Ebook: Regional Health Economies and ICT Services

The General Medical Services (GMS) (Payments) Board in Ireland is the principal agency for Irish primary care reimbursement. All public health services provided by General Practitioners, Dentists, Pharmacists and Optometrists are reimbursed by the GMS, which has an annual budget of EUR 2.0B. The GMS has a policy of improving its services to and communications with its Primary Care clients, and this policy is described in the Board's ICT Strategy. One of the main planks of this ICT Strategy is the development of a business infrastructure for communications with clients, using web technology. I was therefore delighted when the GMS was invited to join the PICNIC Consortium, and I was even more pleased to be asked to be the Project Co-ordinator for the second phase of the project, from April 2001 to March 2003.

The development of leading edge technologies for deployment in healthcare for the benefit of patients and health professionals is at the core of the GMS' mission. Through the vehicle of the PICNIC project, we were able to combine our business knowledge with frontline thinking on the use of ICT to create future technology solutions for healthcare that could be deployed today. The GMS was one of the PICNIC pilot agencies, and we utilised W3C web technologies and HL7's Clinical Document Architecture protocols to build an online patient ID validation and Community Pharmacist reimbursement system. This system was prototyped under PICNIC, and was subsequently rolled-out to pharmacies all over Ireland.

One of the great features of the project was the opportunity to work with thought leaders and technology futurists from all over Europe. Our PICNIC partners from Crete (FORTH), Denmark (Funen), France (Minoru), Finland (VTT), together with many other health agencies, institutions and companies, helped us develop and deploy leading edge ICT solutions for supporting Primary Care. In particular I would also like to thank our fellow partners from Ireland, the North Western Health Board, South & East Belfast Community Trust, the Department of Health & Children (for chairing the National Health Advisory Board) and Hewlett Packard Ireland (which provided technology support).

Out of PICNIC came many ideas and specifications, which will contribute to the building of better systems for all those who work in healthcare throughout Europe. The challenge is for the European healthcare sector and the ICT market to take up these concepts and designs and use them to bring benefits to patients and practitioners.

I would like to thank the European Commission's Information Society Directorate for their support and patience, particularly our Project Officer, Yves Paindaveine, who brought the best out of us.

Patrick BURKE, Chief Executive, General Medical Services (Payments) Board, Republic of Ireland

This chapter describes how the Professionals and Citizens Network for Integrated Care (PICNIC) project was conducted in order to meet its objectives in preparing the regional healthcare providers to implement the next generation, comprehensive, user-friendly, secure healthcare network for patient centred care, and through it contribute to the de-fragmentation of the European market for health telematics. It describes the methodology followed in order to reach certain project results, starting from the selection of common documentation tools and methods, to the delivery of a new model for providing services, assessment plans, and a number of open source software components running on a number of diverse pilots throughout Europe in line with the overall PICNIC architecture.

The PICNIC architecture aims at supporting inter-enterprise integration and the facilitation of collaboration between healthcare organisations. The concept of a Regional Health Economy (RHE) is introduced to illustrate the varying nature of inter-enterprise collaboration between healthcare organisations collaborating in providing health services to citizens and patients in a regional setting. The PICNIC architecture comprises a number of PICNIC IT Services, the interfaces between them and presents a way to assemble these into a functioning Regional Health Care Network meeting the needs and concerns of its stakeholders. The PICNIC architecture is presented through a number of views relevant to different stakeholder groups. The stakeholders of the first view are national and regional health authorities and policy makers. The view describes how the architecture enables the implementation of national and regional health policies, strategies and organisational structures. The stakeholders of the second view, the service viewpoint, are the care providers, health professionals, patients and citizens. The view describes how the architecture supports and enables regional care delivery and process management including continuity of care (shared care) and citizen-centred health services. The stakeholders of the third view, the engineering view, are those that design, build and implement the RHCN. The view comprises four sub views: software engineering, IT services engineering, security and data. The proposed architecture is founded into the main stream of how distributed computing environments are evolving. The architecture is realised using the web services approach. A number of well established technology platforms and generic standards exist that can be used to implement the software components. The software components that are specified in PICNIC are implemented in Open Source.

A key objective of the Professionals and Citizen Network for Integrated Care (PICNIC) project was to provide products for a European and potentially worldwide software market. The approach followed was through the delivery of a number of Open Source (OS) components, to be integrated into applications that deliver similar services across the participating regions, aiming at their exploitation by other regions and the industry. This chapter describes the technology developed during the lifecycle of the PICNIC project, focusing on the three core services of Clinical Messaging, Access to Patient Data, and Collaboration. For each service, the entire process of how to turn its functional specifications into reusable components and common data sets in order to support Information Technology (IT) services for the next generation of secure, user-friendly healthcare networks is presented by means of common documentation tools. Security and privacy issues are also addressed.

Integrity Consulting Partners (ICP) is an independent consulting firm, specialising in healthcare ICT support, with a range of major projects delivered for European public healthcare clients in the areas of systems specification and design, procurement and project management of system implementations. ICP has had a strategic relationship with the General Medical Services (Payments) Board (GMS(P)B) in Ireland over a six year period, and has undertaken many key projects for the Board during that time. Accordingly, when the GMS(P)B became a partner in PICNIC, ICP were contracted to assist in the delivery of the project. In Phase 2 of PICNIC, when the GMS(P)B became the PICNIC Project Co-ordinator, project management and technical support in this role were provided by ICP. David Piggott lead the firm's work on PICNIC and facilitated the development of many key PICNIC deliverables, including the PICNIC Architecture and Exploitation Strategy. This chapter summarises the recommended approach to the implementation of the PICNIC concepts and standards, including a suggested way forward for procuring support on the deployment of the PICNIC products.

Canada Health Infoway Inc. (Infoway) is leading Canada's initiative to develop interoperable electronic health records (EHRs) and accelerate their adoption nationwide. Specifically, Infoway's core business is to invest with its partners—primarily provincial and territorial governments—in the development of robust, interoperable EHR solutions and in their deployment and replication across Canada. This partnership approach produces results faster, more cost-efficiently and more effectively than if any one partner acted alone.

This chapter presents a high-level view of Infoway's seven-year plan to have the basic elements of interoperable EHRs in place across 50 percent of Canada by the end of 2009. In particular, the chapter discusses the business and technical approaches that have been developed to pursue Infoway's aggressive goal. These approaches allow individual jurisdictions to deliver local and regional solutions cost-effectively while contributing to a larger, interoperable national system.

This chapter describes the development of the electronic communication in Denmark and the background behind the Danish project organisation MedCom. Since 1996, there has been an IT-strategy in the healthcare sector by the Danish government, which has been under constant development. These strategies have laid the foundation for MedCom, which was established in 1994 in order to build a Danish Healthcare Data Network. Today, the Healthcare Data Network forms an integral part of the everyday work of the Danish healthcare sector, since the dissemination and use of it has risen sharply since it was established.

The openEHR Foundation is an independent, not-for-profit organisation and community, facilitating the creation and sharing of health records by consumers and clinicians via open-source, standards-based implementations. It was formed as a union of ten-year international R&D efforts in specifying the requirements, information models and implementation of comprehensive and ethico-legally sound electronic health record systems. Between 2000 and 2004 it has grown to having an on-line membership of over 300, published a wide range of EHR information viewpoint specifications. Several groups have now begun collaborative software development, within an open source framework. This chapter summarises the formation of openEHR, its research underpinning, practical demonstrators, the principle design concepts, and the roles openEHR members are playing in international standards.

The National Programme for IT in England has been designed to support the modernisation of the National Health Service, and the Government aims of delivering a high-quality service designed around the needs of the patient. This article describes the architecture for the core component of the NHS Care Record Service including the application, information and security architectures and the requirements for supporting standards and technologies.

Ensuring the privacy and confidentiality of individuals has made security an indispensable component of health information systems. Delivery of healthcare services beyond the enterprise level to the regional, national or cross-border area places new challenges for security implementation. We review the current status and uptake of security measures in healthcare settings across European countries and examine in more detail some of the leading eHealth applications. Drawing on the findings of this analysis, we propose a generic model for streamlining the security implementation process on any level -local, regional, national or cross-border. Finally, we address the future prospects and requirements for advancing secure delivery of healthcare services across European borders.

This chapter reviews the PICNIC experience from conception to its realisation and draws conclusions on several fronts. It puts PICNIC within the current framework of needs and requirements, summarises shortly its main contributions, and discusses its main contributions. Special emphasis is given to understanding the needs and requirements resulting from a fragmented ICT market and the implications and possibilities that PICNIC has created for a consolidation of the market.