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Strategic Health Informatics Networks in Europe

Objective

To construct an open systems framework for the development of regional community health care telematic services that support and add value to the strategic business objectives of European health care providers and purchasers.
The business analysis methodologies used in other sectors to identify improvement and to ensure the best use of resources are being tailored to the he A methodology has been developed for the elaboration of information technology based on health care business needs.

A business analysis methodology for health developed in parallel to a its application in the pilot sites. Extensive trainin which took place was applied in detail in each pilot region to identify the tele support the real business need.

The methodology has been used extensively to id business processes and to align the IT strategy in the 3 different pilot regions Portugal), and also to a lesser extent in other countries' nonpilot regions. The at different stages of using IT, have different health care systems and therefor opportunities for telematic services.

The process of validating the business or the methodology before detailed system specifications can be developed, involves functional models. The United Kingdom's Common Basic Specification (CBS) (a mode United Kingdom's National Health Service) has been used to assess the correlatio CBS models and the situation that exists in the pilots and nonpilots. it will en the methodology to use a formal specification tool to develop functional specifi deliverable has been used describing the health care policy and IT strategy in e in the project. A video has also been produced that describes the philosophy and scenario for telematic services.

Detailed specifications of the user requiremen requirements produced from detailed interviews provide the baseline to develop a architecture of regional health care.
Main Objectives

- To develop a Framework that enables regional health care business strategies.
- The development of a Methodology that identifies regional health care business processes and develops a supporting IT strategy
- The development of an Open Health Environment consisting of an Archi-tecture and Information Standards that support the SHINE Common Services
- The production of a System Architecture that defines the construction of inter-related common services in the support of regional health care
- To work with standards organisations and to adopt health-care informatics standards applicable to the SHINE Framework
- A set of common telematic application services that support regional health business needs will be prototyped.
- To construct three pilots, in regions in Italy, Ireland and Portugal, to validate and demonstrate the results of SHINE
- Increase the awareness of the SHINE Framework
- To work towards providing inter-regional health care information ex-change standards and protocols

Technical Approach

The first year has focused on developing the SHINE Methodology (a Business Analysis methodology for health care) in parallel to its application in the pilot sites and elsewhere. During the first few months of the project, extensive training and development of the methodology took place, later applied in detail in each pilot region to identify the telematic services to support the real business need. Deliverable D3, produced at the end of September 1992, contains the results of this work. The development of the SHINE Methodology is a major piece of work that can be exploited at an early stage by the consortium. It will remain restricted until the project finishes in 1994.

The SHINE Methodology has been used extensively to identify the key business processes and to align the IT strategy in the three different pilot regions (in Italy, Ireland and Portugal), and also to a lesser extent in other countries' non-pilot regions. The three pilot regions are at different stages of using IT, have different health care systems and therefore present contrasting opportunities for telematic services.

The final analysis of the application of the SHINE Methodology has yet to occur but a number of common telematic services have already been identified which will be further examined as detailed requirements are being gathered. Opportunities have also been identified for redefining some of the roles and processes within the regions.

The process of validating the business oriented models of the SHINE Methodology before detailed system specifications can be developed, involves building functional models. SHINE is using the UK's Common Basic Specification (a model of the UK's National Health Service) to assess the correlation between the CBS models and the situation that exists in the pilots and non-pilots. It will enable future users of the SHINE Methodology to use a formal specification tool to develop functional specifications. The result of this work is now available.

Part of the process to ensure that the results of SHINE meet real needs is to have regular validation (by an external panel of experts) and workshops in each country with representatives from the central or regional policy making organisations. The first result of this process has resulted in a deliverable describing the health care policy and IT strategy in each country involved in SHINE. A video has also been produced that describes the SHINE philosophy and presents a scenario for telematic services.

As the analysis and modelling activities draw to a conclusion, so the development of detailed specifications of the user requirements and information requirements have to start. These take the form of detailed interviews to obtain the user requirements, and the development of data flow diagrams to describe the information requirements. These provide the baseline to develop a functional architecture of regional health care.

The developments for the pilots will share a common architecture that will be published at the end of the project as the Open Health Environment (OHE) for regional health care. It aims to be compatible with, and interface to, the emerging standards for hospital systems (e.g. RICHE), with the ENS medical backbone, and will be conformant with CEN TC251 standards. Contacts have already been established with these groups.
Having identified the common services and the pilot-specific services, the project will commence prototype development based, where possible, on existing application system software. A period of installation and testing will occur before the pilot trials take place. The evaluation will be undertaken by repeating on a smaller scale the work during the analysis phase with the objective of assessing the outcome of the enhanced IT infrastructure. The health care professionals will be interviewed for their views on the changes to the working practices. Quality will be monitored, both of the telematic services, and in the measurable improvements in health care provision and outcome.
Throughout the project, an area of work will be concerned with exploitation, liaising with national health organisations, standardisation bodies, etc. Widespread acceptance and use of the SHINE Framework are critical to the success of the project. Therefore the consortium attaches great importance to this work area as a means of ensuring bilateral exchange of ideas, concepts and European standardisation based on open system solutions.

Key Issues

The project's tenet is that linking people together through IT is much more significant than straightforward data transfer and redefining time and distance: it involves linking people's skills and computing services, wherever they are located, to problems needing those skills and services, wherever they arise. Enhanced team working and sharing of skilled and expensive resources is possible through a combination of networked health care informatic services and the resulting potential for redefining the health care business.
One key issue, from a strategic point of view, is how best networks and existing technologies or standards can be used to create telecommunication services that both satisfy the demands for better health care as well as providing a value added service to the region.

Other project issues include:

- collaboration and synergy with other projects - this project has to work closely with other projects within AIM, ESPRIT, RACE and ENS. The key strategic projects have been identified and cooperation has commenced.
- awareness of new developments - the project will not undertake any developments where there already exists a solution
- links with other bodies - the project will work with the CEN and EWOS working groups along with other relevant activities. Again, contacts have been made and members of the SHINE consortium are already active across many of the standardisation work groups and project teams.
- dissemination - one of the key activities of the project is to widely disseminate the results and to place them in the public domain. An initial exploitation plan has been produced.

Relationship to Previous Work

The SHINE project's origin comes from different parts of the CEC Framework Programme. There are links from:
- HOSCOM, CHIC, McACE and others from AIM
- ISA, RICHE, BANK92 and the RIBA work of ESPRIT
- TELEMED and TELEMEDICINE within RACE

Links have been formed across programmes to the current ENS and RACE health care activities.
Members of the consortium were directly involved in the previous ambulatory (regional/community health-care) projects and bring the results of this work into SHINE. There was also involvement was with RICHE that has developed a framework for hospital systems and this experience will be used extensively in SHINE during the technical developments in years 2 and 3.

Expected Impact

National and Regional Government (i.e. Health Policy):

- improvements in public health through the effective use of health resources
- better epidemiological and health service research
- planning for new health care facilities, e.g. hospitals
- financial control of state provided health care
- opportunities to evolve the provision of health care to meet local needs
- better cooperation between the private and public health sectors

Health care Funding Organisations:

- more efficient communication of billing information
- reduced administrative procedures
- improvements in statistical data with respect to delivered care

Hospital Management

- reducing the gap between primary and secondary care
- well defined systems interface between the hospital information system and External world
- automated patient details transfer
- promoting new hospital services and facilities

Community Health care Providers

- data set capture as a by product of community clinical system
- logically integrated management tools running over wide area distributed systems
- quicker referrals and timelier patient data

General Practitioners

- better able to work in healthier market
- monitoring acute service costs, drugs, tests, etc.
- simplified patient referral and follow up process
- health promotion in the community

Patient

- reduced stress of working with the health system
- able to compare health services
- consumer surveys
- better health education

Relationship to Other Projects and Actions

Within AIM, coordination agreements have been put in place with three projects - EPIC, FEST and NUCLEUS, and with the CARE project from the ENS programme. Significant progress was made with identifying the core projects within AIM that are likely to be most useful in the context of concertation and collaboration. Close relationships have been established with these projects both through the AIM Concertation meetings and through having common participants with those in SHINE. The three AIM projects with which some degree of coordination has been developed are FEST, EPIC and NUCLEUS. SEISMED (a project addressing security) will be important to SHINE in year 2 during the development of the SHINE architecture. The NHS-IMC is a partner common to both SHINE and SEISMED.

FEST plans to develop a framework for telemedicine applications by performing a bottom-up technology-driven analysis of requirements that is complementary to SHINE's top-down business analysis approach. The strong telecommunications skills of FEST also complement SHINE's strong applications and services capabilities.

EPIC is a clinically oriented project developing systems for remote care in the home. SHINE can be of benefit in defining the regional infrastructure and services needed to support effective home care. The proposed coordination between SHINE and EPIC starts with a low dependency coordination in year 1 progressing to greater cross-dependencies in year three, but subject to an annual review. Providing both projects agree this could lead to joint working on security, architectures and possibly SHINE results feeding into an EPIC pilot. Both SIMS and IHI are common to both SHINE and EPIC.

NUCLEUS aims to demonstrate the feasibility of a multimedia integrated patient dossier (based on the RICHE concepts) within the hospital setting. The link with SHINE is in two main areas:

- extending patient management from the hospital out into the primary and community health care sectors
- systems architecture, particularly in the area of Open Distributed Systems, platforms

SIG, LISPA and NHS-IMC are common to both SHINE and NUCLEUS. Within the ENS programme there is a health care project called CARE. This project is in the field of emergencies, food safety, statistics and pharmacovigilance. It could provide the 'backbone' links between SHINE regions and for this reason an agreement between SHINE and CARE has been agreed.
Within ESPRIT, the EDITH project is piloting the results of RICHE in Italy, Ireland and Portugal (although not in the same regions as SHINE). LISPA is common to EDITH and SHINE so this link will be exploited.

Testbed Sites and Verification

Italy

Lombardia Informatica (LISPA) currently manages a wide area network, connecting different poles in different geographical sites. The network inter-links USLs, hospitals and regional offices as well as the central regional government.
It is based on an open distributed architecture on top of an X.25 platform; at the present time the network connects multi-vendor computers and workstations (IBM, BULL, OLIVETTI etc).

In particular the LISPA regional network contains:
- about 2000 local and remote workstations
- about 550 local and remote printers
- about 280 remote sites
- about 200 LANs (Ethernet, Token-Ring, etc)
- connection with ITAPAC (the Italian packet switching network) and through it with external data banks.

Ireland

The existing infrastructure in the North Eastern Health Board consists of very basic PC based systems in place in both the community and hospital based programmes. It is not possible to link any of the systems in use at present. There is very little formal linkage between the hospital and community based services.

Essentially this is a green field site in a remote under-developed area of the European Community. A substantial telecommunications network exists through an Bord Telecom and its potential for use in the Health Service has not yet been explored in Ireland.

A commitment to approximately 700 kECUs capital expenditure over 2 years has been entered into by the Irish Department of Health in respect of the North Eastern Health Board. This is providing the necessary infrastructure for the SHINE pilot.

Portugal

The Portuguese pilot region is the Regiono de Aveiro. It currently does not have any health care information network infrastructure. Currently the hospitals and health centres only have personal computers. Some are connected via LANs (Novell in DOS environments, Ethernet with TCP/IP in Unix environments). The databases in use are currently ORACLE and DBASE.

Portugal does have TELEPAC (the National Data Network). There is currently a study to see what is the best way to produce a health care information network, possibly using the services of TELEPAC with improvements (e.g. voice and data images), or maybe by satellite.

Coordinator

International Computers Ltd (ICL)
Address
12 Hadham Road
CM23 2QR Bishop's Stortford
United Kingdom

Participants (6)

ERITEL
Spain
Address
Paseo Del La Castellana 141
28046 Madrid
Lombardia Informatica SpA
Italy
Address
Via Frigia 27
20126 Milano
NORTH EASTERN HEALTH BOARD
Ireland
Address
Ceanannus, Nazan Road Kells
Co. Meath
SERVICO DE INFORMATICA DO MINISTERIO DA SAUDE
Portugal
Address
Av. Columbano Bordalo Pinheiro 87, 1E4
1000 Lisboa
SIG SERVICES B.V.
Netherlands
Address
Maliebaan 50, P.o.box 14074
2508 SC Utrecht
Université de Saint-Étienne (Université Jean Monnet)
France
Address
15 Rue Ambroise Pare
42100 Saint-étienne