Medical Device Daily
PARIS — The world's most ambitious electronic health project passed a first series of tests designed to enable the on-demand exchange of patient medical data.
This first collaborative event among nine European nations in Bratislava, Slovakia at the end of November also served to identify pilot sites for a year-long testing program that is expected to begin in early 2011.
This large-scale, Smart Open Services for European Patients (epSOS) pilot program is expected to involve more than 30,000 healthcare professionals at 2,149 pharmacies and 1,113 point of care and general practice clinics, as well as 183 hospitals. (Medical Device Daily, April 19, 2010).
The four-day epSOS project marathon for 140 IT engineers in Bratislava, called the Projectathon, brought together systems developed by nine European nations to verify interoperability and validate exchanges using 25 test cases typically requiring each participating country to connect with three other countries.
Mature, established systems for medical health records (EHRs) from Sweden, Denmark and the Czech Republic were hooked to emerging national programs from France, Slovakia, Greece and Austria, as well as regional networks from Italy and Spain.
As the host nation, Slovakia managed the complex logistics for broadband internet access for both hard-wire and wireless networks, as well as the hosting of simulators on local servers.
The organizers reported 146 of 165 tests were successfully completed, or 88.5% with the newer systems from Austria, Greece and Slovakia turning in the highest success rates.
Because each test involved multiple peer-to-peer connections, the total tests reported do not reflect the number of tests performed by each country.
The protocols for linking the disparate national systems were specified by epSOS based heavily on integration profiles developed by Integrating the Healthcare Enterprise (IHE; Chicago), an international open source method for the coordinated use of established standards, such as DICOM (Digital Imaging in Communications and Medicine; Rosslyn, Virginia) and HL7 (Health Language Seven; Ann Arbor, Michigan).
And the Projectathon itself is inspired by the successful model developed by IHE for its annual Connectathons held in North America and Europe.
A team of eight Connectathon veterans led by IHE-Europe served as monitors for the Projectathon, assisting engineers in test set ups and verifying tests results.
The Projectathon provided the first real-time test of the epSOS protocols and the European engineers emerged from the experience with praise for the IHE Gazelle test management tool as well as a long list of fixes needed before the next testing event.
The second Projectathon is planned for April, 2011 in Pisa, Italy as a parallel event to the annual IHE European Connectathon.
European e-health converging on Pisa
With an expanded participation expected for this next Projectathon added to the typical participation of as many as 300 engineers from 90 companies in Connectathon, Pisa promises to become a pinnacle moment for European e-health.
In addition to the practical, hands-on focus of the dual testing events, epSOS is planning a full program of meetings as it ratchets up to a larger-scale participation.
IHE-Europe (Brussels) is also planning its annual meeting there, while several international standards organizations and pan-European e-health programs are planning to take advantage of the critical mass of experts on hand to schedule meetings, seminars and workshops.
This convergence of engineers, policy makers, industry experts and government representatives arrives as e-health has moved forward with urgency on the agenda in Europe where healthcare costs are born by single-payer systems funded by the Member States.
While most nations have advanced some form of health IT system with an eye to cutting costs and gaining productivity, these medical records can not follow citizens across borders, whether for work, vacations or specialized treatment in another country.
The stated goal of epSOS is to develop a practical e-health framework and infrastructure to enable secure access to patient health information between different European healthcare systems, with a specific focus on basic patient summaries and e-prescriptions.
The epSOS project uses a novel approach to Europe-wide collaboration that technically operates outside of the scope of the European Union (EU) (Medical Device Daily, July 28, 2008).
While the European Commission provided funding of €11 million ($14.75 million), and while the program is perfectly aligned with the EU's Digital Agenda, it is directed by participating Member States, typically through the Ministry of Health or an appointed agency, such as ASIP-Santé in France.
The Member States agreed to give a place at the table to the non-profit association IHE-Europe, which in turn provides a voice for 35 industry partners.
Three years after announcing epSOS, the Projectathon in Bratislava was the first moment where the program moved out of policy discussions in a conference room to practical concerns for connecting systems.
Beyond computer interfaces, it took a full year just for the epSOS work groups to sort out the legal implications among member states of transferring electronic patient data.
“There are many difficult issues to be solved to fulfill the EC's vision of e-health as an enabler for continuity of care both within the member States and across borders between the member states,“ Fredrik Linden, the epSOS coordinator, told MDD.
With basic patient summaries and e-prescriptions, “the epSOS project picked only two small issues out of this context, yet they proving to be a world-class challenge,“ he said.