At a time when healthcare data is becoming increasingly digital and people are able to move freely between the Member States of the European Union, the interoperability of healthcare systems is a critical issue for tomorrow’s Europe.
Key players in interoperability:
- IHE (Integrating the Healthcare Enterprise) (opens in a new window): This group of healthcare professionals promotes the development of interoperability through the use of standards such as “Digital imaging and communications in medicine” (DICOM) and Health Level 7 (HL7).
- Interop’Santé: the aim of this association, which was set up in 2009, is to promote the development of interoperability. It brings together several organisations that are working to standardise the exchange of computerised data in the healthcare domain, including HL7 France (HealthLevel 7), HPRIM (Harmoniser et Promouvoir l’Informatique Médicale, for the harmonisation and promotion of medical IT) and IHE.
- Continua (opens in a new window): this international organisation includes private, not-for-profit healthcare and technology companies. It works to establish interoperability standards for healthcare products and services.
- HIMSS Europe (Healthcare Information and Management Systems Society) (opens in a new window): this organisation focuses on using information systems to improve the quality of care and security. It maintains and develops a tool named EMRAM, an evaluation grid that makes it possible to compare hospitals’ digital maturity levels.
Interview with Gerald Cultot, European Commission
« Our main challenge is to help implement greater interoperability of European eHealth systems.»
The major strategic project to develop a standardised and coherent system of eHealth in the 27 EU Member States began in 2012, when the European Commission set out its goal of developing an interoperability framework. Ensuring streamlined continuity of care for patients, providing access to healthcare information wherever and whenever required, complying with data security and confidentiality requirements: in order to address all these concerns at European level, the key players in eHealth must come up with common terminology and infrastructures and put together sustainable international standards and norms.
Technical, semantic and organisational interoperability
Streamlining the exchange and optimising the processing of healthcare data: the key to achieving this major eHealth challenge depends partly on a technical and political issue – the interoperability of healthcare systems. But within this term itself lie several other challenges: the interoperability of information, organisations and semantics.
“Primarily, we mean the interoperability of information,” says Jean-Charles Dron, a consultant at HMS1 and a member of French non-profit association Interop’Santé and of HIMSS2. “Currently, when we talk about patient care, we are thinking more and more about the care pathway: underpinning that is the need for patient information that can be accessed by all those involved in this care pathway.”
This goal has resulted in several projects such as the EMR (electronic medical record), which was a key issue in the development of eHealth, or shared medical imaging, which makes it possible to match the patient with the information about them throughout their treatment. “To do this, we need to be able to structure this interoperability: this can be achieved by putting in place the technical infrastructure to access this information, and also by organising the information so that it can be received in a consistent form by all those involved. And so, the key to the entire issue is that the data must be understandable by those receiving it and by those who send it. This involves agreeing a common vocabulary and naming system,” J.C. Dron explains.
Developing European standards
Hence the need to develop standards and profiles, at national level initially, but also with a view to European cooperation. Several key players are working on defining and rolling out an interoperability framework at European level and several projects are already contributing to setting this up: “The European project AssessCT, which aims to improve semantic interoperability, the eStandards research project, launched in May 2015 with funding from the European research programme Horizon 2020, the EXPAND network, the JAseHN (Joint Action to Support the eHealth Network) programme, or OpenMedicine, a project on cross-border digital prescriptions…” lists Michael Strübin, Programme Manager, Europe, for Continua, an international organisation that seeks to establish interoperability standards for healthcare products and services.
Its mission is to “put in place an ecosystem consisting of an interoperable healthcare system, which would enable organisations and individuals to manage their health more effectively, by establishing guidelines on healthcare system standards,” explains Elinaz Mahdavy, Orange Healthcare’s European representative and Secretary General of Continua Health Alliance Europe. “Our objective is to push for these guidelines to be adopted at European level, so as to achieve a standardised system. We are working closely with the IHE on implementing these standards.”
A sector that is still disparate
Although some countries are currently doing better than others, with Denmark in the lead, there is still a long way to go on the road to effective interoperability. “Denmark has adopted the Continua guidelines and has put in place interoperable systems that work. This is a good example for the rest of Europe, and Norway and Sweden are following in the footsteps of the Danes in this respect. Our role now is to push for the Ministry of Health in France to adopt these guidelines,” Elinaz Mahdavy points out, reminding us, too, that real work has already begun on the security and protection of all this medical data that is in circulation.
“In Europe, the level of maturity in terms of interoperability in hospitals varies greatly,” adds Jean-Pierre Thierry, a consultant and member of the HIMSS Europe Governing Council. “It depends, to a large extent, on how the healthcare system is structured. In France, we are faced with a highly fragmented and disparate healthcare sector, with multiple solutions that are not interoperable and a programme of hospital computerisation, which is not even complete,” he explains.
It will be a lengthy process, as Jean-Charles Dron wants to stress. “Systems change over time: we started off with systems which dealt solely with electronic invoicing, and these have gradually developed into those which handle medical treatment,” he reminds us. “Furthermore, that is all compartmentalised – hospitals, GPs etc – and these compartments are not interoperable, although we may think that they are each fairly well organised.” But requirements are constantly changing, and new profiles need to be drawn up to ensure care pathways are coordinated. “Some profiles and standards, such as patient identification, radiology, lab. work etc, have already been integrated and are currently working very well,” J.C. Dron believes.
A large-scale project for the European Commission
“In 2013, the Commission launched a large-scale European project, which recommended increased interoperability,” explains Elinaz Mahdavy. Today, members of the eHealth network, a group of experts from the 27 EU Member States, are responsible for drawing up general guidance for the development of eHealth at European level. Their agenda focuses on matters of interoperability.
“The network launched the joint action plan JAseHN and is focusing attention on standards at European level,” Ms Mahdavy points out. “The European Commission intervenes in this area through regulation, and has ruled on the protection of data in particular, through the ‘Medical Device Regulation’ which was adopted in June 2015 and which will be transposed into national law within two years.”
1 HMS : Health Management Solutions
2 HIMSS : Healthcare Information and Management Systems Society.