How to move Forward the Implementation of the EU Interoperability Recommendation to Establish Trust and user Acceptance Part 1: Perspective of a Member State
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How to move Forward the Implementation of the EU Interoperability Recommendation to Establish Trust and user Acceptance Part 1: Perspective of a Member State. Rossing N. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
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How to move Forward the Implementation of the EU Interoperability Recommendation to Establish Trust and user Acceptance Part 1: Perspective of a Member State
- 1. Implementation of eHealth Interoperability. Perspectives of a Member State Denmark Niels Rossing, M.D. MedCom www.nr@medcom.dk
- 2. Denmark •5.45 mil. Citizens •Area: 43.000 km² •Highest point:171 m! •High Broadband Penetration (35%) •Extensive access to internet •Unique personal identifier •SW based PKI
- 3. 5 Regions: Health Care 98 Municipalities: Home care -60 Public hospitals -Small private hospitals - 2000 GP clinics - 1100 Specialists - 330 Pharmacies Largely Tax paid Co-payment for Dentistry and medicines
- 4. eHealth movers in Denmark • High Connectivity • Uniform healthcare provision • Fairly simple insurance system • 15 years of development and implementation • Market driven approach
- 5. Challenges • Shortage of Skilled Human Resources • Combat against Patients’ Waiting Lists • Investm’t Plans but no Change of Mind Set • And on the IT side: • Interoperability, scalability, modularity and compatibility
- 6. Major Services • We have: • - National Hosp. Pat. Regist. (1977) • - MedCom (1994) • - Telemedicine (2000) • - National Health Portal (2002) • - Nat. Prescr and Disp Rec (PMP)(2004) • - National eRecord (2006) • We plan hopefully epSOS compatible • - Improved Medication Record • - Nat. Patient Index and Summary
- 7. International reports • “Our analysis of available English-language literature and data indicate that three developed countries—Denmark, Finland, and Sweden—are definitively ahead of the United States and most other countries in moving forward with their health IT systems. These three Nordic countries have nearly universal usage of EHRs among primary care providers, high rates of adoption of EHRs in hospitals, widespread use of health IT applications, including the ability to order tests and prescribe medicine electronically, advanced telehealth programs, and portals that provide online access to health information.”
- 8. Hospital 50% LAB RAD EPR Primary Care Clinical PAS Service EPR Treatment HCR 100%
- 9. IT use among GPs (empirica) december 2009 Medcom15 8
- 10. Connected Health Internet- based Public Practising Network authorities doctors Industry Pharmacies Home care Hospital
- 11. Interoperability at National Level • - 12 Hospital PAS/EPR vendors • - 12 Primary EPR vendors • - 11 Laboratory vendors • - 8 X-ray vendors • - 5 Specialist EPR vendors • - 4 Pharmacy vendors 60 IT vendors with 100 IT systems that communicate nationwide across sectors
- 12. The Health Portal National and Regional Den fælles offentlige sundhedsportal Side33 4c. Portal i portalen – ubegrænset struktur og indhold
- 15. Consent • Patients consent is needed whenever confidential information is shared with other health care professionals • Patients written consent is needed to disclose information to people and institutions outside health care
- 17. The Health Data Network
- 18. Secure Health Data Network • Connecting existing secure networks with Virtual Private Network (VPN) to a central node. • Using existing internet connections and not disrupt the EDIFACT communication • The “central node” adjusted to the existing network – reuse of network structure and equipment • A central connection agreement system that takes care of the control of the connections between the participants.
- 19. The Danish Domain of Trust • Three level of ”access” on the Danish Health Data Network: 1. VPN network: Everyone gets access to nothing! 2. The Connection Agreement System: Select IP addresses get access to select services (IP addresses) 3. User control: Chosen users get access to select services and there is a manual and local user control.
- 20. Efficiency of Infrastructure • Today, more than 70 organisations within healthcare is connected to the IP-based Health Data network: • All hospitals • All pharmacies • All GPs • All municipalities (homecare, preschool care) • A large number of private hospitals and IT vendors • Today there are more than 1600 agreements in the system - each one replacing a point to point VPN connection • Interoperable secure connections to Norway, Sweden and two Baltic hospitals through the Baltic eHealth project. • Backbone for the national eHealth portal for citizens Sundhed.dk
- 21. Over 5 million messages/month
- 22. Danish Lessons over 15 years • Start with the basic needs • Make consensus projects Get Users, IT industry and health authorities unite! • Profiles are necessary Off-the-shelf products All-to-all communication • Dissemination projects neccessecary • Keep it simple, stupid! • Keep going: Steady pursuit of goals, patience,political will,financing and championship • Driven by demands and not by technology
- 23. The EU Interoperability Recommendation, 2008 Goal: Full interoperability by 2015 • Agreement of principles of cooperation • Enabling interoperability • Resolving Challenges • Assessment of benefits and obtacles
- 24. The EU Interoperability Recommendation, 2008 • In the Context of: • Connectivity • Data protection, fundamental rights and personal data • Local consensus as a basis for PP partnerships
- 25. The EU Interop Recom’dation, epSOS SPECs + Calliope Roadmap Action at 5 levels: • Overall political and financial • Organizational • Technical • Semantic • Education an awareness raising Danish lessons agree with recommendation We need epSOS specifications! We welcome the Calliope Roadmap!