2. From strategies to services
– eHealth as the enabler for cross-
border healthcare
Michiel Sprenger
Senior adviseur ICT en Innovatie
Nictiz
3. Closer Cooperation on healthcare in the EU
– from threat to possibility
• Healthcare is a strict national prerogative
• Previously only a limited co-operation on a general policy level
• Substantial variations between national healthcare systems, but
also similar challenges are faced and….
• …substantial similarities in political ambitions to reform
healthcare as well as in the challenges to reach these goals
• The work started in 2003-2006 at the Ministerial Conferences
• In 2004 the eHealth Action Plan was adopted and the I2010 was
created
• And in 2007 in Berlin the eHealth Initiative was created.…
4. epSOS – a highly political project
• Member State obligation to deliver the best possible medical
treatment – at home or when travelling
• Introducing a new dimension in national healthcare systems
• Main political objectives:
– support patient mobility nationally and in the EU
– ensure that patient safety is guaranteed
– increase efficiency and cost-effectiveness
in cross-border care
5. Waar gaat epSOS over ?
• Pilotproject
• “Cross-border interoperability”
• Twee gebruikssituaties (use cases):
– Patiënt heeft in ander land zorg nodig (acuut of
niet) en arts heeft daarvoorpatiëntsamenvatting
nodig
– Patiënt heeft medicatie nodig in ander land:
• Nieuw
• Op recept “van thuis”
• Bouwen op het bestaande !!
7. The epSOS Project Team
• The Project Team consists of 27 beneficiaries from 12 member
states: AT, CZ, DE, DK, EL, ES, FR, IT, NL, SK, SE and the UK :
• 9 National Ministries of Health,18 National/regional Competence
Centers; ANDA, ATNA, CATA, CLM, DENA, DKNA, ELGA, EMPIRICA,
FRNA, GEMATIK, GIPDMP, FRNA, IHE, IZIP, LOMBARDY, MEDCOM,
NHIC, NHS, NICTIZ, NLNA, SALAR, SENA, THESS, CNRS, FRAUNHOFER,
PHARMAXIS, ZI
• Competence Centers Including/working with local organizations
with thousands of Contributors
• IHE-Europe representing ICT industry team (40+ members)
• Empirica responsible for administrative management
8. Goals & Challenges
• Goal for the epSOS eHealth Project:
– “to develop a practical eHealth framework and ICT infrastructure
that will enable secure access to patient health information,
particularly with respect to a basic patient summary and
ePrescription, between European healthcare systems”
• Challenges to get there:
– Legal Interoperability
– Organisational Interoperability
– Semantic Interoperability
– Technical Interoperability
9. Regio-situatie
• In sommige landen zijn regio’s zeer zelfstandig
• (gedeeltelijk) eigen wetgeving, minister van gezondheid, etc
• In epSOS:
– Spanje: Spanje + Andalusië, Catalonië, Castilla-La Mancha
– UK: Engeland, Schotland
– Italië: Lombardije
• Kansen: landelijke convergentie-pogingen leerzaam voor EU !
11. Inbreng Nederland
• Ministerie VWS (NLNA)
• Nictiz
• Plaats in Project Steering Board (PSB, VWS)
• Plaats in Project Executive Board (PEB, VWS,
Nictiz)
• Participatie diverse deelprojecten
• Leiding van WP1.1: analysis
12. WP 1.1, analysis
• Analyseer use cases
• Onderzoek in 12 landen en X regio’s het lokale
equivalent (dwz benodigde zorg buiten de
normale “eigen” omgeving maar binnen het
land / de regio)
• Leid daaruit af “opportunities and constraints”
voor de epSOS oplossing
13. Use cases
• Mobiliteitsscenario’s
– Incidenteel in ander land (vakantie, zakenreis)
– Structureel in ander land:
• Regelmatig afwisselend (“grenswerkers”)
• Langduriger (“overwinteraars”)
• Zorgvraag die samenvatting nodig heeft
• Medicatie:
– Herverstrekking
– Nieuw voorschrift en verstrekking
14. Enquete naar nationaal
(regionaal) analogon
• 160 vragen
• 16 landen / regio’s antwoord
• Analyse afgerond
– Robert Breas, Michiel Sprenger, Albert-Jan Spruyt,
Wouter Tesink
– Industry team
• Rapport klaar – final approvement
16. epSOS scenario
Country A (“home”) Country B (Patient + HCP)
3 2 1
Natio Natio
GP
-nal -nal
National National
con- con-
Infrastructure Infrastructure
tact tact
point point
Phar-
macy
17. Availability of patient summary 2008
>25% Nationally available
& operational
<25%
>25% Regionally available
<25% & operational
Not available /
unknown
EU memberstate
(not participating)
Non EU country
18. Availability of patient summary 2010
>25% Nationally available
& operational
<25%
>25% Regionally available
<25% & operational
Not available /
unknown
EU memberstate
(not participating)
Non EU country
19. Availability of ePrescription 2008
>25% Nationally available
& operational
<25%
>25% Regionally available
<25% & operational
Not available /
unknown
EU memberstate
(not participating)
Non EU country
20. Availability of ePrescription 2010
>25% Nationally available
& operational
<25%
>25% Regionally available
<25% & operational
Not available /
unknown
EU memberstate
(not participating)
Non EU country
21. Retrievability of ePrescription 2008
Nationally available
Regionally available
Only in one region
Not available
EU memberstate
(not participating)
Non EU country
Can an HCP retrieve medication prescriptions on demand (status in 2008)
22. Retrievability of ePrescription 2010
Nationally available
Regionally available
Not available
Partially undefined
EU memberstate
(not participating)
Non EU country
Can an HCP retrieve medication prescriptions on demand (status in 2010)
23. Conclusies onderzoek
• 2010 >> 2008 (???) – optimisme viert hoogtij
• Ondersteunend (identity etc) redelijk
ontwikkeld
• ePrescription en Summary erg weinig echt af
• Retrieve mechanisme belangrijk
• Content: veel vrije tekst in Summary
• Noodzaak NCP’s
• Houd pilots simpel !!
24. Uitkomsten voor Nederland
• Heel veel inzicht in andere oplossingsrichtingen
• Veel contacten
• Druk op standaardisatie
• Druk op eenheid van taal – SNOMED CT
• Schaalbare toekomst, alles is deel van iets groters !
– Point of care
– Ziekenhuis
– Regio
– Land
– Europa
www.epsos.eu
