cell phone coverage (no mobile internet is required). Most of services can be ... Main findings core infrastructure alon
2nd MOMENTUM Workshop Main findings and highlights SIG 4:Technical Infrastructures and market relations Montse Meya (
[email protected] Berlin
8 April 2013
Background SIG 4 analysed the data in 3 waves 1. Rough Analysis of Q.32-Q.38 Jan- Feb & first stakeholders feed back in Brussels meeting 6 Feb 2. Feb- March: Elaboration of the Blueprint v0 that was distributed to the editorial team 3. Work with internal editorial team at TICSALUT Inclusion of the amendments/comments in version 1 (CATEL, Diane W. M.Lange,SIG3)
People involved: CATEL,Team in Norway (Leif,Ellen),team in TICSALUT,( Fran Gitt (Weinmann) & S.Schug at later stages) Berlin
8 April 2013
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Block 1a: INFRASTRUCTURES Infrastructure availability: Q32.1Indicate overall infrastructure The majority of the cases have national/reg, Internet IP based network and in 5 cases they have a publickey infrastructure (PKI) network Infrastructure usage:32.2.Indicate specific infrastructure used For each type of service: Diagnostics,monitoring, Home-hospitalisation, rehabilitation, etc…. The type of network used varies (Rehabilitation (6 cases) is done over all possibilities (VC, PKI, Public network, etc) Conclusion > National/Regional secure infrastructures are in place either PKI or not.
Berlin
8 April 2013
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Literature and Analysis for bloc 1 NICTA & Deloitte 2012>> Without an appropriate architectural approach, a large high-bandwidth physical network becomes fragmented into multiple, disparate (real or virtual) private networks that limit the scalability of telehealth Guidelines/recomendations On the provider side, a powerful network is also vital to a successful telemedicine and accept open use of videoconference solutions over VPN when the local infrastructure allows it. Berlin
8 April 2013
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Block 1Networks &connectivity MOMENTUM survey presents a large variety Video conferencing in a LAN, Direct dedicated ISDN lines between primary health care and telemedicine centres Most of services can be accessed via a normal Internet connection (no requirement for high bandwidth) and normal cell phone coverage (no mobile internet is required) ADSL. Main findings
core infrastructure alone is not enough to ensure effective service delivery. broadband availability, systems, connections and locations to the various telemedicine services is very different depending on whether it is a mobile service or not (e.g., wireless network for mobile services or broadband in the home vs teleconsultation). Berlin
8 April 2013
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Bloc 2: Integration, standards and interoperability Q.34.1-Q34.6 Telemedicine is only achievable with the exchange of information between patients, practitioners & suppliers. Q34.2 using standards? Ten respondents confirmed the use of standards whereas two did not Q34.3 (ID) verifications tech.& legally interoperable? YES _answers are a guarantee of interoperability of data between the individuals or processes. Q34.4 use only certified systems? YES ,all (10); SOME (9) I don’t know (9) NONE (2) Q34.5 sensor devices used in the telemedicine service automatically interact with the controlling devices Berlin
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Bloc 2: Integration Q.34.1 Question: indicate if the technology used to run the telemedicine service (devices and/or systems) and basic IT-system are integrated
Berlin
8 April 2013
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Bloc 2: Integration Q: 34.3 were IDs valid across organisation borders This answer indicates whether it is possible for different organisations (across organisation borders) to use the same identifier >> VERY relevant for integrated care
Berlin
8 April 2013
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Bloc2: integration /interoperability Q.34.6 Could the data seamless be transferred between home and other locations for monitoring and receiving data?
Q.34.7 Data transfer between the telemedicine service centre and other actors in health and social care? YES (11) not applicable (10) NO(6) Berlin
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Bloc 2: Integration / interoperability Summry: Literature & analysis important information such as problem lists and medication lists are not easily transmitted or understood by the receiving health IT product/service because existing standards have not yet been uniformly adopted. Interoperability must extend throughout the continuum of care
Berlin
8 April 2013
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Summit report AAMI-FDA on Interoperability
Berlin
8 April 2013
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Bloc 3: Risk managment & security Risk management is in place by 18 of the services. Almost all respondents referred to protective measures only. Denmark referred to “recovery measures”. Only Estonia cited “risk management protocols”. None mentioned “contingency plans”RELATED to Q. 28.1.) Has an assessment of risks to the information security been performed, i.e. risks to confidentiality, information integrity or availability? LITERATURE: “Risk Management for Telemedicine providers” AU reducing exposure to adverse:use Ethical and clinical standardsBerlin 8 April 2013 12
Bloc 4: Purchase and procurement strategy Q36.1- Q36.5 What was bought? platforms (12) end-to-end service (7) Other (3); I don’t know (5)
How did you organise the procurement? Direct from vendor (7) ;tender (5); part of existing contract (4);Other: leasing, own development, collaborative contracts,…(8)
Were there one or several vendors? The telemedicine infrastructure includes devices of different vendors ) Yes (9); NO:9, I don’t know(4) Integration is done by own staff ( 7), by vendor (3) Berlin
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Bloc 4 :Procurement How was it financed? Developed inside an EU programme (3) Developed under a national programme (2) Developed under a regional or local programme (2) Developed in a university-based research project (4) Funded by the healthcare organization (2) Funded by an industry partner (3) Other (2).
Who was involved in the development?
Clinical personnel at hospital Clinical personnel at primary care organisations (e.g. GPs, homecare, community care, municipalities,) Hospital management Regional management Berlin 8 April 2013 Local IT department Regional IT department Local health care authorities
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Procurement: Who was involved in ? (10) Clinical personnel at hospital (4) Clinical personnel at primary care organisations (e.g. GPs, homecare, community care, municipalities,) (4) Hospital management (1) Regional management (10) Local IT department (5) Regional IT department (0) Local health care authorities (1) Regional health care authorities (3) National health care authorities (7) Researchers from Universities (9) Industry (3) Other, Berlin
8 April 2013
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Alternative solutions now/at that time At that time Several alternatives (2) Few alternatives (14)
NOW Alternatives running (11) I dont know (12) NO (4)
Alternative solution in Scottland ,Australia, Vodafone Greece, etc...... Q 37.2 Do you know of similar alternatives running?
Salient recommendations : Area 4 Risk management >> Services MUST have in place Ethical and clinical standards The practice of telemedicine should be the subject of rigorous on-going assessment and evaluation of clinical effectiveness and patient satisfaction The technology that most suits the clinical requirements should be chosen (not vice versa) Ensure that the mode of technical transmission has appropriate security .
Berlin
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Salient results : Area 5 Procurement 1/3 of services do have systems/devices of different vendors and the integration is mostly done with own staff (7), the vendor (3) or other integrator ..and probably incresingly in the procurement it will be requested that solutions/platforms are interoperable. commissioning authorities buy a proprietary product that fits perfectly their requirements or they acquire a bespoke solution. Procurement is initiated bottom-up (clinical,IT..local department):a core team of committed staff) and/or Developed in a universitybased research project Berlin
8 April 2013
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Core findings The core infrastructure alone is not enough to ensure effective service delivery. majority of current systems have “no integration with other systems". Interoperability was cited as a barrier by 47% of the case studies (literature) and > 50% in MOMENTUM Integrated care: IDs valid across organisation borders only in 6 cases Procurement was bottom_up initiated Berlin
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