eHealth as the use of Information and communication technologies in the practice of health care comprises Electronic health records, Healthcare information exchange cross-jurisdictions, Personal health records, Telehealth, telemedicine and remote monitoring. There are several efforts to reflect and measure the practice of eHealth including efforts by the OECD and WHO, but in general there is little reported sharing of health data particularly with patients. Specific barriers frequently mentioned are supporting policies and coherent widely implemented standards. The presentation discusses relevant efforts and programs supported by the European Commission such as the eHealth DSI, eStandards, ASSESS CT, and openMedicine aiming at large scale eHealth adoption It calls for engagement of European Society, its national societies, and its members.

1. eHealth Practice in Europe:
where do we stand?
Catherine Chronaki
Secretary General, HL7 Foundation
ESC e-Cardiology WG

2. eHealth Practice in Europe
• eHealth as the use of Information and communication technologies
in the practice of health care
– Electronic health records (EHR)
– Healthcare information exchange cross-jurisdictions
– Personal health records
– Telehealth, telemedicine and remote monitoring
• Vision of the learning health system and issues with digital health
• Benchmarking eHealth adoption – OECD eHealth study, WHO atlas
• European Commission initiatives to support cross-border eHealth
– eHealth Digital Services Infrastructure
– eStandards, ASSESS CT, and openMedicine
• Reflections on the role of the ESC and its members

3. Vision of the Learning Health System
A healthcare system that
• Draws on the best evidence to provide the care most
appropriate to each patient,
• Emphasizes prevention and health promotion,
• Delivers the most value,
• Adds to learning throughout the delivery of care
• Leads to improvements in health.
2oo6, NIH
Question:
What is the role of e-health in the learning health system?

4. It's time to get doctors out of EHR data entry

5. Source: HIMSS Insights 2015

6. Concerns with wide adoption of EHRs
Unintended clinical consequences of broad EHR adoption:
• reduced time for patient-clinician interaction
• new and burdensome data entry tasks to front-line clinicians
• more patients, lengthened workdays
Frustrations lead to decreased satisfaction with professional work life.
Moreover:
1) Interoperability among EHR systems is nascent.
2) Electronic Health Record Systems have a steep learning curve
and limited usability.
Ref: Payne TH, et al. Report of the AMIA EHR 2020 Task Force on the Status and
Future Direction of EHRs. J Am Med Inform Assoc 2015;0:1–11

7. Atlas of eHealth Country profiles
• 126 countries, 2005, 2009, 2013, 2015, (2016)
• eHealth foundations
• Legal frameworks for eHealth
• Telehealth
• Use of eLearning in Health Sciences
• Electronic Health Records (EHRs)
• mHealth
• Social media
• Big Data

8. 31%
46%
78%
54%
34%
22%
40%
55%
96%
74%
55%
36%
46%
61%
93%
86%
75%
43%
0% 20% 40% 60% 80% 100%
Defines medical jurisdiction, liability or reimbursement of
eHealth services such as telehealth
Addresses patient safety and quality of care based on data
quality, data transmission standards or clinical competency…
Protects the privacy of personally identifiable data of
individuals irrespective of whether it is in paper or digital…
Protects the privacy of individuals’ health-related data held in
an EHR
Governs the sharing of digital data with health professionals in
other health services within country with the use of an EHR
Governs the sharing of digital data with health professionals in
health services across countries with the use of an EHR
Legal Frameworks for eHealth (1 of 2)
WHO (126 countries) European Region EU+Norway+Swiss+UK

9. 39%
29%
32%
18%
28%
76%
65%
53%
43%
47%
34%
49%
81%
70%
68%
61%
68%
46%
68%
93%
79%
0% 20% 40% 60% 80% 100%
Governs the sharing of personal and health data between
research entities
Allows individuals electronic access to their own health-related
data when held in an HER
Allows individuals to demand their own health-related data be
corrected when held in an EHR if it is known to be inaccurate
Allows individuals to demand the deletion of health-related data
from their EHR
Allows individuals to specify which health-related data from their
EHR can be shared with health professionals of their choice
Governs civil registration and vital statistics
Governs national identification management systems
Legal Frameworks for eHealth (2 of 2)
EU+Norway+Swiss+UK European Region WHO (126 countries)

10. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
primary care facilities manage patients online
Radiology images exchange in acute care
Synchronous telehealth capability in acute care
access to test results online by patients
e-appointment booking by patients
e-request perscription renewal refill
secure messaging with patients
26
10
7
0
3
3
0
5
12
8
0
2
2
4
2
9
15
31
26
26
27
Maturity of eHealth solution in 30 European Countries (OECD, EU)
>75% 50-75% <50%
Ref: Zelmer J, et al. International health IT benchmarking: learning from
cross-country comparisons. J Am Med Inform Assoc 2016;0:1–8

11. European Interoperability framework
• eHealth Digital Services
infrastructure
– Organizational framework
– National Contact points
– Multilateral agreements
– Master value set catalogue
(MVC)
– Use cases
• patient summaries
• electronic prescription
• Registries
• Reference networks
www.estandards-project.eu

12. eHealth Digital Services Infrastructure
eHDSI or eHealth DSI is
the initial deployment and
operation of services for
cross-border health data
exchange under the
Connecting Europe Facility
(CEF).
Focus: Patient Summary,
ePrecription/eDispensation
(2015-2019)

13. How to do eStandards for the Digital Age?
At a rapid face of just-in-time
disruption, Standards Developing
Organizations need to cooperate
• to deliver timely, affordably
quality, interoperability, knowledge
• to look outside
• to listen to the users
• to rethink standards and tools that
support their full lifecycle
• To deliver live eStandards
June 24, 2015 eStandards Annual Review
13
Base Standards
Use Case based
Standards Sets
Assurance and
Testing
Live
Deployment
Feedback and
Maintenance
Tooling and
Education
Forums and
Monitoring

14. Assessing SNOMED CT for Large Scale eHealth
Deployments in the EU: recommendations.
1. need for a coherent EU Strategy for eHealth addressing adoption of terminology
resources and optimizing benefits of semantic interoperability in health data
2. SNOMED CT best candidate for a core reference terminology for large-scale eHealth
– part of a terminology ecosystem with WHO ICD and others, multilingualism,
and clinical communication with multidisciplinary professional and lay language
– Be adopted incrementally with terminology subsets for priority use cases
3. Mechanisms should be established to facilitate and co-ordinate European Member
State co-operation on terminology and semantic interoperability,
– common areas of governance across Terminology centres and eHealth
competence centres

15. Equivocal identification of medicines
When scanning the medication
barcode, enhanced information
appears:
– Whether it is the right
medication
– Medication product
characteristics are
highlighted for the patient
(e.g. Considering allergies,
preconditions, etc).
ID
...
...
...
...
...
...
...
...
Prescribing
App
Patient
App
European Medicines
Database
Treatment
data
Product
data
Personal
Product
data

16. EU Patient Summary Guideline
EU patient summary guideline defines patient summary as the “minimum set of
information needed to assure healthcare coordination and continuity of care”
• Emergency or unplanned care refers to “the range of healthcare services available
to people who need medical advice, diagnosis and/or treatment quickly and
unexpectedly”
• Other EHR summaries
– Emergency data set
– Continuity of care record
– Encounter report
– Discharge summary
– 2nd opinion
– Clinical patient summary
– Disease specific summaries
• Around the world many variants of the same basic types of patient summaries
Dec 4, 2014

17. Patient Summary Clinical data for unscheduled care
• Alerts
– Allergy: Allergy description, Agent
– Medical Alert information
• Medical history
– Vaccinations (Disease, Brand, Date)
– Problem (Problem, Onset, Resolution)
– Surgical Procedures (Type, Date)

18. Patient Summary Clinical data (con’t)
Medical Problems
• Current problems / diagnoses
(description, id, onset)
• Medical devices and implants
(Device & implant description, id, date)
• Major surgical procedures (<6 mon)
• Treatment recommendations
• Autonomy/Invalidity

19. Patient Summary Clinical data (con’t)
Medication summary
• List of current medicines
– active ingredient,
– brand name,
– strength,
– dose,
– units per intake,
– frequency,
– duration,
– onset

20. Patient summary for unscheduled care
(con’t)
• Social history
• Pregnancy history
• Physical findings (e.g. ABP)
• Diagnostic tests – blood group
Is this patient summary sufficient to you?

21. What do theMember States think
about the Patient Summary Guideline?
In terms of its value, availability of infrastructure,
and sustainability

22. Status and Future directions of EHRs
(AMIA 2020 EHR task force)
• Simplify and speed documentation
– decrease data entry burden for the clinician
– separate clinical data entry from data reporting
– EHRs enable systematic learning and research during routine practice
• Refocus on regulation
– improve data exchange and interoperability
– reduce the need for re-entering data
– prioritize patient outcomes over new functional measures
• Increase transparency and streamline certification & Foster innovation
– EHR vendors use standards-based application programming interfaces (APIs) and data standards
to be open
• EHR In 2020 must support person centered care delivery
– promote the integration of EHRs into the full social context of care
– Improve the designs of interfaces so that they support and build upon how people think
What would be your recommendations?
Ref: Payne TH, et al. Report of the AMIA EHR 2020
Task Force on the Status and Future Direction of
EHRs. J Am Med Inform Assoc 2015;0:1–11

23. Electronic Health Record: wish list
• researchers, so they can advance our understanding of disease and
health care processes;
• clinicians, so they can provide safe and effective health care;
• administrators, to reduce their reliance on a single-source EHR;
• software developers, so they can develop innovative solutions to
address limitations of current EHR user interfaces and new
applications to improve the practice of medicine; and
• patients, so they can access their personal health information no
matter where they receive their health care.
Extract
Transmit
Move
Embed
Exchange
Ref: What makes an EHR “open” or interoperable? Sittig DF, Wright A J Am Med Inform Assoc 2015;0:1–3.

24. Learning Health System Goal
• By 2020, 90 % of clinical decisions will be
supported by accurate, timely, and up-
to-date clinical information, and will
reflect the best available evidence.
2oo6, NIH
What can we do to make this happen?
Healing is a matter of time, but it
is sometimes also a matter of
opportunity.
Hippocrates (460-370BC)
“. . . For the secret of the care of the
patient is in caring for the patient.”
Dr. Francis W. Peabody, October 21, 1925