical Technology € 64 Bill.

By 2010, a double digit growth rate of up to 11% is foreseen for eHealth, driven by a search for more productivity and performance (source: Datamonitor 2007)

Challenges

Standardisation

Interoperability

Business model & financing

Region 3 Hospital Home Pharmacy Health Centre mobile PC Mobile , Wireless & Broadband Emergency Secure Networks Region 2 Mobility Region 1 Step 1 (past EU R&D activities) Health Information Networks Connecting providers: Messaging, EHR GP

EU World Leader in deployment in primary care (EC Study 2007) 87.4% 80% 66.1% 69% 62.5% 62.3% 55.2% 44.4% 13.9% 15.1% 2.7% 0.9%

IT use among primary care physicians in seven countries

EU GPs using a computer during consultation, in % (EC Study 2007) Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008 100% 66% 3% Random samples of 6,789 GPs in 29 countries

GPs: Electronic exchange of patient data by purpose (selected countries) Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008 0.5 2.9 25.5 34.8 18.6 88.2 NO 0.4 5.1 31.5 26.5 43.2 84.9 UK 1.5 80.9 15.7 13.1 8.2 82.4 SE 0.4 0.4 20.8 54.8 7.6 90.0 FI 4.7 71.0 27.5 26.0 45.4 83.8 NL 0.0 0.7 1.3 1.3 5.3 39.3 EE 1.9 97.3 74.0 73.6 47.9 96.2 DK 1.0 2.4 5.8 3.4 9.7 5.3 BG 0.9 1.6 12.9 12.9 2.5 73.5 BE 0.7 6.3 9.7 10.3 15.1 39.8 EU27 Medical data cross border Prescription to pharmacies Admin data to other care providers Medical data to care providers / professionals Admin data to reimbursers Lab results from laboratories

Interoperability across borders Linking basic information between patient summary systems or giving access to physicians to patient summary in your home country Country or Region 3 Secure Networks Country or Region 2 Mobility Country or Region 1 Patient Summary 1 Patient Summary 2 Standardised exchange/access to common data sets Direct access of physicians when legal

EC Recommendation on Interoperability of cross border electronic health record systems COM(2008)3282 Aims at enabling coordinated care by connecting people, systems and services Provides Member States and relevant bodies with basic principles to address the existing challenges in implementing EHR interoperability Identifies different levels of actions: Political, Organisational, Technical, Semantic, Important issues: standardisation, certification, conformance testing, education and awareness Need for concerted action among all Member States!

Aims at enabling coordinated care by connecting people, systems and services

Provides Member States and relevant bodies with basic principles to address the existing challenges in implementing EHR interoperability

Identifies different levels of actions:

Political, Organisational, Technical, Semantic,

Important issues: standardisation, certification, conformance testing, education and awareness

Need for concerted action among all Member States!

 Quality/Efficacy of Healthcare services  Lifestyle: what we eat, drink, breath, …  Physical and social environment  Genetic “blueprint” /profile at birth  Acquired genetic changes ICT – important tool for all factors! (not only health delivery systems) Factors determining a health status of an individual & population Exogenous Determinants (Nurture) Endogenous Determinants (Nature) Health delivery system

Step 2:Current EU activities Connecting individuals with providers/Health Information Networks Region 3 Hospital Home Pharmacy Health Centre mobile PC Mobile , Wireless & Broadband Emergency Secure Networks Region 2 Mobility Region 1 GP

Boario telecardiology: 35-47% reduction in hospital admissions (in various studies) 12% reduction in outpatient visits UK studies: Wireless Healthcare (2004): Early discharge from hospitals -> up to 85% reduction in weekly care costs Cost of telecare at home with 24 hours response = 1/3 of the cost of a nursing home place Potential of Mobile Monitoring in Germany: Up to €1.5 billion/year savings through early patient discharge (Assuming 3 days less hospital stay for 20% of patients) From ‘hospital-based’ to ‘patient-centred’ care See EC Communication on Telemedicine COM(2008)689 final ec.europa.eu/information_society/activities/health/policy/telemedicine/index_en.htm

Boario telecardiology:

35-47% reduction in hospital admissions (in various studies)

12% reduction in outpatient visits

UK studies:

Wireless Healthcare (2004): Early discharge from hospitals ->

up to 85% reduction in weekly care costs

Cost of telecare at home with 24 hours response = 1/3 of the cost of a nursing home place

Potential of Mobile Monitoring in Germany:

Up to €1.5 billion/year savings through early patient discharge

(Assuming 3 days less hospital stay for 20% of patients)

Step 3 : The full picture of individual’s health status Integrated Health Records Environmental Data Biosensors Phenomic data Genomic data Biochips

New Options for Disease Management Philips Presentation Disease progression Mortality & costs Genetic predis - position First cell mutations asympto - matic disease Diseased cells release biological markers First symptoms/ manifestation Disease proliferation Environmental trigger Current approach In vitro markers Diagnostic (anatomic) imaging, biopsies symptoms diagnosis • Non - personalized medication • Chemotherapy • Radiotherapy • Surgery Follow up Molecular Imaging Molecular Imaging Molecular Medicine approach Molecular Therapy Molecular Therapy DNA screens Protein screens Monitor Treatment Monitor Treatment Earlier Personalized Integrated Efficient

EU Wide eHealth Policy and support to deployment 1. eHealth Action Plan - COM(2004)356 final 2. I2010 flagship initiative - ICT for Ageing Well 3. Lead Market initiative for Europe (eHealth) 4. EC Recommendation on EHR Interoperability (2008) 5. Telemedicine Communication - COM(2008)689 final ec.europa.eu/information_society/activities/health/policy/index_en.htm

EU Wide support for Research & development (FP7) Personalisation of Healthcare Personal health system € 72 Million (M) in 2007, (€ 63 M in 2009) Patient safety-avoiding medical errors € 30 M in 2007, (€ 30 M in 2009) Predictive Medicine – Virtual Human Modelling/simulation of diseases € 72 M in 2007, (€ 68 M in 2009)

Personalisation of Healthcare

Personal health system

€ 72 Million (M) in 2007, (€ 63 M in 2009)

Patient safety-avoiding medical errors

€ 30 M in 2007, (€ 30 M in 2009)

Predictive Medicine – Virtual Human

Modelling/simulation of diseases

€ 72 M in 2007, (€ 68 M in 2009)

Conclusions ICT has shown impact on sustainability but this impact needs to scale. patients need to take more active role in health & care and use ICT in their health/wellness management ( changing consumer behavior pattern ) stronger focus but health delivery system on prevention and early diagnosis, ICT has great potential in: enabling novel approaches for personalised medicine ( cross-disciplinary and multi-stakeholder research ) fostering global research (International effort)

ICT has shown impact on sustainability but this impact needs to scale.

patients need to take more active role in health & care and use ICT in their health/wellness management ( changing consumer behavior pattern )

stronger focus but health delivery system on prevention and early diagnosis,

ICT has great potential in:

enabling novel approaches for personalised medicine ( cross-disciplinary and multi-stakeholder research )

fostering global research (International effort)

For further information INFSO H1 Policy site: http://ec.europa.eu/information_society/activities/health/index_en.htm Research site: http:// cordis.europa.eu/ist/health/index.html Interactive Portal: http://www.epractice.eu •••

INFSO H1 Policy site:

http://ec.europa.eu/information_society/activities/health/index_en.htm

Research site:

http:// cordis.europa.eu/ist/health/index.html

Interactive Portal:

http://www.epractice.eu

Annex •••

EU GPs using a computer during consultation, in % (EC Study 2007) Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008 100% 66% 3% Random samples of 6,789 GPs in 29 countries

Access to broadband in practices Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008

Connectivity: to other GPs Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008

Use: storage of medical patient data Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008

% GPs connected to secondary healthcare (hospitals and/or specialist)

Electronic exchange of data for at least one purpose

Connectivity: to specialists Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008

Connectivity: to hospitals Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008

Connectivity: to health authorities Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008

Link to insurers (reimbursers) Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008

GP Attitudes towards ICT use in healthcare Source: empirica: ICT and eHealth use among GPs in Europe 2007, Bonn April 2008