1. Conclusions from e-Health
National Projects
NPfIT - NHS (UK 2002)
Estonia: Electronic Health Record System ( )
International projects
EpSOS Cross Border eHealth (2008 – 2013)
Baltic eHealth Project ( )
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2. NpfIT – Health – 2002 – 2011 > 15 Bn €
All hospitals, GP's medical staff in UK
Centrally stored Summary Card
Severe and critical audit remarks:
Lack of overall Architecture
Lack of citizen and staff trust in central solution
Lack of basic principles for security/privacy
Numerous examples of security breaches
Development stopped in 2011
Back to decentral organisation
Kristian & Søren Duus Østergaard
Duus.Communications ApS

3. Estonia e-Health System - 2008-
Builds on a national overall ICT strategy (from 2001)
Clear principles and service-oriented architecture
National Identity solution common to all sectors
X-Road – principle connecting sub-domains
Stepwise implementation:
Digital patient Record (decentralised DB's)
Digital booking/reservation
Digital Prescription
Well accepted and take-up steadily increases
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Duus.Communications ApS

4. Estonian eHealth System
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5. Baltic eHealth Project - 2005-2007
Connecting national Health networks for specialists – Radiology + Ultrasound
Supplementing national staff – Rural areas
Central hub + defined set of standards
Infrastructure based on Danish MEDCOM
Secure connection between hospitals
Successful and continued as R-Bay (eTen)
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6. EpSOS – 2008 – 2013 (Smart Open Services for European Patients)
Enable patients to receive medicine and allow transfer of health summary record across broders
Establish trusted network between National Contact Points
Read-Only access allowed to practitioner
No data stored locally (abroad)
Interoperability addressed through:
Clinical Document accepted architecture
A master Value Set Catalogue
Master translation/transcoding catalogue
An epSOS ontology (linguistic reference system)
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Duus.Communications ApS

7. Recommendations 1 General principles for eHealth across EU:
Common Baseline for security of eHealth Data
Framework for x-national acceptance of eID
Baseline set of standards for access control
Common standards for 'secondary use' (like de-identification for health data used for statistics, research etc.)
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Duus.Communications ApS

8. Recommendations 2 International/x-border eHealth solutions
Decision Phase: Define baseline standards for the data contained in the proposed solution and ensure maintaince of these
Design Phase Establish National Control Point/Gateway and a set of x-national rules, audit, logging, access rights Secure Interoperability between users in each country Robust definition of network security between NCP's
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Duus.Communications ApS

9. Recommendations 3 International/x-border eHealth solutions
Operational Phase: Establish common body to ensure audit, monitor and resolve differences between countries Ensure compliance with changes in EU regulations Not only Data Protection skills, but also health authorities (Patient Security + privacy) Updating the common set of ethical and legal standards
Decommisioning Phase Migration of vital data to new system(s)
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10. Back up slides 02-19-2013 Kristian & Søren Duus Østergaard
Duus.Communications ApS

11. NHS – NPfIT - Structure 02-19-2013 Kristian & Søren Duus Østergaard
Duus.Communications ApS

12. Baltic eHealth 02-19-2013 Kristian & Søren Duus Østergaard
Duus.Communications ApS

13. EpSOS - Interoperability
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Duus.Communications ApS

14. EpSOS Structure 02-19-2013 Kristian & Søren Duus Østergaard
Duus.Communications ApS