Document 196176

eHealth for Health in France
How to cope with national
& EU context and priorities
Michèle THONNET
Ministry of Health,
Paris, FRANCE
Bucarest 2011-05-26
1
Outline
the
french system characteristics
challenges of the Health system
the need for a reform : ICT lever
The french policy
developping
a strategy
eHR, ePR & eMR importance and roles
launching a plan
implementation /deployment challenges
‘Stop & Go’process & Lessons learned
2
FR engagement in EU / international world
The french system global status
France has a traditionally high-Q level of care
WHO survey
life expectancy 82 years
main characteristics of french health :
– mortality rate: a low infant, very low for elderly
– a particularly wide gap in risk of death (M&W)
– an correct situation concerning cardiovascular
diseases but a weakness concerning premature
3
mortality & some territorial inequity
Global cost of Healthcare
%
of GDP
around 10 %
with more than 1.7 million jobs
global expenditure on health per capita
about 2000 €
average IT budget of French enterprises 5 %
hospitals IT budget around 1.8 %
(new 2012 hospital plan)
IT savings : need for a business model
saving on paper procedures is unconvincing
4
The french organisation : a complex system
Free of charge universal service
A multitude of actors
– health insurance (compulsory, complementary )
– 300 000 professionals (120 000 doctors),
– 23 000 pharmacies , 4 000 (biology) laboratories
– 4000 hospitals, 1.7 million employees (50 000 doctors)
…with a very large autonomy
& a great impact on global economy
5
The key health actors in France
National
• Ministry of Health & national organisations
(from public agencies to competence centres)
Regional
Healthcare : hospital/Health regional agencies ([ARH]-ARS)
Health insurance : regional bodies [URCAM/CRAM]
GPs/specialists : regional professional unions: URML, UNPS
Public hospitals cooperation groupments for IT
Local
Hospitals : private public structures
Health Insurance : local bodies (CPAM)
Physicians and healthcare professionals
6
Reforming the H system : a necessity
Demographic
changes : ageing population
increased prevalence of chronic diseases
citizen expectations for high Q HC
increasing costs of research, equipments,
examinations, treatment
quicker pandemia expansion
lack of staff & shortage of HCP
mobility of citizens, patients, HCP, workers
7
mastering costs : crisis & ‘business’ model
ICTs : Key expectations
Facilitate access, continuity of HC (mobility)
Improving Q of care, allowing real HC equity
Enhancing coordination, continuity of care security &
safety
Facilitating collaboration between HCP, within/between
HCPO
Improving homecare & adapted delivery services at PoC
Organising mutualisation & intern. standards usage
Facilitating research, L S experimentations & deploymt
Decreasing the number of doubloning exam.
8
Mastering costs through innovative model(s)
ICT : necessary but not sufficient
Increasing expectations of the citizens must be met
-
e-services part of the daily life
internet penetration without borders
free choice
expectations
availability of HC services
Health must benefit from ICT as other sectors
But
reengineering
with security, quality of care & safety
fear (patients, HCP) must be overcome
TRUST is key
9
The french strategy on e-Health
ICT as an enabler for Health : in the law
since 1996
as a first needed framework
difficult Balance :
– priorities vs urgencies
– territorial levels & population size/ specific needs
10
A central objective : a Health strategy
Use the contributions and facilities of the
networks ( technical, medical ) : i.e. ICT
to improve the healthcare system
for a better citizen welfare
improving the level and the quality of care
including the control of the costs
11
Three types of projects / programmes
1. a first stage : SESAM-Vitale
– administrative simplification for refunding health
expenses (citizens/patients focus)
2.
public Health issue
– to manage the consequences of the availability of new
flows of information to the public (education, protection)
3.
a « corner stone » project to improve
the doctor-patient relationship :
– electronic health record (EHR) ; to the ePMR
12
Four main objectives
1.
To facilitate the continuity and the
coordination of the health care :
– reorganisation of the points of care (telemedicine, ...)
– enhance information exchanges
(electronic health records : protected access and transmission)
2.
To improve access to info & knowledge :
– online state of the art for the professionals ( KB, EBM)
– quality of e-health sites (URLs, forums ??)
13
Four main objectives (2)
3.
Better know the reasons for recourse
(to care) and evaluate the expenditure
– organise & pilot via up-to-date information system(s)
4.
Administrative simplification
SESAM-Vitale
– better and quicker refunding
– dematerialisation of the administrative flows (for patients
& HCP)
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– design new services (« web doctor »)
The deployment scenario
Build
on the last objective : SESAM-Vitale
but reuse the investment already done
on this first structuring application
for the other priorities
The
linkage of administrative support systems
to care production and logistics systems is
essential
15
Some outputs & feedback
SESAM-Vitale : First difficult step (IGAS report)
– Standardisation (Hard/Soft)
– PC & HCP
– Network availability
– Security issues (on internet)
– ‘stakeholder’ involvment (HCP)
– human resources availability & training
– To be paid for : equipment / messages
exchange / access / ready to use / adoption16
SESAM-Vitale today’s picture : a success
First national ‘HC’ application :
administrative simplification & procedure acceleration:
Reimbursement in 5 days for citizens
Accessible from any PoC
by authenticated HCP
Buiding on a national secured infrastructure : secured
network and authentication process (citizens & HCP)
17
Paving the way for the new phase : medical applications
Supporting Large Scale Pilots
« e-sante » projects (10 M euros 2000-2002) :
communication between hospitals and HCPs-100
pilots
Hospitals IS : « Hôpital 2007 » plan
– 320 M euros/80 pilots focused on hospital care
processes and regional communication systems
Primary HCPs and healthcare networks : FAQSV
(fund for the quality of primary healthcare)
managed by the health insurance national and
regional bodies
Pilot for shared patient electronic record :
implementation in 2005 (1 M patients)
18
ICT : beyond simplifying adm & reimbt
an enabler for transforming HC
Better health status for the population
– Enhance level & Q of care within « mastering » costs
2 major levers :
– Give access to the state of the art K
– Facilitate transmission, storage, access medical data, K
Need to overcome barriers
– ICT: a tool to « re-balance » the respective roles (P, HCP,…)
Give more freedom to stakeholders
– Internet : a major progress engine without borders
But not a place of non-right
– Need to protect individuals & control the status of info
19
delivered
Legal framework national programmes
& public evaluation
1996 Ordo. Juppe (CPS, SESAM-Vitale)
– IGAS report (Gubler, Dessaint, Thonnet):
Dg and Reco on SESAM-Vitale
2002 patients rights
2004 HC & SS reform : DMP & telemedicine
– DMP ( 07/2007 deadline in the law)
2007 DP, Hospital 2012 plan, Telemedicine report
– 2007/11 join IGF-IGT-IGAS report (5 co-authors):
Dg, challenges, Reco on DMP
– 2008/04 IGAS report (Gagneux & 7co-authors) :
the DMP relaunch proposal
2009 law « Hospital, Patient, Health & Territory »(HPST):
– reorganise the regional & local responsibilitiess (ARS), relaunch
DMP (ASIP), propose a Telemedicine framework
20
2010 eHealth at the political level ; telemedicine decree
The DMP exemple:
created by law 2004
Deployment
Short
term ROI on economic basis
‘Semantic’
More
date written in the law
shift between DM(P) & DM[P]
focus on technical challenges than
on medical issues
21
The DMP’s context opportunities
Short deadline is nevertheless appropriate to
–
–
–
–
–
–
–
Create a dynamic team & structure
Reveal volountary co-operation
Organise concertation & mutual understanding
Clarify respective roles & responsibilities
Facilitate communication, exchanges
Pave the way for « sharing » & change managt
Reveal the continous education& training needs
Identify a medical information exchange dynamic
based on the « patients needs »
22
DMP : GO / No GO decision
Beyond deadline & Political changes
Evaluation process :
opportunities to build upon
– National importance of the project
– Structural components for the health organisation
system
– A set of promising / reusable outputs
– ICT lever recognition
– Collaborative process on the way
23
DMP relaunch new principles
First to enhance Q+ continuity of care
– for authorised HCP by design
– Useful for HCP & patients (Kouchner law)
Technological
choices must serve the usage
Progressive evolving content, infrastructure
Visible, realistic & flexible timeline
Clarification of targets, strategy, ‘highways’
Adequate balance usability / privacy
24
Efficiency & consistency of the governance
The DP exemple
2007/01
Pharmaceutical care record
(DP) creation in the SS law
2007/08
first pilots in some volountary
regions & pharmacists
2010/06
: 3 more steps ‘ready-in-useadopt on daily basis’
16000 pharmacies ; 8.5 M DP
25
The key factors of success
• To join forces of all the concerned actors
– Appropriation & usage of the developed tools
– Convergence with the (nat/reg) existing systems
– Progressive moving to consensual target
– Call for M.S. information/ experiences exchanges &
collaboration
• To organise continuous cooperation
• with the users, payers & industry
26
A way to progress
design
an iterative process
– existing adopted roadmap & context evolution
– conditions of generalisation & sustainability
not forget to nominate A pilot
– strong coordination & clear decisions
– be compliant with subsidiarity principle
do
be
precise in respective roles & liabilities27
French MoH : Mr Xavier BERTRAND
Build upon existing secured infrastructure
1996 laws (SV) ; 2002 ( patients rights), 2004 (HC reform,
secured medical data repositories), 2007(DP), 2009 (HPST)
2008/11/04 + 2009/04/09
eHealth at political level
– Define a clear strategy
– Enhance motivation & coordination of actors
– 4 pillars for ehealth :
•
•
•
•
Modernisation of HIS (H2012)
Relaunch ePR (shared personal medical record): 01/2011 deploymt
Legal framework & conditions for telemedicine (HPST art L 6316-1)
Organise the global governance (include stakeholders):DSSIS
An absolute priority : privacy, security & confidentiality
28
Potential success factors
Interrelated & complementary HC strategy
– Overall approach C, P, Family, HCP, HCPO, SociaI dimension, SDO,I..
Increase Legal certainty
– design legal framework aligned with new ICTs capabilities
Key human leadership :
– encourage networking, mutualisation, re-usability,
– presence of grass root initiatives, dedicated managers, physicians
leaders, engaged empowered patients & citizens
Design a basket of incentives
– appropriate allocation of resources based on mix of stategies :
compensation rewarding Q + Perf (not « volume »)
Capability to design & deploy new flexible innovative
sustainable models
29
Keep open to the ‘outside’ world
involve
the concerned actors since the
beginning
improve
& facilitate the use of standards
[european & international ]
avoid to focus too much on technical issues
keep targets and deadlines realistic
anticipate
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– negative consequences of a new system or
FR-EU co-operation : Health in the EU Treaty
HEALTH
is a national prerogative
– subsidiarity is key
– but challenges are the same in each M.S.
what
could be done at EU level :
– a volontarist collaboration between M.S.
– supported by the E.C.
– confirmed by the « eHealth action plan »
– design through a dedicated organisation
– declined on pragmatic priorities
31
2002-2010: a new era in legal and policy
framework for EU Cooperation on eHealth
Communication on Quality critera for a web site
Communication on the eHAP
Recommendation on cross-border interoperability of
electronic health record systems
Communication on telemedicine for the benefit of patients,
healthcare systems and society
eHealth Standardisation Mandate 403
– ------------------------------------------------------------------------------------
EU Council conclusion on safe and efficient healthcare
through eHealth – December 2009
Adoption of the Directive on patients’ rights in crossborder healthcare - 2011
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other EU current initiatives
Health
– Europe 2020 : “Sustainable health”;
– Innovative Union : EIP AHA
Standardisation
– Digital Agenda for Europe
– IT Standardisation
eHealth M.S. and stakeholders voluntary cooperation
– epSOS
– CALLIOPE
33
– eHealth High Level Governance
eHR Modelling: an input for collaboration (2007)
34
Interoperability RECOMMENDATION REVIEW
– Interoperability is considered for the purpose
of “integrated, connected and interoperable
continuity of care for Europe”:
•
•
•
•
Political
Organisational
Semantic
Technical/standardisational
35
35
epSOS – a highly political project
Member State obligation to deliver the best possible medical
treatment – at home or when travelling
Introducing a new dimension in national healthcare systems
Goal for the epSOS eHealth Project:
– “to develop a practical eHealth framework and ICT infrastructure
that will enable secure access to patient health information,
particularly with respect to a basic patient summary and
ePrescription, between European healthcare systems”
Main political objectives:
– support patient mobility nationally and in the EU
– ensure that patient safety is guaranteed
– increase efficiency and cost-effectiveness
in cross-border care
36
The Roadmap
The
needs
– service innovations needed to focus on
existing or anticipated health care system
priorities
a
vision
– of where we wish to go and what solutions
are needed to get there
a
route for achieving the vision
– to select and develop the right alternatives
needed to create the right services
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AN EU eHEALTH INTEROPERABILITY ROADMAP
What: possible future actions at EU level
For what:
To accelerate ehealth deployment
Who: Health care community
WHERE?
FOR WHAT PUPROSE?
WHO BENEFITS?
WHAT’S AT STAKE?
How: Use Cases, alternatives, maturity
and opportunities, building on what is
shown to work
1st stop Barcelona validation
2nd step
Mai 2011 Budapest
EU interoperability Roadmap progress
A proposal for a common
EU Roadmap for eHealth
38
The process
Roadmap versioned
documents
Roadmap Consolidation workshops
CALLepSO workshops
SDOs X-border project
consultations eID,semantics
39
Collaborative evolving process
Political priorities
2ndstop Budapest, Mai
2011
Agreement and
validation of the
Roadmap by the
Secretaries of State
Stakeholder priorities
Reaching agreements through continuous
bench-learning loop across concerned
actors
40
Adoption of a common
working model
Sustainable Healthcare
Sharing Information and Knowledge
for Better Health
eHealth
eHealth
leadership,
Governance
e.g., Data analysis &
aggregation
Knowledge management, etc.
Other national priorities
Rare diseases
Community services, AAL
Chronic Care Management
Electronic prescribing
Patient summaries
Common EU priorities
policy and strategy
EU & National Stakeholder collaboration
Privacy, quality and
safety policies
National priorities
Foundation eHealth infostructure
Patient
identification and
patient data
discovery
HCP Authorization,
authentication and
rights management
Clinical
terminologies and
classifications and
codifications
Consent
management and
access control
Data structures and
value sets
EHR, EMR, PHR,
other
Data and
knowledge
management tools
Data
interoperability
and accessibility
Data bases and
Registries
Foundation ICT infrastructure
Mobile and fixed
Electronic
Communication
Infrastructures
Access to ICT
Networks,
equipment and
facilities
ICT processing and
storage services
ICT Professional and
technical support;
Training
Legislative and
regulatory
framework
Fostering standards
adoption
Market
development, new
business models,
and incentives
Financing, Resource
allocation and
reimbursement
models
Monitoring,
evaluation
41
41
Recommendations and Outlook
propositions
provide concrete input to decision
making
support of the eHealth high level
governance process
www.calliope-network.eu
Political priorities
42
Directive on patients rights
in cross border Healthcare:
eHealth article (14)
1. The Union shall support and facilitate cooperation and the exchange of information
among Member States working within a voluntary network connecting national
authorities responsible for eHealth designated by the Member States.
2. The objectives of the eHealth network shall be to:
(a)
work towards delivering sustainable economic and social benefits of European
eHealth systems and services and interoperable applications, with a view to
achieving a high level of trust and security, enhancing continuity of care and ensuring
access to safe and quality healthcare;
(b)
draw up guidelines on ▌:
(i) a non-exhaustive list of data that are to be included in patients' summaries and
that can be shared between health professionals to enable continuity of care
and patient safety across borders, and
(ii) effective methods for enabling the use of medical information for public health
and research;
(c)
support Member States in developing common identification and
authentication measures to facilitate transferability of data in cross-border
healthcare.
43
European eHealth Governance levels
Policy level: to set out higher level political objectives,
define common priorities and policy measures
Strategic level: to agree on concrete strategies for
developing and implementing integrated, value adding
eHealth services
Establishment and maintenance of an open platform
for multi-stakeholder trusted dialogue
Operational level: deeper focus in areas such as
ethics, security policies and services, EU infostructure,
re-engineering of the standardisation process,
maintaining links to national stakeholder groups, etc.
44
A further consolidated approach is needed
Establish a European Governance to sustain an
open and transparent process involving all three
levels
Reach out to the national communities, i.e.
beyond what CALLIOPE was able to achieve
within its life span
Establish mechanisms to support MS in their
implementation of the EU Roadmap
45
The eHealth High level Governance Initiative
Thank you for your time
Think globally
Act locally
[email protected]
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