eHealth Guide to Regional Good Practice Innovative Actions Network for the

eHealth Guide to Regional Good Practice Innovative Actions Network for the
Guide to Regional Good Practice
eHealth
Innovative Actions
Network for the
Information Society+
Coordinated by
Co-financed by
DG Regional Policy, EC
eHealth
Contact
IANIS+ Secretariat
eris@ Office
Tel : +32 (0) 2 230 03 25
E-mail : info@erisa.be
http://www.ianis.net
Printed in Brussels (Belgium), September 2007
Design & graphic production: www.altitude.be
Disclaimer
Whilst every care and attention to detail has been taken in the production of this Guide, eris@ takes no responsibility and
can accept no liability for its accuracy nor for any consequential losses. In almost all circumstances, the reader of this Guide
needs to account for the local circumstances in which any advice or recommendation are implemented and does so at his /
her own risk.
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eHealth
IANIS+
Guide to Regional Good Practice
eHealth
Regional Challenges and Impact
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eHealth
CONTENTS
FOREWORD 6
1. PREFACE
7
2. INTRODUCTION
8
3. GOOD PRACTICE OF eHEALTH
3.1
Evaluation of eHealth projects
3.2
eHealth IMPACT
10
10
10
4. PERSPECTIVES OF eHEALTH
4.1
The citizens’ needs perspective
4.2
The perspective of healthcare delivery systems 4.3
The development of ICT tools perspective
4.4
The perspective of policies, rules, laws, and standards to cross-regional
interoperability
4.5
The perspective of co-operation among healthcare actors
for integrated care
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12
13
14
5. THE REGIONAL DIMENSION ON eHEALTH
5.1
Equal access to healthcare
5.2
Healthcare delivery
5.3
eHealth economics
5.4
Regional funding of eHealth
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15
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15
17
6. CHALLENGES FOR REGIONAL eHEALTH
6.1
Essential prerequisites for eHealth
6.2
Meeting the challenges on all levels
6.3
Regional and national differences
18
18
20
21
7. REGIONAL CASES OF eHEALTH
7.1
The IANIS+ collection of eHealth projects
7.2
Types of eHealth demonstrated by eHealth Cases
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22
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8. FACTORS FOR SUCCESS OR FAILURE
8.1
Important factors for a successful eHealth project
8.2
Important factors that can make an eHealth project fail 8.3
Summary of success and failure factors to be regarded as Good Practice
30
30
32
33
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9. CONCLUSIONS
9.1
The coverage of the collection of eHealth projects
9.2
Visions versus reality in eHealth projects
9.3
Who needs regional experience of eHealth
9.4
Regional innovation as Good Practice
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35
10. REFERENCES
36
ANNEX I: Factors of success and failure for eHealth projects
ANNEX II: eHealth Case Studies from Regions
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41
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FOREWORD
This “Guide to Regional Good Practice” is one of six such guides prepared in the frame of the IANIS+ work
programme (2005-07) that has been co-financed by the European Commission, DG Regional Policy. IANIS+ has
been an information society network programme under the Innovative Actions of the Structural Funds and is
a follow-up to a predecessor programme, IANIS (2002-04). IANIS produced ten guides to good practice which
were generally well received – and these are still available for download in PDF format from the Competence
Centre at the eRegion Hub (www.ianis.net). In preparing and negotiating the work programme for IANIS+, it
seemed therefore sensible to plan for a number of further guides to regional good practice.
The working methods of IANIS+ differed from those of IANIS, especially in two regards. First, at the request of
the Commission, IANIS+ has always focused very much on information society projects (rather than on regional
programmes or strategies) and this has the effect of somewhat narrowing the perspective of these six guides
compared to those prepared by IANIS. Second, an important new element of the IANIS+ work programme
(compared to its predecessor) has been the creation and operation of six thematic work groups. These six groups
were charged with the collection and exchange of regional project experiences within their specific domain and
for the preparation of these latest guides.
Each work group has been led and motivated by a chair person and we owe them a considerable debt of gratitude
and appreciation for their hard work and perseverance. Each work group met on at least four occasions but much
of their work has been conducted in virtual mode. Without the effort and contribution of the core membership
of each of these groups we would not have the benefit of these guides. To all those who contributed, but
especially to those who have acted as case study contributors, co-authors and/or editors for these guides, we
are very grateful. These guides were ‘published’ in a first on-line version earlier this year and were presented and
debated at the final IANIS+ Annual Conference (Bilbao, Spain, 13-15 June, 2007) and subsequently modified
and updated for this final version.
We hope that these guides will shed some useful light on regional information society development and that
the issues raised, the advice offered and conclusions reached in these guides will be helpful to others in other
contexts – helping to avoid re-invention of yet more wheels! As always, we urge some caution in adopting ideas
drawn from the experiences of one project in one region. These guides propose, suggest, recommend and offer
advice and conclusions – but they are only advice and suggestions. Each reader needs to adopt that which is
relevant to them and adapt it as appropriate to their own context. Of equal importance, perhaps, is the diversity
of approaches represented by the projects and project experiences upon which these guides are based.
Gareth Hughes
Project Director, IANIS+
ghughes@irisi.u-net.com
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1. PREFACE
This report shows the result of the work of IANIS+ eHealth work group (WG). The WG has collected regional
eHealth experiences from around Europe through a number of activities:
• Regional eHealth case studies of which 17 (from 15 regions) are shown in this report
• Four joint meetings of the group of which one was a policy seminar with invited guests from the EU Commission,
relevant organisations in the field of eHealth and regional authorities
• A meeting with the European Commission DG Information Society & Media, Unit H1 eHealth
• Collaboration with the eHealth network within the organisation Assembly of European Regions (AER)
• Attendance in recent major eHealth conferences:
· Personal Health Systems arranged by the European Commission when launching the eHealth part of the 7th Framework Programme, 11-12 February 2007
· The EU-US eHealth Policy Workshop, 10 May 2007
· The final conference of the INTERREG IIIB project Baltic eHealth, 21-22 May 2007
• eHealth seminars at IANIS+ annual conferences in Blekinge 2006 and Bilbao 2007
The innovation perspective of eHealth in the regions has been the focus for the IANIS+ eHealth WG. Regional
diversity regarding strategies, policies, and action plans for eHealth can act as a driving factor for successful
eHealth projects, but leads also to challenges for interoperability, standardisation, integrity and security.
It is important to learn from others. It may be about how to choose the right technology or what methods to
use for implementation. Depending on what area of eHealth, there are numerous projects and up-and-running
services from which we can learn. Not to forget there are also many experiences from unsuccessful trials. Even if
an eHealth solution has failed in one setting, it can be a success under different circumstances.
The aim of the IANIS+ eHealth Working Group was to share experience between regions belonging to the
network, and bring up some issues of good practice for regional eHealth implementation. Projects brought up
in the IANIS+ working group are projects in there own rights, with pros and cons. The projects cover different
perspectives and types of eHealth. Some were difficult to evaluate while others are valuable comparable
experiences from different settings and circumstances. In any case, we can learn something from all the cases as
examples from reality and as a complement to formal evaluations and scientific studies of eHealth.
We would rather use the term good practice than best practice. There is always something good to learn from
others while there is hardly any best practice that works under every circumstance.
Guohua Bai
Chairperson of the IANIS+ eHealth WG
Blekinge Institute of Technology, Sweden
Gustav Malmqvist
Co-Chair of the IANIS+ eHealth WG
County Council of Västernorrland, Sweden
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2. INTRODUCTION
Information and Communication Technology (ICT) has the potential of changing healthcare services. The use of
ICT in the healthcare sector, eHealth, has in recent years started to change medical work in revolutionary ways
but the expectations on future benefits of eHealth is constantly high.
The first IANIS project in 2004 described in the report on eHealth, that “eHealth is an umbrella term encompassing
a broad range of ICT-driven activities that are transforming the delivery of healthcare”1.The essence of eHealth,
whatever the definition, is that it leads to improvement of healthcare services. Improving quality of care, increasing
the efficiency of healthcare work, making healthcare services more accessible and improving the effectiveness of
medical interventions and patient care.
In the eHealth Action Plan, 2004, the EU Commission defines eHealth as: ”eHealth tools or solutions include
products, systems and services that go beyond simply Internet-based applications. They include tools for health
authorities and professionals as well as personalised health systems for patients and citizens. Examples include
health information networks, electronic health records, telemedicine services, personal wearable and portable
communicable systems, health portals, and many other information and communication technology-based tools
assisting prevention, diagnosis, treatment, health monitoring, and lifestyle management.”2
Many familiar terms are embraced by the concept of eHealth, e.g.:
• Telemedicine
• Telehealth/Telecare
• Healthcare Telematics
• Medical Informatics
• Health Information Management
• ICT in healthcare
All terms with a different perspective or approach to the common challenge of using advanced technology, in the
cleverest way, to change and improve healthcare services and public health.
In the first IANIS eHealth report, about eHealth applications for regions, comprehensive definitions and examples
of eHealth are presented. In this second report, the focus is on expectations, implementation challenges, benefits
and good practice of eHealth based on real life examples from a number of regions around Europe.
eHealth plays a key role for patients but also for regional development. In the European strategy i2010, ICT is
regarded as a means to achieving stronger growth and for creating highly qualified jobs in a dynamic, knowledgebased economy3. Since 1988, the European Commission (EC) has been initiating and funding research and
development activities for eHealth at about 650 million Euros to approximately 450 projects. eHealth is now on
the governmental agenda of EU Members States to be implemented on a broader scale.
1
2
3
(IANIS 2004)
(Commission of the European Communities 2004)
(Commission of the European Communities 2005)
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eHealth
In April 2004, the EU Commission published a European Union Action Plan for a European eHealth Area. Among
others, the following missions are mainly addressed4:
1. Empowering health consumers (patients and healthy citizens) to enable citizens to manage their well-being
through access to qualified sources of health information and active participation in illness prevention, enabling
patients to participate, with better knowledge and responsibility, in the processes of care and rehabilitation,
through intelligent monitoring systems as well as through relevant and personalised health information
2. Assisting health professionals by providing health professionals with access to timely relevant information at
the point of need, new tools for better management of risk and systems to acquire up-to-date biomedical
knowledge and
3. Supporting health authorities and health managers by helping health authorities to manage properly the
ongoing re-organisation of health delivery systems.
In order to realise the EU Action Plan on eHealth, each Member State should develop national strategies for
eHealth. In the recent eHealth ERA report, the EU Commission presents a follow-up of the progress at national
level. In the majority of the EU Member States, eHealth is either a part of a national ICT strategy, along with
eGovernment issues, or a part of a national health and social policy strategy5
Since healthcare in most countries is the responsibility of regional and/or local authorities, the EU Action Plan and
national eHealth strategies will not be sufficient. For things to happen there is a need for regional strategies and
regional decisions, because it is in the regions that eHealth services mainly should be realised. What is apparent
is the need for concerted action and cross-regional and cross-country interoperability of eHealth. Healthcare
needs to change and services should be accessible, efficient and of high quality in a Europe where people moves
around and may have other preferences than before. eHealth should contribute to this.
4
5
(Commission of the European Communities 2004)
(Commission of the European Communities 2007)
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3. GOOD PRACTICE OF eHEALTH
There are often high expectations on how new technology will change the world, or at least the target area or
customer group. The introduction of information and communication technologies in the healthcare sector is
no exception to this. As soon as it is possible to imagine what the technology under optimal circumstances can
accomplish, there are also expectations that hospitals, healthcare authorities, regions and nations should realise
this potential. However, the circumstances for change in healthcare are not always optimal. Healthcare processes
are often complex and diverse and healthcare providers are pressed by financial constraints.
eHealth is not one single technology or application, which delivers immediate benefits. A huge amount of
computer applications, systems and networking solutions used in healthcare can be regarded as eHealth. Also
on-the-shelf products are eHealth if it is used to improve the delivery of care. Besides computer applications,
eHealth is also about cognitive, information processing and communication tasks for medical practice, education
and research6. The essence of eHealth is that it should facilitate the transforming of healthcare processes for the
benefit of patients and the healthcare system.
3.1 Evaluation of eHealth projects
So far, there are not many comprehensive evaluations of eHealth implementations that tell a global truth on
what is best practice. It is very common that implementation of ICT, be it in healthcare or elsewhere, is poorly
evaluated. All too often, the realisation of the vision and expected outcome of the “eHealth solution” is more
important than planning a thorough evaluation. Denis Silber says that there is unfortunately an evaluation
paradox. Evaluation tends to be done during a trial or pilot period, when it is too early to measure a sustainable
outcome of the project. Also, the larger the scale of implementation, the more expensive it is to measure7.
Evaluation of ICT may also be complicated by a constant technological progress that changes the scenery of what
is measured and by organisational change following the implementation of eHealth.
In a recent report on economic benefits of eHealth, Stroetmann et.al discovered that it takes four years, on
average, to reach a level of benefits that exceed the costs8.
3.2 eHealth IMPACT
In the eHealth IMPACT report9 ten carefully selected cases of eHealth were evaluated with regards to costs and
benefits. The main types of benefits measured were quality, access and efficiency.
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7
8
(Iakovidis, I., Wilson, P. et al. 2004)
(Silber, D. 2004)
(Stroetmann, K.A., Jones, T. et al. 2006)
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1. Quality included factors such as informed citizens and carers, timeliness of care, safety and effectiveness, but
also streamlining of healthcare processes
2. Access has to do with healthcare being available to all those in need, when and where they need it. Improved
information flows and use of different forms of eHealth solutions may lead to better access both with regards
to capacity and geography
3. Efficiency benefits consist of improved productivity and optimal use of healthcare resources. The authors state
two common signs of improved efficiency i.e. time savings and cost avoidance
Proven or potential benefits of eHealth are related to all the above measures as values of improvements or
savings. There are also direct economic benefits in the form of cost-savings for healthcare providers and patients,
and indirect savings of costs that would have appeared in the future without the use of eHealth solutions.
Sometimes an investment, e.g. in healthcare networks for electronic prescriptions, show a return on investment
after quite a long time but the alternative cost of having not invested should have been enormously high. This is
the case in both Sweden and Denmark shown in the eHealth IMPACT report10.
9
(Stroetmann, K.A., Jones, T. et al. 2006)
10
(Stroetmann, K.A., Jones, T. et al. 2006) pp. 35 and 45
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4. PERSPECTIVES OF eHEALTH
eHealth is an interdisciplinary area that involves at least two complex disciplines, namely Information and
Communication Technology (ICT) and Health Science. Therefore, the complexities of eHealth must be broadly
approached from a social-technical perspective. It needs efforts from areas of trust, ethical, judicial, economic,
political, informatics, spatial technologies, and methodologies. No organisation can manage a successful eHealth
project without joint efforts by several disciplines. The most obvious being medicine and ICT.
The broad perspectives of eHealth can be described in many dimensions, which are also reflected in the cases
included in the work of IANIS+, for instance:
• The citizens need perspectives
• The perspective of healthcare delivery systems
• The development perspective of ICT tools
• The perspective of policies, rules, laws, and standards to cross-regional interoperability
• The perspective of co-operation among healthcare actors in order to provide an integrated healthcare services
to citizens
4.1. The citizens’ needs perspective
Citizens’ needs for healthcare services have changed just as society has changed. Even though people are healthier
and live longer, the demand for healthcare services has increased. There is also a change in circumstances related
to:
• Development of medical technology (increased possibilities)
• Ageing population (increased need)
• Increased mobility of people (changing the needs for healthcare delivery)
By studying eHealth projects and actions in Europe, in this project and by other initiatives such as the eHealth
IMPACT study, we can get a hint on the trends in eHealth:
1. Monitoring:
• Continuous (on-line) monitoring of vital signs, such as EKG, blood pressure, blood glucose, body temperature,
body alarm clock
• Monitoring and central switch-off for ‘good night’ ‘good bye’ functions, environment alarm
2. Communication /accessibility:
• All measured vital signs should be sent first to a database and if the value is abnormal compared to a preset
value in the database a system should be directed to send an alarm to pre-defined care providers
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• Access medical records from wireless portable computer that brings together at the point of care all information
relevant to the care of patients, and even together with relevant knowledge and evidence.
• Renewal of prescriptions, booking appointments, and questions to care providers
3. Knowledge and decision making:
• Public medical advices and Q&A services armed with search engine FAQ
• ‘My journal’ in which patients medical history can be stored as a profile to decision support and advices from
care providers
• Making diagnoses, detecting trends and react on it with devices as well as with professional services
4. Support for relatives and citizens’ social life
• Provide psychological support to contact relatives by video chat
• ’Community’ forum where people exchange experience and advice
5. Cross-boarder or cross-regional care
• Use of medical expertise wherever it is located for shortening waiting times
• Sharing resources from the ones with access to the ones in need, e.g. bridging lack of radiologists in some
regions or countries
4.2 The perspective of healthcare delivery systems
Health and social service provision is still institution centred. To gain access to the services, people need to go
to several services separately, because they are not synchronised nor delivered as patient-centred services in the
home. Many elderly people have several diseases and varying needs and to run from one place to another can be
very troublesome. In many countries, primary care is of high quality, but still there is a need of a new perspective
to re-organise healthcare delivery systems from the institution centric paradigm to the home centric paradigm.
ICT can make this paradigm shift possible, together with the re-organisation of the healthcare system.
To re-organise the healthcare delivery systems from the institution centric to citizens’ and home centric does not
mean to move all services to home. Instead, it means effective use of the resources in the hospitals to deal with
those healthcare problems that cannot be dealt with at home even by use of advanced ICT tools. By reducing
unnecessary visits to hospitals through use of ICT supported communication, remote diagnoses and monitoring,
some serious healthcare problems such as surgery, complicated diagnoses, or face-to-face meetings can be
effectively planned and performed.
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4.3 The development of ICT tools perspective
ICT has changed our ways of living, doing business and services. For the healthcare services there is still much
to improve. Often ICT solutions have a bad design, not adapted to the context of healthcare and not optimal for
interaction throughout the healthcare chain. The development of ICT for healthcare is not always in line with the
needs of health professionals and is not always taking into account the complexities of healthcare processes. The
traditional way of designing ICT is mostly focused on technology and functions. To support healthcare, the design
of ICT must adapt a social-technical approach. This social-technical approach requires the development process
to be ‘User centred’ and ‘Holistic’. The needs of users and the way that the users would like to use the ICT are
very sensitive to the success or failure of an eHealth project. Involving the users in the development process (not
only for accepting a given solution) is one vital factor identified by our studies of successful eHealth projects.
4.4 The perspective of policies, rules, laws, and standards to cross-regional
interoperability
Regions are the most basic units in healthcare systems. The variety of regions regarding policies, strategies,
and action plan for eHealth have been both a driving factor for successful eHealth projects, but also challenges
for interoperability, standardisation, and security. Increased mobility of people because people now have more
possibilities (or have to) to find a job, to live, and to travel, asks for the healthcare sectors to provide citizens
with healthcare even across the border of regions and countries. However, this is far from reality. From citizen
and patient’s perspective, the system is too segregated and regionalised to achieve a holistic healthcare. Due
to different interpretations of rules, laws, standards, terminologies, regulations, and business processes etc. in
each region, the medical record of the patient cannot always be shared between different actors across regions.
The interoperable healthcare from citizens’ perspective will need high-level regulations (EU) but also regional
willingness to meet the new reality.
4.5 The perspective of co-operation among healthcare actors for integrated care
The more complicated and specific knowledge about human health is, the more sub-specialised health care staff
will have to be in order to meet the needs of the patients. When people have multi-diseases, especially elderly
people, their multiple needs must be co-operatively handled by different specialists. This means that even though
several actors from different units are involve there is a need for transparency between them. Otherwise, certain
needs of the patients will be landed in a ‘grey zone’, i.e. no one care and no one knows who is responsible.
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5. THE REGIONAL DIMENSION ON eHEALTH
5.1 Equal access to healthcare
Equal access to quality healthcare is an overall goal in many countries worldwide, and is a primary priority for
the World Health Organisation. Already in the first WHO declaration on Health for All, in 1978, it was stated
that “attaining health for all as part of overall development starts with primary health care based on acceptable
methods and technology made universally accessible to individuals and families in the community through their
full participation and at a cost that the community and the country can afford”11. eHealth is now becoming such
an acceptable method and technology. Then the important issue is who will be responsible for the development,
introduction, usage and, not least, funding of eHealth systems and tools?
5.2 Healthcare delivery
Healthcare systems vary between different EU Member States. In some, there are regional authorities in charge
of healthcare services to citizens and in some others, there are national authorities, like NHS in UK. In many
countries, there are also local authorities responsible for social services and elderly care, which is also embraced
by the potential improvements of services by the introduction of eHealth. The actual delivery of services varies
from public healthcare institutions to private healthcare providers.
Reimbursement for healthcare services also varies significantly from one country to another, from being covered
wholly by national funding to a mixture of insurances and patients’ own payments.
5.3 eHealth economics
With regards to funding of eHealth there are several stages in the eHealth lifecycle that need to be funded (and
drawn benefits from). The eHealth IMPACT report suggests three periods to be relevant for eHealth investments12:
1. Planning and development
2. Implementation
3. Routine operation
In real life this may in many circumstances be an iterative cycle since many eHealth applications are further
developed, adapted and changed over time. Even though each step has to be financed and, not to forget, drawn
benefits from. For industrial investments, there are easy investment business models that are used but in complex
professional knowledge based organisations such as healthcare this seem to be not as simple.
11
12
(WHO 2005)
(Stroetmann, K.A., Jones, T. et al. 2006)
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In a standardised production line, there is no option other than to use an equipment or system included in the
production process. In the healthcare sector, doctors or other health professionals may have many options other
than to use a tool, system or equipment they are not convenient with. Thus, usage is key in order to make a return
on investment but in healthcare it’s not as simple as in other sectors.
5.3.1 Planning and development
Planning and development of eHealth solutions is all too often done only with the local needs in focus. Even
though active participation by users is essential, it is equally essential to look further than the local healthcare unit.
Whatever the eHealth tool is, there is an obvious need to follow established standards and other requirements for
interoperability. The world of implemented eHealth solutions is unfortunately full of “isolated islands”. Technical
development and research is actively supported by the European Union, for example in the seventh framework
RTD programme, and by other national and international sources. When it comes to funding of regional eHealth
development and implementation these needs are politically weighted in the same balance as other needs from
clinics and healthcare units. Thus, proof of benefits is key to sufficiently high priority at the investment agenda.
5.3.2 Implementation
As will be shown later in this report most of the participants in the IANIS+ eHealth Work Group regard active
user involvement essential for successful implementation of eHealth solutions. There is a cost for this in the form
of “lost” working hours, perhaps loss of revenues for patients, problems in day-to-day operations and other
disturbances during implementation.
More obvious, costs for implementation are the cost of IT consultants, hardware and software, enhanced technical
support and training of users. The latter tangible costs are easier to take into account in the implementation
budget than the costs representing “initial negative benefits”. The eHealth IMPACT report discovered that on
average there is a four-year period before economic benefits are positive, for the studied cases13.
Thus, endurance is key to achievement of future benefits.
5.3.3 Routine operation
This period is when the positive benefits of the use of eHealth could be harvested, if it is used as intended (!).
Often it is also in this period that lack of use, misuse or other problems arise. Sometimes this period is ended with
a phase-out of the eHealth solution due to lack of benefits or simply non-use of the application. For justifying the
costs of operations, such as server operations, systems management, technical support, security and adjustment
and refining of the eHealth application, the presence of benefits is essential.
13
(Stroetmann, K.A., Jones, T. et al. 2006)
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eHealth
For this to happen, it is important to have strong incentives for using the system. For an eHealth application that
leads to direct economic benefit for the individual doctor or the local healthcare unit this may be no problem.
In the cases of eHealth where the main beneficiary is external to the core healthcare unit, e.g. the patient, other
healthcare units or parts of society, the issue of incentives for use is somewhat tricky. Positive benefits and
incentives for use are the keys to justifying cost of routine operations.
5.4 Regional funding of eHealth
Investments in eHealth is politically, in one way or another, always weighted against the potential impact and
expectations on added value for money, in the same balance as other needed investments in healthcare. This
situation is complicated by the common situation of lack of public resources that seem to be a law of nature.
In some countries where healthcare is a national responsibility, such as in UK, and in financially stable regions
there are deliberate long-term ventures in eHealth.
In other regions where the sum of all needs exceeds available resources and the path to a mature eHealth
infrastructure is too far away, decisions on investment in eHealth is not all too easy. In this situation, it may be
even more important to be able to learn from examples of good practice, to have a dialogue with patients on
their needs and to involve physicians and health professionals in the decision process.
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6. CHALLENGES FOR REGIONAL eHEALTH
Obviously financing eHealth is a challenge but for the success of implementation of eHealth and for allowing
eHealth to make a difference there may be a number of issues to be aware of. If they are not successfully handled,
there will be no willingness to pay for eHealth and eHealth will not make the expected contribution to increased
accessibility to quality healthcare services.
6.1 Essential prerequisites for eHealth
In a recent article Michael Rigby discussed the problem of eHealth often being tested and developed in sites
(alfa-sites) where engagement and involvement are high but the next step is not followed by enough proofing of
evidence (in beta-sites)14. The early telemedicine applications with peer-to-peer connections of video-conferencing
between enthusiastic colleagues were indeed examples of this. There are numerous followers of widespread rollout of telemedicine video-conferencing that did not succeed to replicate the success of the enthusiasts’ attempts,
or only partly so. Rigby argued that there is a need for:
• Empirical evidence
• Beta piloting or replication studies
• Appreciation of the magnitude of change for health professionals and systems in electronic working compared
to paper-based systems
He suggests that since healthcare is currently fond of the e-prefix there are a number of factors to take into
account for the successful implementation of eHealth:
• Evidence
• Evaluation
• Equipment
• Education
• Empowerment
14
(Rigby, M. 2006)
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6.1.1 Evidence
In the previous chapter, the need for proven benefits for motivating regional or national decisions was treated.
Rigby also holds this as important. Furthermore, he also lists a number of other issues where there are needs
for evidence:
• Applications: what to choose, what is optimal at least risk
• Configuration: evidence from comparable situations is needed
• New style e-working: need for best practice and techniques
• Staff preparation: what are the best preparation methods
• Facilitating change: what are the best approaches in different situations
• Successful leadership: leadership styles for modernisation, and
• Benefits realisations: It is one thing to say that new systems will be better, it is another to achieve identified
benefits, and this must start with benefits identification and move into a benefits realisation
6.1.2 Evaluation
Lack of comprehensive evaluation of eHealth has been mentioned in previous parts of this report. Rigby also says
it is important to allocate funding for evaluation and that evaluation is as important as the original research to
validate the technique.
6.1.3 Equipment
The equipment needed for the eHealth solution should be fit for the purpose. If not, it will not be used as
intended or not used at all.
6.1.4 Education
By this, Rigby does not only mean simple training for use of applications and equipment. Furthermore, it has to
do with how doctors and other health professionals undertake their duties. How they are educated (trained) to
behave and work and how this could be improved with the use of new technology. There is obviously a need for
specific training in technology and new working procedures but there is also a need to adapt the basic medical
education to the new circumstances eHealth impose on healthcare delivery. The very last case in Annex II of the
IANIS+ collection of eHealth cases, CMAT in Andalucia is an interesting example of using advanced ICT in the
medical education and training of health professionals, which may have a high impact on both the actual training
and the further use of technology.
19
eHealth
6.1.5 Empowerment
Rigby stresses the importance of ensuring that the users of eHealth applications instil a feeling of empowerment.
There are evidently examples of health care professionals being victims to eHealth, and this should definitely be
avoided. What is not brought up by Rigby but has been treated in the IANIS+ eHealth group is the empowerment
of the patients. Not least by all information being available on the Internet and databases, formerly exclusive to
physicians, patients are better informed and ready to actively participate in the decisions regarding there own
health and treatment. This empowerment of the patient is one of the most revolutionary effects of the “Health
information society”.
6.2 Meeting the challenges on all levels
Healthcare is no longer a local concern. Concerted actions in the development and implementation of eHealth
are needed for many reasons, for example:
• People move within countries and abroad
• Healthcare staff moves
• Specialists are needed at many places
• Specialists need to collaborate
The eHealth Action Plan from 200415 supports the EU i2010 strategy16, and aims for the improvement of
healthcare, with the use of eHealth. The i2010 Strategy has three priorities:
• To create a Single European Information Space, which promotes an open and competitive internal market for
information society and media services
• To strengthen investment in innovation and research in ICT
• To foster inclusion, better public services and quality of life through the use of ICT
The i2010 and the eHealth Action Plan were followed by agreements between all the EU Member States to
develop national strategies. In 2006 most EU Member States had developed national eHealth strategies, either
as separate eHealth strategies or integrated as parts of national health strategies or national ICT strategies. In a
recent follow up report17, the different national strategies for eHealth are presented.
In those countries where healthcare is a regional responsibility it will not be enough to only have a national
eHealth strategy. It has to be followed by regional plans and roadmaps for how to proceed with the development
of eHealth.
15
16
17
(Commission of the European Communities 2004)
(Commission of the European Communities 2005)
(Commission of the European Communities 2007)
20
eHealth
6.3 Regional and national differences
Healthcare is either a national or a regional responsibility and thus organisation and funding of healthcare
differs from country to country. In the same way, the use of ICT in healthcare differs and the level of use of
eHealth application differs. In some EU Member States such as the Scandinavian countries and UK their national
healthcare networks have been developed. In an increasing number of regions throughout Europe, there are
regional healthcare networks for facilitating the use of interclinical/interhospital eHealth applications, patient
record systems and medical communications. The availability of broadband connections between hospitals is
essential for the use of eHealth between hospitals.
For citizens to use eHealth applications from home or eHealth for elderly care, the availability of broadband to
homes is an important issue, where there are significant regional differences throughout Europe18.
The trends and needs for eHealth applications are fairly common throughout Europe even though priorities vary
and the level of utilising eHealth differs from nation to nation and region to region. The fact that the development
and implementation are not the same everywhere makes it possible to learn from each other. Even though there
is perhaps not an ultimate best practice, there are definitely many good practices to learn from.
18
The issue of eInfrastructure and broadband is treated by another IANIS+ working group
21
eHealth
7. REGIONAL CASES OF eHEALTH
7.1 The IANIS+ collection of eHealth projects
The IANIS+ eHealth Work Group collected 17 cases19 of various kinds of eHealth projects from the participating
regions. By necessity, they are quite different but some factors were requested for inclusion in the collection of
case studies:
• The focus of a case study should be on innovation, rather than on impact. ‘What makes a project innovative?’ is
the crucial question. When a project is highly innovative and learning points can be drawn from it, the project
does not necessarily have to be successful in the broader sense
• The regional dimension is crucial
• The projects should fit in the definition of eHealth20
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7.2 Types of eHealth demonstrated by eHealth Cases
The 17 cases were sorted into categories for the sake of comparison, even though some of them can be regarded
as belonging to more than one type of eHealth. The categories were:
• Health information sharing and seamless care – 5 cases
• eHealth product development and implementation – 4 cases
• Medical networks and hospital applications – 3 cases
• Cross-boarder eHealth – 2 cases
• Security infrastructure – 1 case
• eHealth for training and education (eLearning) – 2 cases
The group has also come across a number of related cases, e.g. cases submitted to other IANIS+ WGs that
comprises some eHealth, but also Regional Innovative Actions Programmes (RIAP) that includes actions or
projects in the field of eHealth. The boundary between eHealth and other types of “e’s” is not and cannot
be distinct. Some of the most interesting cases are not only eHealth, such as the Spanish CMAT, which is by
definition, both eHealth and eLearning and cases concerning eHealth networks can be regarded as both eHealth
and eInfrastructure.
7.2.1 Health information sharing and seamless care
The five cases included in this category span a wide spectrum of health care services. The cases are
Project acronym / name
Country
Region name
Emergency Service Zeeland e.a
NL
Zeeland
E-care
IT
Emilia-Romagna
Seamless healthcare chain supporter by ICT - OVK
SE
Blekinge
e-Heart Failure
IT
Trento
Eava
FI
West Finland
In these projects, the most common objectives are the improvement of quality and/or efficiency of care through
sharing medical information between several actors in the chain of care. Different parts of this chain are covered
by the projects. For instance, the RIAP project of Emergency Service Zeeland is about sharing information between
ambulances and emergency departments and thus improves the quality and security of acute care. E-care from
Emilia-Romagna is a wide project covering the sharing of information between primary care and specialists as
well as services to the patients such as medical call-centre service and booking of appointments.
23
eHealth
The OVK project from Blekinge, Sweden was the first project in Sweden developing a system for sharing
information related to patients’ admission to hospital between the hospital and primary care and home care.
e-Heart Failure was a proof-of-concept project in Trento for testing a diagnose specific Electronic Health Record
for sharing information about patients with heart disease between different actors involved in the care process.
The project Eeva from West Finland aimed for similar objectives but in the care of patients with dementia.
Examples of good practices:
• User driven projects often initiated by needs from users and/or patients
• Tangible effects in the form of increased quality of care and improvement of care processes
• Strong political support
The importance of having the right people i.e. health care staff involved in the development and implementation
is raised by most of the projects.
Issues and problems:
• Organisational barriers between different healthcare actors/clinics
• Lack of infrastructure and necessary clinical systems. In some case the opposite, availability of good
infrastructure was a strength
•Lack of common healthcare processes
Issues to be dealt with in these types of eHealth projects are most often related to organisation, management
and processes.
7.2.2 eHealth product development and implementation
The EU Innovative Actions Programme funded half of the cases in this category. They are all innovative and
experimental, but not necessarily implemented solutions
Project acronym / name
Country
Region name
Health Account - Patient’s Record on the Net
FI
Turku
Mobile Applications for Healthcare
DE
Bremen
Wireless protocol for the cardiological monitoring
IT
Emilia-Romagna
Mobinet - Pilot network implementation for the
effective health monitoring in remote areas
GR
Central Macedonia
24
eHealth
The Health Account product from WM-data in Turku, is an example of the trend of personalised patient centred
health records on the internet.
Mobile Applications for Healthcare in Bremen was a research project for studying, testing and validating mobile
applications and devices for healthcare use. The cardiological monitoring project from Emilia-Romagna included
technical tests and some implementation of cardiological monitoring using mobile technology. Mobinet from
Central Macedonia tested a range of medical mobile devices and vital signs monitoring devices sending data to
primary care and specialists.
Examples of good practices:
• Involvement of users, which is a key factor, for testing applications and devices
• Commitment of project management
• User attractiveness of the products tested, developed or implemented
Issues and problems:
• It was not easy to arouse interest of the users: usually, they have other problems at the moment
• Conflicting interests between various actors in health care sector
• Overcoming organisational barriers and problems with engagement of hospital staff when using telemedicine
applications from remote sites.
• Compatibility and technical issues
It seems that these types of projects heavily rely on commitment of people on different levels, managers, and
project staff and very much on users for testing and implementation. Most of these projects have raised the need
for the engagement of healthcare staff and problems with the same.
7.2.3 Medical networks and hospital applications
All of these projects aim for efficient communication of medical data, at a broad regional level including several
actors within and between hospitals.
When it comes to medical networks there are both infrastructure issues, e.g. the availability of broadband, and an
application or service component, e.g. issues of interoperability and inter-organisational collaboration.
Project acronym / name
Country
Region name
The networking of health services in the Valle del Chiese
IT
Trento Province
RIM - Image Medical Network
FR
La Reunion
PACS - Picture archiving and communications
systems
CZ
Vysočina
25
eHealth
The Networking project in Valle del Chiese was part of the Regional Innovative Actions Programme in Trento.
It aimed at establishing a networking infrastructure as well as certain healthcare services, such as telecare and
telemedicine, sharing of medical records between certain actors and electronic prescriptions to the pharmacy.
Also, communication of medical reports after hospital care (such as the OVK project in Blekinge) was included.
The objectives of the networking project in La Reunion were to enable different forms of medical communication
between the hospitals on the island, especially teleradiology. The PACS project in Vysocina was a project for the
implementation of digital radiology in the Jihlava hospital, with planned communication to other hospitals in
the Czech Republic.
Examples of good practices:
• Reduction of time for accessing medical data, e.g. clinical reports in Valle del Chiese and accessing radiology
images in La Reunion and Vysocina.
• In La Reunion the first real healthcare infrastructure that will allow for more applications and benefits in the
future
• In Vysočina, using innovative technical solutions led to half the normal cost of similar projects
Communication of medical data within a region, within a hospital or within a clinic is often essential for process
development in healthcare. These three projects are all samples of the needs and benefits of these projects. The
technology used is often state of the art but the innovation lies in utilising the potential of streamlining the
healthcare services.
Issues and problems:
• Interoperability between systems
• Lack of time compared to estimate/demand in the RIAP programme
• Initial lack of broadband in the case of La Reunion
When it comes to communication between systems from different vendors and managed by different organisations/
hospitals there are very often interoperability problems. It can be due to different technical standards but as often
due to different set up or different use of terminology, i.e. semantic interoperability problems. Interoperability is
a common challenge in many eHealth projects.
7.2.4 Cross-boarder eHealth
Cross-boarder eHealth services is about taking communication one step further, with potential benefits but also
with certain problems with interoperability, technical solutions, legal regulation, reimbursement etc.
Both the projects in this group are about radiology readings services.
26
eHealth
Project acronym / name
Country
Region name
EURAD
DE
Baden-Württemberg
Telemedicine Clinic - Offshore Spanish
teleradiology for Swedish hospitals
SE
Västernorrland
EURAD was an eTEN project with the objectives of establishing a decentralised teleradiology service for crossboarder as well as national sharing of radiological competence. The national service is established but the
international part will be established later than expected.
Telemedicine Clinic is a service that started from the beginning as an international service with its base in
Barcelona. The first customer was a small hospital in Västernorrland, in northern Sweden, and the second one
was the larger hospital of Borås in southern Sweden. The service was then rapidly expanded to large-scale
readings from the United Kingdom. The Telemedicine clinic is chiefly specialised in MR and CT imaging but
reads also conventional radiology, and it makes use of a decentralised structure of contracted radiologists from
different countries around Europe.
Examples of good practices:
• Reducing waiting times for radiology due to lack of radiologists
• Allowing for high quality using the best available specialists
• Productivity gains allowing for competitive pricing.
• Functional work-flow is absolutely essential
Issues and problems:
• Interoperability problems between different radiology systems
• Quality assurance of readings essential for trust of cross-boarder services
• Suspiciousness and lack of trust from local physicians occurs
• Uncertainty of legal regulations.
The legal situation concerning this type of medical cross-boarder communication seems to be solved but
nonetheless, trust is an important issue. It is expected that the need for cross-boarder healthcare of different
kinds will increase in the near future. At the end of 2007, the EU Commission is expected to present a proposal
for the regulation of cross-boarder care and patient mobility.
27
eHealth
7.2.5 Security infrastructure
The issue of secure access to medical data and/or storage of some medical data with use of secure digital cards
is exemplified with one case from Germany.
Project acronym / name
eHealth Card Schleswig - Holstein
Country
DE
Region name
Schleswig - Holstein
The project Gesundheitskarte Schleswig-Holstein is a large project involving a large number of health professionals
and citizens, and is based on secure certificate technology and VPN solutions for access to medical data. From the
start, trials were conducted with 150 health care personnel and 1000 citizens but later the project was expanded
to 500 staff and 100 000 citizens. The project has the potential to be expanded to the rest of federal Germany
and possibly to be used as a model for European Union initiatives in this field.
Even though only one case is purely about secure health cards, several of the other submitted projects have also
used this technology, such as the Emergency service in Zeeland and the Networking service in Valle del Chiese.
Examples of good practices (for this project):
• All regional players in healthcare were involved, so use-cases could be optimised from end-to-end and
discussions could be made without national political “overhead” and influence
• Bottom-up development in small steps ensured participation by users, so targets could be reached in a short
time with high acceptance
• Political support helped getting the right people involved, so communication and decisions-management
could be made very efficient
Issues and problems:
• The agreeing of common targets between health-insurance organisations and health-professionals is tricky
when discussing funding-themes and cost/usage
• Some health-professionals dislike evaluation, because they are afraid of being benchmarked in medical topics
• Industrial partners try to place their specific products to be used as “standards”
The issues encountered in this project are probably general in regard to different stakeholders and financing
of solutions. Also, the other issues raised would be general for many eHealth projects. The “good practice”
and benefits of starting this kind of project that should in the end be national on a regional scale is worth
mentioning.
28
eHealth
7.2.6 eHealth for training and education
This category could equally be defined as eLearning, in healthcare. Using ICT for training and education of health
care staff is included in the most common definitions of eHealth and telemedicine, even though not explicitly
in the EU definition referred to in the preface of this report. Healthcare, being wholly dependent on knowledge,
experience and evidence, is by definition dependent on continuous development and training of healthcare staff.
Therefore, it is also sometimes difficult to separate the actions of the medical staff from continuous training.
Project acronym / name
Country
Region name
EDU - HEALTH
IT
Abruzzo
CMAT
ES
Andalucia
The EDU-HEALTH project in Italy developed an eLearning multimedia platform for use by the 16000 health care
staff in the region. The intention is to expand the service with different types of courses that will be accessible
from the local sites in hospitals and health care units.
The CMAT project (Complejo Multifuncional Avanzado de Simulación e Innovación Tecnológica) built up an
advanced centre for education and training of physicians and medical staff, in the Health Science Technological
Park in Granada. It comprises e.g. robotic simulation, virtual simulation, actor-based simulation, video analysis
and eTraining for different medical situations and purposes. Even though the centre is technically advanced, it is,
as far as possible, based on low cost open source technology.
Examples of good practices:
• eLearning for healthcare staff allows for flexible training as well as accessibility for staff otherwise not reached
by training
• For CMAT integration in the Regional Innovation, Information Society and Health Innovation Strategies,
guarantees continuous funding
• Wide impact in the quality of public health services, as an engine for productivity and growth
Issues and problems:
• Technical issues may occur due to multimedia compatibility
• Funding. High quality multimedia and eLearning can be very expensive to develop
• For CMAT specifically the degree of innovation was too high for the private sector ICT solutions to provide on
the shelf products, and therefore in-house development was necessary for most applications
29
eHealth
8. FACTORS FOR SUCCESS OR FAILURE
When and how is it possible to measure success or failure of an ICT project? This has been discussed in the
IANIS+ eHealth WG and also what constitutes a success or a failure. There is no ultimate answer to this, since a
seemingly unsuccessful project can deliver a valuable learning experience necessary for the success of following
projects. The eHealth IMPACT report, referred to previously, stated that economic benefits are shown on
average after four years. Other benefits may appear at other intervals and that depends on types of application.
Infrastructure such as regional or national eHealth networks takes much more time to develop and thus the
benefits are to be seen much later. However, when the infrastructure is in place, it may facilitate benefits from
added eHealth applications faster than if the infrastructure was not present.
What makes an eHealth project a success with tangible benefits or a failure where the application is not used as
intended or does not show expected benefits? Probably there is no distinct boundary between success and failure.
It may be a matter of degree or a matter of perspective. No projects are similar to others due to differences in
local circumstances, human factors, technology or financing. Even though it is possible, by experience, to identify
a number of factors that may constitute prerequisites for success or failure, the outcome of a project can very
well be the result of coincidence or luck/bad luck. Whatever determines success or failure, the common view of
the eHealth WG is that the experiences drawn from many projects are the most important source of information
for further successful implementation of eHealth21.
At a round-table meeting, the participants of the eHealth working group were asked to list the three most
important factors for success and failure. These were grouped according to the type of factor. However, there are
often not distinct boundaries to which group a certain factor belongs, and several factors can belong to more
than one group. The success/failure factors may also depend heavily on local circumstances.
8.1 Important factors for a successful eHealth project
User/Organisation
• Innovative projects work only with a well defined, small group of actors to collect experiences
• Discussion/Survey with requests of the users, for the final acceptance of the solution
• Involve the medical staff (nurses, doctors), Importance of training
• Users’ need must be in focus
• Involvement of citizens/patients
• Professional esteem
• Clinical need and strong patient focus
21
The factors grouped by project are enclosed in Appendix
30
eHealth
Management/Decision
• Political and social support is a must
• Bottom up strategies have to be preferred
• Long-term view on projects
• Commitment of clinical leadership and policy support
• Active participation of regional healthcare actors, hospitals and municipalities
• Predefined goals for investment
Economy/Incentives
• Health benefits have to be combined with business benefits
• Political support and feasible funding
• Attractiveness – project solves problems + IMPACT
• Check who will pay (how much) for the eHealth service in question
• Technical solution is secondary to workflow organisation/money
• Incentives important (economic and organisational) – ”what’s in it for me?”
Project management
• Involvement of all key stakeholders
• Multidisciplinary approach that involves politicians, specialists, researchers and business
• Real motivation
• Bottom-up ‹–› Top Down Together (tactical ‹–› strategical)
• Public-private partnership
• Helicopter view
• Bottom-up approach
• Commitment
• Talk to experts, establish relationships
Application/System
• Meeting an explicit or latent demand – solve a real problem
• User-centred design
Technical
• Choosing the right technology, continuous technical support
• Interoperability and open standards
• Lack of prestige with regards to technical choices
31
eHealth
8.2 Important factors that can make an eHealth project fail
User/Organisation
• Inability to adapt the strategy to changing needs/environment
• Do not reorganise healthcare processes while establishing new technologies
• Lack of involvement of actors – because the solution means ”new organisation”
• Isolation from the organisation and potential users
• Failure to adapt planning to change in needs / knowledge gained
• Resistance to change
Management/Decision
• Lack of political commitment
• Lack of private partners for sustainability of solution
• The short term thinking of government, also ”territory gates”
• Lack of commitment from users and managers
• Lack of long-term view
Economy/Incentives
• Insufficient ratio cost/benefits
• Short term expectations of eHealth project
• Economically driven projects
• Investment cost
Project management
• Trying to solve all problems 100% before getting started
• All actors in eHealth project have not reached a clear labour division
• Do not understand health care processes and ongoing changes in medical environments
• Not enough planning and too quick in ending projects (and lack of evaluation)
Application/System
• Big steps – big expectations
• Lack of market analysis, comparing the solution to existing ones
• Legislation context / importance of interoperability
• Lack of existing information systems (e.g. clinical information systems)
• Developing the project in artificial environment
• Poor clinical relevance
32
eHealth
Technical
• Technology risk / inflexibility of chosen solution
• Supply or technology orientation
• Technophobia – organisational/legal barriers
• Bad communication about technical problems in the project
• Interoperability
• Technology driven
8.3 Summary of success and failure factors to be regarded as Good Practice
Even though some of the factors may be important in one setting but not in another there are some common
factors that can be generally regarded as prerequisites for good practice:
• Commitment at all levels and user involvement
• Projects based on real needs and clear objectives
• Incentives for use of solution (e.g. clinical, economical, personal)
• Human interaction and communication within the project
• Follow technical standards as far as possible for interoperability
• Long-term approach, endurance and sustainability
Both for the factors of success and failure it seems that even if technology may fail it is often not regarded as
the most prominent issue. Rather, it is human factors and issues related to the (complex) healthcare organisation
that seem to be critical for the success of eHealth implementation.
33
eHealth
9. CONCLUSIONS
The main objective of the IANIS+ eHealth Work Group was to study the practice of eHealth in regional innovative
projects, preferably financed by the EC Innovative Actions Programme. Of the studied cases, five were financed
within that programme and many of the others by the EU Structural Funds. Some were financed by national
funds and a few purely by private investments. In the same way as the source of funding differs so does the
size and scope of the projects. Some projects implement eHealth in local settings at one hospital and some are
introducing cross-boarder eHealth. From all of the projects it is possible to learn something.
9.1 The coverage of the collection of eHealth projects
The 17 projects studied by the eHealth WG come from different parts of Europe and represents a vast amount of
knowledge and experience. Even though there are some parts of Europe not represented in the collection, where
there are evidently interesting developments going on in the field of eHealth. Such areas include the United
Kingdom (NHS), Ireland, Denmark, The Netherlands and mainland France. To some extent, this lack of coverage
has been bridged by close collaboration with the authors of the EU eHealth Impact report. Their contribution to
the eHealth WG meetings has been extremely valuable.
9.2 Visions versus reality in eHealth projects
All of the eHealth projects included in the collection have been collected through project templates from the
actual projects22. Most of the projects are thoroughly reported and some are more briefly described. In some
cases, the honesty in describing drawbacks and failure, for learning purposes, is praiseworthy. In other cases, it
may be difficult to value the degree of success compared to the described intentions of a project.
9.3 Who needs regional experience of eHealth
This Guide to Good Practice eHealth – Regional Challenges and Impact, does not provide any ultimate answer
on the issue of how to best exploit the potential of eHealth or how to best conduct an ICT project. For the
latter there are many excellent books on project management, for the ones in need. For the issue of exploiting
the potential of eHealth we have to count on much longer term actions, but this report is intended to be a
contribution to this.
In fact, eHealth is a growing research subject in its own respect, not only from a technical point of view
but furthermore as an interdisciplinary area of research. For the progress of eHealth, experience of practical
implementation is needed, but also for further development of new software applications and health care
services for the improvement of quality and efficiency of care.
22
A summary of all the cases is provided in Annex II to this report
34
eHealth
The experience of the 17 projects included in the case collection in this report may be useful for:
• The EU Commission for further actions and promotion of eHealth research and implementation
• Regional authorities and health care providers, for exploiting eHealth making use of experience from others
• The ICT industry for the further development of high quality eHealth software, hardware and solutions
• All those, including ourselves, who are trying to improve healthcare by the implementation of ICT in different
forms
9.4 Regional innovation as Good Practice
Even though most of the studied cases are not similar to each other there are some common themes and
conclusion to be drawn from the collection:
• Political and organisational commitment is most important
• User involvement and development based on actual needs
• The regional experiences shown in the studied cases confirm the current trends in eHealth
All the regional cases represent innovations even though they follow the current eHealth trends. Innovation is
not only about creating new technology but furthermore about development of the healthcare services, with use
of information technology.
From the discussions in the work group at the policy seminar and the final conference some of the conclusions
are:
• eHealth projects contribute to regional development and improvement of healthcare services, but it takes a
long time to achieve visible results
• Social-technical approach to eHealth projects with a systemic view is a key to successful eHealth projects
• Regions must integrate eHealth in their development strategies and apply a holistic view that includes the
inter-regional and cross-boarder level
35
eHealth
10. REFERENCES
Commission of the European Communities (2004). eHealth - making healthcare better for European
citizens: An action plan for a European eHealth Area. Brussels.COM(2004) 356 final.
Commission of the European Communities (2005). i2010 – A European Information Society for growth
and employment. Brussels.COM(2005) 717
Commission of the European Communities (2007). eHealth priorities and strategies in European countries
- eHealth ERA report March 2007. Luxembourg, Information Society and Media Directorate General, Directorate
H – ICT for Citizens and Businesses.COM(2005) 717
Iakovidis, I., P. Wilson, et al. (2004). Introduction: How We Got Here. In EHealth - Current Situation and
Examples of Implemented and Beneficial EHealth Applications, IOS Press. 100: 246-9.
IANIS (2004). A Guide to eHealth Applications for Regions. Brussels, eris@-The European Regional Information
Society Association
Rigby, M. (2006). “Essential prerequisites to the safe and effective widespread roll-out of e-working in
healthcare.” International Journal of Medical Informatics 75(2): 138-147.
Silber, D. (2004). The Case for eHealth. In EHealth - Current Situation and Examples of Implemented and
Beneficial EHealth Applications. I. Iakovidis, P. Wilson and J. C. Healy. Amsterdam, IOS Press. 100: 27-50.
Stroetmann, K. A., T. Jones, et al. (2006). eHealth is Worth it - The economic benefits of implemented
eHealth solutions at ten European sites. Luxembourg:Office for Official Publications of the European Communities,
European Commission: 56
WHO (2005). The Health for All policy framework for the WHO European Region: 2005 update. Copenhagen,
WHO Regional Office for Europe.European Health for All Series No. 7
36
eHealth
ANNEX I:
Factors of success and failure for eHealth projects
37
eHealth
ANNEX I: Factors of success and failure for eHealth projects, from the
eHealth Round Table meeting, 13th March 2007, Brussels
Success factors for eHealth projects Failure factors for eHealth projects
Veli Stroetman,
eHealth Impact,
empirica GmbH,
Germany
• Involvement of all key stakeholders
• Commitment of clinical leadership
and policy support
• Choosing the right technology,
continuous technical support
Jan Meincke
Gesundheitskarte,
Schleswig-Holstein,
Germany
• Innovative projects work only with a • Ability to adapt the strategy to
well defined, small group of actors to
changing needs/environment
collect experiences
• Big steps – big expectations
• Health benefits have to be combined • Technology risk / inflexibility of
with business benefits
chosen solution
• Political and social support is a must,
bottom up strategies have to be
preferred
A C Lefebvre,
Critt Santé Bretagne,
Bretagne, France
• Discussion/Survey with requests of
• Lack of market analysis, comparing
the users, for the final acceptance of
the solution to existing ones
the solution
• Lack of involvement of policy, medical
• Involve the medical staff
and societal community – because
(nurses, doctors), Importance of training
the solution means ”new organisation”
• Political support, long-term projects • Legislation context / importance of
interoperability
Luis Lozano,
iAVANTE,
Andalucia, Spain
• Meeting an explicit or latent demand – • Supply or technology orientation
solve a real problem
• Isolation from the organisation and
• Involving from the outset, all key players potential users
• Political support and feasible funding • Insufficient ratio cost / means to
expected results
Guohua Bai,
OVK,
Blekinge, Sweden
• Multidisciplinary approach that
involves politicians, specialists,
researchers and business
• Users’ need must be in focus
• Active participation of regional
healthcare actors, hospitals and
municipalities
38
• Ability to adapt the strategy to
changing needs/environment
• Big steps – big expectations
• Technology risk / inflexibility of
chosen solution
• Short term expectations of eHealth
project
• Economic driven
• All actors in eHealth project have not
reached a clear labour division
eHealth
Success factors for eHealth projects Failure factors for eHealth projects
Bertie Augustijn,
• Real motivation
Emergency service in
• Bottom-up ‹–› Top Down Together
Zeeland,
(tactical ‹–› strategical)
Zeeland, The Netherlands • Helicopter view
• Public-private partnership
• Bad communication about technical
problems in the project
• The short term thinking of
government, also ”territory gates”
• Resistance to change
Stefano Forti,
eHeart Failure,
Emilia-Romagna, Italy
• User-centred design
• Bottom-up approach
• Involvement of citizens/patients
• Lack of existing information systems
(e.g. clinical information systems)
• Lack of political commitment
• Lack of private partners (e.g. .....)
for sustainability
Pantelis Angelidis,
Mobinet,
Central Macedonia,
Greece
• Motivation
• Commitment
• Attractiveness – project solves
problems+ impact
• Professional esteem
• Technophobia – organisational/legal
barriers
• Resistance to change
• Investment cost
• Interoperability
Stefan Baur,
Curagita,
Germany
• Check who will pay (how much) for the • Developing the project in an artificial
eHealth service in question
environment
• Technical solution is secondary to
• Failure to adapt planning to change
workflow organisation/money
in needs / knowledge gained
• Talk to experts, establish relationships • Not obeying points 1-3 above
(success factors)
Jari Forsström,
WM-data,
Finland
• Interoperability and open standards • Poor clinical relevance
• Predefined goals for investment
• Technology driven
• Clinical need and strong patient focus • Does not understand health care
processes and ongoing changes in
medical practice
• Managers’ commitment (both clinical • Lack of commitment from users and
Gustav Malmqvist,
and hospital/organisation)
Telemedicine Clinic,
managers
Västernorrland, Sweden • Lack of prestige what regards technical • Lack of long-term view
choices
• Not enough planning and too quick
• Incentives (economic, organisational or in ending projects (and lack of
personal) =”what’s in it for me?”
evaluation)
39
eHealth
40
eHealth
ANNEX II:
eHealth Case Studies from Regions
41
eHealth
Case Study 1
Emergency Service Zeeland e.a
Region
Zeeland, The Netherlands
Contact person
Ms. Bertie Augustijn-Vos, Order of Medical Specialists
Tel: +31 6 51794369
Email: b.augustijn@gmail.com
Category of eHealth
Health information sharing and seamless care
+ eHealth product development and implementation
+ Medical networks and hospital applications
Project partners
Order of Medical Specialists
Provincial Government of Zeeland
CIBG
Nictiz
Public X
X
X
Private
X
Status of the Project
01.06.2004 – 31.05.2006
Completed
Cost and funding
Total cost: € 809,367
57,6%
9%
6%
20,4%
7%
RIAP
Yes
Aims and Objectives
· To develop a uniform registration of patient information in electronic patient file
(EDP) to enable patients transported by ambulances (> 6.000 emergency calls and
>10.000 non-emergency patient transportations per year) and health care suppliers
(3 hospitals and 1 Ambulance organisation) to make optimal use of ICT
in the inter-organisational chain
· To optimise the supply of information for traumatology and the first aid services
(together referred to as emergency services)
Beneficiaries
The hospitals in Zeeland, all medical specialists and the regional ambulance service
Zeeland. Furthermore, the cooperation between hospital pharmacies and private
pharmacies has been intensified. The cooperation between the family doctors will
be expanded. Also, cooperation between health care institutes and suppliers (various
ICT companies, Dutch Telecom et.) has been created. Last but not least of course the
patients in each one of the 16.000 ambulance trips a year
42
EU Structural funds
Order of Medical Specialists
Regional public funds/Province of Zeeland
Private sector investment
Anticipated income CIBG & NICTIZ
eHealth
Project Description
Implementation of an information supply application for the Emergency Services in
Zeeland. This application should comply with present national legislation and regulations. First focus would be the information on medication (possible allergies, use of
medicines etc.).
The disclosure of data and data-entry both in a mobile way (e-rides application)
as well as on different locations (by the general practitioner/ ambulance/ First Aid
Station/ hospital/ medical specialist). For the Netherlands this means a unique cooperation between hospitals and the regional ambulance service in the province of
Zeeland
Main Achievements
Emergency services (hospitals), the Regional Ambulance Service and the Ambulance
Control room have a new tool to support and deliver care at a qualitative higher
level.
Schooling for first aid services, ambulance nurses and ambulance control room officers (in phase 1 about 60 persons)
An insight in costs, coverage e-Infrastructure, adaptation of ambulance according to
laws and regulations, (EU-legislation, occupational health and safety Act) but also
in a number of bottlenecks in present legislation, which with the help of this project
can be amended to eventually result in an Order in Council
Lessons Learned
The people on the “work floor” (doctors and nurses) played a very important role in
the project because of the wish to contribute to a reliable and efficient development
of the emergency services. That is: involving all actors.
Important to keep an eye on the project targets, the art to steer a middle course (in
view of all personnel and political changes), creative determination, loyalty, having
a helicopter view, having knowledge of the forces and powers that play a role in
health care.
Issues
The e-Infrastructure and technical problems in the ambulance with respect to eInfrastructure and the effects on the equipment in the ambulance. For example the
laptops used for the data transmission between the ambulance and the hospital
had to be fixed in the ambulance, to avoid hurting patient and/or nurse in case the
ambulance had an accident. Also, the supply of electrical power for all the medical
equipment turned out to be a problem. The ambulance manufacturer and the factory that equips the ambulances deal with these problems. The solution requires
– quite rightly – a very careful execution, for example an EMC (Electro Magnetic
Compatibility)-test and a crash test
Additional comments The objectives of this project have been achieved. A further roll-out of the project is
being expected in the course of 2006.
The possibilities of a follow-up are being discussed with representatives of the ministries of VWS (National Health, Wellbeing and Sport) and BZK (Internal Affairs and
Kingdom Relationships). However these two ministries differ on opinion with respect
to the development of a casualties monitoring system
43
eHealth
Case Study 2
E-care
Region
Emilia-Romagna, Italy
Contact person
Ms. Licia Mignardi, CUP 2000 SpA
Tel: +39 051 4208411
Email: licia.mignardi@cup2000.it
Category of eHealth
Health information sharing and seamless care
Project partners
Public Private
X
X
X
X
CUP2000 SpA
PHARMACOM
Comune di Bologna
AUSL Bologna
Status of the Project
01.04.2003 – 30.06.2004
Completed
Cost and funding
Total cost: € 336,000
38%
62%
RIAP
Yes
Aims and Objectives
· To build an integrated network of health and social services (e-Care) for the
assistance of elderly and disabled people
· To empower citizens by keeping the beneficiaries knowledgeable about the
resources of the health care system at their disposition and the most responsible
way to utilise them
· To create a health care network that allows direct communication between first
and second level health care structures, general practitioners, pharmacies, unified
booking centres and consumers, thereby:
EU Structural funds
Public funds
· Supporting organised access to health care services by citizens
· Directing clients to the appropriate health care centre
· Improving the standard of quality
· Limiting the costs of running health care and social assistance systems
Beneficiaries
44
The final beneficiaries are about the 30.000 elderly and disabled persons living in the
Bologna city who need access to the e-care system
eHealth
Project Description
The e-Care network links the citizen and their family to the healthcare services, verifying information, providing access (booking, check-in, service contracts), informative feedback (like medical references or bills for services rendered), and Home-Care
services (like domicile assistance). Contact can be made by telephone or using the
internet. The telephone system works by calling an operator who enters into the
system and has a view of all the health-care organisations.
The system implemented was composed of two main integrated parts:
· A subsystem with functions related to the health-care services supply, accessible
by the administrative operators and by the health operators for the planning of
the services
· A subsystem with functions related to the management of the clinical information
accessible by the different interested actors, as doctors, general practitioners,
nurses, etc
Main Achievements
Once developed, the new e-care system has been tested and the health-care operators have followed specific training session on it. Indeed, although final beneficiaries
of the project are the patients and their families, the principal actors of the project
are the health-care operators who can carry on their work in a easier and efficient
way; in particular:
· General practitioners responsible for patients fill-in the case sheet
· Doctors who take care of the patient and need to know the clinical history and to
update the case sheet
· Medical consultants who need to know the planning of the cure and the treatments
followed by the patient
· Administrative operators in charge of the activation of the services
· Patients and relatives can book their health-care services via internet
· Operators in charge of the health-care and social services
Lessons Learned
· Importance of strong political support: The project idea was promoted by the
Bologna Municipality and the regional public health-care organisation. Thus
allowed a strong commitment for all the local organisations involved in the e-care
process
· Use of an open, modular and scalable architecture
· The availability of a good infrastructure: The Emilia-Romagna Region has built-up a
fast broadband network accessible to all public organisations in the territory
Issues
· Huge and diverse amount of the activities had to be analysed which was really hard
and time consuming
· A high number of proprietary applications developed to solve specific problems, did
not communicate with each other. The providers of the proprietary applications
were not always collaborative because they perceived a loss of the power derived
from being the only one able to update the customised applications
· The lack of a common workflow for the different organisations involved in the
different e-care activities. This led to the re-thinking of the procedures used in order
to set-up a common understanding of the e-care process
Additional comments The region has adopted the system and Following the success of this first project, a
number of new projects have been financed by the Emilia Romagna Region
45
eHealth
Case Study 3 Seamless healthcare chain supported by ICT – OVK
Region
Blekinge, Sweden
Contact person
Mr. Guohua Bai, Blekinge Institute of Technology
Tel: +46 457 385848
Email: gba@bth.se
Category of eHealth
Health information sharing and seamless care
Project partners
Status of the Project
Blekinge hospital
Ronneby municipality
Karlskrona municipality
Olofström municipality
Karlshamn municipality
Sölvesborg municipality
Frontec
1997-2000
Completed
Public X
X
X
X
X
X
Private
X
Cost and funding
Total cost: Not available
n/a%
n/a%
RIAP
No
Aims and Objectives
To document and communicate all necessary information about a transferred patient
in a quick and secure way between different levels of healthcare organisations to
guarantee a seamless healthcare process (chain).
The key targets was:
Regional Public Funding
The Swedish Knowledge Foundation
· To build up a digital platform to support necessary information
· Implement a working routine that can be synchronised by different levels of
healthcare organisations
· To fulfil the new regulation issued by Swedish Board of Health and Welfare
(SOSFS 1996:32) about the building up of a structure for transmitting information
and cooperation between different care providers
Beneficiaries
46
All 150.000 citizens in Blekinge region benefit from the OVK when they are transferred from hospital care to secondary or primary care.
eHealth
Project Description
The project (1997-2000) started as a response to the then newly issued regulation
by the Swedish National Board of Health and Welfare (Socialstyrelsen) about the
requirement to share patient information among different care organisations. The
objectives of the regulation are ‘to create a structure for information transmitting
and cooperation between different care providers.’ It is also stated that ‘it is proper
that routines for transmitting information between hospital and social services and
between hospital and open health-medical care can be decided locally and together
with other healthcare organisations’. In the same year, Blekinge discussed how to
apply ICT to follow the above regulation, and project OVK started officially in1997.
Blekinge hospital and three areas of primary healthcare (one in Karlskrona and two
in Ronneby municipalities) were involved in the project as pilot test sites.
Main Achievements
· Improvement of healthcare planning by usable IT platform for transmitting patients’
information among different care organisations
· The OVK system is used for transmitting patient information between organisations,
and care planning is done much more efficiently
· According to a report (IT I Kommunal Vård och omsorg), OVK is one of the two most
successful projects in Sweden about ICT supported healthcare.
· Secure healthcare improved
Lessons Learned
Needs driven (needs from regulation, needs from patients, needs from the employees
are all working together, and all are winners.
OVK was developed under close integration with daily work. This integration guaranteed the acceptance later when OVK started to operate.
The team agreed the same vision and shared the same objective, and each part of
the project had very clear labour division and own financing. Face to face meeting
worked well to synchronise the whole consortium.
Additional comments The region has adopted the system and other Swedish county councils have started
to develop or procure similar systems for seamless care.
47
eHealth
Case Study 4
e-Heart Failure
Region
Trento Province, Italy
Contact person
Mr. Stefano Forti, Istituto Trentino di Cultura-Center for Scientific and Technology
Research,
Trento, Italy
Tel: +39 0461 405307
Email: forti@itc.it
Category of eHealth
Health information sharing and seamless care
Project partners
Istituto Trentino di Cultura, Center for Scientific and
Technology Research
Institut BioMedizinische Technik (IBMT), Fraunhofer
Institute, Germany
Health Care Service Trust of the Province of Trento, Italy
University of Trento, (Department of Sociology
and Social Research and Department of Juridical
Sciences),Italy
University of Pavia (Department of Computer Engineering and Systems Science), Italy
University of Firenze (Department of Medical Surgical
Critical Care Area), Italy
Public Private
X
X
X
X
X
X
Status of the Project
1997-2000
Completed
Cost and funding
Total cost: € 1,417,932
100% Public funds
RIAP
No
Aims and Objectives
· To design and develop a web- based platform of eHealth services supporting a
shared and evidence-based care for heart failure patients, and
· To test the feasibility of the platform
Beneficiaries
During the feasibility study the following healthcare operators were involved:
27 General Practitioners
34 Visiting nurses
18 Hospital specialists
15 Hospital nurses
In the end patients with heart failure should be the main beneficiaries.
48
eHealth
Project Description
The project started in may 2002 and finished in December 2005. During the phases
of the project, both applied and basic research activities were carried out. It follows
a list of the activities developed.
· Hearth Failure Virtual Patient Record (HF_VPR)
This activity was the design and implementation of a web-based virtual patient
record for supporting the integrated and shared care of patients with heart
disease. A homecare module (from the Fraunhofer Institute) for acquisition of vital
parameters (weight, blood pressure, oxygen saturation, body temperature) at the
patient’s home has been integrated into HF_VPR and tested in laboratory setting
· Co-operative work system integrated into HF_VPR
This activity was dealing with the integration into HF_VPR of an asynchronous
teleconsultation system for supporting communication among HCPs involved in the
care process of heart failure patients (hospital specialists and nurses, visiting nurses
and family practitioners)
· Computerised guidelines integrated into HF_VPR
This research activity was mainly devoted to design and implemented a prototype
module of a guideline-based decision support system supporting the delivery of
evidence-base care
· Security infrastructure
Because the family physicians access the HF_VPR using Internet through a Web
server (IIS), security issues were carefully addressed. A security infrastructure and
the access procedure were designed in close collaboration with the Law Department
of the University of Trento
Main Achievements
This was a proof-of-concept project mainly focused in exploring the potential of
eHealth solutions for supporting multidisciplinary disease management involving
both hospital and community health operators.
Although the project had a minor impact on clinical aspects, it has allowed the
assessment of the potential of some innovative ICT-based solutions in supporting
the integrated management of chronic patients (i.e. disease-specific virtual patient
record, security infrastructure, guideline-based decision support system, graphic visualisation of clinical history, etc) and to draw important learning points that should
be taken into consideration for future eHealth projects
Lessons Learned
Using a human-centred computing paradigm allowed to involve the final users and
the domain experts in the design and implementation of solutions centred on endusers needs.
Issues
· Lack of clinical information system and lack of integration with existing clinical
information systems (e.g. digital record of family physicians)
· Unforeseen delay due to coming into effect of National Legislative Decree on
Personal Data Protection Code
· Lack of involvement of healthcare policy decision makers
Additional comments The methods used within the project (i.e. data models, user-centred design, services
analysis) have been used in other eHealth projects currently going on
49
eHealth
Case Study 5
Eeva - A customised safety net for people with dementia
Region
Contact person
West Finland, Finland
Ms. Merja Hedberg
Tel: +35 8 6 4298 800
Email: merja.hedberg@eptek.fi
http://www.eptek.fi/
Health information sharing and seamless care
Public South Ostrobothnia Telemedical Centre
X
South Ostrobothnia Health District
X
The Dementia Society of Ostrobothnia Region
X
Six municipalities of South Ostrobothnia
X
Tamper University of Technology
X
LifeIT Plc
Category of eHealth
Project partners
Status of the Project
Cost and funding
RIAP
Aims and Objectives
Beneficiaries
01.09.2004 - 28.02.2006
Completed
Total cost: € 120,000
70%
20%
10%
Private
X
EU Structural funds
Regional public funds
Private sector investment
No
Development of a complete safety net for persons with dementia and their caregivers
in South Ostrobothnia. The purpose of this safety net is to help in taking care of
individual’s basic needs in daily life
Target group: Thirty people with dementia and their caregivers.
Chosen from among the patients of the South Ostrobothnia Health District The
criteria of selection is that the subjects are living at home and they have Alzheimer`s
disease.
Project Description
Development of a safety network. Social network increases a demented person’s
feeling of security while technology decreases the burden on the family. A complete
dementia safety network supports technology utilisation in a demented person’s
daily life.
Creation of individual safety net for people with dementia. Increase of safety to
Main Achievements
individuals. Appropriate use of technology
· The project has been able to delay admission into a nursing home of people
suffering from dementia
· Thirty-three different technologies were tested
· The choices of technology were based on individual needs
Strong demand, Excellent participation by users and developers and Availability of
Lessons Learned
expertise from a broad range of areas.
Issues
· The role of technology is particularly significant when a demented person has a risk
to wander and get lost
· Lack of financing to disseminate the project
· Need for training of caregivers in technology issues
· Long term support of project solutions
Additional comments The solution is implemented for the target group
50
eHealth
Case Study 6
Region
Contact person
Category of eHealth
Health Account – Patient’s Record on the Net
Turku, Finland
Dr. Jari Forsström
Tel: +358 40 5441809
Email: jari.forsstrom@wmdata.fi
eHealth product development and implementation
Project partners
WM-data Oy., Finland
Public Private
X
Status of the Project
n/a
Cost and funding
Total cost: n/a
RIAP
Aims and Objectives
No
· To improve information flow between care providers in health care
· To improve quality of care
· Reduces overlapping examinations
· Give patients better access to their health data and motivate them to take more
responsibility on their health care
· Encourage health care customers to use electronic communication tools in health
care
The application is targeted at the whole population using health care services
Beneficiaries
Project Description
The project was part of R&D in WM-data. It is enabling technological shift from
hospital based medical records to personal health records. The project was defined
together with existing customers in the healthcare sector
Main Achievements
Concept is ready, but so far no customer implementations
Issues
· Slow change
Health care professionals are reluctant to open their documents to patients.
Overcome: better training of health professionals in eHealth
· Difficulty in identifying correct payer
The concept has several beneficiaries but none is willing to take all the costs
themselves. Since savings come with large-scale use, starting the service is difficult.
Overcome: Pilots with evaluation and reporting of benefits
· Competing political strategies
National model in Finland is aimed at a centralised state-owned database. Health
Account model has been seen as a competing project, which has discouraged the
public organisation from utilising the concept
Additional comments The solution also supports cross-boarder care
51
eHealth
Case Study 7
Mobile Applications for Health Care
Region
Bremen, Germany
Contact person
Dr.Ing. Ingrid Rügge, TZI-Mobile Research Center
Tel: +49 421 218 2731
Email: ruegge@mrc-bremen.de http://www.tzi.de/index.php?id=204&L=1
Category of eHealth
eHealth Product development and implementation
Project partners
Center for Computing Technologies (TZI), Universität
Bremen
Public Private
X
Status of the Project
2002-2004
Completed
Cost and funding
Total cost: € 127,000
50%
50%
RIAP
Yes
Aims and Objectives
The initiation of a dialogue between users in health care and developers of mobile
IT solutions leading eventually to a development of innovative projects was the essential objective of this measure. Systematically sensitising potential users to mobile
solutions and providing them with specific information should help to discover possible fields of application.
Proceeding from an overview of current tendencies of development and application
potentials, the aim of the first project was to identify and to evaluate those groups,
which were actively involved in mobile health care services including the roles they
play and their chances within this network. Special attention was given to a survey
of suppliers and service providers in the economic area Bremen/Bremerhaven, and to
the identification of future users, with priority given to regional fields of application
Beneficiaries
· Users in health care (experts in the application domain)
· Developer of conventional ICT-solutions for health care
· Producer of medical technology
· Developer of mobile ICT-solutions (experts in developing mobile solutions for other
application domains)
52
EU Structural funds
Regional Public funds
eHealth
Project Description
The project was carried out in the framework of the RPIA “Mobile Bremen Initiative”
(MBI). MBI’s main task was to raise awareness about new mobile technologies and
to support the development of Mobile Solutions. The project “Mobile Applications
for Health Care” described as follows is one part of the thematic focus “Mobile
Health Care”.
Two closely linked project parts were carried out. After the first part of the project it
was decided to carry out a follow-on activity, because the application area Health
Care needs long term information support about mobile solutions:
The TZI (Center for Computing Technologies at the University of Bremen) was commissioned with a survey of mobile ICT in health care. In the second part of the
project, a congress on the state-of-the-art of “Mobile Solutions for Health Care”
combined with open discussions about practical applications and experiences and a
mobile solutions presentation was organised by the TZI
Main Achievements
· Market survey: compilation of regional mobile ICT solutions for the health care
sector
· Involvement of relevant players: all relevant groups (developers, users and
deciders) were involved. However, it was hard to arouse the interest of the users
· Sustainability/follow up activities: the amount of follow-up activities (cp. No. 8)
exceeded the expectations
Lessons Learned
· Involvement of developers, users and deciders (key factor success)
· Integrated approach (survey, workshops, final congress)
· Bottom-up approach (involvement of users)
Issues
1. Interest of users
It was not easy to arouse interest in the users. Usually, they have other problems at the
moment, mainly regarding work organisation and resource management. They were
only interested in the topic on personal talks.
2. Name advantages of new technologies
It was difficult to point out advantages and disadvantages of technologies to the public. This problem was solved by using practical examples in form of demonstrators.
3. Conflicting interests of players in health care sector
A clash of interest between the various health care occupational groups was identified during the first project. The development of a special moderation concept made it
possible to reveal these conflicts
Additional comments The project itself will not be continued in the same way. However, some follow-up
activities are:
· The University of Bremen founded a Mobile Research Centre in July 2004 which has
“Mobile Solutions for Health Care” as one focus
· Bremen now funds a demonstration centre for mobile solutions, which has one
focus on Mobile Health Care
53
eHealth
Case Study 8
Mobile Applications for Health Care
Region
Emilia-Romagna, Italy
Contact person
Mr. Fabio Rangoni, Mortara Rangoni S.p.A
Tel: +39 051 6654327
Email: info@mortara.it
Category of eHealth
eHealth Product development and implementation
Project partners
Mortara Rangoni S.p.A.
Laboratorio Fondazione Guglielmo Marconi S.p.A.
Azienda USL Modena
Public Private
X
X
X
Status of the Project
Dates n/a
Completed
Cost and funding
Total cost: € 414,000
19%
15%
66%
RIAP
Yes
Aims and Objectives
The general objective of the project was to develop and market a new technology
for patient cardiological monitoring based on a standard wireless protocol for the
communication of patients’ physiological functions.
EU Structural funds
Regional Public funds
Private sector investment
The specific objectives of the project were the following:
· To develop technical solutions for the transmission of continuous physiological
signals, repetition of signals for consultation and transmission of alerts generated
by the control station
· To develop a solution able to be compatible with the existing instruments from an
electromagnetic point of view
· To allow immediate applicability on all monitoring stations already installed, thus
contributing to the improvement of the organisation of the hospital departments
Beneficiaries
54
Citizens, mostly elderly people and cardiac patients. In 2006 the system realised was
already installed in about 170 cardiological monitoring stations at hospital sites
eHealth
Project Description
The activities carried out included:
· Definition of the system specifications, identification of the most appropriate
solutions and tests
· Software development and customisation
· Validation on site, including the collection of statistical and qualitative data on the
system functionality
· Dissemination of results, through presentation at conferences, international
magazines, etc
The actual implementation of the project was organised along three axes:
1. Analysis of electromagnetic compatibility considering the use of wireless
technologies in the hospital environment
2. Sub-project “Nurse”, to enable hospital operators to monitor the patients’
conditions remotely using wireless communication systems
3. Sub-project “Patient”, devoted to the feasibility study of a non-proprietary
wireless technology for telemetry
Main Achievements
· Product development:
Achieved as planned; the subproject ‘nurses’ was successfully implemented
· Feasibility study for a new technology for a patient transmitter:
Study yielded negative results; current technology is not yet able to achieve the desired
features. The subproject ‘Patient’ was stopped at the test bed level
· Safety aspects of new wireless technology in hospitals:
Clinical engineering group obtained know-how of the safety aspects of wireless
technologies in the hospitals, specifically detrimental effects on existing devices and
associated risks. However, this has not lead to wide-scale diffusion of the know-how
to other clinical engineering / biomedical support groups
Lessons Learned
· Positive with the direct involvement of possible end-users of the device being
developed
· The outcome of the project leads, at least partially, to an immediately marketable
product
· The project is completely integrated in the normal R&D of the company, and is not
something handled “on-the side”
Issues
· Difficult to involve a representative sample of end-users
· Resources for industrialisation of the product...
· This was all solved by the project
Additional comments The prototype was industrialised and the product is now available on the market
55
eHealth
Case Study 9
Region
Mobinet - Pilot network implementation for the
effective health monitoring in remote areas
Central Macedonia, Greece
Contact person
Mr. Pantelis Angelidis, Vidavo SA
Tel: +302311999955
Email: pantelis@vidavo.gr
www.health-telematics.gr/Bdype
Category of eHealth
eHealth Product development and implementation
Project partners
Vodafone Hellas SA
2nd Regional Healthcare Authority of the Region of
Central Macedonia
Vidavo SA
Public Private
X
X
X
Status of the Project
Dates n/a
Completed
Cost and funding
Total cost: € 238,000
100%
RIAP
No
Aims and Objectives
In general, the pilot network implementation for the effective health monitoring in
remote areas aims at the:
· Provision of advanced healthcare services, regardless of geographical limitations
· Preventive medicine
· Efficient human resource management (for the healthcare providers)
· Scientific personnel facilitation and diffusion of specialised knowledge
Private sector investment
· The project generates significant social benefits and enables healthcare
professionals to allocate their time in an efficient and effective manner, as they
are able to manage more patients, since telemonitoring allows the simultaneous
monitoring of the health status of multiple patients
Beneficiaries
56
· Chronic patients in remote areas and citizens in need of health services, as they are
able to receive at the place of their residency specialised healthcare services.
· GPs in remote areas, as they enjoy simultaneous consultations with specialised
healthcare professionals
· Specialised doctors in hospitals, as they are able to treat more patients in the same
time from their office
eHealth
Project Description
The main implementation scenarios include:
· Monitoring of chronic patients with pulmonary diseases
· Utilisation of the Mobinet service for the annual health check up of students, in
order for them to be authorised to participate in the school athletic events
· Use of the equipment at the emergency department for real-time consultation and
support (future scenario)
Main Achievements
· Five health units of the region have been equipped with telemonitoring equipment
and one hospital has been equipped with advanced eHealth applications
· Five GPs and two specialists have received training regarding eHealth applications.
In addition, the GPs have been trained for proper conduction of the spirometry
medical test (100%)
· So far 1500 medical tests have been wirelessly transferred via the Mobinet system;
these tests correspond to two-hundred patients of the region; total number of
patients examined is 1200 cases
Lessons Learned
Selecting the right people to be involved is a critical success factor to every project
implementation, especially, when it comes to applying new methods or systems, as
in the Mobinet GP-model project.
Issues
Overcoming organisational barriers
· Some health units due to legal and organisation complications restricted their
participation in the project. The team proceeded in the project implementation with
the participation of “appointed health units,” a fact that limits user willingness
· Resistance to change from the selected participants and dealt with, by trying to
provide motives, as the provision of bulk anonymous data from the project data
base to the participants, so that they later will be able to present papers in scientific
conferences and journals
Effective involvement of the hospital
· Provision of resources and motivation for the project implementation at the
specialist side
Technical issues
· Unavailability of the network (in regards to the medical data transfer via GPRS)
· Problems arising due to the improper use of the medical equipment, and system
smooth work flow disturbance due to installation of incompatible modules to the
hospital workstation. Incompatibility issue
Additional comments · The adoption of the project technology and systems in everyday activities of the
hospital is expected to generated cost reductions and more efficient allocation of
resources
· As mentioned in the previous paragraph the 2nd RHA-CM aims to continue the
project and fund it via the European Structural Funds. In addition, the 2nd RHACM aims to expand the project scope and collaborate with healthcare actors of
the neighbouring country FYROM in order to initiate programmes for cross-border
preventive medicine and patient education
57
eHealth
Case Study 10
The networking of health services in the Valle del Chiese
Region
Trento Province, Italy
Contact person
Mr. Ugo Pitton, PHS for Giudicarie and Rendena District
Provincial Health Service of the Autonomous Province of Trento
Tel: +39 0464 902998
Email: ugo.pitton@apss.tn.it
Category of eHealth
Medical networks and hospital applications
Project partners
Provincia autonoma di Trento – Servizio Rapporti
Comunitari
Provincial Health Service of the Provincia autonoma di
Trento
Public Private
X
X
Status of the Project
2003 – 2005
Completed
Cost and funding
Total cost: € 557,426
50%
35%
15%
RIAP
Yes
Aims and Objectives
The main objectives aimed at satisfying the needs of the population involved in the
project, which will have advantages in terms of gaining access to health services,
with a streamlining of bureaucratic procedures and a more immediate and continuing
relationship with the various services.
EU Structural funds
National public funds
Regional public funds
· The objective of the project was to offer a series of differentiated and integrated
services throughout the area, allowing the best possible quality of life for the
elderly person, maintaining a balanced relationship between the family and social
environments
· The project also had the objective of improving nursing and hospital services,
making information on the clinical conditions of the patient available at the time
of admission, through linking with the clinical data of the general practitioner and
with area services
Beneficiaries
58
The entire population of the Valle del Chiese and of the Bassa Valsugana and Tesino.
Individual patients and citizens are the primary beneficiary. Advantages are also
envisaged for the family doctor who, by a better knowledge of the clinical conditions
and the services supplied to his patient by other health service departments
eHealth
Project Description
· A telecommunication link has been created between users and services through
a TeleCentre, with 20 provincial teledesks linked together in a network in order
to supply teleservices for the population resident in specific areas identified for
the phase of experimentation. There will also be functions facilitating purchasing
of medicines. Through the service, it is possible to book/purchase the prescribed
medicines at the nearest chemist.
The project has been organised into the following main phases:
· Analysis of computer services and of existing telecommunications networks in the
area
· Completion of computer networks, with particular attention for the guarantees
required for the secure transmission of sensitive data
· Linking the computer networks with the hospitals of Trento and Rovereto.
· Extension of the telecommunications network to general practitioners, to freely
chosen paediatricians and to RSAs in the area
· Project trials in terms of sharing information between actors in the area and the
hospital, with the realisation of medical records
· Implementation of telecommunications infrastructures and development of
applications, development, purchase and integration of applications
Main Achievements
· Every surgery and every doctor received the necessary instruments in order to
realise a specific network between them and the Provincial Health Service.
· The sending by e-mail of the clinical reports to the family doctors.
· Training and digital education of the doctors. Doctors of other Valleys ask for the
implementation of the project in their activity environment
Lessons Learned
· Accessibility
- With a streamlining of bureaucratic procedures and a more immediate and
continuing relationship with the various services
- Thanks to the new technology, family doctors had a better knowledge of the
clinical conditions and of the services supplied to their patients by other health
service departments
· Interoperability
Family doctors had different types of software, and there was a difficult communication
between them and the systems used by the Provincial Health Service
· Organisation
The project had to face a very long development time of the software used by the
Provincial Health Service
· Time of development
The time imposed by the Commission didn’t respect the time needed for the
development of the project
· Infrastructure
The diffusion of the project in the entire provincial territory depends also on
the diffusion of the broadband infrastructure. This project gives an important
contribution to the actions that the Provincia autonoma di Trento is implementing
in order to infrastructure the entire province
Issues
Additional comments After the results gained in Valle del Chiese, it was decided to transfer the solution to
another disadvantaged area of the Province. A collaboration with the region EmiliaRomagna has also started
59
eHealth
Case Study 11
RIM - Image Medical Network
Region
Contact person
La Reunion, France
Denis Fabregue, Regional Council
Tel: +262 262 92 29 29
Email: d.fabregue@protel.fr
Category of eHealth
Project partners
Medical networks and hospital applications
Hospitals at La Reunion
The Regional Council of La Reunion
GIE Telemedecine
Public Private
X
X
X
X
Status of the Project
2002 - Completed
Cost and funding
Total cost: € 4,200,000
60%
20%
20%
RIAP
Aims and Objectives
No
· To generalise the use of technologies of transfer of medical imagery to all health
actors on the Island
· To renew the equipment and facilitate the exchange of images (radiology,
angiography, MRI) between experts in Reunion Island
· The installation of this interconnected network between the establishments of
health will facilitate the development of eHealth applications
Beneficiaries
Patients and healthcare professionals
Project Description
A first pilot project made possible the transfer of medical images between three
hospitals. This first phase authorised a regular transfer of images, confirming the
interest of these technologies to minimise displacements of patients.
The project of network of medical imagery is the natural extension of this first project
towards a transfer and a filing of more complex medical information
Main Achievements
· 7 Conventions signed with health establishments in March 2002
· Equipments implemented in 2003
· Creation of a new structure specialised in eHealth
· Creation of a regional high speed network
Lessons Learned
· It is the first real network between the public establishments and it will open to all
the health community (public and private actors)
· Important to define in this type of project the management and the management
must be done by a neutral actor
· Creation of a neutral structure (GIE Télémédecine), for managing development of
eHealth
Issues
EU Structural funds
National public funds
Regional public funds
Additional comments eHealth development in La Reunion will continue under the management of GIE
Télémédecine
60
eHealth
Case Study 12
PACS - Picture archiving and communications systems
Region
Contact person
Vysocina, Czech Republic
Mr. David Zažímal, Hospital of Jihlava City
Tel: +420 56715 7855
Email: zazimald@nemji.cz
Category of eHealth
Project partners
Medical networks and hospital applications
Hospital of Jihlava City
Fomei
^
Public X
Private
X
Status of the Project
Dates n/a. Completed
Cost and funding
Total cost: n/a
RIAP
No
Aims and Objectives
· Lowering operational cost of X-ray section of the hospital
· Speed up diagnostic procedure in the hospital
· Facilitate communication between hospital and special clinics about difficult
cases
Beneficiaries
Medical staff and ultimately the patients
Project Description
Project influences all technological equipment of the hospital such as computers,
network, software and hardware for diagnostic purposes.
Two basic technologies was implemented:
· Disc field for the X-ray pictures deposit
· “Fusion” software for the communication with the X-Ray database
Full digitalisation of radiology, but some following activities are planned (ICT
connection of the Jihlava hospital with polyclinic and future connection with IT
institute in Brno – provision of the co-operation between the data from Jihlava
Hospital and Masaryk’s oncological institute in Brno. This co-operation could have
positive effect in solving oncological cases in the Jihlava city
· The solution has positively influenced the ICT literacy at the hospital
Main Achievements
Lessons Learned
100% Regional public funds
Issues
· The possibility of low interest from the side of ICT staff was expected but the reality
was different. All target people accepted this solution very positively
· No technological problems were met while implementing the project, risk analysis
has been made for the technological failures
Additional comments Users did not participate in the development but they have accepted this service as
very useful. The digitalisation of radiology will open up for co-operation with other
hospitals and regions
61
eHealth
Case Study 13
EURAD
Region
Baden-Württemberg, Germany
Contact person
Mr. Stefan Baur, Curagita AG
Tel: +49 6221 50250
Email: sab@curagita.com
Category of eHealth
Cross-boarder eHealth
Project partners
Curagita AG
Cirra+
MK Conseil
Public Private
X
X
X
Status of the Project
2003 - Ongoing, but changed focus.
Cost and funding
Total cost: € 350,000
49%
51%
RIAP
No
Aims and Objectives
The project was an eTEN phase one = market validation / feasibility study. The
long-term objective was to leverage, verify and deploy teleradiology services on an
international scale. In order to support that long-term objective, the project itself
aimed at:
· Market evaluation (demand, supply, volume)
· Evaluation of legal, practical, technical and other potential obstacles
· Ways to overcome obstacles
· Practical tests
· Business plan for scale-up
Other EC funds
Private sector investment The project aims at setting up a cooperative Trans-European network (EURad) that
integrates teleradiology service into daily medical routine. The network will facilitate
· Emergency (tele-)radiology services
· Additional diagnosis capacity for regular care
· Second opinion/expert consulting
· Local referrers’ and colleagues’ connectivity
The services will be provided both by teleradiologists located in a central reading
room and suppliers connected to the EURad network. Thus, shortages and surpluses
in radiology capacities across Europe may be balanced at the highest level of
quality...”just a click away”
Beneficiaries
62
· Patients undergoing radiology examinations
· Radiologists and radiology clinics
The driving force for the project was that there are regions with too much (radiological)
reading capacity and those with a demand for reading capacity
eHealth
Project Description
The project started in January 2002 with a one year market evaluation phase, with
the aims being to:
· Verify the proposed market situation: Collect reliable information on radiology
coverage, modalities and software systems used, fees charged and legislation
established directed toward teleradiology in ten European countries
· Gain test sites to verify and test the proposed services, adjust services, prices,
technical infrastructure and the overall business planning to the results of the
market evaluation
· Refine the proposed business planning according to the results achieved
In order to achieve these targets, a work plan with work packages and milestones
was defined and successfully processed. Most important milestones have been
· A detailed market study on ten European countries
· The establishment and operation of a test network
· The refinement of the original business planning according to market study and
test results
Besides these results, numerous contacts were established, potential co-operators
and customers have been involved and potential competitors identified
Main Achievements
· Market study (still valid)
· Technical and practical approach for teleradiology with many partners (not
centralised)
· Operating network, although non-international
Lessons Learned
· Make it work, tune it later: Teleradiology is a complex matter – in order to get
something up and running, don’t ask for perfection
· Don’t fool yourself: Having practitioners as participants is helpful. If they accept a
workflow / technique / business model, it’s because it really helps, not because it’s
politically desirable or somebody gets subsidies for it
· Recycling: Use existing techniques, workflows, standards, legal frameworks
whenever possible. Supports very much aspect 1
· Procurement: It is very demanding, time- and resource-consuming for an
internationally unknown group of small companies to promote services like
teleradiology. This became the most important problem
· Big players require a lot of time: The only remedy we could think of – a partnership
with an international player with a good reputation in the targeted countries – was
impossible to implement within 12 months
· References required: Although the consortium already practised teleradiology on a
local scale, we did not implement an international reference customer immediately,
thus being unable to scale up at the end of the first 12 months
Issues
Additional comments The project has continued for two years now by establishing regional teleradiology
connections for various purposes. We expect to start cross boarder teleradiology
soon
63
eHealth
Telemedicine Clinic – Offshore Spanish
teleradiology for Swedish hospitals
Case Study 14
Region
Västernorrland, Sweden
Contact person
Mr. Gustav Malmqvist, County Council of Västernorrland
Tel: +46 70 6630442
Email: gustav.y.malmqvist@lvn.se
www.telemedicineclinic.com
Category of eHealth
Cross-boarder eHealth
Project partners
Telemedicine Clinic, Barcelona, ES
Sollefteå Hospital, County of Västernorrland, SE
Södra Älvsborgs Hospital, Borås, SE
Alliance Medical, UK
CIDEM-Generalitat de Catalunya
Public Private
X
X
X
X
Status of the Project
2002 – 2004
Completed (ongoing full scale service)
Cost and funding
Total cost: € 350,000
10-20% Regional public funds (Spanish)
80-90% Private sector investment
Public and private reimbursement for services
RIAP
Aims and Objectives
No
X
The main objective for the founders of Telemedicine Clinic was to provide European
hospitals/clinics with subspecialist radiology diagnostic service through telemedicine
solutions. The rational was to bridge the problem of shortage of radiologists in many
European regions.
The Key targets was to:
· Create a functional remote radiology diagnostic service aimed at hospitals with
long waiting lists and a shortage of radiologists
· Gradually increase the services, starting with MRI diagnostics
· Optimal business processes, organisation and return on investment
· Build optimal workflow for referral, allocation of examinations to contracted
specialists and rapid answer to referring clinics
Beneficiaries
64
· Patients: shorter waiting lists to examinations
· Radiology clinics: cost-efficient alternative to hiring radiology locums for diagnostic
work
· County Councils and hospital administrations: better economy for radiology
· Researcher: Potential for Telemedicine Clinic to become a centre of reference in
radiology
eHealth
Project Description
TMC was founded in Barcelona 2002 by a group of Swedish physicians and
entrepreneurs. Their first customer clinic was Sollefteå Hospital in northern Sweden,
which started sending MR images for interpreting in March 2003. In the summer of
2003 the hospital of Borås started to use the services of TMC and in the autumn of
2004 the biggest customer Alliance Medical signed a contract with TMC. Recently, in
the spring of 2006 the University Hospitals of Huddinge and Malmö in
Sweden have been added as customers.
The focus in the project has been to create an attractive service aimed at solving the
problem of:
· Lack of radiologists
· The need for subspecialisation
The build up of Telemedicine Clinic is a combination of
· Creation of a working business model for telemedicine
· Integration of PACS and RIS systems and communication between service provider
and customers and
· Creation of a functional workflow that allows as short a time as possible between
request and final diagnosis
For communication, TMC is connected to the Swedish Healthcare Network (SJUNET).
By this TMC can easily be connected to any hospital in Sweden connected to Sjunet.
For English customers TMC is in the same way connected to the NHS network
Main Achievements
At the TMC centre in Barcelona, there are 6-8 radiologists, conducting mainly
second readings. The lion part of primary readings is done by contracted radiology
specialists all over Europe. Chiefly they are situated in Spain, Germany, Hungary, UK
and Sweden. At TMC there are several co-ordinators who decide who should read
what images based on availability, licensing, skill and language. Thus, the workflow
is telemedicine in a double sense. Images are sent to Barcelona but are worked with
remotely from different places in Europe
Lessons Learned
· Having the right combination of key personnel
· Logistics, workflow and quality assurance
· For success, it is essential that promises for delivery of diagnoses are kept
within stated time limits. Otherwise it would be difficult to get a critical mass of
examinations and attract new customers
· Double-reading of examinations and use of a QA-system integrated with the RIS.
· Non-technical approach and strong incentives
· Even though the project has had to deal with very difficult integration issues, the
approach has been to use what is possible and available, try new technology and
“everything could be solved”. This has been possible due to a very small project
team and high competence of technical staff
Issues
Additional comments The Telemedicine Clinic is a full-scale up-and-running commercial service gradually
expanding with more customers and widened range of services, e.g. emergency and
on call diagnostics
65
eHealth
Case Study 15
eHealth Card Schleswig-Holstein
Region
Schleswig-Holstein, Germany
Contact person
Mr. Jan Meincke, ARGE eGK.SH
Tel: +49 431 8868711
Email: j.meincke@medisoftware.de
Category of eHealth
Security infrastructure
Project partners
Public Administration
SMEs
Foundations
University
Public X
X
Private
X
X
Status of the Project
2001-2006
Completed
Cost and funding
Total cost: € 1,000,000
70%
30%
RIAP
No
Aims and Objectives
The eHealth card project is located in Flensburg (Schleswig-Holstein), next to the
border to Denmark. It is a classic “bottom up” structured healthcare project, where
health professionals from all (in Germany usually highly separated) healthcare sectors
(net-) work together to increase efficiency in medical processes and healthcare. The
focus in this best practice project is on the integration and optimising of “over–all”
workflows and processes to reduce treatment-costs and minimise rehabilitation-time
for the patients
Beneficiaries
Patients, health care staff, research and industry as well as regional and national
authorities responsible for healthcare. Also other regions and nations may benefit by
using the results of the project for a future standard for eHealth cards
66
Regional public funds
Private sector investment
eHealth
Project Description
The project was launched in the year 2000.
Technical backbone is a virtual-private-network (VPN) based on standard-equipment
using IPSec-protocol for en-/decryption. The VPN-platform integrates all the different
IT-systems of the engaged health professionals trough a logical integration layer called
“connector”. This component (implemented as software-only-solution or dedicated
embedded system as combined hardware/software-solution) forces all IT-systems to
adapt standardised message- and document-formats based on the HL7V3.0 RIM
/ CDA2. It also manages and unifies the communication with the smartcards of
health professionals and patients and implements on this way automatically the
whole protection profile/access control/smartcard based RSA en-/decryption given
by law for handling the health records of patients in Germany.
Especially in Flensburg the patient-data-cards (PDC) carry next to the RSA-keys for
authentification and encryption the emergency-records structured in ISO/Netlink
format on the chip, so that international interoperability and high availability is given
at the same time.
All health professionals in the project identify themselves with health-professionalcards (HPC), with are issued by government authorised institutions. Only these cards
allow the cardholders to get access to the VPN and the intranet server-based patient
health records. In most use-cases, access to patient health records is only granted,
when HPC and PDC are present in the same place at the same time. Through this
“two-face-commit” procedure, the data privacy of the patients is also achieved as
access is restricted to health professionals only
Main Achievements
· More than 150 health-professionals and 10.000 patients are trained on processes
and technologies, when implementing the eHealth cards and the infrastructure for
this.
· Agreements between regional partners in healthcare are a result of evaluation,
giving the base for national discussions in the complex German healthcare
funding.
· The region is technologically and organisationally leading in Germany. Most experts
in national boards started their work and experiences in the regional project. More
than 50 jobs have been created
Lessons Learned
· All regional players in healtcare are involved, so use-cases can be optimised from
end-to-end and discussions can be made without national political “overhead”
and influence
· Bottom-up development in small steps ensures participation by users, so targets
can be reached in short time with high acceptance
· Political support helps getting the right people involved, so communication and
decisions-management can be made very efficient
Issues
· The agreeing of common targets between health-insurances and health
professionals is very tricky when discussing funding-thems and cost/usage
· Some health-professionals dislike evaluation, because they are afraid of being
benchmarked in medical topics
· Industrial partners try to place their specific products to be used as “standards”
Additional comments The scale of the implementation of this eHealth card is growing and is likely to
become standard for Germany and possibly for the whole of Europe
67
eHealth
Case Study 16
EDU-HEALTH
Region
Abruzzo, Italy
Contact person
Mr. Nello Ventresca, Abruzzo Region – Information and communication department
Tel: +39 862 363212
Email: neve@regione.abruzzo.it
Category of eHealth
eHealth for training and education
Project partners
ABRUZZO REGION
University of L’AQUILA /
Local Health Body
Local General Doctor Association
Public X
X
Private
X
X
Status of the Project
2004-2005
Completed
Cost and funding
Total cost: € 1,493,000 (estimate)
100%
National Public funds
RIAP
No
Aims and Objectives
EDU-HEALTH has the general objective to start-up the “Regional Plan of digital
Training for Health Operator being in Abruzzo Region” through the planning and the
carrying out of oriented training courses.
More specifically EDU HEALTH aims to:
· Promote and support the Health long life training in correspondence to the
strategies of the National Health Ministry, by the use of broadband infrastructures,
as well as by the use of the e-Learning platform and digital contents
· Support the e-Inclusion, in other words the cutting of the digital divide within the
health community through computer science educational program
EDU-HEALTH consists of planning, the carrying out and the supplying of training
courses through an e-Learning platform for the development and the support of
the eHealth across Abruzzo Region. This investment promotes support of life long
training for all the health operators in the region involving the public bodies, the
public and private hospitals, the associations of category, the training providers and
so on
Beneficiaries
68
Potentially about 16000 health employees in the region.
eHealth
Project Description
EDU-Health will develop :
· A multimedia e-Learning platform
· Co-operation services at national and inter-regional level, in accordance with the
Ministry’ platform
· The Digital Training Plan- detailed content for the education of the health operators
oriented toward the life long training
· The implementation of multimedia sites inside the health and sanitary structures
The project is divided into three different areas: educational, technical and
administrative. For each of these subjects resources will be provided by the regional
administration and by the University of L’Aquila.
1. Educational Area: setting up and management of e-Courses. The development
of contents and the activities of on-line tutoring will be taken in charge by the
University of L’Aquila, Faculty of Medicine.
2. Technical Area, the ICT infrastructure, acquired by the Region , and the Web
Laboratory. The latter implies job seats, computer science and software tools, plus
scientific contents elaborated by the teachers.
3. Administrative Area, it consists of employees who follow the administrative
organisation and the on-line management of secretary activities
Main Achievements
· The e-Learning platform was developed and established
· A considerable share of learning units was developed and tested
· e-Learning contents are under construction
Lessons Learned
One of the strengths of EDU-HEALTH is the educational methodology, developed
by the e-Learning research area of the university. The methodology implies the
concentration on the learning objectives of a set of training tools, which will operate
in a synergic way during the course. The scientific support and continuous monitoring
of the contents is guaranteed by the academic department belonging to the University
of L’Aquila. It is also foreseen a subsequent attribution of formal credits to the staff
that attend the course.
· Server technology.
The technological and development standards are already in evolution. Some
problems have been partly solved; others can be foreseen in the future, which have
to be dealt with.
· Didactics.
The didactical quality of the materials depends on the didactical expertise of the
respective teacher. A good solution may be the setting up of agreement between
Abruzzo region and the University.
Issues
· Compatibility.
Underestimation of the risks linked to the compatibility between accessibility
and technical standard. Accessibility requires agreements on certain technical
development standards
Additional comments The methodology and technical platform has been developed but the future
development has not yet been decided
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eHealth
Case Study 17
CMAT - Advanced Multi-functional Centre for
Simulation and Technological Innovation
Region
Andalucia, Spain
Contact person
Mr. Luis Lozano
Tel: +32 (0)2 762 46 66
Email: Luis.Lozano@brutele.be http://cmat.iavante.es/
Category of eHealth
eHealth for training and education
Project partners
Health Regional Ministry
EPES
IAVANTE Foundation
More than 40 Collaboration Agreements with other
institutions.
Nearly 100 APHS professionals collaborate in the
pedagogical activity
Public X
X
X
Private
X
X
X
Status of the Project
The CMAT Centre was inaugurated 03/10/2004
Completed
Cost and funding
Total cost: € 11,000,000
29%
EU Structural funds
71%
Regional Public funds
No, but it has been conceived in the framework of the Regional Innovation,
Information Society and Health Innovation Strategies
RIAP
Aims and Objectives
The aim of CMAT is to be an exclusive centre in Europe for professional development
and a point of reference in Research, Development and Innovation in new training
methodologies in the Health sector.
The main objectives are:
A) Training and Knowledge Management
· To improve the training offer to the professionals of the Andalusian Public
Health System (APHS) (more than 18.000 in primary care and more than 66.000
in specialised care)
· To develop massive training programmes
The territorial dispersion (90.000 km2) and size of the APHS with around 1.500
primary care centres and 34 public hospitals, allows scale and scope economies in
the use of the high tech equipment of CMAT
· To optimise and enhance disperse knowledge within the APHA
The interconnection of CMAT with all the Regional Healthcare Centres allows
converting them in “virtual classrooms”
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eHealth
B) Development, validation and exploitation of Information and
Communication Technologies
· To be a demonstrator of the use of multimedia technologies and last
generation simulation for its further application in the real healthcare activity
· To facilitate innovation and research in new technologies
CMAT facilitates research and innovation in the fields of simulation, robotics,
pedagogical methodology and ICT. In particular, CMAT is involved in leading
projects in the field of application of image technologies for the creation of virtual
environments and new communication and information access platforms for
pedagogical use and for real application in the APHS
· To develop and supply technological solutions and applications of utility
to other healthcare centres and beyond.
The training and validation offer responds to concrete needs focussed on the
development of professional competences (knowledge, skills, and attitudes) for
the continuous improvement of healthcare activities. CMAT will promote the
identification of innovative practices in the APHS and their appropriation and
diffusion within the system, through collaborative working systems
Beneficiaries
Project Description
The potential targets are the 91.000 professionals of the Regional Public Health
System. At the timing of reporting 15.000 of them have already received training by
iAVANTE (CMAT centre)
CMAT is an Advanced Multi-functional Centre for Simulation and Technological
Innovation.
The Centre is situated in the Health Sciences Campus Technology Park of Granada,which specialises in the health sector. The building contains different simulation areas
for teaching and has a total of more than 2,000 square metres dedicated exclusively
to training activities; these areas include operating theatres, virtual simulation
classrooms, a trauma tunnel, casualty and specialisation consultation rooms, a critical
room, a rehabilitation room, etc. There are also classrooms for in-person training and
e-Training. All training rooms have audio and video recording systems, which can
codify and send information to any point in the building, to the Corporate Network
of the Regional Andalusian Government or to the Internet. The building is equipped
with a high-speed data network with both wire and wireless connections, which are
connected to the Corporate Network of the Regional Andalusian Government and
Internet.
CMAT main characteristics are the following:
· An exclusive centre in Europe for professional development and training
· CMAT is owned by the Andalusia Ministry of Health, was promoted by EPES (the
Public Company for Health Emergences), is managed by the foundation iAVANTE
(Foundation for Technological Advance and Professional Training), and was cofinanced by the ERDF
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eHealth
· The centre is located in the Health Sciences Technological Park in Granada and is a
perfect test-bed for validating innovative technologies and methodologies, creating
virtual environments and new platforms for didactic communication and access to
information and their application to the Andalusia Public Health System
Training methodologies are carried out in different settings, which
simulate real-life healthcare environments at various points of the health
care process:
· Specialised Classrooms: The highly versatile classrooms are equipped with state-of
the-art technology in order to facilitate the knowledge transfer process
· iAVANTE also provides its students with tele-workstations from where they can
access e-Training tools, do exercises, consult tutors and access chats related to
training events. Consequently, access is provided to students who lack the necessary
equipment to connect to everything IAVANTE has to offer on-line
· Out-of-hospital area: urban and domestic settings. The complex has a simulated
urban area where accident and emergency professionals can train in health care
processes and techniques for patients located outdoors
· The reproduction of a small-sized home environment has been constructed where
access difficulties and limitations of space are similar to those encountered by
accident and emergency teams in their daily activity outside a hospital or health
centre.
· Hospital area: casualty and consultation area
The hospital area is designed exactly as any real hospital: a double circuit corridor
with consultation rooms on both sides where patients receive assistance in different
consultation rooms according to their pathologies
· Surgical area: split-level operating theatres with robots and virtual simulators. Nine
multi-purpose operating theatres have been installed where specialisation depends
on the pathology to be treated. The methodologies most frequently used in the
operating theatres are robotic and virtual simulation in order to train students to
deal with diagnosis and surgical techniques
Main Achievements
As in the consultation or out-of-hospital areas, the training activities can be
observed live or previously recorded by means of the complex system of cameras
and microphones installed in all the rooms. This activity is used for analysis and
feedback.
1)To improve the training offer to the professionals of the Andalusian
Public Health System:
· 15.000 trainees have been trained by IAVANTE using advanced methodologies,
virtual and robotic simulation and intensive use of ICT
· 91,7% of trainers consider adequate or very adequate the degree of satisfaction
of training activities; and 87,4% of trainees consider adequate or very adequate the
degree of global satisfaction of training activities
· 4 innovative training methodologies have been demonstrated and used in training:
virtual, scenic and robotic simulation and e-Training
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eHealth
· Seven virtual simulators have been demonstrated and used in training: Gastroscopy,
Bronchoscopy, Urology, Intra abdominal Ecography and Laparoscopy
· 4 advanced robotic simulators have been demonstrated and used in training
· 50 mannequins have been demonstrated and used in training
2) Relating to the objective “To optimise and enhance disperse knowledge
within the APHS”:
· It has been developed, and is 100% operative, the Innovative Practices Bank
(http://www.saludinnova.com/) a unique tool integrating knowledge management
and exploitation and collaborative working tools (video conferencing, SMS, etc.)
3) Relating to the objectives “ To facilitate innovation and research in
new technologies / To develop and supply technological solutions and
applications of utility to other healthcare centres and beyond:
· CMAT is developing a large number of tools and all of them have been liberated as
“Free Software” and can be of immediate use in the virtual FLOSS Community
· CMAT has direct contact with the daily reality of the regional healthcare system
and with the academic community, together with its staff expertise on ICT,
allows the development of innovative solutions, of low cost, using some times
developments already available on Internet and integrating and applying them to
the health sector
· Some examples can be the development of a tele-training platform. CMAT is also
working in projects such as the multimedia transmission of health information
through Internet and 3G, integrated systems for collaborative work (directories,
videoconferences, SMS, VoIP, document management…), telemedicine (e-Operating
Theatre), etc
Lessons Learned
1. Integration in the Regional Innovation, Information Society and Health
Innovation Strategies CMAT is not an isolated project
It is fully integrated into Regional Strategies on Innovation, Information Society, and
Health Innovation
2. Wide impact in the quality of public health services, as an engine for
productivity and growth
The Health sector has not only to be perceived as a social service, but together with
Education should be seen as a key element for social welfare and economic growth
and jobs creation
3. Leverage effects of ERDF funding
It may be that without ERDF funding, some of the objectives of CMAT could have
been much more difficult or even impossible to achieve. In this way CMAT is a good
example of Good Practice in using the leverage effects of public funding and, in
particular, of Community Instruments
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eHealth
Issues
1. Insufficient funding for a project of this magnitude
Available funding has been really below the normal cost of this kind of project. This
problem has been solved (or minimised):
· Using very low cost technology
· Collaboration agreements with the Malaga and Granada Universities, allowing the
participation of low cost professionals
· Free Open Source Software (FLOSS) has been exhaustively used
· Sponsoring Agreements with electro medical hardware and equipment
enterprises.
· “In House” design and development of almost all ICT tools
2. Lack of “references” of similar experiences
There are no similar centres to CMAT
3. Lack of awareness in the private sector
In general, it has been difficult to find technological partners with an open attitude to
“understand” the objectives to achieve and to contribute to their consecution
Additional comments The project will continue and operational funding is ensured by the “Contrato Programa 2005-2008” of the Regional Ministry of Health with the IAVANTE Foundation.
The experience of CMAT is going to be transferred to the Health Calgary Region in
Canada through a Strategic Agreement
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eHealth
75
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