1. Universities and national eHealth infrastructures: Co - developing solutions and competence on the example of the Austrian national EHR (ELGA) Stefan Sauermann Telemedicine: International Cooperation and Experience 26 September 2013, Kladno, Czech Republic

2. Who am I?  Electronics Engineer  15 yrs Med. University of Vienna, research  Biosignal work  Then standards, medical informatics  Program director Biomedical Engineering Sciences (Master)  Key Research eHealth, Department of Biomedical Engineering  Chair ONK 238, founding member IHE AT, HL7, ASSTeH, ProRec AT,.. www.technikum-wien.at

3. Motto  eHealth is big and complicated –How do we connect „Top Down“, „Bottom Up“ to „Real Life“??  Standardisation networks the „Real Life“ –Become a national and international information broker –Be an insider  Get the knowledge to work: Examples –Teaching –Projects 3 © 2012/13 FH Technikum Wien

4. Agenda  Austrian eHealth Evolution, co-growth with Technikum Wien –„historical“ review  Always looking at „Real Life“ –Links to national projects in AT –Students innovate at Technikum Wien  Status and Visions –Certificates for teaching, internationally aligned 4 © 2012/13 FH Technikum Wien

5. Vision in healthcare: Shed light through space and time

7. Visions for personal health: All involved are involved

8. „Interoperability“  The ability of software and hardware on different machines from different vendors to share data. (www.webopedia.com)

9. „Semantic“ interoperability  Semantic“ interoperability enables –automated –further processig of data –without additional manual effort  at the receiving system  Succeed if you address ALL –Legal, –Organisational, –Semantic and –Technical issues

10. Requirements for moving “intelligent” IT into healthcare on a large scale  The need to develop national and international biomedical- networking infrastructures that use existing and future technologies for communication, data exchange, and information retrieval.  The need for credible international standards for communications, data, and knowledge exchange that will allow both commercial and academic developers of medical information systems to know what to do in order to assure the integration of their products with other developing systems  Shortliffe E.H.: The adolescence of AI in Medicine: Will the field come of age in the 90s? Artificial Intell.Med. 5, 1993, 93-105.

11. One more Shortliffe slide: Requirements  „I do believe that we must accept the impossibility of viewing the introduction of decision support tools as a grass-roots activity that emerges from the research lab, (….) and then grows by some kind of mass effect to encompass an entire medical community.  (…) will be realized when the infrastructure for introducing computational tools in medicine has been put in place by visionary leaders,  who understand the importance of networking, integration, shared access to patient data bases, and the use of standards for data-exchange, communications and knowledge-sharing.“

12. Time axis, EU, Austria, Technikum 2003-050607080910111213 12 © 2012/13 FH Technikum Wien e-health Focus Group e-health Action Plan eHealth Initiative Health reform ELGA project company Projects, theses, papers, … Healthy IO Project Focus eHealth IHE Austria eHealth Interoperability FW (eH EIF) Health reform Antilope HITCH

13. First light on the European horizon  Europe: e-health Focus Group (12.2003-21.2.2005) –European Committee for Standardization (CEN) –Within CEN: Information Society Standardization System (ISSS) –http://www.cen.eu/cen/Sectors/Sectors/ISSS/Activity/Pages/eHealth_FG.aspx –Technikum Wien was represented  Europe: E-health action plan –European Commission, 30.4.2004, KOM (2004) 356 –“By end 2005, each Member State is to develop a national or regional roadmap for e-Health.” –http://ec.europa.eu/information_society/activities/health/policy_actio n_plan/index_en.htm  Pain: We have to do something!! –Triggered member state activities

14. 2005 eHI recommendation on EHR standards for Austria (simplified)  ALWAYS: Use open standards –International wherever possible (this is a complex question) –Or you will burn money  IMMEDIATELY: Start off with IHE XDS –As an exchange infrastructure –Use CDA as document format  LATER ON: Upgrade as it comes –EN13606, make an EHR of it –Archetypes / Templates are necessary for flexibility! –Play an active role in international co-operations  This went through politics in 2006  Medical University of Vienna and Technikum Wien were right in the middle

15. The Ministry of Health: Administration  Health reform law of 2005 –Orchestrate residential providers and hospitals –Steer this politically by „Bundesgesundheitsagentur“  Run by Federal Ministry of Health and Women  Operative arm: „Bundesgesundheitskommission“  7 representatives from the state, 9 from the provinces, 6 social insurance, 1 from each city, 1 for hospitals, 1 patient representative, 1 from doctors –Mentions “Electronische Gesundheitsakte ELGA”  ELGA legal body started into operation 9.2006 –„Owned“ by state (Ministry of Health), social insurers (HVB), Provinces –www.elga.gv.atwww.elga.gv.at –Definition of services and standards progressed, slowly 15a B-VG-Vereinbarung über die Organisation und Finanzierung des Gesundheitswesens. Bundesgesetzblatt für Österreich, 2005, 12.7.2005, Teil 1, Online (16.2.2007), http://www.bmgf.gv.at/cms/site/attachments/3/2/6/CH0038/CMS1104315559331/bgbl_15a-vereinbarung_2005.pdf

16. Available resources at Technikum Wien ~2007  Knowledge, people, structure, funding –Individuals knew many things from where they came from –learned all that was necessary from doing it –Large existing projects addressed the topics, no coordination –Bachelor, Master theses, papers, … –Early phases of „Evolution“ –alignment, understanding, contacts, „look and feel“  Research proposals –Some even were acccepted

17. Steps on the national scale  IHE Austria started 2008 –Technikum Wien staff as founding members –Close cooperation with ELGA  IHE Connectathon in Vienna 2009 –Technikum Wien as local organiser 17 © 2012/13 FH Technikum Wien

18. Recent European Developments in eHealth interoperability  European Interoperability Framework, 2013 –Intended for many domains  eGovernment, eBusiness, eXxxx, …  Study on applicability in eHealth, see the report –http://ec.europa.eu/digital-agenda/en/news/ehealth- interoperability-framework-studyhttp://ec.europa.eu/digital-agenda/en/news/ehealth- interoperability-framework-study –Part 2, 3, 4: “Vision on eHealth EIF”, “Assessment framework” „First proposal technical layer“ –IHE, Continua, epSOS were studied as pilots 18 © 2012/13 FH Technikum Wien

19. eHealth EIF II  Principles –Security and Privacy, Transparency, Preservation of Information, Reusability, Technological Neutrality and Adaptability, Openness, Patient Centricity, Use Case Approach  Address all levels of interoperability –Legal, organisational, semantic, technical  Organisational criteria –Type of organisation, openness, consensus, transparency, maintenance and intellectual property rights.  Technical specification criteria –Market acceptance, coherence, availability, relevance and effectiveness, neutrality and stability and quality 19 © 2012/13 FH Technikum Wien

20. Standards and Profiles in eH EIF  “As defined in European legislation (Article 1, paragraph 6, of Directive 98/34/EC), a standard is a technical specification approved by a recognised standardization body for repeated or continuous application, with which compliance is not compulsory and which is one of the following: international, European, national.”  “In the study, profile (term used by IHE) and guideline (term used by Continua) are technical specifications that identify “a consistent set of chosen options from a base standard or from a set of base standards, in order to provide a given function in a given environment” (ETSI standard ETS 300 406).” 20 © 2012/13 FH Technikum Wien

21. Hosting the IHE Connectathon Vienna 2009  90 companies  Accompanying workshop "Sharing Clinical Documents and Integrating Workflow“  www.ihe.net 21 © 2012/13 UAS Technikum Wien

22. Healthy Interoperability (HIO) Project setup  4 years, 1mio € national funding, 2009-2012 –Thanks to FFG and City of Vienna! –Work started on follow up projects  Team –2 key researchers –3 full time developers, 1 full time project coordinator –~ 10 individuals part time  Goals: Support and promote standards based interoperability –Co-organised Vienna Connectathon 2009 –Dissemination, lobbying, networking, cooperative projects –Joined Continua Plugfest 2012, good experience –Feasibility is shown. We want more!!

23. HIO implementations

24. www.projectsolutions.at Technikum Wien eHealth Team: PAN manager, Bluetooth HDP, WAN sender tested successfully! @ Continua Plugfest 2012 Berlin HIO AHD as Android App Against testtools and other vendors Enables data exchange via smartphone from device to server Reference Projects

25. AlveoPic: Advanced lung research for veterinary medicine of particles for inhalation - Cooperation  EU funded project for the development of a mobile extracorporal nutrition system for porcine lung tissue, used as basis for realistic physiological and pathological breathing patterns including the simultaneous measurement of aerosols during in- /exhalation  Started in 2013 25 © 2012/13 UAS Technikum Wien This project has been funded by the European Regional Development Fund and has been co- financed by the AUVA.

26. Students‘ Projects  2010  Development of an RFID and Bluetooth supported thermometer based on the IEEE 11073 communication standard  Presented at “eHealth2010” conference 26 © 2012/13 UAS Technikum Wien Patient Database Bluetooth Module Manager Medical Device-Agent Patient Patient ID RFID Module

27. Students‘ Projects  2011  Health Data Hub (HDH)  Wrist wearable device for:  Context-based measurements  Storage and transmission of medical data  Check of activity of user  Use case: Telemonitoring  Presented at “eHealth2011” conference 27 © 2012/13 UAS Technikum Wien

28. Students‘ Projects  2012  Personal Health Data Identifier (PHDI)  Wrist wearable device for:  User identification in a multiuser environment  Transmission of medical data  Check of activity of user  Use case: Spa, hospital, care residence  Using off-the-shelf PHDs  Presented at “eHealth2012” conference 28 © 2012/13 UAS Technikum Wien

29. Students‘ Projects  2013  mECG  Development of the hardware for mobile ECG including standardized Bluetooth connection to an Android smartphone  Data storage local and on server  Development of an ECG CDA  Will be presented at “eHealth2013” conference 29 © 2012/13 UAS Technikum Wien

30. EM-2012  Small regional football clubs  National football clubs  National football team  Championships  EM Continua EXPERIENCEEXPERIENCE EXPERIENCEEXPERIENCE  PlugFests  Continua Certified

31. Beautiful teaching content - examples  How do you –Move device data into the national EHR –Generate a summary report –Retreive data from the EHR –Build mobile applications –Test and certify interoperabiliy of applications –Become a certified expert for interoperability in eHealth  In the fields of –IEEE/ISO /CEN11073 Personal Health Device standards –IHE profiles –Continua Health Alliance Design Guidelines 31 © 2012/13 FH Technikum Wien

32. IHE Education working group 32 © 2012/13 FH Technikum Wien  Founded 2013  Goal is to establish expert profiles and certificates –Based on learning goals and content definitions  Will align to the structures of IHE Product Certification, maybe: –„Global scheme owner“ –„Local certificate provider“ / „Local examining organisation“ –„Local teaching organisations“ ?

33. IHE Product Certification, concepts 33 © 2012/13 FH Technikum Wien

34. Antilope concepts for EU 34 © 2012/13 FH Technikum Wien www.antilope-project.eu

35. 2012: Research focus eHealth @Technikum Wien  Knowledge as shown, see reference projects  2 Key researchers  4 senior reserchers, all are Technikum Wien graduates  Settled in a stable team –within the Departments of „Information Engineering & Security“ and „Biomedical Engineering“ –with a rich set of network of IT experts close by  Lectures, projects in > 6 study programs –Many student papers, presentations, … –Graduates out there start to help us along 35 © 2012/13 FH Technikum Wien

36. Future vision  Make the knowledge visible and tangible  Provide it to many  Contribute to the community:  This is too big to be ridden by Lucky Luke alone  Align to IHE, IEEE, Continua, EU, USA, …  Adopt best practices 36 © 2012/13 FH Technikum Wien

37. eLearning4eHealth Network  Project Duration: Sept. 2013 – Sept. 2016  The project is funded by the City of Vienna Municipal department Economic Affairs, Labour and Statistics (MA 23)  Project Team is composed of members of the Research Focus eHealth 37 © 2012/13 FH Technikum Wien –Mathias Forjan –Matthias Frohner –Alexander Mense –Birgit Pohn –Stefan Sauermann –Philipp Urbauer

38. eLearning4eHealth Network  eHealth offers potentials for benefits in healthcare  National as well as =>European, International! –Globalization of labour market –EU wide communities(eHealth Governance Initiative eHGI) –Transatlantic communities (EU 2020: Transatlantic eHealth/health IT Cooperation Roadmap) 38 © 2012/13 FH Technikum Wien

39.  Quality is key to eHealth Systems –Systems with a high degree of quality, are built by highly qualified individuals!  How will we spread qulified eHealth expertise to all out there? –The eLearning4eHealth Network rides in! 39 © 2012/13 FH Technikum Wien eLearning4eHealth Network Vision

40.  High degree of flexibility  Diverse audiences => Diverse requirements –academic education –extended vocational training  Certificates! –Common, comparable & accredited qualification attestation 40 © 2012/13 FH Technikum Wien eLearning4eHealth Network Core Requirements

41.  Setup of an international eHealth experts network  Processes for coordinated development of education programs (academic & extended vocational) in eHealth  Increase the quality of educational content & material => International experience sharing!  Development of educational Profiles  Development of a basis set of qualification certificates 41 © 2012/13 FH Technikum Wien eLearning4eHealth Network Core Goals

42.  Draw a „Map of Knowledge“, on some axes –Whom  medical experts, nurses, engineers, managers, economists, lawyers, patients, relatives, politicians, … –What  see whom, all have their specific knowledge areas and views –Intention  Be able to discuss, design, evaluate, … –Level  base, advanced, expert –…. 42 © 2012/13 FH Technikum Wien eLearning4eHealth Network Milestones I

43. Using the map:  Pick out „educational units“ that fit to our profile –On the level of courses  Implement them –In some examples –Using eLearning methods –Describe them using the terms of the „map“  Teach –Provide certificates to attendees  Learn and evolve –Is the „map“ OK? Are out courses OK? 43 © 2012/13 FH Technikum Wien eLearning4eHealth Network Milestones II

44.  We need you!!  NOW!  To co-generate and share requirements, concepts, learning goals, experience, …  So that all our graduates can really have a go in life.  Looking forward to discuss this in detail!! 44 © 2012/13 FH Technikum Wien eLearning4eHealth Network Milestone today:

45. 45 © 2012/13 FH Technikum Wien eLearning4eHealth Network Contact:  Alexander Mense –alexander.mense@technikum-wien.atalexander.mense@technikum-wien.at  Stefan Sauermann –stefan.sauermann@technikum-wien.atstefan.sauermann@technikum-wien.at  Philipp Urbauer –philipp.urbauer@technikum-wien.atphilipp.urbauer@technikum-wien.at –www.technikum-wien.at/mbewww.technikum-wien.at/mbe –www.technikum-wien.at/ibmtwww.technikum-wien.at/ibmt –www.healthy-interoperability.atwww.healthy-interoperability.at