On December 17, 2010, in Washington DC, Neelie Kroes, Vice-President of the Euro-pean Commission and Kathleen Sebelius, United States Secretary of Health and Human Services signed a Memorandum of Understanding on Cooperation Surrounding Health Related Information and Communication Technologies (ICT). This high level partnership between the EU and the US sent a strong signal to all stakeholders that a more global approach was needed to foster a mutual understanding of the opportunities and challenges ahead, and reinforced that advancing the effective use of Health ICT will benefit patients, health systems and the eHealth market.
In this book, we introduce the Policy Briefs which have resulted from the ARGOS project. We trust that this provides a good example of a transatlantic cooperation jointly coordinated by the EuroRec Institute and by the American Medical Informatics Association (AMIA). The ARGOS project was funded by the European Union within the framework of the Pilot Project on Transatlantic Methods for Handling Global Challenges in the European Union and the United States. The general objective of the Pilot Project, created through a European Parliament initiative, was to promote mutual understanding and learning among EU and US policy researchers and policymakers relevant to a number of challenges having a global dimension.
More specifically, the goal of the ARGOS project was to help address and meet global health policy challenges using ICT-enabled solutions, as well as to develop and promote common methods for responding to global eHealth challenges in the EU and the US.
The ARGOS Policy Briefs address key health informatics topics (many of which require interoperability and standardization) and cover the following four areas:
1. Semantic interoperability was the first priority identified by the ARGOS Transatlantic Observatory. This topic represents a globally recognised challenge that must be addressed if electronic health records are to be shared among heterogeneous systems, and the information in them exploited to the maximum benefit of patients, professionals, health services, research, and industry. Progress in this multi-faceted challenge has been gradual, valuable lessons have been learnt, and approaches discovered in Europe and in the US that can be shared and combined. In particular, interoperability between systems requires widespread and dependable access to published and well maintained collections of coherent and quality-assured semantic resources, including models such as archetypes and templates that would (1) provide clinical context, (2) be mapped to interoperability standards for EHR data, (3) be linked to well specified multi-lingual terminology value sets, and (4) be derived from high quality ontologies. Wide-scale engagement and commitment from professional bodies is needed at a global level to develop such clinical information standards.
2. Modelling and simulation of human physiology and diseases is a longer term endeavour also addressed by ARGOS. Life is the result of an intricate systemic interaction between many processes occurring at radically different spatial and temporal scales. Every day, worldwide biomedical research and clinical practice produce a huge amount of information on such processes. However, because this information is highly fragmented, its integration is largely left to the human actors who find this task increasingly demanding in a context where the information available continues to increase exponentially. Investments in the Virtual Physiological Human (VPH) research are largely motivated by the need for integration in healthcare. As all health information becomes digital, the complexity of health care will continue to evolve, translating into an ever increasing pressure which will result from a growing demand in parallel to limited budgets. Hence, the best way to achieve the dream of personalised, preventive, and participative medicine at sustainable costs will be through the integration of all available data, information and knowledge.
3. A common approach towards measuring the adoption, usage and benefits of eHealth was the third area covered by ARGOS. Health policy-makers and administrators are increasingly challenged by insufficient human and capital capacity. As the demand for health care services continues to grow, so do the related costs, which must be strictly managed against fixed budgets. Demographic changes, the rising incidence of chronic disease among young and old, and significant unmet medical needs call for more personalised care. Such evolving needs also call for the design of a new, better, smarter and high-performance healthcare model. For eHealth to deliver the expected benefits, it requires policies to foster and facilitate the actual deployment of different eHealth applications and programs (including investments, improvement of interoperability, reducing legal and other barriers) on the one hand and the deployment of measures that evaluate the effectiveness of current versus future take-up on the other. Micro- and macro- socio-economic evaluations of eHealth systems and solutions can offer significant benefits to health policy decision-makers to assist resource allocation decisions. In particular, these evaluations include evidence-based information to help eHealth decision-makers to identify the type and scope of services to deploy, the related costs and the expected overall benefits to patients, carers, health care professionals, health care systems and other organisations and stakeholders to consider when making decisions to invest in eHealth, including society as a whole. A rigorous evaluation program framework for identifying and measuring the benefits, costs and cost-effectiveness of eHealth programs is needed.
4. Certification of Electronic Health Records in the US and Europe. Health IT has the potential to make a significant contribution to the better management of healthcare provision. This cannot be achieved without the availability of trustworthy Electronic Health Record systems (EHRs) that meet all the necessary clinical information requirements, enabling the timely sharing of up-to-date patients' medical data to support “high quality care” and the “continuity of care”. Given the increasing complexity of EHR systems requirements, and the risk of system deficiencies or failure to meet expectations, there is a need for an assessment process to assure the quality of EHRs on the market and to ensure their interoperability with other systems. Without an agreed set of functional criteria to support the introduction of robust and sustainable EHRs, major ICT investments are potentially at risk. Certification, licensing and accreditation endeavours are now well established and accepted as being essential to quality assurance and continuous improvement. With increasing investments in eHealth and the central and expanding role and dependence on ICT in health, particularly in the core areas of patient diagnosis, treatment and care, there is a growing recognition of the need to ensure the quality of the content, capacities, capabilities and performance of related systems. EHR systems must be suitably developed and sufficiently comprehensive and robust to achieve the benefits. EHR procurers and end-users frequently claim that EHR systems and related product quality, data portability and interoperability are difficult to judge. Certification eliminates this concern for procurers and users.
Three other articles have also been included in this book as they address another topic that has now become a high priority challenge: Strategies for the development of a skilled health IT workforce. There is an increasing demand for human resources specialised in eHealth as a result of the major eHealth developments aimed at supporting more effective healthcare services in many countries. However, there are challenges to ensuring that the eHealth informatics staff involved in the production and operation of such eHealth systems are ‘fit to practice’ professionals. Levels of understanding, qualification, quantification and definition of the existing and projected work-force requirements across Europe and in the US currently differ.
Given these many opportunities and challenges, we hope that you will enjoy reading this book and its different practical recommendations, including an article on a vision for the future. We trust that this work will contribute to many more exciting developments to come in this highly specialised and fascinating field for the benefits of the patients, health care providers and society.
Georges De Moor, University of Ghent, Belgium
Dipak Kalra, University College London, UK
With our special thanks to Pascal Coorevits (EuroRec), Geert Thienpont and Gunther Ruyssinck (RAMIT) and their teams assisting in producing this book.