1. CNR-ITBRIDE Workshop, Brussels 2006-12-08 Policies and Roadmaps for semantic interoperability in the eHealth domain Angelo Rossi Mori, eHealth Unit, CNR-ITB

2. CNR-ITBRIDE Workshop, Brussels 2006-12-08 Policies and roadmaps GOAL: To develop a Roadmap for semantic interoperability for future research and development activities in the context of the eHealth action plan Communication COM (2004) 356, “eHealth – Making Healthcare Better for European Citizens: An Action Plan for a European e-Health Area”.  to compare the strategies in different jurisdictions,  to explore their construction and their limitations,  to work out the principles for the development of a roadmap

3. CNR-ITBRIDE Workshop, Brussels 2006-12-08 disciplined vs. fuzzy environments disciplined environments  diagnostic services (orders and reports), booking, admission, discharge letter, …  systematic interactions, stable workflows  inter-operability, standard messages fuzzy environments  human co-operation, clinical communication  clinical pathways, datasets, narrative  co-operability, document-based approach

4. CNR-ITBRIDE Workshop, Brussels 2006-12-08 main principle successful ICT solutions should  correspond to perceived communication needs of clinicians and citizens,  rely on clear workflows,  be supported by systemic actions by healthcare managers and by adequate policies

5. CNR-ITBRIDE Workshop, Brussels 2006-12-08 IC (T) ? more emphasis on I nformation C ommunication less emphasis on T echnology the context for semantic interoperability what are the interactions ? how far are they systematic ?

6. CNR-ITBRIDE Workshop, Brussels 2006-12-08 1. Policies and strategies a. comparative analysis of strategies in different jurisdictions b. exploration of limitations of the current policies and strategies c. role of non-technological factors d. criteria for roadmap design  preliminary activity: set up an Explanatory Framework

7. CNR-ITBRIDE Workshop, Brussels 2006-12-08 1a. analysis of strategies  comparative analysis of strategies in different jurisdictions, e.g. : NPfIT in England, ONCHIT in US (and the RHIOs phenomenon) Infoway in Canada, OpenConnect in Australia + existing RIDE material + partners' contributions …

8. CNR-ITBRIDE Workshop, Brussels 2006-12-08 1b. limitations of current policies  identify the limitations of the current policies and strategies: What was wrong with the process so far ? How to improve the effectiveness of deployment? How to obtain “a realistic approach and applicability in clinical settings”?

9. CNR-ITBRIDE Workshop, Brussels 2006-12-08 1c. non-technological factors  regulations,  education,  economics,  involvement of stakeholders,  role of public agencies to support the deployment and the research,  ways to involve the research community

10. CNR-ITBRIDE Workshop, Brussels 2006-12-08 1d. criteria for roadmap design  criteria and metrics as an input to the roadmapping process to satisfy the EU eHealth Action Plan on the deployment; on the processes of change management; on the potential role of authorities

11. CNR-ITBRIDE Workshop, Brussels 2006-12-08 + Explanatory Framework  work out a common language to describe policies and strategies  a preliminary activity to systematize: the driving factors for eHealth evolution the evolution of eHealth solutions the layers of interventions (as an adaptation of the ongoing activities within the eHealth ERA Project and the EU Stakeholders' Group)

12. CNR-ITBRIDE Workshop, Brussels 2006-12-08 four layers of interventions  L1. basic tools and services to enable other layers hw, sw, networks, regulations, identification  L2. to improve efficiency of operational workflows booking, prescribing, reporting,... (message formats, terminologies)  L3. to improve quality of shared care synergy of actors, patient empowerment (clinical pathways, data sets)  L4. to improve governance of healthcare system structural actions (indicators)

13. CNR-ITBRIDE Workshop, Brussels 2006-12-08 L1. basic tools and services to enable upper layers  Various large jurisdictions are envisaging national (federal) and regional programmes, to develop coherent inter-sectoral infrastructures (e.g. by eGovernment actions and generic standard, e.g. HTML, XML) and health-specific infrastructures.  In parallel, there is an increasing attention to define and adopt regulations and standards, and to make plans for specific educational activities for the public and healthcare professionals.

14. CNR-ITBRIDE Workshop, Brussels 2006-12-08 L1. basic tools and services to enable upper layers  build the technological infrastructure;  set up the proper regulatory framework, including connectivity, security, privacy;  produce or adopt standards and reference material to achieve semantic interoperability;  set up a certification process on quality and safety of eHealth solutions

15. CNR-ITBRIDE Workshop, Brussels 2006-12-08 L2. to improve efficiency of operational workflows  to improve speed, quality, quantity of procedures performed with a given amount of resources.  stereotypical situations (e.g. on prescriptions, discharge letters, test reports, …) were the topic for intense activities on interoperability standards in last 15 years  largely independent from the actual patients conditions: most of them do not influence appropriateness of procedures and clinical decisions, i.e., the intrinsic nature of healthcare services is not altered

16. CNR-ITBRIDE Workshop, Brussels 2006-12-08 L2. to improve efficiency of operational workflows  provide services to improve the current workflow-oriented services  provide a basic electronic assistance to clinicians and managers  provide support to Public Health Systems, on epidemiology, management and planning (derived usage of information).

17. CNR-ITBRIDE Workshop, Brussels 2006-12-08 L3. to improve quality of shared care rationalisation of the processes of care provision by a problem-oriented perspective: support the daily clinical decisions of multiple healthcare professionals and a more effective behaviour of patients and clinicians with the capture, storage and transmission of specific data items, depending on the particular context within the care plan

18. CNR-ITBRIDE Workshop, Brussels 2006-12-08 L3. to improve quality of shared care  advanced services on information and knowledge for clinicians  services for the empowerment of health consumers: citizens, patients, their families and caregivers  programs supporting the current care processes

19. CNR-ITBRIDE Workshop, Brussels 2006-12-08 L4. to improve governance of healthcare system  information support to discover bottlenecks to negotiate among stakeholders to decide for systemic actions  more effective management of services and refinement of medium- and long- term policies, by the analysis of accurate and timely data, directly taken from the routine care processes of each individual patient  increase in quality and better control on resources (appropriateness).

20. CNR-ITBRIDE Workshop, Brussels 2006-12-08 L4. to improve governance of healthcare system  re-engineering care processes structural actions on the healthcare system to increase quality and appropriateness of care provision  enabling innovative organisational models  production and evaluation of eHealth roadmaps support change management processes for eHealth deployment

21. CNR-ITBRIDE Workshop, Brussels 2006-12-08 L3 - CLINICALLY-ORIENTED PROCESSES chronic elderly children patient etc care empowerment. four layers of interventions prescribing booking reports managerial EIS etc L2 - OPERATIONAL WORKFLOWS L1 – ENABLING INFRASTRUCTURE - standards, certification.. - privacy, security....... - portals............... - document sharing, EHR. - etc.................. L4 – GOVERNANCE structural actions on the healthcare system driven by healthcare managers including eHealth roadmaps, by authorities, alliances competence centres

22. CNR-ITBRIDE Workshop, Brussels 2006-12-08 eHealth evolution: driving factors gradual evolution of ICT market in healthcare eHealth roadmaps (on deployment and research) modernisation of healthcare processes supported by ICT solutions inter-sectoral activities towards Information Society (e.g. eGovernment plans ) L1 L2 L3 L4

23. CNR-ITBRIDE Workshop, Brussels 2006-12-08 eHealth asks for new drivers  increasing role of regional / national authorities (ministries of health and innovation) roadmaps infrastructures and regulations  shift of attention from technological issues (market) to governance and organisation of the healthcare system

24. CNR-ITBRIDE Workshop, Brussels 2006-12-08 Roadmaps 1. develop specific roadmapping principles a. criteria to pass from policies to actions b. reference taxonomy on roadmapping actions c. metrics to select and prioritize actions 2. for each sub-domain, work out: a. tables of preconditions b. business implementation paths c. concrete research tasks 3. synopsis and recommendations

25. CNR-ITBRIDE Workshop, Brussels 2006-12-08 1a. from policies to actions  to work out the possible consequences of selected policy objectives: from the policy issues  to potential specific goals  to systemic actions on the healthcare milieu  to the involved semantic issues  next steps: work out the corresponding actions to promote semantic interoperability

26. CNR-ITBRIDE Workshop, Brussels 2006-12-08 policy issue 1 - safer decisions, quality of care processes  increase influence on medical errors and on patient's errors, by timely providing adequate knowledge to assist proper decisions  increase the quality of care processes, i.e. declaring and following explicit reference clinical pathways  increase the mutual awareness of what other clinicians are knowing, doing or planning on the patient

27. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on errors  goal - avoid errors e-prescribing (producing the prescription)  database on potential drug interactions, adverse reactions (formulary) assist patient in performing procedures  instructions to patients (multi-cultural, multi-channel)

28. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on decisions  goal - leverage authoritative clinical knowledge for clinicians assure quality of routine care provision  reference clinical pathways decision support  assisted access to authoritative knowledge

29. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on information sharing  goal - effectively manage unexpected contacts (patient mobility) emergency patients, not able to effectively present their history  emergency data set, special needs, problems  maintained lists (active problems, allergies, ongoing medications) incidental access, without a shared plan (GP and hospital, second opinion)  basic patient profile, problem-oriented profile

30. CNR-ITBRIDE Workshop, Brussels 2006-12-08 policy issue 2 – sustainable evolution of healthcare  the increasing cost of healthcare requires a rationalisation of services provided, without a negative effect on quality of care. continuity of care, patient empowerment accurate governance based on routine clinical data and suitable indicators, to produce benchmarks and to allow self-assessment of healthcare professionals

31. CNR-ITBRIDE Workshop, Brussels 2006-12-08 role of ICT solutions vs. the evolution of healthcare sector going towards the upper layers,  technological factors become less relevant  semantic interoperability is more crucial  the major goal becomes the governance for a sustainable evolution of the healthcare sector  driving forces are shifting from market and ministries of innovation to clinicians and ministries of health

32. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on care models  goal – support new care models: disease management, long term care support to chronic conditions, frail elderly control of remote devices (home care), support to care managers  patient's folder, problem-oriented profile, context-specific data sets

33. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on care fragmentation  goal - face fragmentation of care provision planned shared care, with multiple professionals (continuity of care)  shared clinical pathways, cooperative shared plans, context-specific data sets  sharing any type of electronic clinical document (according to any format)  referral letter to pass care mandates between professionals avoid duplicated tests  repository of test results

34. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on patient behaviour  goal - patient empowerment adequate impact on lifestyle and on compliance to therapy  recalls, alerts, reminders  clinical knowledge for patients (multi-channel)  Patient Health Record (PHR)  clinical pathways and health balance patient self-assessment, appropriate requests for healthcare facilities / services  simple flow-charts to guide patient's access to appropriate facilities

35. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on governance  goal – improve governance and quality timely information on healthcare processes and outcomes  datawarehouse and indicators of process and outcome  registries for management and epidemiology

36. CNR-ITBRIDE Workshop, Brussels 2006-12-08 policy issue 3 – improve access to services  simplification of the paperwork  rationalisation of organisational and administrative processes increase of efficiency of operational workflows (e.g. prescriptions, booking, reports, …).  effective portals, with practical information and authoritative clinical knowledge

37. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on efficiency  goal – increase efficiency, avoid burden operational workflows  e.g. booking, reminders, prescriptions, reports continuity over time, maintain history across episodes  immunisations, derived lists (e.g. tests, events, treatments, prescriptions) simplify administrative processes  registration data, e.g. insurance, preferred GP, exemptions from payments, enrolment in programs (e.g. home care, dialysis, …)

38. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on appropriate access  goal – select the most appropriate point-of-service (improve patient choice) make information about services more accessible  citizen's portal (multi-cultural, multi-channel), yellow pages about available healthcare services and facilities patient self-assessment, appropriate requests for healthcare facilities / services  simple flow-charts to guide patient's access to appropriate facilities

39. CNR-ITBRIDE Workshop, Brussels 2006-12-08 influence on availability  goal – extend availability of healthcare services primary care centre, on-call physician, out-of-hours, patients shared among a group of GPs  extended patient profile, sharing the local EPRs

40. CNR-ITBRIDE Workshop, Brussels 2006-12-08 1b. reference taxonomy  we developed a reference taxonomy expanding the four layers of interventions potentially involved in a roadmap  the topics enumerated in the taxonomy should be interpreted only as an interlingua to reach an uniform representation of the activities described by the countries, not as a proposal for the actual decisions on the Roadmaps that are actually taken within each jurisdiction

41. CNR-ITBRIDE Workshop, Brussels 2006-12-08 1c. metrics to select and prioritize actions  develop criteria to systematically assess the features of a candidate action: direct economic factors systemic factors (global benefits) cultural feasibility technological feasibility in order to define priorities and to distribute resources across layers and actions

42. CNR-ITBRIDE Workshop, Brussels 2006-12-08 2. analysis by sub-domain  sub-domains: semantic interoperability in Electronic Healthcare records, patient identifiers, eHealth messaging systems, Clinical guidelines business processes.  to work out: a. tables of preconditions b. business implementation paths c. concrete research tasks

43. CNR-ITBRIDE Workshop, Brussels 2006-12-08 2a. tables of preconditions  use the reference taxonomy as a check-list to enumerate the actions that are preconditions for the deployment of solutions for each sub-domain

44. CNR-ITBRIDE Workshop, Brussels 2006-12-08 2b. business implementation paths  clarify the requirements from the healthcare sector and develop robust roadmaps,  to enable European industry to set up and follow a strategy for future product creation procedures based on innovative technologies, and  to be competitive in international markets

45. CNR-ITBRIDE Workshop, Brussels 2006-12-08 2c. concrete research tasks  from the roadmaps, work out the gaps requiring specific research efforts to drive RTD plans for the research institutes and academia to suggest European collaboration on innovative solutions among deployment programs across Member States

46. CNR-ITBRIDE Workshop, Brussels 2006-12-08 3. synopsis and recommendations  produce a synopsis of the methodology and of the criteria developed during the RIDE project, as reference material for the production of new roadmaps  produce a set of recommendations for developers of national and regional roadmaps

47. CNR-ITBRIDE Workshop, Brussels 2006-12-08 thanks ! contact:  Angelo Rossi Mori  rossimori@itb.cnr.it