Extended National ICT Research Directors Forum meetingon European Large Scale Actions (ELSA)

ICT for Health

Dr Dipak KalraUniversity College London

d.kalra@chime.ucl.ac.uk

on behalf of an panel of experts convened to consider ELSA priorities for ICT solutions for sustainable health

Dr Dipak KalraUniversity College London

d.kalra@chime.ucl.ac.uk

on behalf of an panel of experts convened to consider ELSA priorities for ICT solutions for sustainable health

European health systems: priorities and challenges

• Growing expectations for equity of access, quality and efficiency, patient empowerment and engagement

• Rising incidence of chronic diseases and increased complexity of their treatment

• age related: dementia, cancer

• lifestyle related: diabetes, asthma, obesity, ischaemic heart disease

• Growing expectations and concerns about patient safety

• Need for better integration across wellness, health care, public health, occupational health and social care

• Demographic change

• ageing population is driving up demand for health services

• adverse health worker to patient ratio

• Societal pressure for demonstrable protection of privacy

Priorities for reliable state-of-the-art healthcare to all

• focus on prevention and support of patient self-care and life style management

• foster translation and utilisation of research results into clinical practice

• improve chronic disease management: knowledge driven, longitudinal, across care boundaries, patient involving

• focus on (close to) home and ambulatory health services

• achieve better integration with between healthcare services, social care and wellness services

• improve skills shortage: case based and population based e-learning, advanced simulations and modelling

Jennings, Miller, Materna 1997

Point of care delivery

Continuing care (within the institution)

Long-term shared care (regional

national, global)

TeachingResearch

Clinical trials

explicit consent

EducationResearch

EpidemiologyData mining

de-identified

+/- consent

Public healthHealth care

managementClinical audit

implied consent

A pan-European Health Infostructure

Citizen in the community

Social careOccupational

healthSchool health

WellnessFitness

Complementary health

real-time knowledge directed carerapid bench to bed translation

Our present-day approach to these challenges

Implications and opportunities for ICT in health

• Manage increasingly complex clinical care

• Connect multiple locations of care delivery

• Support team-based care

• Deliver evidence-based health care

• Improve safety

• reduce errors and inequalities

• reduce duplication and delay

• Improve cost effectiveness of health services

• Enrich population health management and prevention

• Empower and involve citizens

• Protect patient privacy

• Better inform and exploit bio-science research

Electronic Health Record - EHR 2.0

Date: 1.7.94

WhittingtonHospital

Healthcare Record

John Smith DoB: 12.5.46

Clinical trials,functional genomics,

public health databasesEHR repositories

Clinical devices,instruments

Clinical applications

Decision support, knowledge managementand analysis components

Mobile devices

Personnel registers,security services

Social computing:forums, wikis and blogs

Integrating information

Centring services on

citizens

Creating and using knowledge

Examples of Health ICT research enabled by the Framework Programme

• Comprehensive electronic records (EHR)

• requirements, information architectures, clinical data standards, terminology systems, security - now published as international standards

• BUT now needing to be validated against large scale challenges

• standardised clinical meaning across diverse communities of practice

• cross-border confidentiality protection and de-identification

• pan-European quality assured and certified eHealth interoperability solutions

• Virtual Physiological Human (VPH)

• sophisticated modelling of how body systems and organs behave in health and in disease, to help optimise treatment decisions

• BUT now needing to be refined through

• linkage with real electronic health records, and real-world clinical data quality

• safety testing for real clinical decisions in varied care settings

• Personal Health Systems (PHS)

• wearable and implanted and near patient monitors, communicating with a central repository: integrating and alerting whenever needed

• BUT now needing to

• integrate with holistic EHR data

• safely advise on patients with multiple diseases and using multi-vendor PHS products

Digital Me

Source: Peter Coveney, UCL

Principles for a successful approach

• To focus on a very concrete societal need which can be addressed by user and experience driven R&D, innovation and large scale demonstrators leading to wide deployment

• Special effort to engage payers, clinicians and patients at every stage in addition to the other (more committed) stakeholders.

• Major milestone: European infostructure on top of national eHealth infrastructures (not their duplication!)

• Focus on few applications demonstrating the benefits of such infostructure and open the way for regional/national/international developments

• Provision of visible and useful milestones, at regular intervals

Examples of objectives of an ELSA on eHealth

• Improve the quality and effectiveness of clinical shared care and facilitate cross border care

• Provide “the right information, in the right place, at the right time” to health providers and patients while securing the citizens right to privacy

• Bring into the equation other data relevant to our health beyond medical information (lifestyle, environment)

• Improve the way clinical research is performed and facilitate faster translation into clinical practice

Emphasising translation

• The EU Health Telematics Framework Programmes have inspired some of the best health informatics research on the planet

• But, it has proved difficult for some of the research to be refined and validated at the scale needed for national or European adoption

• potential impact has not been realised yet

• market potential is as yet under-recognised

• societal gains and cost savings remain a missed opportunity

• It is now vital to capitalise on proof of concept and SME level Health ICT research

• ELSA’s have the potential to provide large scale validation, evidence of what works well, and how to turn research results into products and daily experience