1. Certification The Belgian experience and a look forward…. Dr JP Dercq Research Developement and Quality, Health National Insurance Belgium

2. Why certification?  Numerous softwares (25 for 10.000 GP’s)  Inequal prices and inequal quality  No Interoperability  Exchange of data  What happens when I jump to an other software ?

3. How to do?  Legal issue: mandatory system only compliant products are sold only compliant products are sold not very usable: evolution is faster than law, contradictory with free movement of goods, consensus is not always certain  Voluntary Certification issue: not mandatory, performed as a protection for customers, maintains diversity and creativity, can be progressive, consensus is possible, incentives are needed

4. What is Certification Recognition, by an body independant of the manufacturer, that a product complies with fixed criteria Certification is a « deal » between doctors, traders and authority

5. Certification Certification of medical records softwares is a deal between the three main actors  Doctors: security, operability, interoperability, one single input  Vendors:  technical,  training, help desk,  interaction with users, users groups ( collect wishes and needs)  Authorities: security, liability, codification (quality, costs, communication)

6. Doctors priorities (enquiries 2007-2008)  Secure Exchanges of medical data between softwares (Certification)  Secure Exchanges of administrative data (medical insurances) ( Certification)  Interfaced with medical and technical equipment ( Certification)  Respect for privacy patient and physician ( partially Certification)  User friend and made with users ( Certification)  Global information about informatics: why and how, what guarantees for quality  Quotation of softwares ( Certification)  Prices  Training ( basic, continuing education, software, user groups) ( Certification)  Financial support (software, equipment, securised mailing, training)  Helpdesk and technical intervention in the office ( Certification)

7. Some examples Have a look behind the scene: what are the attribute of the data -is linked to patient -is linked to a version of the data -Is linked to a version of a software -is documented -has a status -has a responsible -has an author -has a time -has a confidentiality level -has a level of certainty -Can be archived -Can be repaired - ……………………………………………and more

8. Incentives  If the process is not mandatory you need incentives  each GP receives a premium of 743 € / year for having/using a certified software  Adverse effects:  Each year 743€, with or without a new version but it can be used ( let we hope) for antivirus, peripherals, connexion,….  Some software are cheaper, some are more expansive than 743€: low prices=low quality??  Prices increase to be equal with the premium

9. Business process Identify the functions Translate functions in criteria Translate criteria in technical controls Make a body with independent experts Publish the results Give a second chance Apply the results Reward the users Add new functions (National needs!!) EU 1997. 299 criteria short and long terms Examine the softwares National

10. Same process in all countries?  The core of certification can be extended to other professionals ( nurses, dentist, physiotherapist, specialists, hospitals…..)  Avoid to reinvent the wheel  And let’s work together to an EU solution….

11. The central repository of validated quality criteria to be used to harmonise European quality labelling, procurement specification and documentation of EHR systems. EuroRec Quality Criteria Repository

12. Results: the good -Technical Criteria: better quality and operability -Coding system ( ICPC-ICD10) -Drugs database -Structure of EHR -Sumehr : all GPs software can exchange a basic common set of data ) -Process is extended to Physiotherapists, Nurses, Dentists, Logopedists

13. The Bad  Not really extended to hospitals  Functions created but not used: codification, structuration  Not full compatibility between softwares  web services are not yet implemented  No enough training (basic, professionnal, continued, global and specific): great impact of user clubs

14. And now (1)…….  A lot of projects are partially or totally certification-dependant  Simplification ( one single input, document filling en sending, web services-transactions)  Electronic billing  Electronic prescription of drugs,……..  Disease management processoutcomes team communication quality evaluation

15. And now (2)…..  Ehealth platform  Health portail where all health application can be linked  Single number for all citizens on e-id:  identification, Authentication, authorization for all health professionals  Single number for patients  Secured Mailbox  Anonymisation or coding systems  Time stamping: when?  Logging registration: who ?  Central Register solution ( web application and web services) with reusable components ( cancer, anti tnf, implants), one single input  Standards (xml, kmehr)  Locators of patient information  Official databases: doctors, drugs, Health prestations, ICPC,  Services ( web applications or web services) e-birth, e-handicap, …….

16. A few belgian statements……  We do not aim a central record but exchange of information  Medical record is an access to distributed and may be partial information  GP is (not only) the provider of the synthese of existing medical information  Transactions+standards is much more ge generic………..better a imperfect rule than no rule

17. Health communication (Belgium) Public platform portal EAI Reusable components SAV Official DBs Individual health Insurance Platform portal EAI Reusable components SAV Official DBs Health professionnals Project Group registers

18. conclusions We need EU initiative for  basic certification, in respect with national priorities: that is important for basic exchange of data in an more and more open health market and between all countries  Propose codification systems: (ICPC-ICD10)  Propose Exchange standards: (XML Kmehr)  a non perfect rule is better than no rule  Build official databases: drugs, implants,  And many more…….