Speaker: C. Karanikas PhD Consultant, eHealth Researcher at the Athens Medical Society Presented during the 1st Athens Digital Health (eHealth) Meetup

1. Dr. H. Karanikas
eHealth in the Public Sector
The example of the Electronic Health Record for Primary Health Care
Dr Haralampos Karanikas
eHealth & IT Consultant, Athens Medical Society
eHealth Researcher at NKUA

2. Dr. H. Karanikas
HALF of EU enterprises
provide mobile devices for
business use
276.5 million EUR
turnover
of EU B2C eCommerce (2012)
14% of EU SMEs
selling online
29% of EU
enterprises
use e-Invoices
28% EU enterprises
use Social media
38% EU venture capital
DIGITAL BUSINESS
Digital revolution
“Do or Die”
72% of EU individuals
uses INTERNET regularly
900 000 estimated
demand/supply gap by 2020
150 Million
subscriptions
fixed Broadband
130 mobile
subscriptions
per 100 people
ICT drives 1/3rd
EU GDP growth
1995-2007
2.4%
of workforce
+ 4.1%
yearly employment growth
ICT professionals
55%
work outside ICT sector
7% of GDP
Size of the
digital
economy
6% of
Gov't
R&D
17% of
business
R&D
by ICT
sector
ICT
sector
4.4%
ICT in
Other Sectors
17% EU patents

3. Dr. H. Karanikas
eHealth
eHealth is the provision of health services,
supported by electronic means.
It includes health information networks,
electronic health records, telemedicine,
tele-care, chronic disease management, and
systems for monitoring, supporting patients
and their families.
Internet is an effective means by which in an economic
way one can retrieve anywhere, anytime medical
information.
The "patient" is "consumer” of electronic health
services and requires a more active role in their health
management.

4. Dr. H. Karanikas
IT Applications - Data
In healthcare we are beginning to realize that the real value is not in the IT
infrastructure, but to the data. Good data is the "key" to improve health outcomes,
better chronic disease management and better management of population health
overall.
These data must be kept and be accessible for the entire life of the citizen.
This brings many challenges for current computer systems, as they have not been
designed so that data "survive" outside applications. When we have a change of
application (usually every 7-10 years), it is not unusual to get lost historical data and to
have a fresh start with the new system.
Thus, it becomes clear that the storage of health data should be independent of the
application (and therefore independent of the supplier).
This has already happened in the imaging data, PACS systems. We believe that the same
thing should happen with all clinical data.

5. Dr. H. Karanikas
Big data in health
The most commonly accepted definition, Gartner (the 3 Vs)
“Big data is high-volume, high-velocity and high-variety information assets that
demand cost-effective, innovative forms of information processing for enhanced
insight and decision making.”
to put together multiple sources of information,
coming through many different channels,
to ignore what is not important,
to work under time constraints,
support analysts and end users
The key issue is to utilize all of these together using innovative technology, serving
the needs of users
Includes large data from multiple sources, such as biological, clinical, and
environmental information relating to the health status of individuals and can only
be dealt with by new technologies for large-scale storage, integration and analytics.

6. Dr. H. Karanikas
Strategy Documents 1/2
• Development and operation of ESY.net, KEN-
DRG, ePrescription, ERP part of the hospital IT
systems etc

7. Dr. H. Karanikas
Strategy Documents 2/2
• Εxpanded primary care network. Coordinated
and integrated care, using e-governance and new
technology.
• EOPYY play a vital role to ensure universal
access to care by cost-effective purchasing of
health services.
• Τhe development of the Greek DRG system

8. Dr. H. Karanikas
• IDIKA is one the main institutional partners of MoH for strengthening eHealth
• The establishment of Ministries for Digital Policy and Telecommunications and
Administrative Reconstruction ( includes eHealth and eGovernment Health)
• Establishment and operation of the National eHealth Council
– National Standard of Electronic health record for the citizen,
– National Interoperability Framework,
– National Contact Point for European citizens (cross-border healthcare)
– Integration of Electronic referrals and prescribing.
• Ongoing to establish the Electronic Health Care Network
Current eHealth priorities 1/2

9. Dr. H. Karanikas
• IDIKA to be the national central node of eHealth services with other European
agencies.
• Continue upgrading ePrescription with Medical Prescribing protocols,
contraindications, SPCs filters.
• Develop Patient Registers based on ePrescription.
• EHR for PHC, Patient Consent, eRDV
• “Health Atlas” (www.healthaltas.gov.gr) information database concerning health
professionals, health services etc.
• eGovNow since the beginning of 2017 will interconnect hospitals.
• New ESPA
– «Integrated Information System for the Support of Primary Health Care» (IDIKA)
– «Unified registries and code lists for Ministry of Health»
Current eHealth priorities 2/2

10. Dr. H. Karanikas
IDIKA
 ePrescription
 electronic Appointments
 Patient Summary (PS)
 Electronic Health Record
 Patient Consent
 Register of Chronic disease
 Prescription guidelines (with the coordination of Athens Medical Society)
EOPYY
 E-DAPY
 Notices
 Insured Health Record
 Central monitoring announcements for hospitalization
 eDAPY for materials and special diet formulation
 Disease Registries (Hepatitis C, Chronic Myelogenous Leukemia)
Main eHealth stakeholders

11. Dr. H. Karanikas
Ministry of Health (MoH)
 Integrated Hospital Information Systems (13 projects for Health Care Regions HCR)
 ΒΙ MoH
National Telemedicine Network (2nd HCR - EKEPY)
 a. Tele-diagnosis – Tele-consulting, b. Distance Learning, c. Telemedicine in emergency cases, and d.
Tele-psychiatry.
 Medical instruments with which it is equipped a typical Telemedicine unit include: Otoscope,
Dermatoscops, Ophthalmoscope, High resolution examination camera, stethoscope, vital signs
measurement device, cardiograph
EDET
 Cloud for health applications
 Blood registry
EOF, EKAPTY, KEELPNO, EPY etc
Main eHealth stakeholders

12. Dr. H. Karanikas
Avoiding incorrect prescribing problems - control 5 points
– right medicine
– correct dose
– proper patient
– Timing
– Proper administration route
ePrescription:
– «creation, sending, execution and monitoring of pharmacological treatments
based by electronic means» [Miller et al, 2005].
– ability to send error-free, accurate and understandable prescriptions
electronically from the healthcare provider to the pharmacy.
Example: ePrescription

13. Dr. H. Karanikas
The implementation of an integrated electronic prescribing system was established by the law
– 3892/2010 (ΦΕΚ Α΄ 189/04.11.2010) Electronic, entry and execution, of prescriptions and orders for
medical tests.
• In conjunction with the data protection law 2472/1997 (ΦΕΚ Α'50 10.4.1997)
13
Total
 9.000.000 persons
 43.000 doctors
 11.900 pharmacies
Per month
 5.500.000 medicines'
prescriptions (99%)
 2.000.000 referrals of
diagnostic tests (92%)
 3.000.000 persons
The ePrescription System

14. Dr. H. Karanikas
14
– Directives 2011/24/EU, 2012/52/EU
– GUIDELINES ON MINIMUM/NONEXHAUSTIVE PATIENT SUMMARY DATASET FOR
ELECTRONIC EXCHANGE IN ACCORDANCE WITH THE CROSS-BORDER DIRECTIVE
2011/24/EU
• Status: Adopted by eHealth Network, Date: 19 November 2013
– GUIDELINES ON ePRESCRIPTIONS DATASET FOR ELECTRONIC EXCHANGE UNDER
CROSS-BORDER DIRECTIVE 2011/24/EU
• Status: Adopted by eHealth Network, Date: 18 Nov 2014
• non-binding guidelines on electronic prescriptions
• Minimum technical requirements for cross-border ePrescriptions
• Minimum technical requirements with regard to data security
• Storage periods, Organisation of dispensations
• Minimum requirements for ePrescriptions with regards to their content
• Legal background, Evaluation and quality assurance
• etc
– Patient Registries Guidelines (Adopted by eHealth Network, November 2015)
EU Guidelines

15. Dr. H. Karanikas
Guidelines Adopted - EU eHealth network

16. Dr. H. Karanikas
Registry holders and Member States:
• to improve registry quality and interoperability between registries and their data sources by
following and implementing the PARENT Guidelines
• to demonstrate the importance of registry data for evidence-based policy making and to
encourage data use and re-use via means of collaborative research studies and publication of
results
• to increase patients' awareness of the importance of high-quality registry data and
encourage their involvement in the generation and use of data
• to share the national legislations, plans and strategies concerning the areas of registries,
eHealth/Electronic Health Records, Rare Diseases, HTA and potentially European Reference
Network.
eHealth Network recommends

17. Dr. H. Karanikas
Primary Health Care (PHC) – Electronic Health Record (EHR)
• Consistent use of an EHR for PHC does not ensure successful use for improving the
quality of health care.
• Continuing efforts to encourage the adoption and meaningful use of EHR in
primary care should focus and ensure that the use manages to improve care.
• In an outpatient setting, a medical record covers the entire life of the patient
(citizen), is not an episode of care (such as hospital stay). So we should have an
EHR from which we can create reports in time. In the absence of continuity of
care, continuity of information is necessary to optimize healthcare.
• Support for integrating EHR to user workflows.
• Can improve care, when, for example, reminders in conjunction with the regular
health check and vaccinations, as common tools support health personnel.

18. Dr. H. Karanikas
Building the EHR for the PHC

19. Dr. H. Karanikas
 It covers the majority of diagnoses occur in primary care.
 Easy to use.
 Collaborates with other encodings.
 Continually evolve and be accepted.
Coding for PHC

20. Dr. H. Karanikas
Access to EHR: ePrescription - Visit

21. Dr. H. Karanikas
Initial screen

22. Dr. H. Karanikas
Diagnoses

23. Dr. H. Karanikas
Medications

24. Dr. H. Karanikas
Dynamic diagrams

25. Dr. H. Karanikas
Concluding remarks
• Redefining roles of stakeholders and optimum utilization of existing nationwide
applications
• Clarifying the role of IDIKA and relationship with EOPYY
• Interoperability Standards - Certification of IT resources
• Open data – Open Systems

26. Dr. H. Karanikas
On going work
Athens Medical Society has developed a Health Portal dedicated to Health
professionals. Includes eLearning, medical knowledge base, Health Journal
and other services.
http://www.mednet.gr/ - http://www.e-healthnet.gr/
Athens Medical Society & ΕΕΜΕΠΥ is leading or participate on the following
on going actions:
– Developing Diagnostic protocols in a machine processable format for the ePrescription
system.
– Developing Patient Registries.
– Developing and incorporating to Protocols system a Drug Summary subsystem, including
drug specific information such as Drug Interactions, Allergies etc
– Application of Clinical guidelines to NHS hospitals (Pilot stage).
– A national committee has been established to set up the framework and coordinate all
actions for the application of Therapeutic Protocols.

27. Dr. H. Karanikas
Synergies are needed …
... to regain the advantage of the relation of health 'needs' with
health data and thus improve the quality of health care.
… clear, feasible plan followed up until the end.
Thanks …
h.karanikas@gmail.com
Dr. Haralampos Karanikas
eHealth Consultant