Microsoft EMEA Health Blog

Microsoft Health User Group–European Meeting

opurcarea — Mon, 06 Dec 2010 10:31:12 GMT

Last week, Microsoft organized a meeting in Brussels with more than 100 participants debating about the use of technology as a factor of health sustainability and improvement across Europe. Topics such as use of cloud computing and its promises have been discussed, so as the future plans of the European Commission in the area of ICT for Health. The use of cloud computing as technology is widely supported by the EU Commission and it appears as one of the key technology driver to empower the patients. My colleague Ruediger Dorn – Director of Applied Innovation from Microsoft outlined the benefits of the cloud computing in health care:

Moreover, cloud computing appears to support the promise of ubiquitous, easy to access, affordable and personalized health…

Across different sessions on Personal Health Records and ICT tools for Disease Management, the salient observation was the need for constant involvement of patients in design and development of these solutions. Indeed, the European Patient Forum representative – Ms Nicola Bedlington - was part of two successive sessions and her messages were:

Patient education and access to clear and understandable information should be ensured through continuous investment in health literacy which should go hand in hand with any future technological advancement in eHealth.

If patients are not put at the heart of future development in this area these tools might risk becoming barriers hindering rather than enhancing patient centred care, increasing rather reducing health inequalities, and hampering rather than promoting meaningful collaborative care.

As a take away message, the Patient Forum developed a set of guidelines for effective involvement of patients in EU projects. The guidelines can be consulted at www.eu-patient.eu

The MS HUG event continued in the EU Parliament premises where the support for eHealth was reaffirmed by EU Parliamentarians and EU Commission representatives.

For anyone interested in Microsoft technology in health – Microsoft Health User Group can be accessed at: http://www.mshug.org

Dr Octavian Purcarea

Director – Industry Market Development Europe

Worldwide Health

Microsoft

The show goes on

opurcarea — Thu, 25 Nov 2010 11:41:05 GMT

Recently, Financial Times article Microsoft drops US HealthVault profit plans has been making some waves about a change in strategy regarding Microsoft’s HealthVault platform.

In reality, there is no change in strategy - HealthVault is part of Microsoft overall business, but was never intended to "make a profit" on it as a standalone product in the United States. My US colleague Sean Nolan explained on his blog, since day one, the position and strategy of HealthVault solution in the US.

HealthVault is an important part, together with Amalga of Microsoft end-to-end strategy for connecting care across the healthcare ecosystem. Together with other Microsoft solutions and partner solutions, it enables integration of multiple sources of information and knowledge across the continuum of care. As my colleague Sean was outlining, HealthVault is core to Microsoft’ business model in at least three key ways:

HealthVault in the US is Microsoft "model home" for innovation in the ecosystem. Microsoft currently has 141 applications and 71 healthcare devices connected to the platform --- and those numbers are growing.
The innovation was licensed internationally. With last week's launch of Assignio, the German instance of HealthVault operated and marketed by Siemens IT Solutions, HealthVault is now live in three countries outside the US (Canada, Germany and the UK) --- with a growing interest from users.
Worldwide (including in the US), HealthVault helps adoption of Amalga and HealthVault Community Connect, Microsoft products focused on the healthcare enterprise. Both are "pre-wired" to HealthVault, supporting scenarios such as patient empowering and remote monitoring - features that are in high demand from our partners and users.

We expect that HealthVault will play a key role in the international dialogue about the individual's interest and duty to understand and participate actively in their own care. The numerous expression of interest that we are receiving and testifying in favour of the importance of such a Personal Health Record platform.

The show goes on!

Dr Octavian Purcarea

Director – Industry Market Development Europe

World Wide Health

Microsoft

Germany launches its HealthVault platform for all

opurcarea — Fri, 19 Nov 2010 08:18:00 GMT

During Medica 2010 event in Dusseldorf, our HealthVault team, represented by Jens Dommel - Head of HealthVault, Western Europe at Microsoft Health Solutions Group, announced the launch in Germany of Assignio, a health platform powered by Microsoft HealthVault. The platform, which will be operated and marketed by Siemens IT Solutions, marks a change in the way individuals can approach their health and wellness and will steer the German health sector in a new direction.

During Medica 2010 in Dusseldorf, we are expecting to hear various discussions around innovation and development in the healthcare ecosystem and we believe Assignio, using HealthVault technology, is one example of how innovation can change an industry. By introducing HealthVault to the German market Siemens will help bridge the information gap between citizens and the professional medical and healthcare organisations that they interact with on an on-going basis.

HealthVault provides a central repository for people to record data on their health & wellness, ranging across exercise regularity, diet management, weight monitoring, temperature and blood pressure monitoring. Anyone using Assignio will be able to manage their own health and the health of their families and will be able to store data and easily share this with doctors, hospitals and pharmacies.

There are four key categories of services within Assignio covering:

· Prevention

· Fitness and wellness

· Patient service

· eMedication (to help with a patient’s previous medication history)

There is a long line of applications being developed for the HealthVault platform. Data can be entered manually into the platform, through the applications or automatically from a range of compatible devices, such as weight scales, blood pressure monitors and pedometers. The most important aspect of this service is that individuals are in complete control of their own health management and can decide who has access to what information.

This is the second launch of HealthVault in a European country after UK launch some months ago. It is already fully operational in the US, Canada and UK, and we look forward to working with Siemens to help boost the opportunities HealthVault presents for organisations in the German healthcare ecosystem.

Dr Octavian Purcarea

Director – Industry Market Development Europe

World Wide Health Team

Microsoft

Health as a duty…

opurcarea — Thu, 14 Oct 2010 13:46:11 GMT

Prague is beautiful at this time of the year… The weather is cold but sunny and the parks are enchanting the eye by their autumn colours. The historical buildings and the old part of the city are, as I always saw them, preserved in a perfect condition.

Prague is also the cradle of democracy for Central and East European countries… And this was reminded to me by the event I attended this week. The Forum 2000, a open high level meeting, was initiated 15 years ago by Vaclav Havel, former president of the Czech Republic, and the Nippon Foundation from Japan. The themes approached (democracy, governance, health, economy…) are discussed in an open minded way with philosophers, politicians, technocrats, associations and other stakeholders. There is no parade of solutions or answers to the big problems that our society faces (aging population, consumerism, empowerment, globalization… to name a few of them). The forum acts as a eye opener, a reflection facilitator, a meeting place for people coming from totally different fields.

This is the place where the health panel was held – Goethe Institute in Prague.

The forum was organized in a professional way, with just-in-time venues, perfect timing, respectful and courteous assistance and problem solving staff. I must recognize that I was impressed by this discrete and very efficient organization.

The session I was part of, the Health Panel, gathered representatives from the government (Mr Pavel Hrobon from the Czech Republic, Mr Rudolf Zajac from Slovakia, association of patients (Ms Jana Petrenko from the Czech Republic), industry (that was me…), consultancy (Mr James Rice from Integrated Healthcare Strategies - US) and a catholic priest (also biologist and ethicist) from Czech Republic (Mr Marek Vacha). Under the moderation of Pavel Hrobon, the first speaker – Mr James Rice – was able to draw an accurate picture of challenges of cotemporary healthcare. the First idea shared by the participants was that healthcare should be seen as a component of health and more broadly of wellness. Moreover the right to be healthy must be accompanied by the duty to care of your own health. The participants outlined that pretending healthcare at the highest standards must be accompanied with a conscious taking of responsibilities to do the best for your health. In this context, prevention, change in life style and the necessity for an active involvement in managing their own health by each individual were outlined. In my speech, I underlined that the Information and Communication Technologies can underpin the empowerment of individuals. The increase in computing power, miniaturization, networking of devices, cloud computing, natural user interfaces are all trends that will facilitate self monitoring, education and training of individuals, communication with the health professionals. Of course, these developments must be applied in harmony with principles of privacy and data protection. The intrusion of technology, or replacement of human interaction should be carefully avoided in order to preserve the humanity, empathy and solidarity in the relation between health professionals and their patients. Ideas were exchanged around sustainability of healthcare and I outlined the importance of building new business models around prevention of chronic diseases. Especially, building local communities involving patients, health professionals and payers would be beneficial. A wealth of ICT tools are now available (integrated Personal Health Record platforms – see HealthVault and Amalga) to support these developments and good proof of benefits is appearing from many implementations around the world.

Dr Octavian Purcarea

Director – Industry Market Development Europe

World Wide Public Sector

Microsoft

Together for Health – a Strategy for the EU 2020

opurcarea — Fri, 02 Jul 2010 10:58:53 GMT

On the 29th of June, COCIR association was invited by the European Patients Forum to present some of he key aspects of the structural funds use in eHealth in a Conference called EU Health Open Forum 2010 . As a representative, my industry fellows from COCIR named me… But, what is the context of this Open Forum? The EU Health Strategy aims to deliver concrete results in improving health. As set out in the Lisbon Treaty, the EU has a unique role to improve and protect health and in addition to facilitate cooperation on health. Given Member States' responsibilities in health at national, regional and local levels, and the need to respect subsidiarity, all stakeholders must be closely involved in the implementation of the strategy. To that end, Health in all policies is also about involving new partners in health policy. The European Commission will develop partnerships to promote the goals of the strategy, including with NGOs, industry, academia and the media.
In addition, the on-going process within the EU 2020 strategy demonstrates the importance of health in all policies: EU citizens must be key partners in constructing the strategy and are able to play a key role in delivering the objectives which were laid down.

Under the overall theme of "Together for Health – a Strategy for the EU 2020" the conference was set to mark an important step towards strengthening the involvement of all stakeholders in contributing to the development and implementation of actions and activities to protect and improve the health of European citizens. Building on the progress made through structures as the EU Health Forum, the European Commission will work closely with stakeholder groups, and with regional and local level bodies with a view to optimising their contribution to the implementation of the EU health strategy.

So, I was delighted to stress again the main advantages and the main difficulties that the industry is facing in applying for tenders based on structural funds. Many of them are related to the lack of support for local and national authorities to prepare tenders, other are related to the lack of transparency and local bias towards preferred providers and other related to the inherent complexity of the eHealth implementations. These implementations are not implying only technology but also training human resources, managing change management and developing visionary business models.

The main problems that the industry is facing are:

As a synthetic view, the COCIR recommendations are:

1. Integrated approach needed from EC (coordination and coherence between DG SANCO, DG Digital Agenda, DG REGIO and MSs);

2. Continue to invest in health projects, recognizing increasing demand of chronic disease and ageing;

3. Pay particular attention to training and education of health providers/users and change management programs;

4. Increase transparency of public tender (translate national tenders and submit them to public consultation on EU portal);

5 .Facilitate access to public tenders (foresee budget for building tenders and reduce the part of co-financing for the Member States);

6. Control the time to pre-financing (limiting the time to 45 days);

7. Provide functional specifications in Health tenders and quality criteria by type of tender (e.g. infrastructure, EHR, ePrescribing);

8. Avoid national/regional detailed technical tenders that risk to be obsolete due to the pace of innovation in technology and could favour specific providers;

9. Increase EU scrutiny of major implementations;

10. Simplify the application process for eligible beneficiaries.

We look forward working with the EC on the applications of these recommendations in order to speed up the implementation of successful and proven eHealth applications in countries supported by structural funds.

Dr Octavian Purcarea

Director – Industry Market Development Europe

World Wide Health Team

Microsoft

HealthVault in Europe…

opurcarea — Wed, 23 Jun 2010 14:30:12 GMT

HealthVault – the Microsoft Personal Health Record platform – is now in Europe! While, in several posts, I was discussing the potential benefits of such a platform in Europe, a first launch happened yesterday in UK.

According to research, 13% of the UK population are actively interested and engaged in looking after their ‘wellness’ – i.e. they do things such as exercise regularly, look after their diet, monitor their weight, take their temperature and blood pressure. Many of these people record this data in a variety of places – from apps on their phones to scraps of paper.

According to John Coulthard, Senior Director Healthcare and Life Sciences, with the launch of Microsoft HealthVault in the UK, Microsoft is offering those people a central repository for that data, where information can be entered manually by an individual for themselves or their family – or automatically from a range of compatible devices including weight scales, blood pressure monitors and pedometers.

Microsoft Health team partnered with MSN Life & Style and Nuffield Health to provide an application that enables wellness management. My Health Info, in partnership with Nuffield Health, is the first application to connect with HealthVault in the UK and provides a range of interactive tools to help users gather and visualise their health data to gain useful insights. The end-goal is improved health and wellness management for UK citizens. Nuffield Health will develop new functionality, start to offer weight loss advice and screening programmes and will encourage people to sign-up to gyms through interactive widgets within My Health Info.

Evidence shows that those people actively engaged in their wellness use only two-thirds of the UK NHS resources of those who don’t look after themselves. If Microsoft HealthVault and its partners can help raise that 13% of people engaged in their wellness to, say, 25%, it is inferred that the savings for NHS could be as high as £5bn a year.

The first implementation of HealthVault in Europe is just an additional step towards empowerment of individuals in dealing with their own and theirs families health. We expect that many applications, in the area of fitness and wellness, will be developed by Microsoft partners. Further developments, especially integration with health professionals’ EHRs could bring additional benefits to research, control of costs and increase of quality of care.

Dr Octavian Purcarea

Director – Industry Market Development Europe

Worldwide Health

Microsoft

Useful links

www.healthvault.co.uk
Towards a healthier Europe – A Microsoft special report on how innovations in eHealth can improve medical care, increase efficiency, and create new jobs.
Microsoft HealthVault virtual pressroom - Launched in 2007, HealthVault is a personal health technology platform designed to put people in control of their health information. A free HealthVault account can be used to privately and securely collect, store and share health information that otherwise would remain trapped in disconnected silos. At their discretion, individuals can use HealthVault to share health information with a wide range of Web applications, EMR systems, and health and fitness devices, and with physicians, family members or others they choose. Please check here the most recent announcements on HealthVault.

EU Structural Funds and eHealth – lessons learned

opurcarea — Mon, 14 Jun 2010 08:16:15 GMT

Last Friday, COCIR (the European Association of Radiological, Electrotechnical and IT Industry) has been invited to present the key recommendations that the European industry can give to the European Commission (DG Health and Consumer Protection and DG Regional Policy) and the Committee of Regions. The meeting has been part of the launch of the Committee of the Regions' Technical Platform for co-operation on Health. See agenda here.

I represented the COCIR and the main messages we send to the EU Commission and the Committee of Regions were related to the accessibility of structural funds, with the lack of vision concerning health projects, the lack of exchange of views and strategy in health care among EU and the difficulties related to the calls for tenders.

After a short introduction defining the role of industry in the development of modern healthcare and the acknowledgement of the role of structural funds in healthcare, I overviewed the successful steps already accomplished:

More focus on health (infrastructure and eHealth),
Increased funding available,
Diminishing the co-funding requirements
Recent (modest) modification of procurement framework.

Then, I outlined the problems that the EC and governments are facing in funding eHealth:

• Strategic :

–Many Health projects are lacking vision and coordination

• Procurement issues:

–Procurement procedures are too lengthy (up to 4 years!)

–The transparency is not always ensured (tender published in local language)

–Criteria of selection are too restrictive and too technical

–Release of pre-financing is too lengthy (9 to 18 months in some cases)

–Support for building proposals is not always provided or/and advertised and known

–The countries are lacking best practice repository and guidance

I also outlined the importance of the following elements for a successful eHealth project (from eHealth is worth it study):

1. Commitment and involvement of all stakeholders;

2. Strong health policy and clinical leadership that guides a flexible and regularly reviewed eHealth strategy;

3. Regular assessment of costs, incentives and benefits for all stakeholders;

4. Organisational changes in clinical and working practices;

5. Strong clinical leadership, good organisational change management, multi-disciplinary teams with a well-grounded experience in ICT and clear incentives;

6. Long term perspective, endurance and patience.

As a conclusion, I presented the COCIR recommendations, that can be summarized:

1. Integrated approach needed from EC (coordination and coherence between DG SANCO, DG Digital Agenda, DG REGIO and MSs)

2. Continue to invest in health projects, recognizing increasing demand of chronic disease and ageing

3. Pay particular attention to training and education of health providers/users and change management programs

4. Increase transparency of public tender (translate national tenders and submit them to public consultation on EU portal)

5. Facilitate access to public tenders (foresee budget for building tenders and reduce the part of co-financing for the Member States)

6. Control the time to pre-financing (limiting the time to 45 days)

7. Provide functional specifications in Health tenders and quality criteria by type of tender (e.g. infrastructure, EHR, ePrescribing)

8. Avoid national/regional detailed technical tenders that risk to be obsolete due to the pace of innovation in technology and could favour specific providers

9. Increase EU scrutiny of major implementations

10. Simplify the application process for eligible beneficiaries

We hope that this will be an on-going cooperation with the Committee of the Regions' Technical Platform allowing governing bodies to benefit from industry experience as a stakeholder implicated constantly in eHealth implementation.

Dr Octavian Purcarea

Director – Industry Market Development Europe

World Wide Health Team

Microsoft

Smart Home

opurcarea — Thu, 10 Jun 2010 08:38:25 GMT

I come back to you with another demo that we recorded in the Executive Briefing Centre in Brussels. In the era of aging population and in the context of the challenge that this is entailing for health care, the home care applications can offer a viable and sustainable alternative to hospitalization or institutional care. The demo you can see bellow illustrates a range of measurements that can be performed at home, in pharmacy or drugstore or in a health kiosk and transferred to the Personal Health Record Platform (HealthVault).

A wide range of medical devices can be connected to the hub allowing the transfer of data to the Personal Health Record account:

Moreover, the Smart Home applications can be enriched by home surveillance, catering, alarm and fire detection, remote control of doors, windows and climate control. We assist today at a range of projects all over Europe, supported by local and regional authorities and deemed to facilitate the care for elderly or/end disabled people. In this context, telemedicine applications can offer a good alternative or a complement to increase the quality of service for the traditional care.

Dr Octavian Purcarea

Director – Industry Market Development Europe

World Wide Health Team

Microsoft

Microsoft Surface and HealthVault Demo

opurcarea — Thu, 10 Jun 2010 08:30:08 GMT

Many of our guests are visiting the Executive Briefing Centre located in Brussels, Belgium and have the occasion to see some of the Microsoft demos related to smart house applications and the Personal Health Record platform (HealthVault).

Some days ago, I made a short film outlining the user friendliness of Microsoft Surface device coupled with a demo of the Microsoft HealthVault. In this short demo, my colleague Christoph-Matthias Voltz kindly demonstrated the secure access to a medical record from the point of view of a health professional or a patient managing his family Personal Health Record. measuring vital parameters, communication between patient and health professional and prescribing or checking medication is facilitated by intuitive interfaces:

Moreover, the interaction between patient and a health professional during a consultation is facilitated by the joined implementation of the Personal Health Record (HealthVault) and Amalga UIS (Unified Intelligence System) by one of the partners of Microsoft (Infusion). The result is a seamless cooperation and exchange of information between patient and his or her care provider:

Hoping that you enjoyed these short films, I hope that we will meet you in the future in one of our Executive Centres around the world.

Dr Octavian Purcarea

Director – Industry Market Development Europe

World Wide Health Team

Microsoft

An important step for Europe

opurcarea — Thu, 10 Jun 2010 06:55:42 GMT

Two days ago, on the 8th of June, the EU Council agreed on a Draft Directive on cross-border care. While this is not the final step for full adoption of this important document, the positive vote of the EU Council is opening a new perspective on cross-border care and on the use of eHealth as a tool to facilitate the mobility of EU citizens.

This legislative document was designed to facilitate the mobility of people around Europe for tourism, work and study by offering them reimbursed health services in any of the 27 EU countries, under some good sense conditions. The main elements that would ease the access to cross-border care are related to:

• as a general rule, patients will be allowed to receive healthcare in another member state and be reimbursed up to the level of reimbursement applicable for the same or similar treatment in their national health system if the patients are entitled to this treatment in their country of affiliation;
• in case of overriding reasons of general interest (such as the risk of seriously undermining the financial balance of a social security system) a member state of affiliation may limit the application of the rules on reimbursement for cross-border healthcare; member states may manage the outgoing flows of patients also by asking a prior authorisation for certain healthcare (those which involve overnight hospital accommodation, require a highly specialised and cost-intensive medical infrastructure or which raise concerns with regard to the quality or safety of the care) or via the application of the "gate-keeping principle", for example by the attending physician;

• in order to manage ingoing flows of patients and ensuring sufficient and permanent access to healthcare within its territory a member state of treatment may adopt measures concerning the access to treatment where this is justified by overriding reasons;
• member states of treatment will have to ensure, via national contact points, that patients from other EU countries receive on request information on safety and quality standards on their territory in order to enable patients to make an informed choice;
• the cooperation between member states in the field of healthcare is strengthened, for example in the field of eHealth and through the development of European reference networks which will bring together, on a voluntary basis, specialised centres in different member states;
• the recognition of prescriptions issued in another member state is improved; as a general rule, if a product is authorised to be marketed on its territory, a member state must ensure that prescriptions issued for such a product in another member state can be dispensed in its territory in compliance with its national legislation. See Press release here.

The last two elements are important elements for facilitating from a political and practical point of view the implementation of interoperable eHealth solutions at EU level. But what would be the impact of interoperable eHealth at EU level? Some year ago, a study performed by the Nordic Telemedicine Centre from Norway outlined that the cross-border flow of citizens is estimated at 1% of the total population and the potential benefits of fully interoperable eHealth systems could be as high as 560 million Euros, culminating at 8 billion Euros, if we take into account the regional benefits.

This important step will underpin the Digital Agenda of the EU Commission which is designed to support Europeans with better health care, safer transport, new media opportunities and easier access to goods and services. The important policy elements outlined by the EC, that the industry fully supports, are the policy elements related to the implementation of a EU “Health Passport” by 2015:

• Key Action 13: Undertake pilot actions to equip Europeans with secure online access to their medical health data by 2015 and to achieve by 2020 widespread deployment of telemedicine services;
• Key Action 14: Propose a recommendation defining a minimum common set of patient data for interoperability of patient records to be accessed or exchanged electronically across Member States by 201256;
• Other actions:
• Foster EU-wide standards, interoperability testing and certification of eHealth systems by 2015 through stakeholder dialogue;
• Reinforce the Ambient Assisted Living (AAL) Joint Programme to allow older people and persons with disabilities to live independently and be active in society.

We hope that these new political elements will facilitate the implementation of eHealth based on open standards and architecture and that will open a real EU market in the area of eHealth avoiding fragmentation of information and lack of communication between health providers and users.

Dr Octavian Purcarea

Director – Industry Market Development Europe

World Wide Health Team

Microsoft

When lawyers are looking at eHealth…

opurcarea — Thu, 27 May 2010 09:16:38 GMT

Yesterday I have been invited to speak about new business models of eHealth at a conference in Copenhagen, Denmark. Very surprising is that the Conference (entitled The New Age of Health IT) was organized by the International Bar Association and centred on eHealth.

Many presentations were around the legal environment of eHealth, governmental policies and some law cases around confidentiality and privacy. It appears that in some countries, such as South Africa, the legal environment in Public Administration is so restrictive that it impeaches the collection of vital statistical data. However, the private sector is a heaven for clinical studies being less surveyed.

In my presentation, I identified the main barriers to the eHealth adoption namely – trust, usability, lack of business model, empowerment of patients and users.

I also reminded to the audience my previous work in the European Commission and the efforts that the eHealth team did to make available legal details concerning eHealth in each EU country. The legal environment in EU is developed in a series of reports recently published by EC. See here.

I also outlined that numerous changes in computing power, emergence of cloud computing, new interfaces such as Natural User Interface, will change the way that health practitioners will perceive technology.

Moreover, I outlined the need for Electronic Health Record with Decision Support System and workflow management as a minimum condition to achieve real saving and increase of quality of healthcare.

I also met the Chairman of the association Patient Privacy Rights (www.patientprivacyrights.org) – Dr Deborah Peel) who acknowledged the important efforts that Microsoft did to largely consult patients and individuals about the privacy concerns, before launching the Personal Health Record platform HealthVault. In her opinion, these efforts are unique and should be largely taken as an example for building eHealth applications.

On my way home, I was thinking that finally the main barrier to eHealth implementation in Europe is not the privacy and confidentiality aspects of health data but the procurement procedures. In many countries, there is a lack of real business model around implementation of eHealth technology and the procurement procedures is following some perceived urgent needs without building a comprehensive architecture. Of course, there are some exceptions in EU – Denmark being and example of well thought implementation.

I hope that this kind of multidisciplinary congresses – were people of different horizons are meeting – will provide more guidance to the governments in their strategy for sustainability of healthcare.

Dr Octavian Purcarea

Director – Industry Market Development

Worldwide Health

Microsoft

“Health for All, Care for You”

opurcarea — Fri, 23 Apr 2010 11:11:08 GMT

Yesterday, 22 of April, I attended a Conference in London entitled “Health for All, Care for You” on the theme of Personalized Healthcare. The Conference was organized by Science and Business journal with the participation of the Royal College of Physicians. For memory, the Royal College of Physicians is the oldest and the most prestigious English Medical foundation, incorporated by Royal Charter in 1518.

But what is Personalized Healthcare? According to a study performed by Karolinska Institute, Personalized Healthcare is a methodology, enabled by modern genetic, biopharma, diagnostics and ICT technologies, that attempts to tailor the treatment to the individual biological characteristics of a patient or a sub-group of patients. This study, sponsored by Genzyme, Novartis, Pfizer and Microsoft, and performed in several European countries on a significant panel of individuals from health care world, shown that respondents see very high potential in this new approach to medicine but also important barriers on legal, organizational and funding levels.

Important to note is that a wide majority of respondents (80%) consider that personalized healthcare will avoid errors and improve healthcare but this will entail new cost in short time.

One of the biggest challenge identified was related with the availability and development of biomarkers where a EU effort is desired.

Important for ICT industry is that a wide majority (63%) believe that citizens should have more information on Personalized Healthcare and have access to their medical records:

I was in the panel during the presentation of the results of the study together with the Vice-Provost of the University College London – Sir John Tooke and I have been questioned by the participants on the role of ICT in facilitating the Personalized Healthcare. My intervention outlined the huge advancements that ICT bring the recent years – with the refinement of usability of ICT solutions, the efforts of Microsoft and other providers in the area of interoperability (Connected Health Framework, Common User Interface, Health Accelerators), deployment of Personal Health platforms such as HealthVault and data integration and interpretation tools (Amalga UIS). Moreover, the advent of Decision support systems in EHRs, workflow management systems and complex alert system based on business intelligence, is able to support the interpretation and use of large amount of data coming from a variety of biosensors, medical devices and therefore allow tailored healthcare. As principal barrier, I identified the semantic interoperability in Europe and the Personalized Healthcare business models. Even if we agree on a terminology set, implement it wisely as a meta-level (or as Cloud service) on shared EHRs for overcoming the semantic hurdle, the way we are attracting, rewarding health professional for using these new ICT tools is essential. The report of Karolinska Institute and the press releases from Science and Business magazine will be available very soon and I will create a link in this blog to these sources.

Dr Octavian Purcarea

Global Industry Manager

World Wide Health Microsoft

Funding opportunities for eHealth in CEE (Romania)

opurcarea — Tue, 09 Mar 2010 10:08:45 GMT

Last week Microsoft Executive Briefing Centre from Brussels hosted a meeting for health executives from Romania, including governmental bodies, industry and users.

The event gathered 25 Romanian policy makers, prominent speakers, media and other members of the Romanian community based in Brussels who discusses about the role technology has played in the local society and especially in the field of health, as well as to demonstrate the importance of the involvement of private sector when it comes to investing in innovation.

The expectations for participants were focused on understanding the level of eHealth solutions in EU, how they can be applied in Romania and share ideas for a strategy in eHealth.

John Vassallo, Microsoft VP, EU Affairs/Ilias Iakovidis – European Commission, Acting Head of Unit, ICT for Health at the DG Information Society and Media /Octavian Purcarea Microsoft Health Industry addressing the audience

Agenda included distinguished speakers who engaged the audience in a strategic debate around role of technology but mostly system interconnection, interoperability and standards. Role of governments, European institutions, local administration and also non-governmental organization involvement and cooperation among stakeholders was the topic who determined the intervention of almost all participants in the debate. Another important topic was related to financing opportunities, how the EU funds can be accessed, cohesion policies and regional policies.

On behalf of Microsoft, John Vassallo, EU Affairs, presented what Microsoft is and does in EU. “Microsoft contributes to building the “union” , the “U” in EU, we do things together growing the market related to IT, to use the software for improving health.

Ilias Iakovidis – European Commission, Acting Head of Unit, ICT for Health at the DG Information Society and Media shared the key lessons learned in the past years with implementing projects such Electronic Prescribing, Electronic Health Record and Patient Insurance Card in other countries. Successful case studies but also blocking factors were described. Mr. Iakovidis emphasized the role of research and innovation and kept the dialogue at the very practical level. Health solutions are very complex, nobody can solve alone and we need to learn from each others. The main advice that he gave can be summarized:

Another important topic was related to financing opportunities, how the EU funds can be accessed, cohesion policies and regional policies.

Mrs Ana Raducu – Program Manager EU Policies - presented Cohesion policy supporting investments in the health sector in Romania. There are at least 19 Priority themes which could be linked directly to health sector (infrastructure, support to SMEs, IT, human resources, R&D, policy and program design, etc).

The opportunity for funding of eHealth in CEE is very high:

How Microsoft can help partners to increase the absorption of funds, to identify the opportunities for financing the ideas was another topic on the agenda presented by Juan Bossicard (APCO) and Oana Pinu (Schuman Consulting).

Juan presented the EUGA programme (the Europe Union Grant Advisor Programme). The EU Grants Advisor (EUGA) is an initiative developed by Microsoft, in partnership with HP, Intel and the European Software Association, as well as other local public and private institutions to increase the awareness and understanding of the funding opportunities available, as well as allow SMEs, start-ups and LRGs to take advantage of a facilitated application process should they wish to apply for funding for which they are eligible. Microsoft has recently aligned EUGA with its highly successful BizSpark program designed to support Europe’s entrepreneurial community.

It offers free orientation on funding opportunities in EU and consulting services for submitting proposals.

EBC visit and demos on eHealth services developed for Microsoft Surface generated interest and excitement among participants.

Participants expressed their satisfaction about the discussions and sent us messages on possible follow-up:

Prof George Mihalas, , Vice President IMIA, European Federation for Medical Informatics, expressed his willingness to lead the initiative toward:

- Creating a eHealth Association in Romania – invite doctors associations, patients associations, researchers, technology partners;

- Applying for EU funds for Associations;

- Setting a Microsoft innovation Center on eHealth in Romania where Microsoft partners can be involved in order to test and develop new solutions, develop training and education activities for IT developers, health professionals and patients.

Dr Octavian Purcarea

Global Industry Manager

WW Health

Microsoft

The future is mobile…

opurcarea — Tue, 22 Dec 2009 14:09:57 GMT

For the last months, I assisted at the development of several mobile applications very useful for remote diagnostic, second opinion and emergency situations. Based on innovative software, such as Waaves, allowing lossless compression, medical images can be send using simple GSM connection and visualized in high definition on Windows mobile phones.

Sample images compressed with Waaves:

Waaves is available now on Windows Mobile 6.1 and 6.5 and used on a variety of phones. It has been tested on ACER phones (S200 and GSMART S1200) and the results are astonishing. I also tested them and the navigation is easy, the decompression time is very reduced (2-6 seconds). The images are clear, the details can be magnified and the contrast and gray level modified by simple touch of the screen… Here are some pictures of the ACER S200 that I tested:

The most important feature remains the possibility to send the medical images in seconds from a hospital or a clinic to a remote specialist. Annotations and Bluetooth communication with other devices is also possible. Waaves is also available on PCs, Netbooks, USB Keys and ADSL Routers. All these devices are distributed by PARTELEC in France. See coordinates here.

Such devices have been tested by a French company (Nazounki Global Medical Network) ensuring medical repatriation and remote second opinion in Africa. A case study has been developed by Microsoft and can be found here… Moreover, my colleague Dr Bill Crounse, Senior Director from Microsoft, introduced this case study on Microsoft Health Tech Today program. This month’s program features a segment with Nazounki Global Medical Network. Here is the link to that segment: http://www.microsoft.com/industry/healthcare/healthtechtoday/default.aspx#0-4

And here is the link to our full show: http://www.microsoft.com/industry/healthcare/healthtechtoday/default.aspx#0-0

I truly believe that these devices will allow better care, avoidance of errors and orientation of a diagnostic in emergency situations. Moreover, in developing countries, such devices will allow to reach a specialist when such persons are unavailable in certain areas…

Dr Octavian Purcarea

Global Solutions Manager

WW Health

Microsoft EMEA

Mobile medicine

opurcarea — Sat, 24 Oct 2009 12:40:00 GMT

Some weeks ago, I met Mr. Marc Van Anderlecht, representing the company Uni-Com Medical based in Belgium. Uni-Com is distributing in Belgium the products of QRS based in US and has managed to spread its products on numerous sites across Europe and Africa.

I tried some of them and I was impressed by the user-friendliness, accuracy and autonomy of these solutions. First, their 12 leads portable ECG can be plugged in any computer having a version of Windows installed and a software called Office Medic. This software can be interfaced with several Electronic Medical Records distributed by All Scripts, Cerner, CardioComm Solutions, iMedica and many others.

Results are displayed on-screen for quick assessment. A full set of diagnostic measurements are automatically interpreted by the advanced Louvaine Algorithm.

Other interesting products are the SpiroCard that brings full-function spirometry to off-the-shelf computers and handhelds, the OxiCard PC Oximeter and the Blood Pressure Meter. The latter is an automated blood pressure meter that matches the quality and reliability of your old mercury manometer. It appears that, since aneroid manometers require regular calibration and mercury is banned in many countries, the digital BPCard is a practical solution for taking accurate blood pressure readings.

All this products do not additional batteries.

QRS software has been designed, tested, and proven on the Microsoft Windows® platform. It has been thoroughly tested by Microsoft in the Microsoft computing environment to offer enhanced stability, ease of use, and consistency.

In France they started to be used in Emergency situations, exploratory missions, GPs visits and various projects in Africa.

Moreover, through the Numerical Solidarity Fund from Switzerland in cooperation with WHO, 1000 sites will be equipped across Africa with satellite stations, solar power central, mobile computer and Uni-Com, QRS devices allowing remote locations, small clinics and hospitals to perform diagnostic exams and follow up impatient and chronic patients. Such stations are already installed in Burundi and Mali…

Moreover, the devices can be assembled into a diagnostic suitcase, particularly useful in difficult, wild environment. It has been tested during automobile competitions in the dessert and it gave accurate results.

The specifications and the film have been kindly provided by Uni-Com.

Dr Octavian Purcarea

Global Solution Manager

Worldwide Health Team

Microsoft Corp.

Nao – the friendly robot

opurcarea — Fri, 23 Oct 2009 14:12:00 GMT

Walking through the exhibition in the AAL Forum in Vienna, I was impressed by a new robot development performed by a French company called Aldebaran Robotics.

After 3 years of research, Aldebaran Robotics has developed NAO - a 58-cm biped robot. It is a unique combination of hardware and software in a great design. Nao stands tall in all points amongst its robotic brethren. Platform agnostic, it can be programmed and controlled using all available platforms. The hardware has been built from the ground up with the latest technologies providing great fluidity in its movements and offering a wide range of sensors.

The programming environment called Choregraphe® was developed by Aldebaran Robotics to allow rapid development of complex behaviors by novice users while providing the ability to have a fine control of motions for demanding programmers.
Its intuitive graphical interface makes the difference: it allows you to get started by dragging and dropping pre-defined behavior boxes from the Box library and link them together to compose your own Nao behavior in the flow diagram.
Once familiar with the software, you can compose your own boxes, play with time scheduled programming and execute your behaviors: on real Nao via Wi-Fi, via Choregraphe’s 3D window or by using advanced simulators such as Microsoft Robotics Developers Studio and Cyberbotics Webots.

You can see Nao in action in two videos that I saw at the conference:

http://www.aldebaran-robotics.com/download/NaoAcademicsV3.mov

http://www.aldebaran-robotics.com/download/NAOPlaytime.mov

The use of NAO as a companion for elderly people seemed to me the most effective but last week, travelling to Milan, I discovered an astonishing use: in San Raffaele Hospital – one of the leading University Hospitals in Italy, several NAOs are used to train diabetic children to take the insulin injections. The training is so effective that children are showing total adherence to the treatment and become even “proud” to have such condition which allows them to be seen and filmed with the robots. The films are than showed (with the parents and children consent) to the classmates who discover that having diabetes and being obliged to treat yourself is not such a fatality but an excellent occasion to learn a new healthy behavior and even play with robots… This is one of the most sensible proof that I found on how technology can change delivery of healthcare…

Nao at the Doctors'TV

Discover how the Nao robot can help children develop their social interaction skills by providing predictable play and repetitive behaviors. Click on the picture below to watch the video.

Dr Octavian Purcarea

Global Solutions Manager

Worldwide Health Team

Microsoft Corp.

Vienna – Ambient Assisted Living Forum

opurcarea — Fri, 23 Oct 2009 13:50:48 GMT

From 29 September to 1 October 2009 the first AAL FORUM took place in the Vienna Hofburg. This kick-off event of the international conference series of the Ambient Assisted Living - Joint Programmes (AAL-JP) served as an information and discussion platform for stakeholders, scientists and users. The thematic priorities of the AAL FORUM 09 were national and European AAL activities, R&D projects and economic aspects of the joint programmes, the third AAL call for proposals as well as key questions of AAL-JP. The conference was attended by more than 500 experts and LRG representatives and was designed to shape future EU programmes in the area of aging and assistance of elderly people (see http://www.bmvit.gv.at/aal) .

An exhibition accompanying the conference provided institutions, companies and projects with the opportunity to present their services and products in the field of 'active and independent ageing'. A hands-on area invited visitors to try out interactive games for the elderly. Ambient Assisted Living means life in a supportive environment. The central theme of the exhibition was the technical design of the home through ICT to promote independence of the elderly as well as communication with the social environment.

Microsoft representatives were present at the Industrial Round table in the AAL Forum. Jan Muehlfeit – Chairman of Microsoft Europe- provided some clear insights and identification of barriers to implementation of ICT in the healthcare and social services area that were very appreciated by many participants.

Jan identified one of the most pressing health issues throughout the world as being the growing epidemic of Chronic Disease.

As the World Health Organization noted, “In the history of mankind few, if any, pandemics will have led to as much suffering and premature deaths as is emerging from the global epidemic of chronic disease. A combination of lifestyle factors including diet, lack of physical activity, and smoking have contributed to the rising incidence of chronic disease in all parts of the globe, accounting for the majority of premature deaths in all but the lowest income countries.”

Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 60% of all deaths. And chronic diseases are equal opportunity, affecting everyone, young and old, men and women.

Microsoft is reacting to these realities by launching a series of solutions for Health and Wellness in the area of Personal Health, Chronic Diseases Management and Population Intelligence.

In the end of his speech, Jan addressed a direct call for action to start large governmental programmes, solve reimbursement and legal issues that were largely acknowledged and recognized by many responsible persons in charge with these aspects (see below).

The exhibition was very interesting and hosted several home applications and interesting solutions for elderly and disabled people. Microsoft presented Microsoft Surface and its high usability. My colleague – Dr Bill Crounse- wrote a very good blog on it and I advise you to check his film on medical applications for Surface.

Dr Octavian Purcarea

Global Solution Manager

Worldwide Health Team

Microsoft Corp.

EHTEL – A decade of dedicated support to eHealth in Europe

opurcarea — Fri, 23 Oct 2009 13:17:09 GMT

Microsoft was one of the sponsors of the symposium organized by the European Health Telematics Association (EHTEL) in Brussels on the 21st, 22nd of October 2009. EHTEL mission is to be the "grid" which creates trust, coherence and consensus between all stakeholders who are interested in using ICT as an enabling tool. Started as an industry initiative, supported by the European Commission 10 years ago, EHTEL managed to contribute to many political initiatives (eHealth Action Plan, EC recommendation on interoperability of EHRs in cross-border care, Telemedicine communication) and implementation projects.

The Anniversary Symposium was hosted by the European Economic and Social Committee (EESC). The EESC is a consultative body that gives representatives of Europe's socio-occupational interest groups, and others, a formal platform to express their points of views on EU issues. Its opinions are forwarded to the larger EU institutions - the Council, the Commission and the European Parliament.

EHTEL pursues the vision of enabling personal wellbeing and positioning patients/ citizens at the very centre of health and social care. EHTEL expects that eHealth infrastructures and services will more or less "disappear" from the perception of patients and health professionals, hence becoming a fully integral part of health care. This would enable health care systems to deliver smarter Patient Care" where:

Accessible health information, smart diagnostics and tailored advice and therapies empower citizens to stay healthy.
Intelligent clinical care is enabled by underlying clinical evidence in all diagnostic and therapeutic activities. Thus it provides high quality medical support and contributes to the step change in productivity demanded by the demographic and economic challenges that face healthcare.
Ambient technologies support staying healthy and coping with increasing needs for assistance.

Through its 10^th anniversary symposium EHTEL took a look forward at the next steps of the eHealth evolution.

I was part of the industrial panel trying to explain the vision of Microsoft in healthcare:

The main facts were around the necessity to consider healthcare as an integrated system and not as a collection of separate departments (administrative, medical, research, financial etc.) and processes (prevention, care, rehabilitation) and not even as a collection of actors (patient or provider or payer centered). This vision allows us to model implementation in eHealth taking into account a multitude of factors and propose solutions supporting this holistic vision.

Today's realities (population aging, spur of chronic diseases and lack of sustainability of health systems, empowerment or at least increased interest from individual in managing their own health, exponential grow in available knowledge…) made us propose a range of solutions in order to make possible early prevention of chronic diseases, change of behavior and health lifestyle, managing of acute episodes and supporting population health intelligence (epidemiology and statistics).

The solutions that Microsoft proposes today, together with more than 5000 partners in Europe, are underpinning the Personal Health & Wellness, Condition Management and Population Health Intelligence.

Typical solutions in the area of Personal Health & Wellness are the Health Portals, CRM solutions and the HealthVault platform.

Microsoft Health Portals make it easier to integrate information from different systems; work on documents and information with peers, colleagues, and patients/citizens; and distribute that information to individuals, departments, agencies and other entities. Designed for all users at a personal, team, and organizational level, Microsoft Health Portal Solutions facilitate workflow and processes, provide access to information and transactions of all kinds, reduce the “hassle-factor,” and improve communication and collaboration in a format that helps to ensure well-informed decisions and improve efficiency.

In Personal Health & Wellness, portals can be used to:

offer new ways for patients to access health information and communicate with their doctor or case manager
educate audiences on health issues tailored to their needs, enhancing the perception of an organization
organize, store and share personal health data for each patient/citizen;

Increasingly, patients and citizens are recognizing the need to take control of their health. They need to track and manage chronic conditions, as well as their progress toward health and fitness goals. And they expect to access medical records and prescription information online from anywhere, then share selected information with family or caregivers, as well as their doctors.

With Personal Health solutions from Microsoft such as HealthVault,, all the health information could be in one place. People can securely store copies of their health records obtained from their doctors, health plan, pharmacies, government, and employers, and they can upload information from health and fitness devices. Then they can share that information with healthcare providers and trainers; as well as access online products and services. Sharing relevant information helps patients and their care and services providers work more effectively together to improve the patient’s health.

Health organizations can also use HealthVault’s shared data platform to provide patients with innovative health and wellness tools and services to help patients take preventive health steps and lead healthier lifestyles. By connecting and sharing information more easily in a secure manner, both health professionals and patients can be more proactive in improving patients’ health and wellness.

With Condition Management solutions for Case Management and Caregiver Collaboration , health professionals can efficiently and proactively help citizens’ manage their health conditions to minimize acute episodes, hospitalization and expensive procedures.

Health professionals can more quickly and easily predict needs and modify activities to help prioritize and refer patients based on current conditions and past history with predictive modeling tools.

An integrated view of patient health status, lets health professionals and case workers reduce duplicated efforts and better manage cases. And automated care coordination activities between provider organizations with customized process workflows, can also reduce workloads while helping to improve patient outcomes.

Caregivers and case workers can communicate and share information more efficiently and effectively so they can collaboratively make knowledge-driven decisions that improve the treatment and management of citizens’ health conditions.

And, automated communication tools help health professionals schedule appointments, plan post-treatment follow-ups, and set up alerts for recursive maintenance to improve communication before, after and between office visits without adding administrative burden.

When both patients and their care team have better access to all the relevant information, everyone involved can make better decisions and provide better, more proactive care.

Population Health Intelligence solutions can be used for activities such as Measuring and Monitoring Population Health; Disease Preparation and Response; and Managing Quality and Health Outcomes.

Tools such as our family of Business Intelligence solutions and Microsoft Amalga provide easy-to-use, flexible technology tools that will help your health organization:

•Gain contextual insight into clinical key performance indicators (KPIs) across organizations and agencies to improve treatment outcomes and patient/citizen health, improve immunization rates, reduce disease outbreaks and episodes of illness, minimize chronic disease complications and treatment, and better control healthcare expenditures.

•Track and analyze performance metrics for health programs, such as health and wellness service lines (e.g. weight management, nutrition) and chronic disease lines (e.g. cancer, heart, COPD, and diabetes).

•Improve disease prevention testing and adherence.

•Create executive dashboards to monitor performance against objectives and analyze demographic information and trends to align service offerings.

•And more easily identify & analyze recurring episodes of illness and track immunization rates and disease outbreaks.

The panel conclusions were that technology is already existing, we need to do more efforts in describing the sustainable models, involve the health professionals and payers in developing new business architectures. Moreover, the eHealth specialists should participate more in health professional meetings around the world, in order to diminish the perception of eHealth as a separate field…

Dr Octavian Purcarea

Global Solution Manager

Worldwide Health Team

Microsoft Corp.

Global Forum 2009 – Bucharest, Romania

opurcarea — Fri, 23 Oct 2009 10:07:10 GMT

I have just returned from Romania, where an important congress took place. The Global Forum is an annual international and independent event, a Think Tank dedicated to the Economic, Political and Social issues related to the successful evolution of the Information Society.

Romania has won the competition with US, China and Switzerland to organize this year the 18th edition of the Global Forum.

The event was organized under the High Patronage of the Romanian Presidency. Traian Basescu, President of Romania, attended the forum sessions.

The Forum took place in the Parliament House (the second largest building in the world) and hosted over 250 political leaders, mayors, multinational company leaders, university professors and different association representatives, well-known consulting and law firms.

Among the attendees, representatives of the US Administration, the European Commission, the United Nations Organization, governmental representatives from Europe, America, Asia, Africa and Middle East were present.

This year meeting was dedicated to discussions about the crisis and its effects, measures to stimulate and reshape the global economy, through the means of IT&C.

The session I chaired (session 4 – Innovation and Sustainable eHealth) had 12 speakers covering governmental issues, European affairs, telecom, IT vendors, patient representatives, web services, change management consultants and legal advisors.

The speakers were able to present in a short time their achievements:

we learned the exceptional development of the Emergency Mobile Units (SMURD) in Romania with telemedicine fully equipped ambulances and interhospital telemedicine and we acknowledged that telemedicine for emergency situations is not a luxury but an economical and cost efficient solution.

we admired the patient certification scheme from Sweden – a regional government initiative aiming at educating and informing patients about chronic diseases, accompanying patients in changing behavior and even certifying their ability to take care of their own health.
we understood the necessity for cost comparison in the area of over-the-counter drugs with portals such as ComparSanté in France;
we learned about the local government developments in Asolo area – from Veneto region in Italy. The local health and social services succeeded in creating a citizen portal accessing medical information from the local hospital and building citizen services based on Web 2.0 applications.

we discovered new services proposed by mobile operators such as Orange in hospitals in France – see here;
Finally, we learned about the EU Member states initiatives epSOS and Callioppe as an effort to structure eHealth implementation around Europe and the EC initiatives to support the European implementations in the eHealth area.

In conclusion, the Global Forum 2009 was a very rich experience for all stakeholders of healthcare and eHealth providers - local and regional governments, industry, insurance companies, patients and healthcare professionals.

Dr Octavian Purcarea

Global Solution Manager

Worldwide Health team

Microsoft

Windows 7 – a sound choice

opurcarea — Mon, 21 Sep 2009 13:24:08 GMT

After a long silence induced by several long travels, I come back to you to share my observations on the newly installed Windows 7. Last week, I have been in Redmond and had a quick installation of the new operating system of Microsoft.

My first impressions were very favorable: my portable computer became faster and more fluid. The colors of the display seemed clearer and enhanced and the navigations across open windows was facilitated by . There are many features that I appreciate highly – such as the enhanced security, single sign on and voice recognition. I had no error messages or any stalling on my computer since the installation.

As an early adopter, Dr Bill Crounse, previously noted that Enterprise users will find a lot to like. With DirectAccess, Windows 7 makes it easy to connect to corporate resources without going through a Virtual Private Network. Windows BitLocker™ protects sensitive data (which is just about everything in healthcare) on internal and external drives while advanced network backup and Encrypted File System also protect sensitive data. BranchCache™ decreases the time remote workers need to open files running on the corporate network. AppLocker helps IT staff prevent unauthorized software from running on corporate machines.

All these new features will delight professional users and will enhance usability and security of data for health professionals. The starting and shut down time is diminished and the navigation between applications is very quick. While this would appear as simple features, the professional applications will largely benefit from a quicker and robust Operating System.

Please take a tour on the Windows site for more information by visiting resources on the web. The commercial version will appear on 22nd of October. I hope that you will all enjoy it.

Octavian Purcarea

Quality and Performance Driven Health

opurcarea — Thu, 16 Jul 2009 12:56:56 GMT

For several years, I followed and admired the organizational process and excellent results of Kaiser Permanente Health organization. I truly think that this is one of the best example of sustainable economic model and wise use of eHealth. Founded in 1945, Kaiser Permanente is the nation's largest not-for-profit health plan, serving more than 8.6 million members, with headquarters in Oakland, California It comprises:

Kaiser Foundation Health Plan, Inc.
Kaiser Foundation Hospitals and their subsidiaries
The Permanente Medical Groups.

See more information here

Several studies outlined the outstanding results of Kaiser Permanente as shown in one of previous presentations:

The whole system is build around empowerment of patient, increased collaboration between healthcare professionals and with the patients, pay per quality ad performance. The patients are encouraged to manage their own health, are educated and informed. They have their own health space (called My Health Manager) based on a web access provided by the supplier of technology - Epic Systems. Additionally, the HealthVault platform was connected to the EHR of Kaiser Permanente and allows the exportation of medical results to the PHR.

On the healthcare professionals side, the ICT tools are very advanced with the use of EHRs with Clinical Decision Support, agreed Care paths and clinical process management. This would not be possible without semantic interoperability and agreed terminology. The integration along the clinical process allow them to achieve a multi-specialty coordination for chronic conditions and outstanding results.

A recent study published in March 2009 shown that "Kaiser Permanente Colorado has significantly reduced the mortality rate for patients with heart disease, which is the US's number one killer for both women and men. Using team-based medical best practices and computer-supported care registries, doctors and clinical care teams reduced overall mortality by 76 percent and cardiac mortality by 73 percent. Coronary Artery Disease is the dangerous buildup of plaque inside the coronary arteries. Cardiac mortality refers to all deaths related to heart events.

The ability of clinical care teams to coordinate their efforts in cardiac care is greatly enhanced by the availability of electronic health information-which provides instant access to patient information-and evidence-based clinical care guidelines and protocols.

What is the impact of Chronic Conditions : Ten percent of U.S. patients account for 80 percent of all health care costs, and 75 percent of those costs are related to chronic conditions. CAD affects 80 million Americans and is one of the five top chronic conditions that drive the vast majority of health care costs. It remains the leading cause of death in the United States. Poorly managed, CAD too often results in hospitalization and early death. The American Heart Association and the National Heart, Lung and Blood Institute estimate that the total U.S. medical and social costs associated with heart disease and stroke was $475.3 billion in 2008.

Managing Chronic Conditions: Empowering People with Technology

Clinicians at Kaiser Permanente are working in teams and across departments and using electronic health information to help prevent manageable diseases, like CAD, from becoming life-threatening crises.

The care teams in Colorado tackled CAD by creating a new electronic care registry and support program called the Collaborative Cardiac Care Service. Recognizing the importance of early treatment and intervention, every patient who presented with CAD was enrolled in the program for both short- and long-term care.

Physicians, nurses and pharmacists, using proven CAD risk-reduction strategies, work collaboratively with CAD patients to coordinate care. Activities such as lifestyle modification, medication management, patient education, laboratory results monitoring, and management of adverse events are all coordinated across a multifunctional team.

The program is driven by agreed-upon, consistent clinical care guidelines and protocols that are integrated into Kaiser Permanente HealthConnectT as decision-support tools to guide the care teams, at the point of care, as they treated more than 12,000 CAD patients. Immediate access to reliable, evidence-based information at all points of care enables each care team member to support a given patient's care plan, encourage treatment adherence, and allow disparate care teams-from primary care to pharmacy to rehabilitation centers-to coordinate care, regardless of setting.

Clear Results: Better Survival Rates and Reduced Need for Emergency Interventions

The results were impressive. Nationwide, research indicates that fewer than 20 percent of CAD patients are expected to survive 10 years after their first heart attack. The coordinated, evidence-based care, enabled by KP HealthConnect and an electronic care registry, increased that survival rate dramatically. It is estimated that more than 135 deaths and 260 costly emergency interventions were prevented annually, as a result of improved care.

In addition, the program achieved the following results:

patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program
the number of patients meeting their cholesterol goal went from 26 percent to 73 percent
the number of patients screened for cholesterol went from 55 percent to 97 percent

Implications for Health Care Policy and the Future of Care Delivery

These early results illustrate how coordinating activities between various health providers throughout the care delivery system, and equipping caregivers with real-time information, can support patient care and improve outcomes. Maximizing information for the clinician means optimizing care for the patient. Done well, a computerized system supports clinicians' efforts to spend more time with patients, have better information about their care and spend less time with traditional paperwork. Health information policy for the United States must include incentives not only for implementing electronic medical records in provider offices, but also for developing the skills of the people who use the tools and for coordinated use of information systems between providers. The value of information technology is directly related to how caregivers and staff use it and whether it supports sharing information between settings of care.

The right information systems and the right delivery system reform will create care teams that are able to coordinate care across every point of service-the physician's office, laboratory, pharmacy, hospital, on the phone, and even online-thus providing patients with affordable, well-informed, customized and compassionate care. " For more information see here.

What can we say? I think this is a brilliant example that we should follow in Europe. The tools are available: putting together on an integrated platform EHRs synchronized on line with Clinical Decision support and Process Management, coupled with a PHR (HealthVault) we can provide healthcare organizations with the tools to increase the quality of healthcare provided, decrease costs and explore new ways of payment of health professionals (such as pay per performance). For the existing implementations , using Amalga UIS would facilitate integration with HIS and other legacy system and achieve the vision of coordinated, integrated care. There are providers today able to offer the new type of EHR, EPR with clinical decision support- Medicognos, Fresenius, C-Systems and some others. They can be the suppliers of an integration system encompassing patient needs, health professionals activity and institutional management requirements. In one single view:

In perspective, the future will be to fusion the PHR and EHR in one synchronized platform with two views: one for patient and one for health professionals, each equipped with specific tools according to the activity of each user. As a first step, in order to achieve quick savings, the availability of an PHR such as HealthVault will be enough, as outlined in a speech of George Halvorson, the CEO of Kaiser Permanente.

As a conclusion, I encourage you to take several minutes and watch this video featuring from Kaiser Permanente CEO who suggests his version of how we should change health delivery and discusses prospects for health reform.

George Halvorson, CEO, Kaiser Permanente from Health 2.0 on Vimeo.

Dr Octavian Purcarea

Global Solutions Manager,

World Wide Health

Microsoft

Semantic interoperability - Dream or reality?

opurcarea — Mon, 29 Jun 2009 17:08:19 GMT

Last week, European Commission and the Ministry of Health from Germany, with the support of Microsoft, organized a two days workshop on semantic interoperability in EHRs. The initiative was triggered by the work performed by 12 countries in the project epSOS - the large scale pilot conceiving and testing a EU shared EHR and ePrescribing solution. The workshop involved experts in terminologies from Europe, United States and from international organizations such as WHO, European Commission and International Health Terminology Standard Development Organization (IHTSDO).

As a reminder, the epSOS project (Smart Open Services for European Patients) is Large Scale Pilot (2008-2011) funded by European Commission and 12 Member States (additional 6 Member States are joining now). It is a Public-Private collaboration of National Authorities, Competence Centers and a Industry-Team (35 international and European IT-vendors managed by IHE-Europe). Cooperation has been initiated with European eGovernment Pilot on electronic Identification and electronic Health Professional and Health Insurance Card projects.

We had all a lot of expectations from this workshop, knowing that the pilot epSOS is in a stage where a structure and terminology must be chosen for building the "Health Passport". The terminology must be simple, enough standardized and unequivocal, in order to allow easy understanding and translation across 12 languages. Moreover, because of the economic pressure, patients empowerment and the need for sustainable health, semantic interoperability is a key to exchange of knowledge, clinic decision support, intelligent alerts, business intelligence. In short, all the enabling tools for a knowledge based healthcare.

Here enclosed are the main messages delivered during the workshop. I think it was a very open, productive and intense session.

The meeting was opened by Ilias Iakovidis, Deputy Head of Unit from eHealth, DG INFSO and Media, EC who outlined that the overarching goal of this workshop is to advance the understanding of patient summary and EHR-related standards with a view to enhanced semantic interoperability. The issues to be addressed are important not only for reasons of efficient data exchange, but also for industry, in light of the possibility of arriving at commonly agreed-upon standards for certification and interoperability testing ("test once use everywhere").

The first presentation, made by Erwin Bertels, representative of the German Ministry of Health, outlined that the European Commission, Member States and Associated States of the European Union agreed during the eHealth Conference in April 2007 in Berlin on a structured and coordinated collaboration in eHealth. This European eHealth Initiative intends to encourage a European and international collaboration on the development and implementation of interoperable and open eHealth infrastructures and electronic health services mainly based on international standards.

This collaboration will be structured on several levels according to the principles outlined in the EC Recommendation on cross-border interoperability of electronic health record (COM(2008)3282):

At political level, an eHealth governance process will be established under the Swedish Presidency in the second half of 2009, an European eHealth roadmap is under development, including the implementation of a Electronic Health Record framework (European Commission recommendation: until 2015), ensuring "second use" of medical data for biomedical research, evidence based medicine, epidemiology, biostatistics, health policy and management.

At organizational Level the national eHealth Competence Centers will co-operate to facilitate implementation and operation of cross-border eHealth services. At semantic level, it is acknowledged that the European multi-lingual environment requires semantic interoperable electronic health services, the knowledge must be human and computer interpretable.

The epSOS project developed 2 use-cases:

Patient Summary Use Case

"A European citizen from Country A requires unattended medical care in Country B as e.g. a tourist or travelling salesperson or attended care as e.g. a citizen living in Country A but crossing the border on the way to her or his working place in Country B daily. Receiving consent from the patient the physician in Country B can access the patient summary located in Country A and use it in his or her own native language."

Electronic Prescribing Use Case

"During a medical care event described above the physician can prescribe drugs urgently required by the patient based on his or her medication record as part of the patient summary or new drugs checking for interactions and contraindications. Dispensation of the prescription can take place either in Country A or B.

In these two situations, epSOS Patient Summary and Electronic Prescribing Services must support sharing of medical knowledge about a patient between two physicians in two different countries normally requiring translation (in at least one of 11 "epSOS" languages). The experts (physician and computer scientists - participating in the epSOS Work-Package: Semantic Services" - unanimously agreed that mapping of terms is required but is not sufficient to map the complete semantic of a patient summary. Therefore, Patient safety requires ontology-driven semantic interoperability (comprising content, context and interrelations).

Erwin expressed his expectations from the workshop regarding short term recommendations that can benefit projects such as epSOS and longer-term recommendations to be taken account for example by the European Commission eHealth Standardization Mandate 403.

Charles Parisot from GE, actually representing the IHE-Europe in this context, presented an overview of the US HIT-related provisions of the American Recovery and Reinvestment Act insisting on ARRA / HITECH calls for "meaningful use of EHRs" and the importance of semantic interoperability for future investment.

Barry Smith from US National Center for Biomedical Ontology summarized the Roadmap for Interoperability of eHealth Systems advanced by the EU's RIDE Coordination Action. He showed how elements of this Roadmap are being realized in a practical demonstrator project that is designed to yield practical experience of integration of useful medical data across linguistic boundaries within the framework of the epSOS Patient Summary Scenario. The EU RIDE project was entitled to design secure networks to exchange medical summaries (incl. Emergency Dataset), Business process interoperability across healthcare domains, Mechanisms to uniquely identify patients, healthcare professionals and institutions, semantic interoperability based on classification and coding scheme standards. Using the principles developed in RIDE: "Applying realist ontology to terminologies and EHR architectures means in the first place applying it to those entities in reality to which these artifacts of the human intellect refer, such as concrete patients, diseases and therapies", Barry is proposing: "Finally, it is time to solve the problems of semantics by using the theories and tools that have been developed so far, and that have been tested under laboratory conditions. This means using . an ontology that is able explicitly and unambiguously to relate coding systems, biomedical terminologies and electronic health care records (including their architecture) to the real world". However, this is a very difficult and costly project due to a lack of unambiguous mapping of languages in several terminologies such as UMLS, SNOMED-CT.

The epSOS demonstrator that Barry describes is based on a simple terminology (less then 200 terms) focusing on emergency dataset. In the eventuality that a patient is unconscious, we have urgent need for a small amount of information about the patient to be rapidly accessible to and reliably interpreted by the healthcare provider.

The item needed and tested would be:

1. Term lists from each project country

2. Shared reference ontology to support automatic translation and evolution over time

3. Summary snapshots / screenshots, one for each country (a template, to be filled in using terms taken from the term lists).

The terms will consist initially of the statistically most frequently used terms in all project languages, they will be organized into classes and subclasses under major headings such as allergies, medications, clinical problems. The goal is to find terms which, in total, cover some 90% of all relevant cases in each of the dimensions distinguished - focusing on those terms relating to features likely to be of relevance to cross-border healthcare. Thus, focus exclusively on those features on the side of the patient relevant to emergency care - not e.g. on healthcare transactions.

The snapshot will provide an emergency practitioner in country B with a quick overview of relevant features of the condition of the patient visiting from country A.

This template would be incrementally enlarged and with appropriate software will allow creation of patient snapshots via drop-down lists followed by an additional request: Name other allergies [etc.] from which this patient suffers and which you believe may be of relevance in case of need for urgent care. Entries under this heading will be collected and used as basis for extensions of the system in the reference ontology and in the separate term lists.

My presentation outlined the necessity for semantic interoperability: the exasperation of users due to the low usability of today's solutions, the wealth of studies showing that, without Clinical Decision Support systems, the EHRs are not really improving the clinical outcome. The new trends, disease management, care communities, Regional health information networks need semantic interoperability for increased efficiency and safety. Moreover, Microsoft made important efforts in the area of interoperability, developing standardized connectors for its HealthVault platform and Amalga Unified Intelligence System and Radiology Information System, allowing export and import of reports from and to legacy systems in standards such as Continuity of Care Record (ASTM E34), Continuity of Care Document (HL7), XML. Moreover, Microsoft and its partners contributed to IHE XDS b profile and HL7 ballots.

Microsoft issued the Common User Interface guidelines as a result of a project funded by the UK NHS. As a formal definition, the Microsoft Health Common User Interface (CUI) provides User Interface Design Guidance and Toolkit controls that address a wide range of patient safety concerns for healthcare organizations worldwide, enabling a new generation of safer, more usable and compelling health applications to be quickly and easily created.

I also reminded the efforts of Microsoft in the area of ICT system architecture with the Connected Health Framework, a vendor-agnostic set of best practices and approach based on Services Oriented Architecture (SOA), for architecting eHealth solutions for health information networks ranging from within health organizations to across multiple government agencies.

In conclusion, in my view, as industry members, we would like to have practical guidelines to enable implementation of interoperable solutions in the area of chronic disease management, condition management including behavioral changes. We know that the semantic layer in industrial solutions is still underdeveloped and the ICT Industry would need consensus about a terminology to be used in EHRs, Clinical Decision support and Alert systems.

Thomas Beale from Ocean Informatics and OpenEHR described healthcare is an information-intensive business where healthcare data is captured piecemeal during clinical work processes but used by other processes. Clinical care of patients is shared among multiple provider enterprises (exacerbated by increasingly mobile citizens), requiring information sharing. Information needs to be aggregated per-patient to be computable - to allow personalized healthcare and decision support and then across populations, for public health analysis and medical research.

Thomas described the archetypes structure allowing semantic interoperability and set the requirements for true interoperability in his view:

Stefano Bertolo, from the European Commission, DG Information Society and Media made an overview of the projects funded in 6th and 7th Framework Programme. In FP6 the project supported collaborative work such as NeOn (advanced ontology editor) and OpenKnowledge (semantic P2P). In FP7 the project funded were designed to support work on massive scale: OKKAM (global identity management), LarKC (large scale inference), Focus K3D (semantically interpreted 3D), CALBC (massive collaborative annotation).

Ioana Singureanu (Eversolve, HL7) presented some considerations about the work performed by various vendors in the framework of HL7 organization.

Since its introduction in the mid 1980s, the HL7 messaging protocol has successfully displaced a series of vendor-proprietary messaging formats for Electronic Data Interchange. Not happy to stop there, the HL7 organization has worked diligently with its latest version to move the standard in a new direction that is object oriented and model driven. Recently, HL7 has been exploring a Service-Oriented Approach, but what is the verdict on model-driven design and development? Ioana's presentation explored the use of the HL7 Reference Information Model as a mid-level ontology for achieving semantic interoperability by aligning concepts between organizations or jurisdictions. While HL7 Version 2 is still the work-horse of clinical enterprise interoperability, how has HL7 Version 3 delivered on its promise of clear conformance and semantic interoperability? In answering this question, the presentation described practical implementation methods that harvest the findings of over 10 years of HL7 information model development and use in order to develop semantically interoperable solutions that cross jurisdictional and language boundaries. The presentation covered the work in progress on defining healthcare privacy requirements and specifying engineering solutions for privacy policy and data consent enforcement.

The day 2 of the workshop, Jennifer Zelmer from International Health Terminology Standard Development Organization (IHTSDO) stated that effective use of standardized terminologies such as SNOMED CT, along with other health information standards, is key to making this possible, whether information is being shared around the corner or across national borders. She explained that IHTSDO orchestrates a globally co-ordinated effort for agreement on a core terminology for recording and sharing of health information, seeking pooling of resources to share the costs and benefits relating to the sustainable development and maintenance of the terminology products, consistent promotion of the uptake and correct use of the terminology and active harmonization activity with other SDOs.

She gave a brief staus update:

She gave relevant examples about successful implementation of SNOMED CT:

Jennifer concluded with a call for action for improving SNOMED CT use and uptake by sharing experiences, becoming active in the Community of Practice, visiting their collaborative web site, affiliate Forum and contribute with suggestions for improving the standard (additions, changes, etc.).

Her presentation was followed by a through presentation of the new classification terminology from WHO - ICD 11. Robert Jakob presented the main components of ICD:

Then he detailed what are the expected changes in ICD 11:

The ambitious goals of ICD 11 is to serve as an international and multilingual reference standard for scientific comparability and communication purposes and to ensure that ICD-11 will seamlessly function in an electronic health records environment, to link ICD logically to underpinning terminologies and ontologies. The ICD Categories are "defined" by "logical operational rules" on their associations and details. ICD 11 will be an electronic database available on-line. The calendar of implementation can be found bellow.

Dr Sylvia Thun from DMDI (Germany) presented the latest news from epSOS and the decision regarding use of very simple models for the emergency summary. Starting from a health passport available on paper version, they have proposed the use of a simple model with less then 100 terms.

Dr Thun presented after some snapshots of a demonstrator using this simple terminology:

It appears that epSOS is ready to prove that we can transmit medical information from one language to another in a medical useful way (human and machine understandable). Though very simple, it can be an invaluable way of preventing errors of interpretation of symptoms and treatment for patients travelling cross border or found unconscious.

Dipak Kalra from the University College of London (UK) had a provocative speech about practical ways of achieving semantic interoperability. Achieving semantic interoperability, ensuring that the clinical meaning of entries in an electronic health record are fully and safely computable across systems and countries, is a significant challenge. The tools available to help achieve this, such as EHR information models, archetypes and SNOMED CT, have yet to be proved at scale but nevertheless are critical to this challenge. The presentation summarized the findings of the Semantic Health roadmap on near-term and practically-achievable semantic interoperability goals. The roadmap is an excellent visionary exercise on long term interoperability and I recommend you to take a look. *

Paolo Ciccarese from Harvard University presented Medicognos platform - an innovative EHR using embedded semantics. He excited us with the paradigm shift from the forty-year old problem-oriented medical record to a fully process-oriented knowledge management platform for continuity of care and disease management, possible only through adoption of explicit semantics. Electronic Health Record he described rely on a unified semantic model combining in one single framework biomedical data, clinical processes and a model of information. This comprehensive approach will make it possible to document and share not only patient data but also other fundamental aspects of the health care process. Many questions were raised about the interoperability to other existing solutions but it appears that the EHR platform he conceived with the help of enthusiastic GPs is so advanced that can interoperate with multiple systems if, of course, they use the same core terminology. The model looks very appealing and corresponds to the last generation of EHRs able to support collaborative healthcare process and disease management.

The brainstorming at the end of the workshop around semantic interoperability agreed that EHR vendors to be urged to create a common format for presentation of de-identified data. We need to collaborate across vendor organizations, epSOS project and invited experts to build a Venn diagram of semantic requirements, testing criteria and debate with the users on the possible business case and incentive programs. We hope that, at the political level, we will have an eHealth governance and in the next CIP (Competitiveness Innovation Programme) we will advance towards common health services pilots.

In conclusion, we assisted at a collection of views and solutions for semantic interoperability, we saw different roadmaps from RIDE, Semantic Health, WHO, SNOMED CT, HL7, we admired some implementations (Ocean Informatics, Medicognos) and we acknowledged the important steps that epSOS did on the path to create an interoperable Health Passport in Europe.

We agreed that a new meeting will be organized after the summer, in order to refine the terminology proposed by epSOS and get additional input from experts.

Dr Octavian Purcarea

Global Industry Manager

World Wide Health

Microsoft

Overcoming the challenges to eHealth.

opurcarea — Sun, 28 Jun 2009 02:02:43 GMT

Brussels seemed to be the center of the world last 2 weeks - several conferences were organized, unfortunately overlapping as topic and time. For example, on the 17th of June, members of COCIR (European Radiological, Electromedical and Healthcare IT Industry) celebrated 50 years of existence of the association and organized a series of workshop around eHealth.

On the same day, I have been invited to attend a workshop organized by Linklaters - a law firm that has a practice related to eHealth. The title was very appealing ("Overcoming the challenges to eHealth), as well the quality of attendance so I opted for this particular workshop.

Why a law firm would organize such a workshop about eHealth? Linklaters received a mandate from Rockefeller Foundation to prepare, with the International Society for Telemedicine & eHealth (ISFTeH), a feasibility study on the creation of a new international Convention governing the key aspects of eHealth. The report of Linklaters will be published later this year. The workshop was one of the main initiatives designed to get feedback for this study.

Under the brilliant moderation of Nigel Jones, the Global Co-Head of Healthcare Group from Linklaters, we assisted at a first group of presentations setting the scene of eHealth at international and European level.

I will detail some of the presentations I enjoyed the most.

Professor Yunkap Kwankam, executive Director of the ISFTeH made a quick overview of the main features of eHealth and expectation related to its implementation. He outlined the importance of eHealth for boosting the human resources performance, especially in countries with critical shortage of health professionals (doctors, nurses and midwives). A view of the countries with critical shortage is given by WHO:

He outlined that, even in the poorest countries, the accumulation of information and available knowledge makes impossible for the health professional to cope with the problems of their patients. There is no way that this quantity of data could be used without computers and internet.

Unfortunately, the knowledge gap has innocent victims: 11 million children under 5 years old die every year - 90% of them in the developing world. 2/3 of these death (7 million) can be prevented by available, effective and cheap interventions.

The challenges to eHealth identified by Yunkap in developing countries are related to the local capacity to implement eHealth. The low institutional capacity (Infrastructure and connectivity, legal and regulatory environment, administrative structures) is accompanied by a limited human capacity (lack of ePractitioners - health workers able to use ICT in their activity, lack of tools to enable citizens to be transformed from a passive observer to active participant in his own care, lack of eHealth specialists in the Ministries of Health with career prospects to attract and retain them).

Moreover, there is eHealth '"pilotitis" in developing countries - a wealth of small scale pilots, often not adequate with the size of the problem tackled, with no repository of information and knowledge about the results of the initiative.

Yunkap identified the mobile health (mHealth) as being the future and the solution for many health problems in developing countries; the mobile technologies are a convergence of media, communications and computing that can be available where the real need is. The mobile technologies can facilitate exchange of information from trained volunteers and spread of basic medical knowledge in the most remote areas.

Yunkap described the initiative of the ISFTeH in the area of sharing of best practices - an international eHealth registry with comparable information on eHealth projects around the globe, shared freely and linked to other repositories of information on ICT in Health. The three main conclusions of his speech are: the need for a continent-wide vision in eHealth, with local insights; the human resources are the key and partnerships are the model (private-public, local, national and continental networks).

Next speaker, Ilias Iakovidis, Deputy Head of Unit from the eHealth Unit of the DG INFSO and Media (EC) made an overview of the EU activities in the area of eHealth.

He explained which are the main barriers to eHealth in his vision, such as, market fragmentation, lack of interoperability, the legal uncertainty, lack of availability and access to finance and lack of procurement in the area. A special discussion was engaged around cultural barriers: in some countries, ICT is seen by the doctor as a tool to be controlled by the state or to loose the power on his patients. The collaboration among practitioners and exchange of information raises concern about loosing patients. That's why, empowering patients, informing them, giving access to medical records is seen as an intrusion in a private space. An interesting discussion was also triggered by the different perception of factors determining the health status of an individual or a population. While the environmental factors, the quality of the healthcare and genetic "blueprint" seem to be very important, in reality the paramount factor is the healthy behavior and lifestyle. Moreover, Ilias explained the EC focus is to explore the legal way of exploiting the data from Electronic Health Records, while protecting the fundamental right of data privacy, for secondary treatment - clinical studies, epidemiologic studies, intelligent alerts.

Next speaker, Tanguy Van Overstraeten, from Linklaters UK, raised our attention on the legal constraints on the use of health data. eHealth application often involve the processing of information regarding identified or identifiable patients and trigger issues of data protection, confidentiality and security. The EU level legislation such as the Directive 95/46 has no effect without national transposition of the same principles throughout Europe.

There are a number of Directives related to use of personal data (such as 95/46, 2002/58) Council Recommendation and opinions of the Art 29. Committee related to eHealth (see N° 131 of 15th February 2007 on the processing of personal data relating to health in the EHR). The EU legislation has a twofold ambition: protect the data privacy while allowing the free movement of personal data within EU. Some of the texts such as the Art 29 opinion on use of EHR data, limit considerably the exploitation of medical data for secondary purposes especially for research and public health. Briefly, the speaker explained the main definitions related to use of personal data in eHealth and concluded that in EU a legal framework is in place that must be taken seriously into account and data protection issues should be identified as early as possible as specific technological features may help compliance (e.g. privacy by design).

The users perspective was detailed by Professor Iain Carpenter, Clinical Lead on Record Standards at the Royal College of Physicians from UK. Iain led an outstanding work on a clinical guidelines regarding the presentation of an EHR. Curiously, after exploring the needs of many categories of specialists, it appeared that a common EHR could suit most of the specialties. As a conclusion, Iain presented us the main clinical elements of the medical record agreed by all associations of health professionals. A number of stages of consensus was used to get the feedback of working clinicians. The first stage began in July 2006 with a poll we conducted through Doctors.net to gather opinion on standardizing the structure of the admission clerking proforma across the NHS. The poll showed 2:1 in favor of having a standardized proforma with 73% of consultant physicians in agreement. A similar poll was conducted with the fellows and members of the RCP with 86% of consultant physicians agreeing. Both polls had over 1000 respondents. A formal launch and publications of the Record standards are planned for the Autumn. Templates of admission, handover and discharge records will also be available online as would a clinician's guide. More information can be found here.

The patients perspective was expressed by Ms Marlene Winfield, Director for Patients and Public, NHS, UK. Ms Winfield explained that one the most important barriers is the lack of availability of medical information for the patients. There is still a blockage of the patients' data by the physicians.

The ICT must be a collaboration tool and the computer must be part of the sharing exercise before, during and after a consultation. The main elements that the patients could share with their doctor or other health professional might be a questionnaire that the patient prepared for the consultation, a regular health tracker - a questionnaire/graph/video diary that the patient keeps about general health, symptoms, results of the patient self-monitoring, photos taken by the patient if his own wounds for example, test results (lab, scan or X ray.), treatment preferences, information on prescription, feedback on the service given by the patient or other persons. One of the initiatives of the NHS in order to reinforce the information for patients is a pilot on prescription (see www.informationprescription.info).

Ms Winfield described a scenario involving a person with diabetes using internet, Personnel Health Records and monitoring devices for decreasing the risk of acute disease and complications.

The conclusions were that the patients want more information to enable them to look after their health (Picker Institute studies.), eHealth can facilitate communication between patients and health professionals, the EHRs must be jointly held, there is no sustainable alternative in the future to the partnership clinician/patient. This partnership is a big cultural change for clinicians and patients and must be part of the education in schools and professional training. The patients are unlikely to use their eHealth tools to the maximum unless they become a routine part of the care.

The next presentation made by Pieter Van Den Broecke from Linklaters Belgium was around the Intellectual Property Rights (IPR) in eHealth. he outlined the available resources for IPR protection and the specific legal issues that are to be considered. IPR is an opportunity for innovators in the area of mobile devices, personnel health and monitoring devices.

My presentation around eHealth barriers identified the usability, trust, sustainability and empowerment as the main difficulties in eHealth. Why usability? Several studies shown that due to the low usability many IT programs are abandoned:

Moreover,the software vendors have left all the technical complexity for the user.

The only way to get to the desired level of usability is to design a software that would reflect the work process of the user (workflow ) and the the mental model (concepts) of the user (terminology). Such a development would give birth to a new generation of Clinical information systems (partner level) that would enable assisted clinical decision, use of care path and real disease management (built on evidence based medicine and evidence based management).

This kind of innovative software is developed by some of the partners of Microsoft (such as Medicognos, C-Care, Fresenius, Parrot Systems) and is seen as a very promising solution for many IT plans regarding management of chronic diseases in view of a sustainable healthcare. The usability is also related to the user interface and I will remind the project funded by the UK NHS - Common User Interface guidelines. As a definition, the Microsoft Health Common User Interface (CUI) provides User Interface Design Guidance and Toolkit controls that address a wide range of patient safety concerns for healthcare organizations worldwide, enabling a new generation of safer, more usable and compelling health applications to be quickly and easily created.

Moreover innovative data entry, speech recognition, surface computing are some of the innovations the Microsoft and its partners are proposing to increase the speed of interaction of health professionals and patients in eHealth.

Some examples can be figured:

The second barrier - trust - (detailed in my previous blog) has as solution involvement of the clinicians, the health professionals very early in the process of planning and implementation of a eHealth solution. We need to convince them by showing solid proof of improvement of outcome of healthcare in similar settings and train and assist them to enable the appropriation of an IT solution.

What about sustainability? The paradigm of care versus cure is the one to which I adhere. The approach of an individual, a patient as whole, an entity with personality, living in certain environment (social, natural) and having certain genetic predispositions and habits is offering the key to sustainable healthcare. Using the IT tools we can inform, empower, facilitate the information of the patients and enhance communication between caregivers and the patients.

One of the key elements could be the Personnel Health Record supported by a platform such as HealthVault.

Such solutions could facilitate in Europe the empowerment of individuals and pave the way towards efficient disease management solutions and a real, incentive based containment of costs.

Dr Octavian Purcarea

Global Solution Manager

Worldwide Health

Microsoft

Trust and usability - the two weak links

opurcarea — Fri, 26 Jun 2009 18:12:18 GMT

I attended last week in Brussels the meeting of the International Insurance Association (AIM) Disease Management group. The AIM is a grouping of autonomous health insurance and social protection bodies operating according to the principles of solidarity and non-profit-making orientation. This meeting was one of a series of meetings organized by AIM on the topic of business models and sustainability of healthcare focusing especially on Personal Health. I will details some of the presentations that seem to me outstanding.

The meeting started with a very interesting report of the visit in Israel of the AIM members. Rachele Kaye (Director, Maccabi Institute for Health Services Research) presented the main features of their integrated IT system for healthcare. We learned that all information flows in Maccabi Healthcare are digitized, a health portal is opened for the individuals enrolled in their insurance and the health professionals can access all relevant information regarding a patient. The continuum of care seems preserved in this setting. More impressive was for me the concentration of lab test and the real time access to results from any point of the health care facilities. Some words about the healthcare in Israel: There is an universal social health insurance system, managed by 4 competing HI funds (mutual benefit society) with an open enrollment and a free choice of HI funds. The total health expenses are presenting 7.9% GDP which are 66.5% public and 33.5% private. Maccabi Healthcare is one of the 4 health insurance fund covering 24% of the market (1.780.000 members), supplying health services both via its own facilities and through outside providers that are paid on a capitation basis. Maccabi Healthcare principles in Chronic Disease management are the multidisciplinary team and a model based on pro-active intervention by team members based on EBM, integrated IT (registries, reminders, ...),empowering patients (active role in the management plan), monitoring clinical quality measures, improved patient centered services (web-based services, call center, free choice, direct access, reduced bureaucracy..), high tech services (telemedicine, EHR..) and a dynamic management method (managerial IT, trained mid-managers physicians, rewarding continuous improvement with a large set of indicators). One of the most interesting feature of their eHealth solutions is related to the patient information booth (self-service stations for patients), allowing them to printout : lab results, X Ray results, fill in physiotherapy follow-up questionnaire and access education material on lifestyle and basic measurements (BMI).

Another interesting presentation was done by Mr Maghiros from IPTS (Institute for Prospective Technological Studies - IPTS - Joint Research Centre - European Commission). The IPTS, based in Seville (Spain), is a part of Directorate General JRC of the EC which groups 7 Research Institutes across Europe. The mission of IPTS is to "provide customer-driven support to the EU policy-making process by researching science-based responses to policy challenges that have both a socio-economic as well as a scientific / technological dimension". The institute is conducting a study called Strategic Intelligence Monitor for Personal Health Systems that aims to unveil the barriers to adoption of personal health systems (PHS) perceived as a key patient and consumer driver (driver of the economy - Lead-Market) and decongestion of secondary care infrastructure (chronic disease segment). In the IPTS vision, people are in the center of the healthcare system and the personal health systems can be divided in 3 categories:

There are a number of questions that IPTS will tackle in the following month, such as the role of Personal Health Systems in the future healthcare, known barriers to adoption, positive motivation, policy initiatives, barriers to public health re-imbursements, how will prevention and wellness become reimbursed, the insurance as a driver for change.

Len Deacon from South Africa made a brilliant presentation emphasizing the difference between healthcare in the developed and developing countries. In few words in developed countries we are talking about delivery of care at home, move away from hospital-based treatment, move to prevention and remote monitoring as a way of cutting high costs and preserving or increasing the quality of care. In developing countries we are talking about extending healthcare to more of the uncovered (State/Public), Public/Private Partnership (extending care), monitoring intervention for "at risk" members (Coaching / disease management), preventing future illness (communication, coordination of care, wellness - prevention of HIV/Aids, demand management). South Africa has specific problems related to a discrepancy in wealth distribution, high unemployment, many languages (11), low life expectancy due to high prevalence of HIV (11% of the population). The model emphasized by the speaker is total health management across continuum of care:

This model implies an absolute interdependence between the patient, the doctor and the medical scheme. The patient is empowered but in strict cooperation with the health professional. The type of interventions performed are detailed above (right image).

Very interesting is the proposed methodology to act on the high risk patients. After a local study the risk identified can be grouped:

The categories at high risk are proposed changes in behaviors, incentives, wellness and disease management programmers in order to allow them to change their risk category (see above right picture).

The coaching program and use of Personal Health Systems has been studied on year basis and the results are quite impressive: on more then 20.000 members of the insurance, 2800 have been coached according to the risk and the ROI was about 1:1,8 (3,660 million R - about 450.000 USD net savings in one year). This makes about 160 USD/person/year.

The message of Len is suite clear: we can achieve high return on investment only by a close collaboration between the individual, the health professional, the insurance and the employer. The last two categories can bring the sustainability, the incentives and the institutional support for achieving a total health management.

Very interesting also was the study performed by Abbott on the compliance and adherence of the patients to their treatment (Patient Adherence Research Project).

The two definitions must be kept in memory:

Compliance (from Vermeire et al.. J Clin Pharm Ther (2001) 26, 331-342)

.The extent to which a person's medicine-related behavior coincides with medical advice

.Assumption that "rational" patient behavior means following medical advice precisely

.Paternalistic: doctor makes choices and directs patient to follow

Adherence (from World Health Organization - Adherence to long term therapies: Evidence for Action (2003))

.The extent to which a person's behavior - taking medication, following a diet and/or executing lifestyle changes - corresponds with agreed recommendations from a healthcare provider;

Often ignored, the problem of compliance is much more important then assumed. The prevalence of non-adherence is 40% to 60% in arthritis (Belcon, M.C. et al (1984), Arth and Rheum, 27: 1227-1233; 1984. Hicks, J.E. (1985),Comp Ther, 11: 31-37), 15% to 43% among organ transplant recipients (Didlake, R.H. et al (1988),Trans Proc, 20(3): 63-69; Rovelli, M. et al (1989),Trans Proc, 21: 83-834), 18% to 70% in the treatment of depression (Engstrom, F.W. (1991) in J.A. Cramer and B. Spilker, eds., Patient Compliance in Medical Practice and Clinical Trials, Ravens Press, New York, NY; Myers, E.D. and A. Branthwaite (1995), Br J Psych, 160: 83-86.), up to 50% of patients on hypertensive medications cease treatment. Of those staying on treatment, 33% do not take sufficient medication to control their blood pressure (Vermeire et al. 2001, J Clin Pharm Therapy, 26(5):331-34).

What is cost of non-compliance? Research shows that in the U.S. non-adherence causes 125,000 deaths annually (Smith, D. (1989). Compliance packaging: A patient education tool. American Pharmacy, NS29 (2)), non-adherence costs an estimated $100 billion a year in direct and indirect costs (National Council on Patient Information and Education. (1995). Prescription Medication Compliance: A Review of the Baseline of Knowledge. Washington, DC), approximately $47 billion of this cost is associated with 8.8 million drug-related hospitalizations per year (Friend, T. (1995). Health and education. USA Today, Tuesday, October 3, 1995. 4D).

It is believed that: Increasing the effectiveness of compliance interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments (Haynes RB et al. Interventions for helping patients follow prescriptions for medications. Vol. 1. Oxford: The Cochrane Library, 2001).

As a solution there are foreseen (see bellow) interventions in the area of awareness, communication among stakeholders including patients and healthcare professionals as well as personal health systems making easy the correct drug intake for patients.

In such a context, my presentation emphasized the advantages of Personal health solution notably of the Microsoft solutions around the Disease management, Case Management and Health & Wellness. Hence, one of the keystone of personal health systems is the Healthvault platform. Developed after a thorough assessment of the patients and healthy individual needs, the platform offer a wide range of services (storage and communication of health data in several standards, communication with medical devices, alerts and statistics.) which can be easily adopted by a variety of health institutions. We see the use of Personal Health system as a way to shift healthcare from cure towards care, enhancing awareness, favoring behavioral changes and information as well as increasing communication between health professionals and the individual.

The patient involvement in health care is seen as a key aspect for improving healthcare outcome and solutions such as HealthVault platform can enable this side of the equation. Moreover, the addition of AMALGA UIS on the platform could solve the interoperability issue with heterogeneous Hospital Information Systems and populate the Patient Health Record with the data stored in hospital.

But why I started with the trust and usability as title? In order to achieve an efficient disease management system one should think that two of the most important barriers are the trust and usability. Let's take a closer look: usability has been one of the major cause of failures in the IT programs; with a poor design, the health professionals loose time, can add other errors of interpretation and finally abandon the use of the software. The IT industry must take a particular care on these aspects. Microsoft issued the Common User Interface guidelines as a result of a project funded by the UK NHS. As a formal definition, the Microsoft Health Common User Interface (CUI) provides User Interface Design Guidance and Toolkit controls that address a wide range of patient safety concerns for healthcare organizations worldwide, enabling a new generation of safer, more usable and compelling health applications to be quickly and easily created. Moreover, several IT programs across Europe initiated by the governments and/or insurance companies have encountered resistance from the health professionals. Imagine how difficult would be to change the behaviors of the health professionals and persuade them to use new IT tools, change the way they are working and communicating. One solution to the trust problem would be to allow them to decide on the care path, on the design of the IT tools and to involve them in the overall organization of a chronic disease management program. In exchange, performance and quality management should be enabled so as a program of incentives. There is no other solution to the trust problem then the collaboration, active involvement of the health professionals in any of the insurance and governmental healthcare programs. The same stand for the patients trust. Patient associations and customer rights association should be deeply involved in large IT programs in order to achieve adherence of the users from the inception of the initiatives.

The IT solutions are available and must be wisely assembled in a comprehensive eHealth solution that will help all the stakeholders (favoring change in behavior, empowering users, increase adherence to the treatment, increase health care user communication and information), while being trusted, usable and sustainable.

Dr Octavian Purcarea

Global Solution Manager

Worldwide Health

Microsoft

Research in Portugal

opurcarea — Thu, 04 Jun 2009 13:42:58 GMT

My souvenirs about Lisbon were associated with an intense, golden sun light and impeccable blue sky. Unfortunately, my last week visit in Lisbon was accompanied by a gray weather and steady rain. This was not impeaching a group of enthusiasts to assist at the launch of the MICROSOFT RESEARCH CHAIR IN HEALTHCARE. The meeting took place in the Knowledge Pavilion - an interesting science and technology museum attracting many visitors.

The primary goal of the MICROSOFT RESEARCH CHAIR is to attract to Portugal a top level researcher currently working abroad, in order to develop and to promote emerging areas of knowledge, namely fostering the growth of research and development activities, and advanced education in fields of common interest both to MICROSOFT and to the University(ties) which will be selected as host institutions, with special focus in one of the following knowledge areas:

Electronic clinical record;
Health Information systems interoperability;
Health Business Intelligence;
Interaction citizen /Health information systems.

The Foundation for Science and Technology (FCT) and MICROSOFT will launch a public call for the attribution of a programme-contract with one or more scientific institutions in articulation with universities, aimed at the co-funding of the MICROSOFT RESEARCH CHAIR IN HEALTHCARE. The total funding is between 600 and 900.000 Euros for a period of 5 years.

The opening ceremony was attended by Prof. José Mariano Gago - Minister of Science, Technology and Higher Education, Dr Manuel Pizarro, Secretary of State from Ministry of Health, Prof João Sentieiro - president of the Foundation for Science and Technology (FCT) and Mr Nuno Duarte, Director General of Microsoft Portugal. Some pictures are included.

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This initiative is very interesting and unique in Europe. The aim is to support the implementation efforts in the area of Electronic Health Records and foster interoperability between system installed across the country. Moreover, the research performed should offer guidelines and solutions to semantic interoperability and practical ways to surface clinical knowledge to all health workers (and perhaps citizens) without the need for heavy EMR applications.

Personally, I appreciated very much the wise approach of the Portuguese government regarding eHealth implementation. For example, during several weeks, a Committee of well recognized national experts is performing a large consultation of different stakeholders. Their interest is less turned towards IT solutions but more towards overall vision, success factors and business elements. Of course standards and IT architecture is important but the most important appear to be the practical way to implement a system able to contain costs while improving the quality of healthcare delivered to individuals by health professionals and paid by the government.