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Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Quality Labelling and Certification of
Electronic Health Record systems (EHR s)
Georges J.E. DE MOOR, M.D., Ph.D.
Belgium
EUROREC
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Definitions (1)
Electronic Health Record (EHR)
Repository of information regarding the health status of a subject of care, in computer processable form.
(ISO TR 20514:2004)
The EHR is the primary source of data and information in Health
Information Networks (HINs)
Goals:
- Supporting continuing, efficient and high quality integrated healthcare
- Ability to share patient health information between authorized users
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EHRs: TRENDS (1)– transmural– virtual– multidisciplinary and interactive
AdministrativeRecords
Patient Health Diaries
MedicalRecords
NursingRecords
! Integration with other health care software applications ...!
EHRs become
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EHR: TRENDS (2)
-Medical and Bio-Medical data -Security: Privacy Enhancing Techniques-Semantic interoperability: Ontologies-Added value of EHRs: Decision Support Systems-TeleHealth-GRID Technology: HealthGrid
“The PHENOME meeting the GENOME in the EHRs of the Future”
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EuroRec
– The « European Institute for Health Records »
– A not-for-profit organization, established April 16, 2003
– Mission: the promotion of high quality Electronic Health Record systems (EHRs) in Europe in Primary and Acute Hospital - Care settings
– Federation of national ProRec centres in Europe
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EUROREC: ORGANIZATION (1)
EUROREC
PROREC - CENTRES … (Complementarity / Languages)
(Economy of scale / Synergy)
Healthcare
Authorities
…
Users
(Clinicians, Citizens)
EHRs -
Vendors
Purchasers,
Payers
“Think Globally, but act locally”
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EUROREC: GOALS
– Support to ProRec centres
– Inform users of current trends in EHRs and express their needs
– Help public authorities to define and implement strategies
– Defend the EHRs-industry (ROI)
– Promote research, education and development in EHRs
– Foster international co-operation (with US, Canada, Japan, Australia…)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
ProRec CENTRESCentres
BelgiumBulgariaDenmarkFranceItalyGermanyIrelandRomaniaSloveniaSpain
Applicants
NorwayGreeceHungaryPortugalPolandSwedenThe NetherlandsUnited KingdomSlovakia
“ Differences in languages, cultures and HC-delivery systems ”
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
HISTORY of EU-PROJECTS (1)
WIDENET : Offering World-Wide Services through an International Network of Health Record
centres (CEU, FP5,IST-14203, 2000-2003)
PROREC : Promotion Strategy for the European HC Record
(CEU, FP4, HC 1110,1996-1998)
QREC : Quality Labelling and Certification of Electronic Health Record systems in Europe (CEU, FP6, IST-27360, 2005-2008)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
HISTORY of EU-PROJECTS (2)
PROREC First PROREC centres established and
cooperation between all stakeholders
{ Extension of the PROREC network
WIDENET (additional PROREC centres created) Establishment of EUROREC (June 14, 2003)
{ QREC Harmonisation of EHRs-Certification Delivery of EuroRec Services
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
European Conferences on Electronic Health Records
1997, Paris1998, Rotterdam1999, Sevilla2001, Aix-en-Provence2002, Berlin2003, Dublin2004, Brussels
PROREC
WIDENET
QREC
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EUROREC: FUNDING
– Membership fees
– Annual conferences
– Services (cf. business plan)
– E.C. projects funded: CERTFE, QREC, RIDE,...
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
The European eHealth Area (2004)
– Electronic health cards, common approach to patient identifiers, standardisation of electronic health record architecture, secure access to personal health information;
– Health information networks between points of care (with broadband connectivity where relevant);
– Online health services to citizens, quality criteria for websites...
This EU action was endorsed by the EU Health Ministers in June 2004. Developing Electronic Health Records was one of the key policy priorities, with as targets:
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
The E-Europe Action Plan (2005)
– By the end of 2005: EU member states must define national and regional e-health strategies (deployment of e-health systems, use of electronic health records, interoperability and re-imbursement of health services)
– By the end of 2006: identification of interoperability standards for health data messages, electronic health records, taking into account best practices and relevant standardisation efforts
– By the end of 2009: EU member states and the EC will set the baseline for standardised provision of e-health services in clinical and administrative settings
E-Health was identified as one of the EC priorities, with as deadlines:
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Interoperability: general definitions
• ISO 2002:12 : Interoperability refers to the ability of two or more systems (computers, communication devices, networks, software and other information technology components) to interact with one another and exchange information according to a prescribed method in order to achieve predictable results
• CEN/ISSS 2005 : Interoperability is a state which exists between two application entities when, with regard to a specific task, one application entity can accept data from the other and perform that task in an appropriate and satisfactory manner without the need for extra operator intervention
• NAHIT (US) :Interoperability is the ability of different information technology systems, software applications and networks to communicate, to exchange data accurately, effectively and consistently, and to use the information that has been exchanged (March 09,2005)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Interoperability: types
• Technical interoperability• Organisational interoperability• Functional interoperability• Syntactic interoperability• Semantic interoperability• Political interoperability• Legal interoperability• Social interoperability• Inter-standard interoperability
• Many references (IDABC/EIF 2004, CEN/ISSS 2005, NAHIT 2005, TMA 2004, Miller 2000, ETSI 2005:3, LISI …)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: FP6-IST4
Results of the 4th Information Society Technology (IST4)
Call for proposals under the EU’s 6th Research
Framework Programme (FP6):
– 276 new research projects
– With EUR 1 billion in EU funding
QREC-project on « Quality Labelling and Certification of EHR systems in Europe » is a Specific Support Action (SSA) with EUR 1.3 million in EU funding.
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: Main Objective
To develop formal methods and to create a mechanism for the certification of EHR systems in Europe
EuroRec Institute is coordinating partner QREC has 12 partners and 2 subcontractors
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: Coordination with Health Authorities
The coordination with healthcare authorities will be done through the collaboration with the eHealth ERA consortium and its European Health Care Authorities (HCA) Ministries Group that is co-ordinating with the national e-Health roadmap activities within the EU-Framework Programme.
Both platforms (EuroRec and eHealth ERA) will follow the necessary bottom-up and top-down approaches for the adequate assessment of needs and for the optimal choice of methods for EHRs certification in Europe.
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EHR & interoperability
Biomedical informatics
HealthGrid
Deployment
Applied/Industrial R&D
Basic research
5 years 10 years 15 years
Decision Support Systems
Support to eHealth “Action Plan”
Health info networks & services
Personal Health Systems (wearables)
General issues:EHR, Security, Interoperability
I
II
III
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Implementation
I
eHealth ERAeHealth ERA
I2HEALTHIdentification
doctors/patientMessages/requests
I2HEALTHIdentification
doctors/patientMessages/requests
Certification EHRSSA
Certification EHRSSA
TMA BridgeInterop. approach
TMA BridgeInterop. approach
RIDEInteroperability
RIDEInteroperability
SHARE Healthgrid
SHARE Healthgrid
SYMBIOMATICSBMI ERA Pilot
SYMBIOMATICSBMI ERA Pilot
STEPVH CA
INFOBIOMEDINFOBIOMED
BIOPATTERNBIOPATTERNSEMANTIC MININGSEMANTIC MINING
Semantic HealthInteroperabilitySemantic HealthInteroperability
II III
Short time research Long time research
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: ORIGIN
Several EU-member states (Belgium, Denmark, UK, Germany, …) have already proceeded with quality labelling and certification schemes, but they differ in scope, in legal framework under which they operate, in policies, in organization, in the choice of quality conformance criteria for benchmarking and testing…
These differences could represent a risk of further market fragmentation: harmonization efforts should help to avoid this!
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EHRs Certification: the case of Belgium
– Early 1998: PROREC Belgium develops a quality labelling system for EHRs in ambulatory setting (333 Quality Criteria defined)
– Belgian Ministry of Public Health and Social Affairs establishes a national Health Telematics Committee, and implements the EHRs certification process in Belgium (May 3,1999):
– the conformance criteria list is reduced in size (100)
– the certification is a voluntary one, but is incentivized by legislation and budgets: GPs are actually paid to use certified systems (about 750 EURO per physician per year)
– The conformance testing (initially organized on a yearly basis) is now being conducted (since 2005) on a permanent basis
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Stakeholders / Benefits
INDUSTRY
Standards / Certification
OPENS UP the MARKET & REDUCES RISKS
QUALITY & SAFETY EFFICIENCY & COST SAVINGS
CLINICIANS, PATIENTS, PUBLIC HEALTH
HEALTH AUTHORITIES
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EHRs Certification: EXPECTED IMPACT
– to reduce EHRs investment risk for buyers
– to foster availability, accesibility, interoperability and portability of the patient records no matter where the patients are located or travelling
– to stimulate confidence and increased investment in EHRs
– to guarantee better return on investment (ROI) for vendors
– cost savings in healthcare
– improvement in quality of care and safety of patients
– to encourage patients to play a greater role in managing their own health information
– to provide valuable population health information
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EN 13606: Five Parts
- 1. Reference Model (stable since 2004)- 2. Archetype Interchange Specification (*)- 3. Reference Archetypes and Terms Lists- 4. Security Features - 5. Exchange Models
(*) EN 13606 has adopted the OpenEHR archetype methodology
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Definitions (2)
Archetype (in eHealth):
A uniquely identified, reusable and formal expression of a specific health concept.
Expressed by means of an Archetype Definition Language and composed of descriptive data, constraint rules and ontological definitions.
Archetypes can be specializations of other archetypes.
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: Core Tasks (1)
1. Study of current EHRs « Quality Labelling andCertification » -systems (State-of-the-Art Report)
2. Assay of the requirements amongst all stakeholders across Europe, covering both current and planned EHRs certification activities (Survey)
3. In-depth analysis of the ways to classify and profile EHR systems (based on “functional profiles” and other aspects)
4. Comparison of various possible EHR certification systems
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: Core Tasks (2)
5. Definition of a model (a common European template) with harmonized guidelines and procedures for EHRs certification
6. Benchmarking process manual for EHRs certification
7. Business plan for EHRs certification (cf. sustainability of services)
(Extra: harmonization of terms and concepts ( an iterative process) to be used, resulting in a general glossary)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: Main WorkPackages
WP 1: Consortium Management, Project Co-ordinationand Quality Assurance
WP 2 : EHR systems Quality Labelling and Certification Development
WP 3 : Resources for EHR Interoperability
WP 4 : Benchmarking Services
WP 5 : Communication and Dissemination Activities
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: WP 1
WP 1 : Consortium Management, Project Co-ordination and Quality Assurance
T1.1 Consortium ManagementT1.2 Project Co-ordinationT1.3 Quality Assurance
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: WP 2
WP 2 : EHR systems Quality Labelling and Certification Development
T2.1 State of the Art Report on existing EHRCertification Schemas
T2.2 Pan-European Requirements AssayT2.3 Labelling Terminology and Functional Profiles for
EHRs to be certifiedT2.4 Comparison and Harmonisation of Certification
Guidelines and ProceduresT2.5 Model Certification Guidelines and Procedures
including Legal IssuesT2.6 Plan for Validation of Guidelines
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: WP 3
WP 3 : Resources for EHR Interoperability
T3.1 Register of Conformance Criteria and GuidanceDocuments
T3.2 Inventory and Register of EHR Archetypes andGuidelines for their Use
T3.3 Register of Health Coding Systems in Use in EuropeT3.4 Inventory of Relevant Standards for EHR systemsT3.5 Register of XML Schemas and Open Source
Components for EHR systems
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: WP 3/ T3.3
T3.3 Registration of Health Coding Systems in Use in Europe
Implementation of the European Standard EN 1068
EuroRec has applied to act as a Registration Authorityand has been mandated by CEN/TC 251
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: WP 4
WP 4 : Benchmarking Services
T4.1 Benchmarking Services Manual for QualityLabelling and Certification of EHRs
T4.2 Business Plan (for new certification related services)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
QREC: WP 5
WP 5 : Communication and Dissemination Activities
T5.1 EHR TutorialsT5.2 Project Website Development and MaintenanceT5.3 LiaisonT5.4 Conferences
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EUROREC: Communication and Dissemination (1)
Fostering a harmonised implementation of high quality EHRs will require promotion, awareness and organization of educational events, hence :
– EuroRec Website and associated services based on trustworthy resources (to help purchasers, vendors and end-users)
– Tutorials on EHRs and Certification
– Workshops and Annual Conferences:
– Liaison (with US, Canada, Japan, Australia…)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EUROREC (QREC): Communication and Dissemination (2)
– Conferences :
– EuroRec 2006 Conference (in Bulgaria)– ? Together with HIMSS & others in October 2006 in EUROPE– EuroRec 2007 Conference and Global EHRs Certification Summit (in Slovenia)– Eurorec 2008 Conference (in Romania)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EUROREC’s wish to liaise (example: with the US)
– Standards :
– ANSI-HISB (Healthcare Informatics Standards Board)– HL7 (CDA / Care Record Summaries)– ASTM E31.28 Electronic Health Record SC (Continuity of Care Record)
- Certification : - CCHIT (Certification Commission for Healthcare Information Technology) - NAHIT (National Alliance for Healthcare Information Technology) - AHIC (American Health Information Community)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EHR- Interoperability and - Standards
- CEN EN 13606: EHRCOM:2004, Message based standard- GEHR/ OpenEHR: Archetype concept based- ISO/ TC215’s EHR- related standards- HL7 Version 3: RIM and CDA based message protocols- ACR-NEMA’s DICOM standard- IHE’s XDS Integration Profile , eb- XML based- JAPAN’s MML, Medical Mark-up Language
“All these standards vary in scope and content !...”
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EN 13606: Five Parts
- 1. Reference Model (stable since 2004)- 2. Archetype Interchange Specification (*)- 3. Reference Archetypes and Terms Lists- 4. Security Features - 5. Exchange Models
(*) EN 13606 has adopted the OpenEHR archetype methodology
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
EHRcom (EN 13606): Basic Building Blocks
- 1. EHR: the EHR for one person
- 2. Folders: high level organisation e.g. per episode, per clin.specialty
- 3. Compositions: a clinical care session,encounter or document
- 4. Sections: clinical heading reflecting workflow & consultation process - 5. Entries: clinical statement about observations,evaluations,instructions
- 6. Clusters: nested multi-part data structures
- 7. Elements: leaf nodes with single data values, e.g. body weight
- 8. Data values: instance values,e.g. coded terms, measurements with units
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
ISO/ TC 215’s EHR Related Standards
– ISO TR 18307:2001 Interoperability and compatibility in messaging and communication standards (a list of fundamental principles and objectives)
– ISO TS 18308:2004 Requirements for an Electronic Health Record Architecture (EHRA) (a list of requirements, not the architecture)
– ISO TR 20514 EHR, definition, scope and content (a pragmatic categorization of Electronic Health Records)
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Harmonization Efforts
CEN/ TC 251 EHRCOM
Convergence
OpenEHR Archetypes HL7 CDA, RMIM...
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Future?...
– The e-Health communities have started to interact across global networks
– Make sure that the standards correspond with the real needs of the health communities over the world and that they will be supported by the industry
Prof. Dr. Georges De Moor, the Eurorec Institute , 1 /12/ 2005, Brussels
Belgian Health Telematics Syposium 2005
Thanks for listening!
http://www.eurorec.org