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THE E-HEALTH PANORAMA by Christian FOURY

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Official Representative of the International Research of the Mission for European and International Relation and Cooperation (MREIC) of the French National Health Insurance Fund (CNAMTS)

Official Representative of the International Research of the Mission for European and International Relation and Cooperation (MREIC) of the French National Health Insurance Fund (CNAMTS)

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  • 1. Quitter sommaire préc. suiv.Créé le :Par :Quitter sommaireTHE E-HEALTH PANORAMAChristian FOURYOfficial Representative ofthe International Research ofthe Mission for European and International Relation andCooperation (MREIC) ofthe French National Health Insurance Fund (CNAMTS)
  • 2. Quitter sommaire préc. suiv.Créé le :Par :Quitter sommaireThe E-Health PanoramaThe Electronic Medical Prescription of MedicinesThe Electronic Medical Record and the Shared ElectronicPatient Summary RecordThe Software Editors offers either in the Gp’spractices/healthcare centres and in the hospitals
  • 3. Quitter sommaire préc. suiv.Créé le :Par :Quitter sommaireThe E-Health PanoramaThe Electronic Medical Prescription of Medicines (PEM)Synthesis of the international comparative study
  • 4. Quitter sommaire préc. suiv.4Page courante organisme nationalQuitter sommaire préc. suiv.4Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicamentsThe Electronic Medical Prescription of MedicinesThe methodology used123 The main conclusions4 The Analysis by Countries
  • 5. Quitter sommaire préc. suiv.5The Medical Electronic Prescription of Medicines5• In FranceThe dematerialization project of the Prescription of Medicines has been initiated at the beginning of 2012.Before the target, foreseen to start in 2014, a functional prototype of Medical Electronic Prescription ofMedicines will be realized in the course of 2013.The Medical Electronic Prescription of Medicina is an important stake to enhance the efficiency of theHeathcare system• AbroadThe dematerialization of the prescription of the Medicines is also an important stake in several EuropeanCountries and already a reality in some of these Countries.The level of progree of these projects are nevertheless different according to the Countries. Some of themare in course of deployment and in some others the system is already operational since many years.Many Countries have also initiated some works but are still in phase of definition of the projectSynthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicaments
  • 6. Quitter sommaire préc. suiv.6The Methodology used6• Identification of any relevant Foreign Insitutions and or Foreign ExpertsAn Intenatioal comparative study has been undertaken by the International Research of the Mission for Europeanand International Relations and Cooperation (MREIC) of the French National Health Insurance Fund to identifyeither the Most advanced Countries regarding the Projects of the Electronic Medical Prescription and therelevant foreign institutions/experts with whom to exchange.• Note of issue and paper based questionnairePaper based questionnaires have been sent to all the Countries identified with some specific questions regarding thestate of progress of the project to the perimeter retained, to the referential used, to the technical environmentof the project…The feedback from the following countries have already been analyzed : Denmark, Spain (Andalousia), Italy (Emilia-Romagna), Italy (Lombardy), Great-Britain, Finland, Norway, The Netherlands, Switzerland.The other answers received will be analysed in a second stage• Videoconferences/audioconferencesIn order to analyse more deeply the answers to our initial questionnaire, some videoconferences, audioconferenceshave been organised with the most advanced Countries and having some similarities with the French ContextProject.Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicamentsDenmark • Sweden • Spain (Andalousia) • Italy (Emilia-Romagna) • Italy (Lombardia)
  • 7. Quitter sommaire préc. suiv.7The Main Conclusions (1/3)7• Main gains expected from the project For the Doctors : Reliabilisation of the prescription, more simple renewal prescription by incentive the use ofthe Help Prescription Softwares. Reduction of the theft of the prescription receipt. For the Pharmacists : times savings thanks to the automatic data integration, more readable prescriptions… For the Reimbursement organisms : gains in Work Full Time Staff and this when the invoice process is linked tothe Electronic Medical Prescription. Improvement of the Fight against the fraud. For the narcotics prescription : reduction of the misappropriations, traceability either of the prescription and ofthe deliveries.• Points of attention- Name of the medicines The medicine codification is not similar in all the Countries. In some countries the GP’s prescribe in using only theTrade Medicine Name and somewhere else the prescriptions are made in International Common Name. It does not exist any codified and shared nomenclature for the International Common Name.- Sizing of the infrastructure The volume of data is important in all the Countries studied. the Healthcare professionals expectations in terms ofavailability and times of answers are strong. The technical dysfunctioning are the majorn risk of the project. An inadequate infrastructure and or under sizedincluding at the beginning of the project could put in danger the use of the system.Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicaments
  • 8. Quitter sommaire préc. suiv.8The main conclusions (2/3)8• Proposal of evolution- For the Doctor : Access to all the Electronic Medical Prescriptions of the patient : this would allow to fight againstthe therapeutic redundancy. Visual display of the deliveries made on its Electronic Medical Precriptions : Thus, the Doctor couldensure that the patient has well withdrawn the prescribed medicines instead of being able toensure that he takes correctly his treatment.- For the Pharmacist : Access for the Pharmacist to all the prescriptions of the patient : This allow to make sure thatthere is no risk of incompatibility and or adverse effect between several treatments in process forthe patient. Possibility for the Pharmacist to suspend an Electronic Medical Prescription : In case of risk for thepatient, after advise of the GP, the pharmacist can suspend the Electronic Medical Prescription..Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicaments
  • 9. Quitter sommaire préc. suiv.9The main conclusions (3/3)- For the patient : Identification of the patient : Many functionnalities can not be offered if the patient isnot identifiable in a unique way with a high level of security and condidentiality for theaccess of the medical data.Today and regarding the French Situation : Our Social Security Card is not personal due tothe fact that it contains also the data of the beneficiaries. The Number of Registration inthe Directory called NIR is predictible and does not offer a high level of security andconfidentiality. A web interface allow a patient to access to its Electronic Medical Prescriptions. Differentfunctionalities are proposed according toe the Countries studied. A single account bypatient is essential to guarantee the confidentiality of the Electronic MedicalPrescriptions.
  • 10. Quitter sommaire préc. suiv.10Analysis by Countries10Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicaments• Key figuresFrance Denmark SwedenSpain(Andalousia)Italy (Emilia-Romagna)Italy(Lombardia)Population(in millionsofinhabitants)65 6 10 8 4 10Medicinesexpenditures(in euros byyear andper capita)437 219 277 218 NC NC Number ofprescriptions(in millionsby year)Env.600Env. 25 36 180 70 140Number ofDoctors120000 20 500 38 000 NC  4000 NCNumber ofPharmacists22 000 250 900 3600 NC  NC
  • 11. Quitter sommaire préc. suiv.11Analysis by Countries11Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicamentsDenmark• Decentralized Healthcare system.• Decentralized reimbursement system• Project started in the 1990’s• Up to 2007, around 97% of the prescriptions was sent and exchangedelectronically that it to say around 25 millions of prescriptions by year.Gains of the project :• For the Doctors : Reliabilisation of the prescription due to the use of an informatic module allowing todetec any medicines interactions.• For the Pharmacists : times savings by avoiding to enter again the data and reduction of the calls to theprescriber in order to obtain any confirmation regarding the elements contained on the prescriptionsDifficulties met :• Initial process insufficiently flexible : the patients should choose the pharmacy during the consultation.This system has been reviewed to answer to the patient expectations. Today the system looks like to thisone we would like to implement and to generalize in France.• Under sizing of the infrastructure : Problems of availability have been occured at the beginning of thedeployment of the project which has delayed anc complicated the build up process of the project.Elements of reflection :• Important penetration of the system, due to an important « accompanying measures ».• The patient has an important role in the process. He controls the access of its Electronic MedicalPrescriptions.
  • 12. Quitter sommaire préc. suiv.12Analysis by Country12Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicamentsSweden• Decentralized Healthcare System.• Centralized Reimbursement System.• Projet started in the 1990’s• In 2010, 80% of the prescriptions (that means 2,6 millions by month)have been electronically sent and exchanged.Gains of the project :• For the Doctors : Decrease of the insecurity linked to the drug addicts, The theft of the secure medicalreceipt have totally disappeared.• For the Pharmacists : times savings by avoiding to enter again the data and reduction of the calls to theprescriber in order to obtain any confirmation regarding the elements contained on the prescriptions• For the patients : possibility to go to any pharmacy with only an Identity Document for the delivery of themedicines which has increased the flexibility of the process.• Reliabilisation of the prescriptions : The Electronic Medical Prescription has allowed an enhancement ofthe quality of the prescriptions (reduction of 10% of the prescriptions which should be reviewed by thepharmacist) thanks to the use of the referentials and a more readable writing.Difficulties met :• Insufficient gains for the prescribers : the prescribers find that the Electronic Medical Prescription doesnot improve their medical practices. They blame the absence of visibility on the Electronic MedicalPrescription of the patient and the deliveries made on their Electronic Medical Prescriptions.• Technical environment : The Electronic Medical Prescription has been taking place in an informaticenvironment containing several bricks of Information System not coherent according to the Counties.Problems of compatibiliy between the systems have delayed the deployment in several County Counties.
  • 13. Quitter sommaire préc. suiv.13Analysis by Country13Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicamentsSpain (Andalousia)• Healthcare system is managed by the Autonomous Community, thedoctors are salaried of the Andalousian Public Healthcare System.• Centralized Reimbursement system.• Project started in the 2000.• In 2011, 71% of the prescriptions (that means 127 millions par an) areelectronically exchanged.Gains of the project :The project Receta XXI has been realized with the European funding. An evaluation of the benefits broughtby the project has been performed by the European Commission (Study EHRimpact).12 years after the launch of the first works, the analyse cost-advantage show a net cost benefit ratio of 1.12.In 2006, 3 years after the beginning of the implementation of Receta XXI, the earnings exceed the costs.Notably thanks to the reduction of the consultations of the patients having a chronic diseases, the reductionin the use of the paper, the increase of the generic prescriptions and the improvement of the qualityprescriptions.Difficulties met :• Lack of flexibility for the patient : the delivery of the medicines is only possible if the patient have withhim its Social Security Card. The patients wish to have a dispensation system based only on an identitycontrol.• Realization of a medicine nomenclature : A codification table of medicines in Common Name has beenrealized in Andalousia and adopted later by the other Autonomous Communities. The doctors canprescribe among a list of 12 000 medicines (in trade name) and 3 000 active ingredients. In Andalousia,around 92% of the Electronic Medical Prescriptions are drawn up in active ingredients.
  • 14. Quitter sommaire préc. suiv.14Analysis by Country14Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicamentsItaly(Emilia-Romagna)• Healthcare System managed by the Region.• Reimbursement System in course of centralization.• Project initiated in 2006, prototype foreseen for the end of 2012 andtarget solution in 2014.Gains of the project :•The project is in progress, No one benefits evaluation study has been undertaken at this date.Difficulties met :•Under Healthcare Professionals informatics equipment : The acquisition cost and or the renewal of theinformatic equipment park can not be only supported by the Healthcare professionals.•The High number of softwares which has been modified in order to allow the emission of the prescriptionhas got some consequences in terms of costs and time schedule.Elements of reflection :•Two documents form the prescription : an order form destinate to the pharmacist containing the medicinesto deliver (notably the number of packages) and a patient instructions for use in order to know how to takethe prescribed medicines. The instructions for use is not sent electronically.
  • 15. Quitter sommaire préc. suiv.15Analysis by Country15Synthèse de l’étude internationaleCNAMTS/Programme 2Prescription électronique de médicamentsItaly (Lombardia)• Decentralized Healthcare System.• Reimbursement system in course of centralisation.• Project initiated in the 1990’s on a restrictive perimater (not deliverypossible).• In 2011, 86,5 millions of Electronic Medical Prescriptions have beensent and exchanged from the doctors to the pharmacists.Gains of the project :• The project is in progress, no one evaluation benefits study has been undertaken at this date .Difficulties met :• The high number of softwares which has been modified to allow the emission of the prescription has gotsome consequences in terms of costs and time schedule.• The project is introduced by legislation, any healthcare professionals accompanying measures areforeseen. The Healthcare Professionals adhesion is the main risk of the project.Elements of reflection :• Two documents form the prescription : an order form destinate to the pharmacist containing themedicines to deliver (notably the number of packages) and a patient instructions for use in order toknow how to take the prescribed medicines. The instructions for use is not sent electronically.
  • 16. Quitter sommaire préc. suiv.16The E-Health PanoramaThe Electronic Medical Record and the Shared ElectronicPatient Summary RecordSynthesis of the international comparative study
  • 17. Quitter sommaire préc. suiv.17The Electronic Medical RecordThe Electronic Medical RecordThe main conclusions123 The analysis by Countries
  • 18. Quitter sommaire préc. suiv.18The Electronic Medical Record● In FranceIn France, the initiative was officially launched at national level in 2004 inthe context of the law introduced by Health Minister Philippe Douste-Blazy bearing on reform of the Social Security system. Major return oninvestment was expected, but today it must be said that a good dealmore reserve is called for, with focus first of all on development of uses.● AbroadElectronic Health Records have been in use in a variety of forms in manycountries for several years now
  • 19. Quitter sommaire préc. suiv.19The Main Conclusions (1/2)● First step :We need to work closely an directly with the Healthcare Professionals and notably withthe Gp’s in order to help them to buy a computer and to use any compatibleProfessional EMR Softwares – PROFESSIONAL EMR SOFTWARES● Second step :We need to work closely and directly with the Healthcare Professionals and notably withthe Gp’s in order to identify all the documents that they would accept to share with theother Healthcare Professionals and Hospital Establishments and this in the frameworkof the Shared Medical Electronic Patient Summary Record – SHARED MEDICALELECTRONIC PATIENT SUMMARY RECORD
  • 20. Quitter sommaire préc. suiv.20The Main Conclusions (2/2)● Third step :We should determine in the framework of the Shared Electronic Patient Summary Recordwhich categories of documents the most important put at the disposal of each patientand this through a dedicated secure internet portal. ACCESS FOR THE PATIENT TO ITSEMR THROUGH A SECURE INTERNET PORTAL● Fourth step :● Regarding the EMR of the chronic diseases patients and in the framework of the GlobalHealhcare Pathway we should provide all the information needed by all the HealthcareProfessionals concerned. FOR CHRONIC DISEASES PATIENTS PROVIDE TO ALL THEHEALTHCARE PROFESSIONNALS CONCERNED ALL THE DOCUMENTS NEEDED IN ORDERTO OFFER A COMPREHENSIVE ANSWER TO ALL THEIR HEALTHCARE PROBLEMS
  • 21. Quitter sommaire préc. suiv.21Analysis by Country● Germany- The Electronic Medical Record does not exist at the Federal/National Level at this date.Nevertheless, it exists some pilot projects at the Lander Level which have not for aim to implementa unique solution at the Federal/National Level- In the Primary Care Sector the GP’s use a Professional Electronic Medical Record to register eitheradministrative and clinical data. These Electronic Medical Records are under the control of the GP’sthemselves- In the hospital Care Sector the Information System are used to register the similar data at thoseregistered in the primary care sector. The Hospital Information System are also under the controlof the Healthcare professionals.The data and categories of documents contained in the Electronic Medical Record vary according tothe Software editors.
  • 22. Quitter sommaire préc. suiv.22Germany● Germany (to continue)According to a recent publication from a multidisciplinary working group, the Electronic Medical Record should contain :• A certain number of clinical documentation on the healthcare events :- Medical measures,- Symptoms,- Diagnostics,- Therapeutic objectives• A special documentation :- Laboratory test results,- Documentation on the medications.• A certain number of complementay documents :- Documents provided by the other medical specialists• Virtual views :- Set of data from the Emergency Care,- Basic clinical information- Source : ZTG Zentrum fûr Telematik und Gesundheitswesen GMbh : Electronische Akten im Gesundheitswesen –Ergebnisse des bundesweiten Arbeitskreises EPA/EFA, 2011.
  • 23. Quitter sommaire préc. suiv.23Germany● Germany (to continue and end)- The prior objective before the implementation of the Electronic MedicalRecord is to deliver to all the patients insured by The German Health InsuranceFunds an Electronic Healthcare Card (70 %) in the framework of the basicdeployment which should have been started at the end of 2012- The Electronic Medical Record should be available at the Federal/National Levelup to 2019
  • 24. Quitter sommaire préc. suiv.24Austria● Austria- The Austria is currently working on the implementation of an Electronic Medical Record whichshould be generalized in 2016.- In the Primary Care Sector the GP’s use a Professional Electronic Medical Record to register eitheradministrative and clinical data. These Electronic Medical Records are under the control of the GP’sthemselves- In the hospital Care Sector the Information System are used to register the similar data at thoseregistered in the primary care sector. The Hospital Information System are also under the controlof the Healthcare professionals.- A certain number of patient data and documents should be available to these one (first step) :*Discharge letters delivered by the hospitals,* Laboratory test results,* Hospital, Gp’s and Pharmacies prescriptions,*Medical and or Clinical register.
  • 25. Quitter sommaire préc. suiv.25Austria● AustriaIt is also foreseen in a second step of the deployment of the Electronic Medical Record toto have a Shared Medical Electronic Patient Summary Record.In the first sept of the development of the Electronic Medical Record, the patients are notauthorized to register their own documents and or to put them available.The informatic equipment being different from a doctor to another one the necessity tofund partly the modernization of the equipment has been recognized by the AustrianAuthorities.
  • 26. Quitter sommaire préc. suiv.26Belgium● Belgium- The Electronic Medical Record should be seen here as a Shared Electronic Patient Summary Recordwhich should contribute to the enhancement of the healthcare quality and safety- The Belgium authorities will is to allow thanks to the implementation and the real use of theProfessionals Electronic Medical Records the access of the data in a Shared way :* Contained in the Professional EMR software of the Healthcare professionals-Gp’s,* Contained in the hospital establishments servers.- It is important to notice that at this date the EMR is not yet available.- Existence of the E-Health box tool, which is a secure electronic mailboxes offer for free at all thehealthcare professionals includind the hospital establishments. This allow at the hospitals forexample to send for free the discharge letters (encrypted) to the Gp’s.
  • 27. Quitter sommaire préc. suiv.27Belgium● Belgium (To continue) :- It is foreseen to open the Shared Medical Electronic Patient Summary Record to thepatients/citizens.- To allow the Belgium Healthcare professionals to buy an EMR Software the Belgium Authority havedecided to delivrer a grant of 850 euros by professional (Gp’s, Nurses and Physiotherapists).- The process of labelisation/credentialing process enhance the quality of the softwares but doesnot incentive the real use of these ones by the Healthcare professionals mentioned above.Taking into account this fact, the belgium authorities have decided to measure the good use of theEMR Software by the Healthcare Professionals concerned and to ensure if these one have an EMRSoftware and if they use them really.
  • 28. Quitter sommaire préc. suiv.28Belgium● Belgium (To continue)The Belgium authorities have therefore decided to help to the development andto the concrete use of the Professionals EMR :- By allocating a lump sum payment of 80 euros by year and by doctor for themanagement of the Professional EMR and this in the interest of the patient,- To incentive financially the patients to have a referent Gp’s in charge ofmanaging his EMR by reducing the outpocket co-payment for each patient.
  • 29. Quitter sommaire préc. suiv.29Belgium● Belgium (To continue)- According to the Belgium Authorities the Hospital Informatisation System is notperformant in the sense they produce only summary of hospitalization documents andthe consultation of the clinical biological test results. These documents being thenstorage in a result server.To address this problem the Belgium Authorities allocate each year and by hospital theamount of 12 000 euros.- The Belgium authorities are in favour of gathering all the regional existing results serversin one server in which we will find the all the relevant documents concerning a patient.The GP’s could connect him thus at this regional network wich would allow at this oneto access to a list of documents for a patient and if there are several regional servers tocollect all the documents known in these ones for a patient.
  • 30. Quitter sommaire préc. suiv.30Belgium● Belgium (To continue)-In the Dutch Community, there are 4 regional results servers,- In Brussels capital there is 1 regional result server,- In the French Community, there is 1 regional result server.The French Community for example offer to their hospitals to be interconnected with aunique results regional server to allow the Gps and the other Healthcare professionalsto access to any relevant documents for any patient.
  • 31. Quitter sommaire préc. suiv.31Spain● SpainThe Electronic Medical Record is still not available at the National LevelThey are many initiatives undertaken by each Autonomous CommunityExample : The Autonomous Community of the Catalogna- A Professional EMR is used by almost all the Healthcare professionals and the Hospitals (88 %) :* 7,9 Millions of Professional EMR existing including 40 M of clinical documents - the Catalogna have7,5 Millions of inhabitants,* 50 500 Healthcare Professionals access to these Professional EMR through a dedicated ProfessionalPortal : In 2012 there are been 1,74 Billions of consultations.- All the Medical Imaging are stored in a Regional PACS Server,- The Electronic Medical Prescription is already operational between the prescribers and thepharmacists. This project is deployed since 2008.
  • 32. Quitter sommaire préc. suiv.32Spain● Spain (To continue)- Each citizen/each patient can consult some of their medicalinformations on a dedicated and secure Internet Portal. A version forsmartphone is in progress in the framework of a pilot test.- It is foreseen to have an Shared Medical Electronic Patient SummaryRecord as it exist in the Autonomous Community of Catalunya at theNational Level.
  • 33. Quitter sommaire préc. suiv.33Italy● Italy – National Level and Emilia-Romagna RegionIn Italy the Healthcare System is managed by each Region andconsequently the EMR is therefore build up with each Italian Regionshereby certify by the EMR study within the Emilia-Romagna RegionIt does not have an EMR at the National Level. Nevertheless there are thewill of the Italian Public Authorities to have at the National Level aShared Medical Electronic Patient Summary Record called « FascicoloSanitarie Elettronico ».
  • 34. Quitter sommaire préc. suiv.34Italy● Italy – Emilia-Romagna Region- In the Primary Care Sector and concerning the GP’s, there are 16 Professionals EMR Softwares. Onthis subject, the Emilia Romagna Region is currently in the way to proceed to a call for tender inorder to retain only and at the end of the process a unique EMR Software editors.- In the Hospital Care Sector we find too the existence of compatible Professionals EMR Softwares.- All the Healthcare Professionals of the Italian Emilia-Romagna Region are computerized and thisthanks to :* First the creation of a regional server called « SOLE-SANITA ON LINE – HEALTH ON LINE »implemented since 2003 and up to 2005 among which the main objective was to build up ainformatized network in the framework of the individual clinical pathway of the patient and toshare all the relevant clinical documents contained in the Professional EMR of the GP’s, Paediatristswith all the Healthcare Structures of the Emilia-Romagna Region.
  • 35. Quitter sommaire préc. suiv.35Italy● Italy – Emilia-Romagna Region- And secondly through the financial participation of the Healthcare Regional Directorate :• in the Gp’s and Healthcare Professionals training,• Cost of the 16 Professionals EMR maintenances,• The cost of connexion of the GP’s computer,• The Online Help Desk Service for the Gp’s, the Healthcare Professionals and the citizens,• The purchase of the informatic material (Personal Computer and Printers) for the GP’s
  • 36. Quitter sommaire préc. suiv.36Italy● The Shared Medical Electronic Patient Summary Record is managed by the Italian Minister ofHealth at the National Level and by each Italian Region at the Local Level – Example of themanagement of this project by the Emilia-Romagna Region :- The Facicolo Sanitarie Elettronico FSE– Shared Medical Electronic Patient Summary Record is aSecure Internet Portal containing all the data of the patient which has been developed within theEmilia-Romagna Region from 2008 to 2010. There have been an experimentation stage launched in2011 and a generalization stage since 2012.- The Healthcahre Professionals who have the responsibility of the healthcare of their patients in thePublic Structures can access to the FSE.- The Healthcare Professionals should send any relevant clinical documents in the FSE and this by theintermediate of the corporate software user integrated to the Sole Infrastructure.
  • 37. Quitter sommaire préc. suiv.37Italy● Shared Electronic Patient Summary Record managed by the Italian Minister of Health atthe National Level and by each Italian Region at the Local Level – Example of themanagement of this project by the Emilia-Romagna Region ( to continue) :- The Gp’s through their own Professionals EMR can see all the referral documents produce bythe Public Structure, the Specialists Pharmaceutical Prescriptions and send the « PatientSummary » of the Patient with the information of their own Professionals EMR Sofwares.- The patient have an access to his FSE and he is free to add any paper documents by scan.- At the 31st of December 2012, there have been :• Created 13 500 actives FSE,• Stored in the Regional Data Server around 19 millions of clinical documents and around 33millions of specialists pharmaceutical prescriptions,• Consulted by the patients : 63.500 clinical documents and prescriptions.
  • 38. Quitter sommaire préc. suiv.38Switzerland● SwitzerlandIn Switzerland, the Healhcare System is managed par each County calledthe Swiss Cantons. The EMR is therefore build up at a Local LevelIt does not have an EMR at the Federal Level. Nevertheless there are thewill of the Swiss Public Authorities to have at the Federal Level a SharedMedical Electronic Patient Summary Record.
  • 39. Quitter sommaire préc. suiv.39Switzerland● The EMR managed by the Geneva Canton- A Shared Medical Patient Summary Record exist as one of the pilot project in Switzerland. It iscalled « E-Toile Project ».- In Switzerland around 20 % of the doctors have and use a compatible Professionals EMR Softwareand it is the situation in the Geneva Canton too.- The originality of the E-Toile Project is that E-Toile does not store any information but allow (ornot) the access for any request of all the databases of all the stakeholders involved in this project(clinics, radiologists, pharmacists, hospitals, doctors, etc).The partners themselves keep the control on their own data and decide which informations of theirProfessionals EMR software they wish to put eventually at the disposal of E-Toile.
  • 40. Quitter sommaire préc. suiv.40Switzerland● The EMR managed by the Geneva CantonE-Toile store only any pdf documents at this stage, at the exception of the medication informationswhich are codified (possibility to exchange information).The project E-Toile is in a pilot project stage within a Region of 50 000 inhabitants in the MedicalCenter of the Onex Medical Group.The Onex Medical Group is composed of 80 Gp’s who share at this date 280.000 Professionals EMR.These Professionals EMR contains : a synthesis, the medicines, the radiologies imaging, thelaboratories results, the letters, the medical reports, the medical certificates for the population ofthe Onex Region.
  • 41. Quitter sommaire préc. suiv.41Switzerland● The future Shared Medical Electronic Patient Summary Recordby the Ministry of Health at the Federal Level and among whichthe example could be the Pilot Project of the Shared MedicalElectronic Patient Summary Record fom the Geneva Canton- The main objective of the E-Health Swiss Strategy is to encourage all the Swiss Cantons toimplement an EMR and to have a Shared Medical Electronic Patient Summary Record if it ispossible in 2015.- The pilot projects of an EMR in the Swiss Cantons are : Canton of Geneva (E-Toile), Canton of Basel-Stadt, Canton of Wallis.- It has not been yet defined at this stage the kind of documents we will find in the future SharedMedical Electronic Patient Summary at the Federal Level. The discussions around this issue willstart in 2013. We think if we refer to the pilot projects of the Swiss Cantons that we will find thefollowing documents : Medical Reports, laboratories tests, the e-prescription, the e-medication, theresults.
  • 42. Quitter sommaire préc. suiv.42The E-Health PanoramaThe Software Editors Offers either in the Gp’spractises/Healthcare Centres and in the HospitalsSynthesis of the international comparative study
  • 43. Quitter sommaire préc. suiv.43Software editors offers of the Gp’s practices● The Results obtained show us a first classification in two categories of practices, that isto say :- For the Software Editors offers of the Gp’s practices/Healthcare Centres :- In one side, the Countries and or Regions, County Councils, Autonomous Communitiesensuring themselves the healthcare dispensation : have a few number of housesoftware developed internally and sometimes a unique one from a call for tenderprocess :• Canada (Alberta),• Spain (Catalogna),• Scotland,• United States (HMO Intermountain Healthcare and Kaiser Permanente),• Italy (Emilia-Romagna),• Sweden.
  • 44. Quitter sommaire préc. suiv.44Software editors offers of the Gp’s practices• In an other side and similar to France, some Countries are leaving the free market andensure nevertheless an homologation/labelisation/certification process of thesoftwares used :*Austria,*Belgium,* United States (Federal Level),* The Netherlands,* Switzerland among which the Geneva Canton.
  • 45. Quitter sommaire préc. suiv.45Software editors offers in the hospitals- For the Hospital Care Sector, the situations met in the other foreign Countries arerelatively and or quite similar to what we meet in France :• A small editors number cover the major part of the market,• Even if they do not cover all the needs from an hospital,• This conduct the hospital to launch a call for tender to many editors and softwares,• We find either some public offers and or Hospital Establishment Owners (again thispractice is less developed in France) and some national and international private offers,• To notice in some Countries a quicker start offer with external storage share theInformation System of several hospitals : type Saas and or CloudWe do think that the Ambulatory/Hospital communication is everywhere at its beginning –except in any Integrated Healthcare System (USA Intermountain Healthcare, KaiserPermanente, Spain Autonomous Community of Catalogna).
  • 46. Quitter sommaire préc. suiv.46Thanks for your attentionTHANKS FOR YOUR ATTENTION
  • 47. Quitter sommaire préc. suiv.47Professionnal contact detailsChristian FOURYOfficial Representative ofThe International Research ofThe Mission of the European and International Relations and Cooperation(MREIC) ofThe French National Healh Insurance Fund (CNAMTS)CPAM de la Sarthe178 Avenue Bollée72 033 Le Mans Cedex 9Telephone : + 33 2 43 50 74 89Mobile : + 33 6 60 49 58 87E-mail : christian.foury@cpam-lemans.cnamts.fr

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