Paper José Enrique Borrás - eHealth policies review: From European Union to the Valencia Region
eHealth policies review: From European Union to the Valencia Region José Enrique Borrás Morell#1, Rosa Valenzuela Juan*2, Vicente Traver Salcedo#3 # ITACA - Health and Wellbeing Technologies, Universidad Politécnica de Valencia 1 email@example.com 3 firstname.lastname@example.org * Agencia Valenciana de Salud, Consellería de Sanitat 2 email@example.comAbstract— The Information and Communication Technologies Health Organization and the European Union on eHealth.(ICT) offer an endless opportunities and challenges, besides Once this analysis is performed, a more detailed analysis ofnowadays, their usages do not stop growing and expanding, and eHealth in Valencia Region will be done, to know thehealth sector is taking part in this revolution. Telemedicine, guidelines that have been taking in Valencia Region. ThenePrescription, Patient Summary, etc. shows a new reality in there is a detailed study of Valencia eHealth System,health sector, the eHealth. A tour, along the policies and actionsthat are been performed in the eHealth sector is being made analyzing the current state of the art and considering some ofthrough this document. Starting from a global case, as the basis the experiences of eHealth that are being executed in Valenciaof our review, the World Health Organization, continuing with Region. Finally there is a conclusion point, with an analysis ofthe European Union as an example of policies evolution and future eHealth trends.eHealth actions, and the Spanish Ministry of Health as theMinistry responsible of health in Spain, until to reach a II. WORLD HEALTH ORGANIZATIONparticular case, the Valencia Region and its actions and policies The United Nations system responsible for health is theon eHealth through the Valencia Region Health Agency. World Health Organization (WHO). In 2004 as a part of theStrategic Plans, actions, policies, and new trends that are beingmade on eHealth will be analysed, with the aim to show how, step Department of Knowledge Management and Sharing (KMS) was created the e-Health unit, with the objective of sharing theby step, the eHealth goes from to the health of the future, to thecurrent health, which is heading to the future. use of knowledge through ICT. In 2005 after the Fifty-eighth World Health Assembly, the WHO established an eHealth I. INTRODUCTION strategy. The basis for policy coordination, at the According to the World Health Organization “eHealth is international and WHO activities, in the eHealth area, arethe use, in the health sector, of digital data—transmitted, provided in this strategy. The strategy is divided in two parts,stored and retrieved electronically— in support of health care, the first one aimed to countries, where the WHO urgesboth at the local site and at a distance.” . member states to develop an eHealth action plan as a main Everyday ICT are becoming more important in our goal to develop their eHealth activities and the second one,environment, from our private life until our work, and health which are the WHO commitments to provide support tosector is no exception. Combined correctly, health and ICT member states with the promotion and the development ofcan be a powerful set of tools to help to improve life quality their eHealth activities, such as provide technical support toand have more efficient healthcare services for all. member states or the submission of regular reports with Electronic medical records, telemedicine, management of eHealth state .health centers, such as economic and human resource Following the same direction, the study and analysis ofmanagement, are some of the key application areas of e- eHealth impact, The Global Observatory for the eHealth (GOe)Health, but there are much more, such as optimize the sources, was created in 2005, and its functions are aimed to:improve the efficient in health processes, improve the quality a) Study the eHealth benefits on the countries andof the service, etc. analyse eHealth policy. eHealth helps the interaction between patients and health- b) Know what strategies and developments are beingservice providers or health professionals, improving the done around the eHealth.quality of health tasks and processes. eHealth offers a way for c) Provide strategic management practices and effectivecitizens and health professionals to access to health policies.information. eHealth can be a tool to complete diagnosis and d) Give the standards in eHealth to the member states ina pillar to health tasks and processes. the WHO. During this paper a tour is being performed along thedifferent policies that have been proposed from the World
The Observatorys mission is to improve health by providing III. EUROPEAN UNIONMember States with strategic information and guidance on Since 1990 the European Union has been working oneffective practices, policies and standards in eHealth . developing and research of eHealth tools and systems. In 2004 A global survey was the first action GOe performed. This was approved the eHealth Action Plan 2004 (eHAP). This survey had two objectives: First to understand the state of art plan was the first commitment between member states of the in eHealth in the world. Second to know in what key areas European Union to cooperate in the eHealth sector . the WHO should act, such as create an international network The eHAP main objective was to allow the European Union to share practical experiences or study the development of to achieve the full potential of e-Health systems and services generic tools for eHealth. Following this line a second global within a European e-Health Area. The eHAP main points were: survey was done in 2009 to know the development of on the side of the Member States, to draw up national or eHealth plans, in every country, and set new requirements on regional roadmaps for eHealth, the commitment of national eHealth area, these were the new objectives. These surveys and regional health authorities with the eHealth , and provide have been the basis for the elaboration of a series of tools and leadership to eHealth implementation efforts. On the other guidelines, about strategies and polices on eHealth, aimed at side, the European Union in collaboration with the States governments and Health institutions. Members had to identify and elaborate standards for electronic Since 2005 a series of papers have been given from the health records and health data messages and study of aGOe for assisting in the development of eHealth strategies. framework for better legal certainty of e-health products.The first one was the “eHealth tools and services Needs of the Finally, on the side of the European Union, continue with theMember States”. Published in 2006 this document gives an investment in eHealth area and the publication of documentsidea about the state of eHealth tools in the world in 2006, related with the European best practices, the state of art inincludes a collection of proposed actions on eHealth by the deployment, etc. as guidance for Member States forWHO. In 2007 was published the “Building Foundations for developing their eHealth plans.eHealth Progress of Member States”. This document contains In 2005, the i2010 subgroup on eHealth, on i2010 High-the results and findings of the first survey, giving a global Level Group was created to provide advice for the correctvision of eHealth; some recommendations for the implementation of the eHealth action plan. For the perioddevelopment of eHealth strategies are there. 2005-2009, the EU policy framework for the information Continuing with the results of the first survey, in 2008 was society and media with the information and communicationpublished "Building Foundations for eHealth in Europe". technologies was promoted by i2010 High-Level Group. TheUnlike “the Building Foundations for eHealth document” this i2010 subgroup tasks on eHealth were focused on: innovationdocuments contains a more detailed survey analysis of the and the better access to all eHealth initiatives and thecontents and findings, in the European Region. involvement and inclusion of Europe’s citizens in healthcare Once the second survey was completed, was published, in through electronic means. From 2010 this task be assigned to2010, the “Global Observatory for eHealth series - Volume 1”. a new initiative – the Digital Agenda (Digital Agenda is anData from second survey and findings are in this document initiative of the Europe 2020 Strategy to prepare Europe forand describes the current status of eHealth; finally it provides the next decade, which objective is to maximize the potentialinformation about the current eHealth development. of ICT) [7:10]. In 2011 two documents have been published: First the In 2006, with the objective to create the proper framework“Global Observatory for eHealth series - Volume 2” a to foster lead markets, was launched The Lead Marketdocument based on the second survey and focalized on Initiative (LMI), one of this markets was the eHealth. In theTelemedicine, as an essential part of eHealth; note that the action plan of the LMI was included a roadmap of policydocument is intended for health professionals. This document recommendations on the period 2008-2010 in eHealth, withbrings an analysis of four fields of telemedicine: teleradiology, the goal to reduce market fragmentation, promoteteledermatogy, telepathology, and telepsychology. By the standardization and increase interoperability between eHealthmiddle of 2011 was published the “Global Observatory for systems .eHealth series - Volume 3”, based on the second survey. This In 2009, with the idea to facilitate the cooperation betweendocument gives and analysis of mHealth (mobile health), as Member States and the European Commission, in the updatean opportunity to apply mobile technology for health . of the 2004 action plan, was established by the Employment, The previous documents are a complete guide for the Social Policy, Health and Consumer Affairs Council (EPSCO)governments, to improve their eHealth policy, for the practice The High Level eHealth Governance Group. This initiativeand management of eHealth, and for knowledge generation. will bring forward eHealth for the "deployment and actual use Besides, with the objective to explore the potential of of interoperable eHealth services within and between nationalcollaboration between WHO and public or private entities, healthcare systems"involved to achieve the goals of the organization in the healthsector, was created the eHealth Standardization Coordination A. ActionsGroup (eHSCG); with the goal to define the framework and During this point is going to review some of the mostguidelines to ensure that such collaborations reach their significant achievements have been performed, or are beingobjectives in a measurable actions . performed by the European Union.
The first one is a 10-point action plan. These points are based professionals in Europe. Besides the card mayon the communication "Telemedicine for the benefit of serve as medical validation or for access topatients, healthcare systems and society". This communication medical records .is centered on telemedicine and it relationship with eHealth. b) The European epSOS (Smart Open Services forBelow are some of the most significant achievements : European Patients). Citizens’ treatments are a a) Actions at the level of the Member States: the report problem when they are in a foreign country. “eHealth in Action: Good Practice in European This project helps to access to their health Countries”, that contains an analysis and description information, electronics health records and of some eHealth projects. Also the report “eHealth ePrescription, all over Europe. Making easier a priorities and strategies in European countries”. It personalized citizen treatment . contains a completely analysis of the eHealth c) RenewingHealth (REgioNs of Europe WorkINg strategies in 2006. toGether for HEALTH). Telemedicine is a b) The member states actions to be supported at EU powerful tool for eHealth. This project aims to level: the document “study on the Legal Framework conduct studies to validate and evaluate for Interoperable eHealth in Europe”, providing an innovative telemedicine services targeted to idea about the legal and regulatory framework for patients . electronic health services in the European Union d) Calliope Network. This project has established member states. a successful collaborative platform for c) Actions to be undertaken by the Commission: The interoperability in Europe. The goal is making study “Economic Impact of Interoperable Electronic value makers for the national eHealth Health Records and ePrescription in Europe”. implementations and how to establish Continuing with the actions performed, in 2008 was interoperable eHealth services .established a recommendation on cross-border interoperability Finally to note a European Commissions proposal,of electronic health record systems. The objective is to get the launch of a European Innovation Partnership on Activeinteroperability between different healthcare systems . and Healthy Ageing, to enable our citizens to live longer in In December 2010 the “European eHealth Interoperability good health, by increasing the average number of healthy lifeRoadmap”, a study about interoperability in Europe was years by 2 in 2020  .presented . In January 2011 the study "Enhancingprocurement of ICT solutions for healthcare", a guide for thehealthcare authorities and care delivery organizations to planeHealth policy, was carried out. A specific consultationbetween members of Union European has been performed in2011, by The European Commission, to continue monitoringeHealth development and eHealth initiatives deploymentacross Europe. Highlight the eHealth ministerial Conferences, annualmeetings between health experts and ministry of healthworkers, to discuss the actions to perform on Action Planobjectives. Other important point is being done by the EU is theresearch in eHealth. More than 450 collaborative R&Dprojects in eHealth have been done by the EuropeanCommission. The Seventh Research Framework Programme(FP7) is a program to improve Europeans’ standards of living, Figure 1: epSOS participating nationswith a total budget of more than €50 billion for the period B. Action Plan 2012-20202007 to 2013. The FP7 has focused on three fields, thePersonal Health Systems (PHS) with researches related with In 2009 conclusions of the European Union Council calledpersonalized monitoring, the Patient Guidance Services (PGS) upon the European Commission to update the 2004 eHealthwith researches about Risk assessment and patient safety, and Action Plan. Once consolidate the goals, which had beenthe Virtual Physiological Human (VPH) with researches about achieved through the 2004 Action Plan, the objective is to setComputer models for personalized and predictive healthcare the eHealth in the new context of the Europe 2020 strategy .  . Finally, to note some of the most important European The following action points related with eHealth areLarge Scale Pilots: included in the Digital Agenda, as a part of the Europe 2020 a) In 2009 was presented the HPRO card. This strategy: project allows, with a professional card, the free a) “Undertake pilot actions to equip Europeans with movement of citizens with the health secure online access to their medical health data by
2015 and to achieve by 2020 widespread deployment V. VALENCIA REGION HEALTH AGENCY of telemedicine services”. The Valencia Region Health Agency (AVS) carries out the b) “Propose a recommendation defining a minimum management and administration of the health in Valencia and common set of patient data for interoperability of healthcare delivery in the Valencia Region. It is organized in patient records to be accessed or exchanged health departments. There are 24 health departments and they electronically across Member States by 2012”. are equivalent to the areas of health where they act. c) “Foster EU-wide standards, interoperability testing The organism responsible for the coordination between the and certification of eHealth systems by 2015 through AVS and health departments, in computing and stakeholder dialogue”. telecommunications terms, is CITESAN, while AITO is the d) “Reinforce the Ambient Assisted Living (AAL) Joint organism responsible for the development of the Information Programme to allow older people and persons with Systems Plan of the Valencian Health Service. disabilities to live independently and be active in The Information Systems Plan 2009 - 2011 is aimed at society”. enhancing the global integration of systems and ensures the e) “Demonstrate eHealth interoperability testing and sustainability of the solution, improve the capacity of the certification on a large scale”. citizens to access to their health data and implant the f) “Develop a European eHealth Interoperability Electronic Health Record. The following action points, Framework” . related with eHealth, are included in the Health Plan of the Valencia Region 2010-2013 : IV. SPANISH MINISTRY OF HEALTH a) Develop ITCs and e-health as a strategic tool to The Spanish Ministry of Health is the responsible for the improve interaction with patient.management and administration of health in Spain. In 2006 b) Incorporate intelligence to systems as a tool to improvethe eHealth program on the Quality Plan for the National efficiency and outcomes. The objective is on the oneHealth System (SNS) was approved. The goal is to improve hand incorporating support systems to dailyservices to citizens in the SNS through ICT, this includes professional health; and on the other hand, to analyzesome important points, such as ensure the unique the data information from the patients and to identifyidentification of citizens throughout the SNS by the health the patterns of patients with special problems to be ablecard, promote electronic medical records and ePrescription to design differentiated programs tasks.system ,offer new services for the relationship between c) Develop and maintain the technological channelscitizens and professionals, improve the accessibility of the (access to information for mobile programming, visitorseHealth services, etc. . on-line, etc.) of communication with the user, according In Spain nowadays more than 90% of the health centers to the Information Systems Plan.use ICT to improve clinical management assistance, help d) Analyze the situation of intersectional channels, todoctors to consult the primary medical record, information propose and to develop them. The main objective is tosystems for the management of health care centers and record show the Department of Health as technical leader onthe outcome of consultation . health issues for different sectors of society, to provide Some initiatives have been carried out from the eHealth information for eHealth interventions, or to improveprogram are related with de medical prescription like the health and habits of the population.ePrescription project. This project allows the electronic The AVS systems plan budget was €51 million for 2010prescribing of medicine through ICT level and collaborates and €46 million for the 2011.with the European project EpSOS on the exchange of clinical The Health Information System of Valencia is calledinformation; others initiatives are related with the Patient SISAN . SISAN is composed of different subsystems, theSummary like the HCDSNS project (Clinical History Digital Clinical and care subsystem, the economic managementfrom the National System Health). This project allows, health logistics and human resources subsystem, and the businessworkers, to have access to the patients’ health information Intelligence subsystem. A global vision of the information(electronic health record (EHR) Patient Summary), regardless system is showed by the union of all of them.of the region where they are. To note that this project foresees To understand the SISAN is needed to know ARTERIAS,a future integration into the electronic medical record at the network that interconnects all health centers andEuropean level and also collaborates with the European administrative services in Valencia Region. It is a networkproject EpSOS. But there are other initiatives, such as The designed to handle voice, data and image .Health Card, a project that uses a personal card as an Nowadays AVS is working on the improvement of theidentification system in all the Autonomous Communities and SISAN systems; many of their developments are focused toallows that all health cards can be read anywhere in the improve each subsystem of SISAN.national health system; and more projects related with the One of the most ambitious projects of the SISAN, in the Careencouragement of telehealth and the use of Internet to Subsystem, is the project HSEAVS, the Electronic Healthfacilitate the administrative relationship between citizens and Record in AVS. HSEAVS is a Service-oriented architecturethe health system, such as online previous engagement or based on interoperability standards. A platform that allowsincreasing the bandwidth, etc. [27:29]. access to the Clinical History Summary, Emergency care
reports, high clinical reports of hospitalization, reports be analyzed. The objective is to know the interoperability withlaboratory test results, reports test results image and nursing the SISAN and to study the advantages and disadvantages ofCare Report, is based on the project HCDSNS from the integrating each experience in the SISAN.Spanish Ministry of Health. The intention is to integrateHSEAVS in the European Union initiative epSOS  and VI. CONCLUSIONSobtain interoperability between different health systems EU Neelie Kroes, Vice President of the European Commissionmember states. Continuing with the Care Subsystems, for the and Commissioner for Digital Agenda says "30% of the EUsambulatory care, the health centers can use a system called inhabitants will be over 65 years in 2050. Furthermore we seeABUCASIS. This system, based on other sub-modules, can be estimates point to a shortage of one million healthused for healthcare activities and administrative task, such as: professionals in the EU by 2020, and this is likely to reachePrescription, registry vaccine, or request an appointment. On two million if other employees in the healthcare sector arethe other side, for the management of the health centers there accounted for”. Besides World Bank studies show that publicis Orion-Clinic a hospital information system . Orion- expenditure on healthcare in the EU could jump from 8% ofClinic is based on three modules, Orion-HIS responsible for GDP in 2000 to 14% in 2030 .the management of patients, Orion-Farma responsible for the The eHealth policies are reflected on the facts cited before,management of ePrescription and Orion-Ris responsible for this document show how new trends are heading to:the management of medical images. Finally for the a) Utilization of eHealth to extend healthcare from thecoordination of extra urgent hospital care there is the hospital to home, with the same quality of healthcare,CORDES system . to reduce financial and human resources in healthcare. The other main module of SISAN is about the economic This includes the analysis of the RenewingHealthand logistics management, for the management resource of the project results, the development of solutions onhospital, SISAN offers Orion-Gesto. Orion-Gesto is a system telehealth to expand hospital processes into telehealthfor the management of hospital resource and is based on two processes, the improvement of the access tomodules, the Orion-Logis a system for the management of specialized clinical services, the improvement of theeconomic and logistics issues, whereas the Orion-Person disabilities and chronic disease management andallows the management of human resources. improve and save client care time.There are others significant projects where SISAN is working, b) Greater cooperation between the Europeanlike IDESAN, a project that shows the information stored, in Commission and member states. This includescorporate information systems, on Internet mapping, or the interoperability of national eHealth systems in Europe,Oficina 2.0 a website that provides support and training tools for the simplification and reduction of administrativefor citizens and health professionals . task, and the improvement of the provision of One of the objectives of AVS is to get interoperability healthcare in Europe. Analysis of the Calliopebetween the different healthcare systems; on figure 1 appears Network project, HPROCard project and epSOShow the interoperability is achieved. project, with the objective to develop solutions to improve cross-border interoperability of eHealth; and the development of common electronics health records, for all the EU member states, through the experience gained from the projects cited before. Finally both tasks should develop an appropriate level of security due to the transfer of health personal information. c) Exchange of knowledge between EU Member States, it allow them, to know the latest progresses and decisions in eHealth sector. d) New systems to give healthcare professionals more time to treat patients and spending less time in bureaucratic paperwork. e) Study of active and healthy ageing. Promotion of healthy and active ageing to live longer in good Figure 2: Example of interoperability health. f) Continue with research programs in eHealth Besides, there are some experiences on eHealth development.implemented on each health center, such as Teleradiology, To emphasize, after to analyse the eHealth policies, actionsTeledermatology, Teleophthalmology, Telecardiology, and new trends, is observed that in general, new trends matchRemote Access Medical History, Videoconferencing and up with the conclusions given in the eHealth Ministerialothers like Health Web Portal. Conferences . AVS is working on the future eHealth strategic plan, whereall the health centers individual experiences on eHealth should ACKNOWLEDGMENT
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