Days of eHealth: Healthcare digitalization in Catalonia, Germany, Finland and Israel
End of August, Days of eHealth were organised as part of the Slovenian Presidency to the Council of EU. Among other presentations were panel discussions about healthcare digitalization practices in Germany, Catalonia, Israel and Finland. Find the summaries and recordings below.
The creation of a European Data Space is one of the priorities of the European Commission between 2019-2025, including the health sector. There’s already a lot happening.
Europe currently has 24 European Reference Networks (ERNs), which are virtual networks involving healthcare providers across Europe to discuss complex or rare diseases.
By 2025, 25 EU countries should offer 2 electronic cross-border health services - Patient Summaries and ePrescriptions and eDispensation. This means that when patients visited a doctor in another country that doctor would see their medical infromation. With ePrescriptions and eDispensing a patient from one country can pick up his medication in a pharmacy in another country.
Catalonia: Betting on openEHR
Catalonia is investing 40 million EUR for the regional digital health strategy, which will be based on open data. It was designed by 300 experts and heavy clinical involvement. “We have worked with a consensus method to choose consensus-based solutions for different groups of specialists. We have a group of experts for mental health, another group for primary care, and another group for social care,” mentioned Pol Pérez Sust, director of Catalonia’s Information System Area.
In its healthcare digitalisation strategy, decision makers in Catalonia have chosen to use openEHR as the data standard, which will enable easy semantic interoperability and the best possible data fluidity on a regional level. Catalonia has had electronic healthcare records since 2007, but the cost of maintaining all of their different solutions is high and is hindering the scaling up of innovations, said Pol Perez Sust, director of Catalonia’s Information System Area. “We have a rigid model which does not allow for applications to change, and makes communication between service providers difficult. It does not enable semantic interoperability,” Pol Perez Sust remarked critically. “In 2018, we started writing a digital health strategy which has concrete goals. The first goal is to consolidate a person-centred model of information,” he also said. The plan was written in collaboration with over 300 experts and clinicians.
Germany: Hospital Digitalization Initiatives
In the past two years, a lot of efforts have been put in place to accelerate the progress on the digitalization of the healthcare digital infrastructure in Germany. Many laws were passed, the country received a lot of international attention about the DIGA process, which enables startups to make their apps reimbursable. The bigger national projects which saw the day of life this year, however, were the introduction of electronic patient records, telemedicine, and e-prescriptions.
On the funding side, the federal ministry of health and the federal states are investing EUR 4,3 billion for concrete projects that work towards the digitalization of hospitals. On top of the already mentioned 4.3 billion EUR of funding for digitizing hospitals, the German Federal Ministry of Education and Research (BMBF) launched its medical informatics funding scheme to make data from healthcare and research more useful and meaningful. It provides around 180 million euros with the aim of strengthening medical research and improving patient care. All of Germany’s university hospitals have joined forces with research institutions, businesses, health insurers, and patient advocacy groups to create a framework that harnesses research findings to the direct benefit of patients.
“In Germany, the legislators decided that they didn't want to trust one company to build up the basic national healthcare infrastructure on which the applications would run, but rather decided that they would like to have a kind of open market where vendors can participate freely. National standards organisation Gematik would only do the specification and offer requirements for all those components and services needed to bring up infrastructure. So we have is a multitude of paper-based specifications wrote on 6000 of 7000 pages for every component, every service of the telematics infrastructure. It takes in average seven years from an idea to implementation: 1-2 years for each law, 1-5 years for mapping of specifications for each component, 2 years for implementation, and 6-24 months for certification,” explained Mark Langguth.
Ministry of Health in Germany is investing 4.3 billion EUR for the digitalization of hospitals and the Ministry for Education is adding an additional 180 million EUR to speed up medical research efforts. 4 consortiums of academic institutions are working on this medical informatics initiative, among them the HiGHmed consortium, which chose to go with the open data standards and archetypes approach.
“The important thing about this is that we cannot only share research data, but we can also share the clinical applications that we build on open interfaces. This is creating an ecosystem of applications, and this came quite handy during the pandemic because we are very flexible to share not only the data but also the applications, for example, the smart infection control system,” mentioned Michael Marschollek.
The impact of structured data use in healthcare will bring a shift in the way clinical practice guidelines are published in Germany, said Johannes Starlinger: “From standards and PDF reports to a more structured computer-readable format, an interoperable way, so that clinical practice guidelines and recommendations can then be linked to the data that is currently already being collected at hospitals so that these recommendations can be fed more seamlessly into the treatment process.”
Finland: driving the use of data for secondary purposes
Since 2019 Finland has had a regulated process of using healthcare data for secondary uses - FINDATA is a centralized institution that grants or rejects proposals for secondary use.
Minna Hendolin mentioned - among other things - that Finland is a small, geographically, linguistically, and culturally isolated country, which has developed during this 100 years from a very poor, agricultural industry to a very developed society, known for high education, high quality social and health care services, and also a high level of trust, stability of a society. “All this contributed to building the health sector and data sharing capabilities, which put Finland to the forefront of using the data not only for primary purposes but secondary purposes.”
As mentioned by Jukka Lahesmaa, examples of research done with the help of data provided through Findata include the development of advanced AI-based analytics for providing services for families with small kids. The second example is an academic study on outcomes of insulin treatment at the population level. And the last example is a public-private cooperation project for developing bi-dimensional bone cancer tissue models for improved treatments.
How can we translate that to the EU level?
Angel Martín: “We need to have more consistent implementation and interpretation of rules. The implementation and interpretation of GDPR is not consistent across member states, within member states, even from hospital to hospital. Our industry is really facing big challenges. Even if you were to go into a federated model, from one hospital to another how privacy officers are interpreting the rules, and sometimes we can find solutions, but sometimes we can not.”
Dipak Kalra: “Our problem really is not the lack of good standards but the limited adoption. Interoperability has been enmeshed in the value chain obstacle for decades because the drivers for investing in connectivity between healthcare organizations to give a patient, a holistic data landscape that any clinician or any patient themselves can access; has defeated us. At the moment, the incentive structures for investments in health IT at each healthcare organization, do not favor investing in connectivity with others. The incentives favor using it to improve internal organizational efficiency. That does not include interoperability.”
Israel: Working with startups enables faster transition of innovation to practice
Israel is a country of 9 million people, attributes 7,5% of its GDP to healthcare and is home to roughly 1,500 companies operating in the healthcare and life sciences. There are roughly 700 digital health companies in the country, which already had the infrastructure that enables patients to carry only their ID with them when seeking medical help, because doctors can pull patient data from other systems as well (only for the duration of the medical visit, federated approach to data storage)
“The health information exchange network helps us to securely share clinical information among professionals. It's not available for the patients. We look at it as a life-saving platform. As a government, we're also responsible for the policy and regulation related to the platform, which brings many very difficult ethical questions in place. Who do you give access to such a best clinical information? You need to balance between the right of privacy of the patient and the fact that you would like to give them the best medical treatment available,” said Esti Shelly, Director for Digital Health at the Ministry of Health in Israel.
There are 50 digital health accelerators in Israel and it’s part of the culture for Health Maintainance Organizations (HMOs) and hospitals to work with startups. As described by Noa Kedem Dotan, Strategist for digital health at Maccabi Health care Services: “We are constantly looking at our challenges and connecting to startups with a solution. Once we have a match a lot of parties within the organization get involved to look at a solution from a clinical way clinical aspects legal aspects, safety, risk assessment, security aspects, technical aspects, a financial. It has to be a win-win financial solution, otherwise, it won't hold.”
“One of the challenges we have is that if we want to work together and create solutions, we need to share all the information. Then it will be much more versatile, much more accurate. MDClone is a company that gave a solution for this. They built a very easy-to-use search engine for research, the second thing, they used an algorithm, and initially, they looked at anonymization of the data. At the end of the day, this is not good enough, because still, in certain cases, you can go back to a patient. So they've made another algorithm that takes the actual data and creates a synthetic replica that cannot be connected back to the patient. So when you want to check the concept, you can take this data and get a using the search engine. By getting all the data together we are getting more unbelievable information,” said Michael Halberthal, CEO of Rambam Hospital.