Update: IHE advancing in key European programs

The past year saw substantial advances across e-health projects in Europe as regional, national and European-level programs reported moving from strategy development to deployment. Two days of presentations during the ninth annual European Connectathon in Vienna provided a panorama of progress with updates and profiles of best practices.

As 230 engineers and programmers ran hundreds of tests for interoperability between new e-health systems and devices in an adjacent workroom, speakers in a workshop program organized by IHE-Austria highlighted projects moving forward that all share IHE processes and tools.

A special evening presentation on "Best Practices for Interoperability" organized jointly by COCIR and HIMSS-Europe also offered perspectives from leaders across the landscape of healthcare interoperability.

Peter Kuenecke, the co-chair for IHE-Europe representing vendors, showed how testing at Connectathon is the key moment in a step-by-step process for assuring interoperability between e-health systems and that the event is truly a marathon with thousands of tests conducted over the five days.

Successful results are published and provider vendors with a precise and public interoperability profile for a specific commercial product, which when included in the procurement process is helping to create what he called "an effective pressure point for market-driven interoperability."

As an example, all new and replacement radiology equipment in Austria must conform to IHE profiles in the tender to be eligible for procurement.

Real progress with IHE gaining credibility

Charles Parisot with GE Healthcare, who was introduced as IHE-Europe's Guru for Interoperability, reminded the audience that IHE-Europe was the first regional organization to formally engage countries to deploy IHE and that today nine European nations host IHE initiatives (See IHE-Europe National Initiatives).

Four other countries, Denmark, Poland, Turkey, and Switzerland, are currently in the process of joining IHE-Europe, he said, and Switzerland sent a special delegation to the Connectathon in Vienna to observe the live testing.

"The challenges of e-health are well-known and e-health projects remain high-risk with interoperability remaining the key issue," said Parisot. "Hospitals continue to struggle with interoperability of their systems while health authorities, buyers and vendors suffer with too much interoperability customization," he said, adding that while there is no shortage of standards for healthcare informatics there remain inconsistent approaches in adopting those standards.

"We have struggled with these issues for years, but in 2008 real progress was made with IHE gaining a recognition as a solution to these problems and winning credibility at the highest levels of stakeholders in Europe," he said.

The European Commission (EC) launched a major technical coordinating activity in 2008 entitled the eHealth Interoperability Standards Mandate (M403), he reported. Cross-border interoperability falls into a crack between the Commission and the individual countries with the EC having no provenance to fill the gap.

In the first phase the process and organizational have been defined in a report that was approved by the EC in March, 2009. (For more information, please visit www.ehealth-interop.eu

Parisot also updated workshop participants on advances for IHE in Europe across a number of programs that range from high-level policy programs, such as the i2010 subgroup on eHealth and Calliope with the EC Directorate for the Information Society, to vendor-driven initiatives with COCIR, IHE-Europe and the Continua Alliance.

Large-scale project for European cross-border exchange launched

A landmark European-level program launched over the past year that links health authorities, users and implementers is European Patients Smart Open Services (epSOS), which engages 12 European countries in cross-border information exchange of patient identification with patient medical and medication summaries.

An overview of this ambitious large-scale European project was presented by Frederik Linden, the epSOS program manager who is also a project coordinator for the Swedish national e-health program, while Peter Brosch with the Ministry of Health for Austria described his country's participation in the program as leader of the work package for patient identification. (For more information, visit www.epsos.eu)

epSOS also became the subject of a lively discussion between Erwin Bartels from the German Ministry of Health and Charles Parisot during the session dedicated to Best Practices for IHE Interoperability sponsored by COCIR and HIMSS-Europe.

Describing the progress of the epSOS project for workshop participants, Linden reported the focus is on concrete cross-border services, saying "if we can solve these issues of identification and patient summaries, we will have accomplished a great deal for health information technology in Europe."

"It's time to get our money's worth out of investments made in this area," he said by moving from e-health strategies to specific service delivery.

Patients will gain quality and safety for healthcare services when traveling, he said, and industry will also benefit greatly from this program.

Brosch told workshop participants that beyond technical interoperability, the epSOS group faces other significant challenges to cross-border services that include legal interoperability, organisational Interoperability and semantic interoperability. The endpoint for the work is a pilot operation in 2011.

IHE-Europe is a partner in the epSOS project with the 12 countries and represents an industry team made up of 30 companies.

"The industry group is making us focus sharply on objectives continually asking that we deliver, deliver, deliver," said Linden.

Bartels from the German Health Ministry also acknowledged that an industry voice at the table with 12 governments was a valued contribution of IHE-Europe.

"It was a precondition that if industry was to participate in this project it must do so with a single voice, and Charles (Parisot) said it could be done. We did not believe it was possible, but by some mysterious force, it was done and is working well," he said.

"From the perspective of the health ministries of the Member States participating in epSOS," said Bartels, "implementing these cross-border services is not solely a political challenge, it is an ethical issue of patient safety as well."

"With 16,000 deaths each year in Germany due to medication errors and the challenge for chronic disease management in the face of demographic changes, we need communication services with an ability to share knowledge among all the people who provide care to a patient," he said.

During the Best Practices forum organized by COCIR, a lively discussion emerged from the observation that technology is not the obstacle to achieving better patient services, but that it is alack of political will to implement these solutions.

Bartels replied, "My health minister will not discuss XML or XDS, and we have heard for many years promises about patient-centered care while only seeing organization-centered solutions".

"If you can demonstrate continuous care in a secure manner, then you will win the political will to get it done," he said.