02-19-2013kristian & søren duus Østergaard duus.communications aps conclusions from e-health...

02-19-2013 Kristian & Søren Duus ØstergaardDuus.Communications ApS

Conclusions from e-Health

National Projects NPfIT - NHS (UK 2002) Estonia: Electronic Health Record System

(2008 - ) International projects

EpSOS Cross Border eHealth (2008 – 2013) Baltic eHealth Project (2005 - 2007)


NpfIT – Health – 2002 – 2011

> 15 Bn € All hospitals, GP's medical staff in UK Centrally stored Summary Card Severe and critical audit remarks:

Lack of overall Architecture Lack of citizen and staff trust in central solution Lack of basic principles for security/privacy Numerous examples of security breaches

Development stopped in 2011 Back to decentral organisation


Estonia e-Health System - 2008-

Builds on a national overall ICT strategy (from 2001)

Clear principles and service-oriented architecture

National Identity solution common to all sectors

X-Road – principle connecting sub-domains

Stepwise implementation:

Digital patient Record (decentralised DB's) Digital booking/reservation Digital Prescription

Well accepted and take-up steadily increases


Estonian eHealth System


Baltic eHealth Project - 2005-2007

Connecting national Health networks for specialists – Radiology + Ultrasound

Supplementing national staff – Rural areas Central hub + defined set of standards Infrastructure based on Danish MEDCOM Secure connection between hospitals Successful and continued as R-Bay (eTen)


EpSOS – 2008 – 2013(Smart Open Services for European Patients)

Enable patients to receive medicine and allow transfer of health summary record across broders

Establish trusted network between National Contact Points

Read-Only access allowed to practitioner

No data stored locally (abroad)

Interoperability addressed through:

Clinical Document accepted architecture

A master Value Set Catalogue

Master translation/transcoding catalogue

An epSOS ontology (linguistic reference system)


Recommendations 1General principles for eHealth across EU:

Common Baseline for security of eHealth Data Framework for x-national acceptance of eID Baseline set of standards for access control Common standards for 'secondary use'

(like de-identification for health data used forstatistics, research etc.)


Recommendations 2International/x-border eHealth solutions

Decision Phase:Define baseline standards for the data contained in the proposed solution and ensure maintaince of these

Design PhaseEstablish National Control Point/Gateway and a set of x-national rules, audit, logging, access rights

Secure Interoperability between users in each country

Robust definition of network security between NCP's


Recommendations 3International/x-border eHealth solutions

Operational Phase:Establish common body to ensure audit, monitor andresolve differences between countriesEnsure compliance with changes in EU regulations

Not only Data Protection skills, but also health authorities (Patient Security + privacy)

Updating the common set of ethical and legal standards

Decommisioning PhaseMigration of vital data to new system(s)


Back up slides


NHS – NPfIT - Structure


Baltic eHealth


EpSOS - Interoperability


EpSOS Structure

02-19-2013kristian & søren duus Østergaard duus.communications aps conclusions from e-health...

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