D I G I TA L
H E A LT H
E-HEALTH — A RANGE OF PILOT PROJECTS
An e-card solution is being develop in Austria (left). A similar system is being tested in Germany (right). In each case, systems are being tailored to national healthcare and insurance requirements.
IT support can make healthcare more efficient — something that has been proven by success stories worldwide. The Lombardy region in Italy is showing how health cards can im- prove medical treatment, while also reducing healthcare costs. There are similar projects around the world, in Spain, for example, and in Austria, Canada and Germany. Although national health- care systems are very differently organized, many processes are similar, which means that the technologies required for the IT infrastructure are essentially the same. Confidential information must be exchanged at high speeds, and large volumes of data have to be securely managed. But patients see only a chip card in their wallets — the key to the entire system. In nearly every case, the ultimate goal of these projects is an electronic patient file. The ap- proaches to realizing this, however, are frequently different. Usually, the first step is to be able to check the patient’s insurance files online, often together with electronic prescriptions. In Valencia, Spain, for example, Siemens has helped to network ambulatory care centers. Doctors at the cen- ters now have online access to some treatment records, and billing is conducted electronically — so it’s faster than ever before. Furthermore, the system allows physicians to sign prescriptions with a digital signature. In Austria, social insurance providers are replacing health insurance certificates with e-cards this year — also with support from Siemens. During visits to the doctor’s office, this makes it possible to more quickly scan in the insured person’s administrative data and evaluate it more efficiently. Doctors treating patients can enter digital signatures by using their medical profession ID card, or “doctor’s card.” And that’s just the beginning. The cards that have already been issued are suffi- ciently sophisticated to access electronic patient files. To accomplish this, however, it will be nec- essary to make additional infrastructure investments . The electronic patient file is also the objective of the GO IN physicians’ network in Ingolstadt, Germany. GO IN was founded in 2000 by Siegfried Jedamzik, a general practitioner who wants to show in detail what can be done with health cards. Today, more than 250,000 GO IN patients are already enjoying the benefits of individual health files in paper form. The members of the physi- cians’ network (currently more than 500 family doctors and specialists in private practices and at hospitals) make their entries on the form after treating a patient. This helps to prevent unneces- sary duplicate examinations. But the volume of patient data is continually increasing. “Modern, efficient and patient-oriented medical care can not function without IT support,” says Jedamzik. In particular, the automatic monitoring of possible side-effects and contraindications is only possi- ble if patient data — as is the case in Lombardy — is stored on a server and continually updated. That’s why plans call for the paper files in Ingolstadt to be replaced with digital files as quickly as possible. Siemens is helping to develop the IT infrastructure and the chip cards that will make it all possible. “We expect the cards to be issued in the Ingolstadt area by spring 2006,” says Martin Praetorius of Siemens Communications, who is providing support for the project. Information gleaned from experience with the Ingolstadt project will be used for the introduction of a planned German national health card. According to the latest plans for the German healthcare system, cards will initially be limited to electronic prescriptions. For GO IN doctors and their patients, however, the electronic patient file is the top priority. The Bavarian physicians’ network wants to introduce them as soon as possible. “In terms of technology, it can certainly be done,” Praetorius says. “Things have already progressed further in other parts of the world.” ■ Andreas Kleinschmidt
room, which he calls a “digital Fort Knox,” only by using his chip card and an access code. Security guards protect the room from outside, and cameras record who goes in and out. To prevent the mammoth computers from overheating, gigantic air conditioners cool the air to exactly 21.3 degrees Celsius. Some 220 servers already store the medical files of approximately one million citizens, and the data is continuously updated, when- ever a doctor writes a prescription, a blood test is performed, or a patient picks up a med- ication at a pharmacy. By late this year, the system’s operators expect the number of citi- zens benefiting from the network to be dou- ble what it was back in April.
“Our top priority is security,” says Zino as he clicks on a monitor. “Even I can’t call up pa- tient files. Hackers who try to penetrate the system from outside won’t have a chance. We’ve built up a complete extranet that is practically invisible to the outside world.” Not even an earthquake could disturb the sys- tem’s operation, according to Zino. “Even if the whole building that houses our servers collapsed, emergency systems located out- side Milan would take over the core func- tions,” he says. Updated copies of the data- base are stored in emergency systems and at another secure location.
Highly Transparent. Dr. Tedeschi has often had to convince his colleagues that the new system is secure. After all, even he was ini- tially skeptical. “Every step I take is now being documented. At first, that makes you nerv- ous. But it’s good for the patients and helps me manage my practice. I can now monitor my budget continually, and that’s important in view of the rising cost of health care,” he explains.
The region’s economy is certainly benefit- ing from the citizen card, which is expected to reduce the cost of Lombardy’s health care sys- tem by one to two percent. By lowering ad- ministrative costs, reducing the number of re- dundant examinations and speeding up processes, the system should save up to 240 million euros annually. What’s more, it will be- come more difficult to cheat the health care system.
And in the future, when not only lab re- sults but also X-ray images and photos will be routinely transmitted online, costs are ex- pected to decrease even further, while treat- ment becomes even more efficient. “Siemens could provide an even more comprehensive system, from the cards to the IT infrastruc- ture,” explains Maurizio Michi, a project man-
ager at Siemens Informatica in Milan. The cit- izens of Lecco will eventually be able to use their cards not only to visit their doctors, but also to withdraw money from the bank or provide a digital signature. Today, they can al- ready use the cards to borrow books from the local library.
But today the cards’ greatest benefits are still experienced at the doctor’s office. “Al-
most all of my patients think the card is a good thing,” says Tedeschi. “It has increased their faith in the health care system.”
The security of confidential data is also growing. Dr. Negrini in Grosotto will soon be able to throw away his padlocked cupboard, because his patients’ medical records will be safely stored in servers in Milan.
In some cases, though, even the citizen
card is not the fastest way to transfer a pa- tient to a specialist — and Maurizio Tedeschi is a case in point. If one of his patients needs to go to the dentist, he simply goes to the of- fice next door, where Dr. Tedeschi’s twin brother Marziano has his dental practice. He too has been a member of the new card- b a s e d h e a l t h c a r e s y s t e m f r o m t h e v e r y s t a r t . ■ A n d r e a s K l e i n s c h m i d t
Dr. Gérard Comyn (59) is Acting Director of the Directorate for Information and Communication Technologies (ICT) for Citizens and Businesses in the Directorate General for Information Society and Media in the European Commission. He is also head of the unit on ICT for Health. Before joining the European Commission, he was managing director of the European Computer Industry Research Center (ECRC) in Munich, and was also a Professor at the University of Lille. Comyn holds a Master’s Degree in Applied Mathematics and a PhD in Computer Science.
“e-Health Is Playing a Crucial Role in Health Care”
What role will ICT play in tomorrow’s healthcare systems? Comyn: Today, Europe’s main concerns in relation to health care are often about in- creasing costs.But they are also about access to quality care. These challenges could be amplified by the health needs of an aging society. We have to act now to secure good quality and affordable health care tomorrow for all of Europe’s citizens. ICT has a crucial role to play here, as it enhances the safety, efficiency and quality of medical care. ICT also enables the development of innovative new products and services, which will also help to decrease costs, and which will in turn offer huge potential opportunities for Euro- pean industry.
Which eHealth programs is the Euro- pean Commission pressing ahead with? Comyn: The Directorate General for Infor- mation Society and Media has been co-fund- ing R&D projects in the area of eHealth for over 15 years now. Its cumulative funding has totaled over 500 million euros, and hun- dreds of projects have been successfully completed. The eEurope 2005 program — through its 2004 communication and related eHealth action plan — has also made people and governments increasingly aware of the benefits and opportunities of ICT for health.
In the context of the new i2010 initiative, we now plan to encourage widespread demon- strator, piloting and multiplier-effect activi- ties that will spread these messages.
What benefits does ICT offer physicians, patients and insurance companies? Comyn: Doctors can keep abreast of the lat- est medical news and knowledge. They can work more efficiently and flexibly, with less paper, and benefit from mobile access to electronic health record systems. This leads to enhancements in the quality of health care delivery and a reduction in the number of medical errors. Patients obtain more rapid access to improved medical services and benefit from a shift from hospital-centered care to more self-care, personalized care and home care. Insurance companies can benefit from better quality, speed and savings in the delivery and reimbursement of care. They can also reduce costs and spot new and emerging health trends that are emerging on the scene.
What economic advantages do you see? Comyn: Today, Europe’s health sector em- ploys 9.3 percent of the total workforce of the EU and constitutes over 8.5 percent of its gross domestic product. Improvements in ef- ficiency and care can result in tremendous
qualitative enhancements and quantitative savings. However, economic advantages, es- pecially cost benefits, are one of the hardest things to prove in terms of a better quality of life. This is why we are now supporting sev- eral cost-benefit assessments of eHealth.
Which new technologies are most im- portant in improving health care? Comyn: Lots of new possibilities are arising at the moment. Biomedical informatics, modeling and simulation of human physiol- ogy, knowledge extraction and management systems, molecular imaging, wearable moni- toring systems, labs on a chip, broadband and mobile communications, intelligent sen- sors, decision support, as well as security systems, are some of today’s key technolo- gies. The successful integration of many of these technologies will help us to achieve the vision of ubiquitous, personalized med- ical care.
Will computer-assisted diagnosis and therapy, which help physicians to man- age steadily increasing data volumes, be part of the game? Comyn: Undoubtedly. As stated in the international Open Clinical report (www.open clinical.org), recent growth in the scientific understanding of diseases and their manage-
Pictures of the Future | Fall 2005