eHealth & Telemedicine Projects

This is the second study in a series of three linked studies to develop eHealth benchmarking at European level. The study will cover all 27 EU Member States plus Norway and Iceland as well as Canada and the USA. It will conduct background research and review existing measurement tools and systems for ICT for Health, as well as available eHealth statistics, in order to establish a framework for data compilation and to make progress towards the future establishment of an effective eHealth benchmarking system in Europe, collect the data on an agreed set of eHealth related phenomena from existing sources including professional bodies and regional and national ministries. The study will compile data from existing sources rather than generate original data and – depending on the data availability – provide a measurement for each of the agreed indicators in each country, identify, analyse and report good practice in developing and applying eHealth measurements and benchmarking frameworks for informing policy-making (in all 29+2 countries), and develop and deliver 29(+2) Country Briefs summarising key results for each of the European countries and plus Canada and the USA and make all study results available through a dedicated Online Knowledge Base. Thus this study will significantly enhance the capacity of the i2010 initiative to achieve its goals in relation to monitoring and benchmarking eHealth, a key aspect of information society developments in the old and the New Member States.

In 2004, Europeans made approximately 180 million trips of four nights or more outside their own country. Ensuring their access to seamless and safe healthcare has become a top priority for the European Commission. Information and communication technology plays a key role in this process as it facilitates the transfer of vital medical data across borders. So far, national health IT solutions have coexisted without any interaction. The EC funded Smart Open Services project will for the first time unite key Member States and industry players in a joint effort to get medical data and prescription information to any doctor in the Union - when and where it is needed, and in comprehensible form.

The EC Large Scale Pilot in eHealth aims to develop "Smart Open Services" providing patients travelling across Europe access to the same quality of care as in their home country. As its acronym "S.O.S" suggests, one focus is on getting medical data to doctors urgently when needed, another is on enabling patients travelling in another country of the EU to use a local pharmacy to obtain their prescription medicines ("e-prescription").
The proper consent of patients is crucial to acceptance of these services. In meeting patient concerns about unauthorised access or loss, the project will build on the now extensive knowledge available on reliable and safe methods to store and transfer personal data. Building on national initiatives, it is expected that a minimum data set, incorporating emergency and demographic data, can be agreed. Limiting the data set facilitates translational work and ensures that the doctor in charge of treatment fully understands the patient's data - which may be coming from a country with a different language to the doctor's own. Citizens can thereby be sure to receive appropriate medication and care. To achieve the new services, the participating countries will for the first time establish IT links between their healthcare systems.

The Smart Open Services project has the potential to lay the groundwork for a future pan-European eHealth infrastructure which would revolutionise healthcare provision by reducing medical errors and avoiding unnecessary treatment.

This study for the European Commission will make a substantial contribution towards accelerating the implementation of the European eHealth Action Plan. Specifically, the study will actively support ongoing initiatives and implementation work on interoperable EHR and ePrescribing systems by illustrating and widely spreading new knowledge about their socio-economic impact and lessons learned from successful, beneficial applications.

The value added by eHealth will be measured in quantitative terms based on a small number of successful implementations covering a wide variety of types of applications, of healthcare provider organisations and health systems, and of local, regional or even national frameworks. Whereas the individual examples will provide insights on success factors and requirements, the aggregation of results will allow to draw macro level conclusions.
It is foreseen that the study will deliver the following key outputs:

• A methodology for evaluation of the socio-economic impact, tailored to the context of interoperable EHR and ePrescribing systems
• Ten evaluated good practice case studies
• A validation and dissemination workshop in Brussels, at which preliminary results will be presented for in-depth discussions with selected global experts
• Synthesis of outcomes, providing insights on the socio-economic impact of interoperable EHR and ePrescribing systems, on critical success factors in the process of design, development, piloting, implementation, and routine operation, on lessons learned, and finally on implications for European and Member State health policies.

Best results have been obtained when involving local doctors, nurses and other stakeholders, experts and promoters who have a good integrative understanding of medical/clinical, health policy and ICT-related issues and who are aware of new developments and emerging technologies.

EU FP7 Large-scale integrating project: develop a multiscale modelling technology based on conventional diagnostic imaging methods that makes it possible, in a clinical setting, to predict for each patient the strength of his/her bones, how this strength is likely to change over time, and the probability that the he/she will overload his/her bones during daily life. With these three predictions, the evaluation of the absolute risk of bone fracture will be much more accurate than any prediction based on external and indirect determinants, as it is current clinical practice. These predictions will be used to: i) improve the diagnostic accuracy of the current clinical standards; ii) to provide the basis for an evidence-based prognosis with respect to the natural evolution of the disease, to pharmacological treatments, and/or to preventive interventional treatments aimed to selectively strengthen particularly weak regions of the skeleton. For patients at high risk of fracture, and for which the pharmacological treatment appears insufficient, the VPHOP system will also assist the interventional radiologist in planning the augmentation procedure. The various modelling technologies developed during the project will be validated not only in vitro, on animal models, or against retrospective clinical outcomes, but will also be assessed in term of clinical impact and safety on small cohorts of patients enrolled at four different clinical institutions, providing the factual basis for effective clinical and industrial exploitations.

EU FP7 Large-scale integrating project: Based on advanced text, image and structured data mining of about 3m individual patient data from various hospitals new knowledge and decision support will be developed to improve patient safety in antibiotic use, to fight the fast emergence of resistances among pathogens, misuse and overuse of antibiotics.

In half a century of antibiotics use, new challenges have surfaced: the fast emergence of resistances among pathogens and the overuse of antibiotics. Antimicrobial resistance results in escalating healthcare costs, increased morbidity and mortality and the (re-)emergence of potentially untreatable pathogens. For infectious diseases DebugIT will

• Detect patient safety related patterns and trends
• Acquire knowledge
• Invest this knowledge to upgrade quality healthcare.

The DebugIT project, with its innovative approach, is a prime example of how ICT tools can be used to address the emerging challenges in healthcare. This project addresses several of the overriding call topics at once by tackling the problems around antibiotics and of antimicrobial resistance of infectious diseases in an international consortium uniting world class research facilities, SMEs and industry partners.
It is an example of partnering at the European level to keep pace with soaring research costs by making use of complex IT technology technologies. This program addresses the main socio-economic challenges in healthcare, namely to make Europe's healthcare systems safer and sustainable.

EU FP7 Large-scale integrating project: An advanced telemonitoring approach will be developed to close the loop between patients and professionals, giving appropriate access to monitoring, diagnosis and treatment results and reacting immediately, adapting personalized care plans and using automated decision support to derive therapy recommendations.

Each year Cardiovascular Disease (CVD) causes over 1.9 million deaths in the EU, causing direct health costs of €105 billion. Coronary Heart Disease (CHD), half of all CVD deaths, is the single most cause of death in Europe. Heart Failure (HF) – a CHD being the most frequent cause of hospitalization for people over 65 – has 10 million patients in the EU. Current treatment of HF entails recommendations from clinicians on medication, diet and lifestyle. Patients only receive feedback at doctors visits, or when facing symptoms. Daily monitoring, close follow up, and help on treatment routine is lacking. Non-adherence to the treatment regime is a major cause of suboptimal clinical benefit.
HeartCycle will provide a closed-loop disease management solution to serve both HF and CHD patients, including hypertension, diabetes and arrhythmias as possible comorbidities. This will be achieved by multi-parametric monitoring of vital signs, analysing the data and providing automated decision support, to derive therapy recommendations.

European Commission, Directorate General for Public Health-supported project to improve the involvement of patient associations in health-related European studies and research.

Based on the WHO definition:

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,

we have in recent years seen a shift in health policy priorities towards considering a broad spectrum of citizen and patient needs. Globally, health system policy makers are now subscribing to the new paradigm of citizen or patient-centred services. If empowering the citizen is to imply more than just generic policy declarations, one needs to provide him with the means and tools to become a well-informed and self-assured patient, to involve him in decision processes in a way best suited to his level of understanding and knowledge, and to provide him with optimal medical services in situations when he does not want to, or is physically or mentally unable to be part of such processes. Value Plus will provide patient organisations with the tools to influence policy-making at EU-level and to participate in EC-funded projects of concern to their constituency. Empirica is supporting these efforts through the statistical analysis of past and ongoing EC-funded projects which show elements of patient involvement to derive insights on barriers and facilitators for greater patient involvement.

Mobility of people is increasing, products and services can be bought in another Member State when the need arises, but obtaining healthcare outside their residence country is still problematic for many Europeans. And this in spite of the legal framework for healthcare provision across Member States having been set up already in 1971 by the EU and its Member States with the so-called E-forms and the later European Health Insurance Card (EHIC). However, knowledge about this is not wide spread, and the administrative processes accompanying cross-Member State provision of healthcare have not developed at the same pace as leisure travel and labour mobility. To alleviate this situation, the TEN4Health project contributes towards improved healthcare provision for mobile European Union citizens. Initiated by leading public health insurance providers, the TEN4Health service package assures access of citizens to healthcare in participating Member States’ hospitals, based on a secure web service and its integration into developing European eHealth infrastructure networks.
The package’s key components include:

• information on local rules, co-payments and other aspects of healthcare for citizens in their respective language at the point and time of treatment abroad
• instantaneous online verification of insurance status for healthcare providers and as-surance of cost coverage
• efficient support for fast electronic post-processing at the national level
• electronification of reimbursement procedures across Member State borders, with special attention to interoperability.

Realising that financing is potentially a powerful inhibitor to effective eHealth diffusion, the EC’s Directorate General Information Society and Media commissioned a study on "assessment of financing opportunities to support and boost investment in eHealth." The approach is to uncover opportunities for financing eHealth in the context of overall investment in healthcare development and to identify the range of financing models available for eHealth. This results in support for decision-makers of organisations investing in eHealth. The preferred financing models differ according to types of eHealth solutions and the socio-economic and regulatory environment. The different impacts and affordability issues for the short term and the medium term are highlighted.
eHealth can be financed in different ways, including as part of general healthcare development financing, public private partnership, leasing, research funds, and venture capital. Also, public funds are available on local, regional, national, EU, and international level. The best option for financing a particular endeavour can be determined by the type of eHealth investment that is envisaged. Different financing opportunities can be used in different phases of an eHealth investment life-cycle. For example, a pilot of a Hospital Information System can start with initial support from government funds on ICT development, but once operational, the system may yield enough return of financial and other resources that it can move towards internal financing from re-allocating existing expenditure budgets.

Based on the vision of patient-centred European healthcare systems, empirica will develop scenarios of ICT enabled new models of healthcare and assess their potential economic impact. This policy oriented project allows empirica to make full use of its expertise in the evaluation of ICT solutions in healthcare and combine it with an innovative scenario building methodology. Two focused, by invitation only workshops will guarantee expert input from the Health Systems Research and eHealth communities and assure the project’s impact with European health policy and healthcare decision makers. In addition, new insights into future eHealth research needs are expected.

In this study for the European Commission DG INFSO and Media a survey of almost 6,000 primary care physicians on their use of ICT and internet for communication with patients and between primary and secondary care and other health agencies will be carried out in all 27 Member States of the European Union and in Norway and Iceland. The fieldwork will start in the third quarter of 2007. The purpose of the present study is to: measure the use of ICT by primary care physicians in the EU and EEA countries, which is to be achieved by means of a survey of primary care physicians and their use of ICT and Internet for communicating with patients and between primary and secondary care and other eHealth agencies. Through this survey up-to-date information and data on eHealth developments will be obtained and an appropriate benchmarking framework and procedure for eHealth defined, thereby - and through the 29 Country Briefs for each of the 27 Member States, Norway and Iceland - enabling member states to monitor their performance to improve public services. The study is a continuation of the earlier benchmarking exercise for eEurope 2002 and was carried out as a Eurobarometer survey.

Despite the relatively slow implementation of eHealth in Europe, many eHealth developments have nevertheless been successfully implemented. These implementations constitute a source of valuable experience and of examples of good practices which to date have not yet been properly communicated for emulation and exploitation.
The objectives of this study are thus to:

• Identify good practices and their associated benefits;
• Develop and implement common approaches to wider dissemination and transfer of learning experiences;
• Stimulate and foster accelerated uptake of eHealth by addressing the common challenges of eHealth and common lessons learnt.

ICT can make a vital contribution to improving the safety of European patients by helping to reduce medical errors and other negative incidents, thereby saving lives, and enhancing efficiency, in particular in the field of risk management in healthcare. The eHealth for Safety study has the following overarching goals:

• Identifying key issues, topics and challenges where ICT can have a high impact on patient safety and risk management in healthcare, and which have particular relevance in the European context, as well as on the level of the Member States
• Developing both a ten year vision/strategy and concrete recommendations for RTD measures (within the EU’s 7th framework programme and for longer term research activities)

These goals translate into a three-phase approach, consisting of (1) baseline research, (2) empirical analysis, and the development of (3) a synthesis report as well as a roadmap for further research. Good practice case studies will form part of the study in order to demonstrate concrete applications of ICT tools to enhance patient safety.

The semantic aspects of interoperability have only recently been recognised as the major enabling factor for the safe and sensible communication of patient data. Health language is very large and diverse, and as such not equalled by other professional languages. This SemanticHEALTH SSA develops a European and global roadmap for deployment and research in health-ICT, focusing on semantic interoperability issues of e-Health systems and infrastructures. The roadmap will be based on consensus of the research community, and validated by stakeholders, industry and Member State health authorities. It

• identifies key short-term (2-5 years) and medium-term (4-10 years) needs to achieve semantic interoperability of e-Health systems
• analyses unsolved issues arising in the context of realistic approaches to priority clinical and public health settings
• takes account of the impact of non-technological (health policy, legal, socio-economic)aspects
• reflects and integrates results of related FP6 studies.

The EHR has evolved to become centre-stage in the national health informatics strategies in Europe. There is a need for interoperability standards that can permit clinical computer systems to share health record data whilst preserving faithfully the clinical meaning of the individual authored contributions.
Q-REC’S main objective is therefore to create an efficient, credible and sustainable mechanism for the certification of Electronic Health Record (EHR) systems in Europe by addressing

• EHR Systems Quality Labelling and Certification Development
• Resources for EHR interoperability
• Benchmarking Services

The core objectives of Q-REC will be to define a Model with harmonised guidelines and procedures for EHR systems certification and to incorporate the formal test plans into a Benchmarking Process Manual for quality labelling and certification of EHR systems across Europe.
The main kinds of outputs that will be accumulated through the Q-REC work packages are as follows.

• A State of the Art Report on existing EHRs Certification Schemata;
• A Labelling Terminology and Functional Profiles for classification of EHRs to be certified;
• Model Certification Guidelines and Procedures;
• A Benchmarking Services Manual for EHRs Quality Labelling and Certification;
• An Inventory of Resources for HER Interoperability, with registers of Quality
• Conformance Criteria, EHR-Archetypes, XML schemes, Health Coding Systems and relevant EHR Standards;
• A fully worked out Business Plan.

empirica is involved in Q-REC  as a subcontractor.

The recent emergence of Grid technology opens new perspectives to enable interdisciplinary research and technology development at the cross roads of medical informatics, bioinformatics and system biology impacting healthcare. The HealthGrid roadmap, to be developed by the SHARE project, will provide a comprehensive coverage of the RTD domain and the uptake of Grid applications in healthcare, including inter alia infrastructure, security, ethical, legal, financial and economic issues.
The roadmap will focus on identifying requirements for further research and technology development. It will also sketch a realistic picture with respect to desirable applications/ICT implementations and indicate which technologies may have the potential to make a substantial contribution in this context. This will be supported through the presentation of good practice examples.
Each section of the roadmap will detail actions to be taken in terms of objectives and possible methods or approach as well as recommended milestones for completion, stakeholders responsible, appropriate methods of coordination etc. All relevant stakeholders will be involved in a bottom up approach so as to ensure the relevancy and positive impact of the roadmap. Care will also be taken to include issues related to standards and security requirements for handling medical data. Non-European issues will be also factor in to our roadmap in order to ensure international interoperability.
empirica is involved in SHARE as a subcontractor.

The goal of the project is to coordinate planning of national innovation-oriented e-health RTD as the basis for a common road-map and joint RTD activities, thereby establishing an effective ERA in this key IST field and important European market. This Coordination Action emerged from an initiative involving 20+ Member States Health Ministries to improve RTD coordination and exploit the potential for European synergy. They wish to avoid barriers to patient and professional mobility in the Union threatening from uncoordinated IST uptake and ensure progress in line with the Commission's e-Health Action Plan. The consortium of 5 research management bodies - coordinated by empirica at the request of the German Ministry of Health - will research and structure European e-health RTD, build a suitable e-health ERA portal, identify priority topic clusters, locate cooperation opportunities, identify best practice, set consensual benchmarks, propose priorities for action and draw up a coherent Europe-wide road-map and action plan, finally proposing sustainable long-term mechanisms for European coordination. A Coordination Committee, to which over 25 Ministries have already committed, will oversee and direct work, adopt priorities and road-map, initiate engagement in joint RTD activities and adopt sustainable mechanisms.

Currently various Member States (MS) are launching initiatives to introduce e-health infrastructures and applications. They are dealing with critical issues of technical, semantic and workflow interoperability almost exclusively at the regional or national level. These developments threaten to hamper the further development of a European market in e-health applications and cross-border services.Building upon the activities in MS, the results of European RTD, and learning from international efforts, the project will initiate a process for accelerating the deployment of interoperable e-health infrastructures and applications for trans-European use. It will

• identify interoperability and connectivity issues and priorities, barriers and gaps, and solution approaches,
• focus on fundamental interoperability issues (like identification of actors, organisations, adequate measures to achieve interoperability, integration tests and certification)
• analyse similarly key topics relating to e-prescription and messaging
• develop a roadmap and concrete projects involving all relevant actors - guided by an open discussion process amongst Member State Health Authorities.

Allowing for patient mobility and cross-border medical care is a key EU policy priority and one focus of the e-Health Action Plan. Identifying needs, gaps and next steps will help to realise concrete solutions to reach these goals. Interoperability will allow more effective health services to be delivered wherever citizens are and wherever they may have come from in Europe.

Presently, despite the availability of e-Health systems and services, they are not yet widely used in real-life medical or health situations. A major reason why European and national policy goals have so far not been achieved with respect to e-health is that very little reliable evidence is available on the positive (economic and other) impacts of these innovations. The objectives of this project are:

• to develop a generic assessment and evaluation framework and method, including measurement tools for quantitative indicators, for e-health products and services, focusing on optimising economic resource allocation;
• identification of good practice examples of e-health applications across Member States which have relevance in the domain of this study (hospitals, regional networks)· integrating the experience and lessons learned from these examples into the method;
• applying the method and measurement tools developed to 10 application sites reflecting the regional and health system diversity of the Union in the fields of hospitals and regional networks;
• making the assessment method and tools generally available online.

The MobilAlarm project tested an innovative, location-independent alarm and teleassistance service which enables older people, chronically ill, and other persons at risk to initiate an alarm call whenever and wherever he or she needs or wants to do so. The project analysed the European market for such services in general, and in particular developed and tested business models in three distinct markets. This involved providing such services to selected user groups over an extended period of time. Finally, a comprehensive plan for fast market roll-out and diffusion across Europe was developed, and market deployment was initiated. To establish such an efficient, trans-European service meeting the needs of users across the European Union, various British, German and Spanish partners - representing the whole value chain - were involved in this project.

The IST Impact Study analyses and assesses the socio-economic impact of Information Society Technology research and development projects supported by the EU framework programmes (FP4 and FP5) in three domains:

• eHealth applications,
• mobile communications and systems,
• microelectronics and microsystems.

empirica is responsible for the eHealth area. Output is to be used for improving programme performance and suggesting recommendations for future strate-gies.
The study’s methodological framework builds on the basic model of causality which considers that RTD projects have downstream consequences that can be described in terms of a range of project outputs (publications, new tools and techniques etc.) and a range of resultant outcomes affecting different sets of actors.
The study will assess the performance of projects and programmes focusing on the following evaluation criteria: effectiveness, efficiency, impacts, additionality, relevance, progress factors. A key feature of the methodology is the analysis of results by type of stakeholders.
Quantitative project and programme data are collected by e-mail questionnaires. Data analysis techniques include multivariate techniques capable of identifying groups of results and type of stakeholders/projects (cluster analysis) and searching for correlations between them.
In addition, qualitative stakeholder interviews will provide information to allow for a well-grounded interpretation of the statistical data, setting these into the ‘societal’ context. Further-more, they will provide a qualitative view on those impacts downstream the impact chain which are difficult to assess using quantitative tools.

• Databank Consulting (project coordinator)
• Idate
• Teleport Sachsen Anhalt
• Wiseguys

It was the aim of the TEN-HMS-Project to enhance a modular Telemonitoring-System for the medical care of chronically ill, elderly and disabled citizens. The benefit of telematic home-care support should be methodically proved and models for market-launch be prepared and tested. Research focused on three benefit-dimensions:

• Medical outcome
• Quality of Life
• Impacts on the Health Care System (cost reduction)

The project started in January 2000. Patient recruitment started in June 2000 and continued into March 2002. Collection of patient follow-up data ended in November 2002. Data for more than cumulative 205,000 patient-days were collected. The main focus was on medical care for heart-failure patients; with a small pilot project on dialysis patients.