Transcript rossimori-RIDE-policies&roadmaps07

Policies and Roadmaps
for semantic interoperability
in the eHealth domain
Angelo Rossi Mori, eHealth Unit, CNR-ITB
CNR-ITB
RIDE Workshop, Brussels 2006-12-08
Policies and roadmaps
GOAL:
To develop a Roadmap for semantic interoperability
for future research and development activities
in the context of the eHealth action plan
Communication COM (2004) 356,
“eHealth – Making Healthcare Better for European Citizens:
An Action Plan for a European e-Health Area”.
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to
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to
of
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compare the strategies in different jurisdictions,
explore their construction and their limitations,
work out the principles for the development
a roadmap
RIDE Workshop, Brussels 2006-12-08
disciplined vs. fuzzy environments
disciplined environments
 diagnostic services (orders and reports),
booking, admission, discharge letter, …
 systematic interactions, stable workflows
 inter-operability, standard messages
fuzzy environments
 human co-operation, clinical communication
 clinical pathways, datasets, narrative
 co-operability, document-based approach
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main principle
successful ICT solutions should
 correspond to perceived
communication needs
of clinicians and citizens,
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rely on clear workflows,
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be supported by systemic actions
by healthcare managers
and by adequate policies
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IC (T) ?
more emphasis on
I nformation
C ommunication
less emphasis on
T echnology
the context for semantic interoperability
 what are the interactions ?
 how far are they systematic ?
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1. Policies and strategies
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c.
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comparative analysis of strategies in
different jurisdictions
exploration of limitations of the current
policies and strategies
role of non-technological factors
criteria for roadmap design
preliminary activity:
set up an Explanatory Framework
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1a. analysis of strategies
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comparative analysis of strategies
in different jurisdictions, e.g. :
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NPfIT in England,
ONCHIT in US (and the RHIOs phenomenon)
Infoway in Canada,
OpenConnect in Australia
+ existing RIDE material
+ partners' contributions …
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1b. limitations of current policies
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identify the limitations
of the current policies and strategies:
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What was wrong with the process so far ?
How to improve the effectiveness of
deployment?
How to obtain “a realistic approach and
applicability in clinical settings”?
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1c. non-technological factors
regulations,
 education,
 economics,
 involvement of stakeholders,
 role of public agencies to support the
deployment and the research,
 ways to involve the research community
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1d. criteria for roadmap design
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criteria and metrics as an input
to the roadmapping process
to satisfy the EU eHealth Action Plan
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on the deployment;
on the processes of change management;
on the potential role of authorities
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+ Explanatory Framework
work out a common language
to describe policies and strategies
 a preliminary activity to systematize:
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the driving factors for eHealth evolution
the evolution of eHealth solutions
the layers of interventions
(as an adaptation of the ongoing activities
within the eHealth ERA Project
and the EU Stakeholders' Group)
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four layers of interventions
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L1. basic tools and services to enable other layers
 hw, sw, networks, regulations, identification
L2. to improve efficiency of operational workflows
 booking, prescribing, reporting, ...
(message formats, terminologies)
L3. to improve quality of shared care
 synergy of actors, patient empowerment
(clinical pathways, data sets)
L4. to improve governance of healthcare system
 structural actions (indicators)
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L1. basic tools and services
to enable upper layers
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Various large jurisdictions are envisaging national
(federal) and regional programmes,
to develop coherent inter-sectoral infrastructures
(e.g. by eGovernment actions
and generic standard, e.g. HTML, XML)
and health-specific infrastructures.
In parallel, there is an increasing attention
to define and adopt regulations and standards,
and to make plans
for specific educational activities
for the public and healthcare professionals.
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L1. basic tools and services
to enable upper layers
build the technological infrastructure;
 set up the proper regulatory framework,
including connectivity, security, privacy;
 produce or adopt standards and reference
material to achieve semantic
interoperability;
 set up a certification process on quality
and safety of eHealth solutions
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L2. to improve efficiency
of operational workflows
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to improve speed, quality, quantity of procedures
performed with a given amount of resources.
stereotypical situations (e.g. on prescriptions,
discharge letters, test reports, …)
were the topic for intense activities
on interoperability standards in last 15 years
largely independent from the actual patients
conditions: most of them do not influence
appropriateness of procedures and clinical
decisions, i.e., the intrinsic nature of healthcare
services is not altered
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L2. to improve efficiency
of operational workflows
provide services to improve the current
workflow-oriented services
 provide a basic electronic assistance to
clinicians and managers
 provide support to Public Health Systems,
on epidemiology, management and
planning (derived usage of information).
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L3. to improve quality of shared care
rationalisation of the processes
of care provision
by a problem-oriented perspective:
support the daily clinical decisions
of multiple healthcare professionals
and a more effective behaviour
of patients and clinicians
with the capture, storage and transmission of
specific data items, depending on the particular
context within the care plan
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L3. to improve quality of shared care
advanced services on information and
knowledge for clinicians
 services for the empowerment of health
consumers: citizens, patients, their
families and caregivers
 programs supporting the current care
processes
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L4. to improve governance
of healthcare system
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information support
 to discover bottlenecks
 to negotiate among stakeholders
 to decide for systemic actions
more effective management of services and
refinement of medium- and long- term policies,
by the analysis of accurate and timely data,
directly taken from the routine care processes
of each individual patient
increase in quality and better control
on resources (appropriateness).
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L4. to improve governance
of healthcare system
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re-engineering care processes
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structural actions on the healthcare system
to increase quality and appropriateness
of care provision
enabling innovative organisational models
 production and evaluation
of eHealth roadmaps
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support change management processes
for eHealth deployment
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four layers of interventions
L3 - CLINICALLY-ORIENTED PROCESSES
chronic
care
elderly children
patient
etc
empowerment .
L1 – ENABLING
INFRASTRUCTURE
- standards, certification . .
L4 – GOVERNANCE
- privacy, security . . . . . . .
structural actions
on the healthcare system
driven by healthcare managers
- portals . . . . . . . . . . . . . . .
- document sharing, EHR .
- etc . . . . . . . . . . . . . . . . . .
including eHealth roadmaps,
by authorities, alliances
competence centres
prescribing booking reports managerial EIS etc
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L2 - OPERATIONAL
WORKFLOWS
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eHealth evolution: driving factors
modernisation
of healthcare processes
inter-sectoral activities
towards Information Society
(e.g. eGovernment plans)
L1
supported by ICT solutions
gradual evolution of
ICT market in healthcare
L2
eHealth roadmaps
(on deployment and research)
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L3
L4
eHealth asks for new drivers
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increasing role
of regional / national authorities
(ministries of health and innovation)
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roadmaps
infrastructures and regulations
shift of attention
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from technological issues (market)
to governance and organisation
of the healthcare system
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Roadmaps
develop specific roadmapping principles
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criteria to pass from policies to actions
reference taxonomy on roadmapping actions
metrics to select and prioritize actions
for each sub-domain, work out:
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b.
c.
3.
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tables of preconditions
business implementation paths
concrete research tasks
synopsis and recommendations
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1a. from policies to actions
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to work out the possible consequences
of selected policy objectives:
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from the policy issues
 to potential specific goals
 to systemic actions on the healthcare milieu
 to the involved semantic issues
next steps:
work out the corresponding actions
to promote semantic interoperability
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policy issue 1 - safer decisions,
quality of care processes
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increase influence
on medical errors and on patient's errors,
by timely providing adequate knowledge
to assist proper decisions
increase the quality of care processes,
i.e. declaring and following
explicit reference clinical pathways
increase the mutual awareness of what
other clinicians are knowing, doing or planning
on the patient
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influence on errors
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goal - avoid errors
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e-prescribing (producing the prescription)
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assist patient in performing procedures
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database on potential drug interactions, adverse
reactions (formulary)
instructions to patients (multi-cultural, multi-channel)
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influence on decisions
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goal - leverage authoritative clinical
knowledge for clinicians
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assure quality of routine care provision
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decision support
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reference clinical pathways
assisted access to authoritative knowledge
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influence on information sharing
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goal - effectively manage unexpected
contacts (patient mobility)
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emergency patients, not able to
effectively present their history
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incidental access, without a shared plan
(GP and hospital, second opinion)
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emergency data set, special needs, problems
maintained lists
(active problems, allergies, ongoing medications)
basic patient profile, problem-oriented profile
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policy issue 2 – sustainable
evolution of healthcare
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the increasing cost of healthcare requires
a rationalisation of services provided,
without a negative effect
on quality of care.
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continuity of care,
patient empowerment
accurate governance based on
routine clinical data and suitable indicators,
to produce benchmarks and to allow
self-assessment of healthcare professionals
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role of ICT solutions vs.
the evolution of healthcare sector
going towards the upper layers,
 technological factors become less relevant
 semantic interoperability is more crucial
 the major goal becomes the governance
for a sustainable evolution
of the healthcare sector
 driving forces are shifting
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from market and ministries of innovation
to clinicians and ministries of health
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influence on care models
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goal – support new care models: disease
management, long term care
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support to chronic conditions, frail elderly
control of remote devices (home care),
support to care managers
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patient's folder, problem-oriented profile,
context-specific data sets
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influence on care fragmentation
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goal - face fragmentation of care provision
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planned shared care, with multiple
professionals (continuity of care)
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avoid duplicated tests
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shared clinical pathways, cooperative shared plans,
context-specific data sets
sharing any type of electronic clinical document
(according to any format)
referral letter to pass care mandates between
professionals
repository of test results
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influence on patient behaviour
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goal - patient empowerment
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adequate impact on lifestyle and on
compliance to therapy
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patient self-assessment, appropriate
requests for healthcare facilities /
services
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recalls, alerts, reminders
clinical knowledge for patients (multi-channel)
Patient Health Record (PHR)
clinical pathways and health balance
simple flow-charts to guide patient's access to
appropriate facilities
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influence on governance
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goal – improve governance and quality
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timely information on healthcare
processes and outcomes
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datawarehouse and indicators of process and
outcome
registries for management and epidemiology
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policy issue 3 – improve access
to services
simplification of the paperwork
 rationalisation of organisational and
administrative processes
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increase of efficiency of operational workflows
(e.g. prescriptions, booking, reports, …).
effective portals, with practical information
and authoritative clinical knowledge
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influence on efficiency
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goal – increase efficiency, avoid burden
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operational workflows
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continuity over time, maintain history
across episodes
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immunisations, derived lists
(e.g. tests, events, treatments, prescriptions)
simplify administrative processes
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e.g. booking, reminders, prescriptions, reports
registration data, e.g. insurance, preferred GP,
exemptions from payments, enrolment in programs
(e.g. home care, dialysis, …)
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influence on appropriate access
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goal – select the most appropriate
point-of-service (improve patient choice)
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make information about services more
accessible
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patient self-assessment, appropriate
requests for healthcare facilities /
services
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citizen's portal (multi-cultural, multi-channel),
yellow pages about available healthcare services
and facilities
simple flow-charts to guide patient's access
to appropriate facilities
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influence on availability
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goal – extend availability of healthcare
services
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primary care centre,
on-call physician,
out-of-hours,
patients shared among a group of GPs
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extended patient profile, sharing the local EPRs
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1b. reference taxonomy
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we developed a reference taxonomy
expanding the four layers of interventions
potentially involved in a roadmap
the topics enumerated in the taxonomy
should be interpreted only as an interlingua
to reach an uniform representation
of the activities described by the countries,
not as a proposal for the actual decisions
on the Roadmaps that are actually taken
within each jurisdiction
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1c. metrics to select and prioritize
actions
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develop criteria to systematically
assess the features of a candidate action:
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direct economic factors
systemic factors (global benefits)
cultural feasibility
technological feasibility
in order to define priorities
and to distribute resources
across layers and actions
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2. analysis by sub-domain
sub-domains:
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semantic interoperability
in Electronic Healthcare records,
patient identifiers,
eHealth messaging systems,
Clinical guidelines
business processes.
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to work out:
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a.
b.
c.
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tables of preconditions
business implementation paths
concrete research tasks
RIDE Workshop, Brussels 2006-12-08
2a. tables of preconditions
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use the reference taxonomy
as a check-list
to enumerate the actions
that are preconditions
for the deployment of solutions
for each sub-domain
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2b. business implementation paths
clarify the requirements
from the healthcare sector
and develop robust roadmaps,
 to enable European industry
to set up and follow a strategy
for future product creation procedures
based on innovative technologies, and
 to be competitive in international markets
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2c. concrete research tasks
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from the roadmaps, work out the gaps
requiring specific research efforts
 to drive RTD plans
for the research institutes and academia
 to suggest European collaboration
on innovative solutions
among deployment programs
across Member States
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3. synopsis and recommendations
produce a synopsis of the methodology
and of the criteria developed during the
RIDE project, as reference material for the
production of new roadmaps
 produce a set of recommendations
for developers
of national and regional roadmaps
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RIDE Workshop, Brussels 2006-12-08
thanks !
contact:
 Angelo Rossi Mori
 [email protected]
CNR-ITB
RIDE Workshop, Brussels 2006-12-08