Government Strategies in Implementing e-health in

Transcription

1 Government Strategies in Implementing e-health in Germany Ulrike Flach Parliamentary State Secretary Federal Ministry of Health Dr. Matthias von Schwanenflügel Director Federal Ministry of Health DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Government Strategies in Implementing e-health in Germany Ulrike Flach Parliamentary State Secretary Federal Ministry of Health Dr. Matthias von Schwanenflügel Director Federal Ministry of Health

3 Part I - Political challenges and answers - Ulrike Flach Parliamentary State Secretary Federal Ministry of Health

4 Global challenges - spiraling costs - 90 rising costs M rising W life expectancy rising11 insurance rates Stone Age: new medical technologies Source:

5 Improving performance - contribution of ICT - Boosting the quality of medical services Enhancing the efficacy of national insurance contributions Avoiding iatrogenic follow-up costs Avoiding adverse effects (i.e. adverse drug events) Avoiding submission of false claims Reducing administrative expenses

6 The use of the ehealth Card needs a modern IT infrastructure 150 health insurance funds hospitals approx working doctors Panel Doctors Associations Pharmacy data processing centers approx dentists pharmacies approx. 80 million insured persons

7 More than a card project - a secure and trustworthy infrastructure - Source: gematik

8 More than a card project - a dedicated technical infrastructure -

9 Status Quo Based on the coalition treaty and the stock-taking done, the following applications are being energetically pursued: 1. Online updates of insurance members data 2. Secure communication among service providers 3. Set of emergency data 4. Medication safety checks 5. Patient summary

10 Outlook and time schedule Basic nationwide rollout with new card readers is completed Electronic health cards is being distributed nationally Tests for the consented applications will start in mid-2013 Start of operations of the additional applications scheduled for 2014

11 Additional Government Measures Fee scales for physicians must be adjusted to include telemedicine applications by March 2014 Barriers to implementing additional telemedicine applications to be removed (ehealth Initiative of the Federal Ministry of Health) Long-term development steps (such as updating the basic, post-basic and continuing training of medical and paramedical professions) to be coordinated with the stakeholders

12 Part II - Practical Challenges and Answers - Dr. Matthias von Schwanenflügel Director Federal Ministry of Health

13 Technological Status Quo in Germany The use of IT systems is especially accountancy-driven Although nearly 80 % of physicians and hospital are using IT systems, electronic communication between these units is currently not taking place Due to the prior use of IT for internal purposes (i.e. 200 different IT systems are in use) there is a lack of communication standards Platform with interoperable standards is needed

14 Legislative guidelines for supported applications Mandatory part: Administrative data Status of deductible Electronic prescription European regulations on benefit claims between the EU member states Voluntary part: (i.e. optional for owners) Documentation of medication Emergency data Patient receipt Electronic medical report Patient storage space Electronic patient file

15 Two cards form the basis of a telematic infrastructure ehealth Card photo encryption of data access to medical data Health Professional Card access authorisation qualified signature professional ID card

16 Patient s rights and data privacy Health data are under the patient s control Consent to storage and use Technical access authorisation (PIN) Right to delete voluntary data Access right of the insured Additional legal safeguards Access only in conjunction with health professional card/electronic professional id card Access logging Protected from confiscation Ban on use

17 The ehealth Card as the citizen s key to accessing health care services Secure data storage Access Log EHIC Emergency data Identity Card Medication log

18 The ehealth applications will be gradually established Successfully completed Parallel use of present old Health Card and ehealth Card without net connection Under preparation by responsible participator Electronic update of administrated data of the insured Direct (safe) communication between doctors Emergency data set Drug therapy assistance Electronic Patient Record

19 Convergence of ehealth Infrastructure Mandatory Applications (legislated) Optional Applications (legislated) Added-Value Applications Further ehealth Applications Telematic Infrastructure Other ICT Infrastructures These structures are currently being rolled out

20 New Opportunities - common challenges - New services can use a secure and efficient infrastructure, can use established standards, can reach the critical mass more easily, have to prove that the services will lead to greater efficiency, that reimbursement models are able to match the (current) system.

21 1. Federal Ministry of Health 2. German Medical Association 3. Federal Union of German Associations of Pharmacists 4. German Hospital Federation ehealth Initiative - Supporting Institutions - 5. Federal Association of Panel Doctors 6. National Association of Statutory Health Insurance Funds 7. German Association of Private Health Insurance Funds 8. German Society of Telemedicine (DGTelemed) 9. Federal Association for Information Technology, Telecommunications and New Media (BITKOM) 10. Bundesverband Gesundheits-IT (bvitg) 11. Atos Origin (Co-Chair in the IT Summit process) 12. ZVEI - the German Electrical and Electronic Manufacturers' Association 13. Fraunhofer Institute for Open Communication Systems FOKUS 14. Fraunhofer Institute for Software and Systems Engineering ISST

22 ehealth Initiative - Measures to improve development - I. Establishing a dynamically scalable information and support system II. Creating process structures for interoperability (medical/technical) standards (Interoperability Drive) III. Speeding up the process of integrating telemonitoring applications into standard care IV. Operationalising the key points of the ehealth strategy (basic, post-basic and further training, etc.)

23 Questions???

24 Rationale for SNOMED CT in National EHR Implementations David Markwell and Jan-Eric Slot

25 Conflict of Interest Disclosure Both speakers are employees of IHTSDO (the International Health Terminology Standards Development Organisation) Jan-Eric Slot MB MSc MBA is Chief Executive Officer David Markwell MB BS LRCP MRCS is Chief Implementation and Innovation Officer Neither speaker has other real or apparent conflicts of interest to report

26 Rationale for SNOMED CT in National EHR Implementations This presentation addresses five questions What is SNOMED CT? What does SNOMED CT add to an EHR? How does SNOMED CT fit in with classifications such as ICD-9 and ICD-10? How is SNOMED CT maintained & licensed? Why does SNOMED CT make sense as part of a national EHR implementation?

27 SNOMED Clinical Terms A controlled coded clinical terminology for use in Electronic Health Records Content from SNOMED 3.5 and SNOMED RT developed and owned by the College of American Pathologists Read Codes owned by & widely used in the UK NHS Design based on Identified user requirements Practical experience Scientific principles established in peer reviewed publications First released in 2002 Acquired for the public good by IHTSDO in 2007

28 IHTSDO: INTERNATIONAL HEALTH TERMINOLOGY STANDARDS DEVELOPMENT ORGANISATION International not-for-profit association Based in Denmark Owned by National Members Governed by General Assembly of its Members Funded by countries based on national wealth Delivers SNOMED Clinical Terms Licensed to registered Affiliates Free use in Member countries Low-cost licenses of institutions in other countries Free in poorest countries Free for Public Good applications

29 IHTSDO Current Members Australia Lithuania Slovenia Canada Malta Spain Cyprus Denmark Estonia Iceland New Zealand Poland Singapore Slovak Republic Sweden The Netherlands United Kingdom USA

30 Requirements for Meaningful Health Records Making health records electronic A significant step forward Improves communication Increases availability of relevant information but it is only a partial solution; the real challenge is Making health records meaningful Identifying significant facts in oceans of data Enabling effective meaning-based retrieval Linking the EHR to authoritative clinical knowledge SNOMED CT represents clinical information meaningfully as part of a well-designed EHR

31 Classifications (e.g. ICD-9 & ICD-10) Essential to the big picture view of healthcare Group ideas for aggregation and analysis Add statistical value to data Limited value in an individual patient EHR Represent one dimension of meaning For example viral pneumonia (J12 or J12.9) Classified as a respiratory disease But not classified as a viral disease No links to body sites, causes, etc. For example, viral pneumonia (J12 or J12.9) Not linked to site lung Not linked to causative agent virus

32 SNOMED CT Adds Meaning Every coded concept is linked to related concepts Multi-axial subtype hierarchy ( is a relationships) Logical definitions (attribute relationships) infection respiratory disease is a is a infective pneumonia lung is a virus Viral pneumonia

33 SNOMED CT and Classifications Classifications like ICD-9 and ICD-10 Essential to the big picture view of healthcare Limited value in an individual patient EHR SNOMED CT Rich semantic structure adds meaning to the EHR Adequate detail for clinical recording Broad scope of coverage SNOMED CT maps to Classifications Existing maps to ICD-9 (US) and ICD-10 (UK NHS) Enhanced rule-based approach to mapping Being applied to ICD-10 by the IHTSDO Adopted by the NLM for mapping to ICD-10-CM.

34 EHR Benefits of SNOMED CT Enhancing the care of individual patients: Display of appropriate information Guideline and decision support integration Communicating and sharing relevant information Enhancing the care of populations of patients: Epidemiology monitoring and reporting Research into the causes and management of diseases Supporting cost-effective delivery of care: Guidelines to minimize the risk of costly errors Reducing duplication of investigation and interventions Auditing the delivery of clinical services Planning service delivery based on emerging health trends

35 Design Benefits of SNOMED CT Comprehensive clinical scope Reduces need to support multiple code systems Common framework for consistent retrieval and processing Logical definitions Allow clinically relevant meaning-based retrieval Post-coordination Combining codes to add detail and specificity Increases scope without combinatorial explosion of codes Updates and versioning Regular updates to International Release (six-monthly) Support for incremental updates Full historical view of all previous versions of SNOMED CT

36 SNOMED CT - Comprehensive Scope

37 Member, Vendor and User Engagement IHTSDO Member Forum National bodies involved in SNOMED CT development and implementation IHTSDO Affiliate Forum Vendors and other SNOMED CT Licensees working with the IHTSDO to identify and address the needs of implementers IHTSDO Working Groups Open collaborative environment Topic focused Special Interest Groups Assignment focused Project Groups

38 Global Benefits of SNOMED CT IHTSDO ownership Independent of proprietary code systems Shared collaborative development and maintenance Transparent affordable licensing Free use in Member countries Free use in approved research and public good initiatives Costs elsewhere related to national wealth International approach Standard world-wide coding of clinical concepts Full support for translation to national languages

39 National Flexibility with SNOMED CT SNOMED CT - Extensible design Enables addition of National or local content Configurable to meet National requirements Reference Sets: a standard representation for Subsets and Value-Sets of SNOMED CT Cross Mapping to/from SNOMED CT Other references to SNOMED CT content IHTSDO Workbench Open source tools to support maintenance and release of National Extensions to SNOMED CT

40 SNOMED CT in National use (1) Summary Countries in which SNOMED CT is used: >50 IHTSDO Member countries: 19 National policies endorse use of SNOMED CT in several countries US The Office of the National Coordinator for Health Information Technology adopted SNOMED CT as an alternative to ICD-9 and ICD-10 for entry of structured data in certified EHR systems SNOMED CT is already widely used in EHR systems in the US (e.g. Kaiser Permanente),

41 SNOMED CT in National use (2) Australia SNOMED CT is the preferred national clinical terminology England SNOMED CT was selected and approved as the terminology to be adopted by the NHS in England Singapore SNOMED CT is part of the National Electronic Health Record Sweden SNOMED CT is now translated into Swedish and will, together with other classifications, be the national resource in the field of terminology and classifications

42 Harmonization with a family of EHR standards IHTSDO is working with other standards bodies to encourage and assist the convergence towards a family of effective standards EHR Consistent use of SNOMED CT in harmony with other recognized standards is building new opportunities to realize the full potential of a National approach to Electronic Health Records

43 Thank you for your attention Questions? Contact IHTSDO: Web site: