establishing the value and business model for sustainable ... · pdf filethis report describes...

Project co-funded by the European Commission within H2020-PHC-2014-2015/H2020_PHC-2014-single-stage

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PP Restricted to other programme participants (including the Commission Services

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CO Confidential, only for members of the consortium (including the Commission Services)

DELIVERABLE

Project Acronym: VALUeHEALTH

Grant Agreement number: 643847

Project Title: Establishing the value and business model for

sustainable eHealth services in Europe

D1.1. Example use cases and classification scheme

Authors: Contributing Authors:

Jeremy Thorp HSCIC

Michèle Thonnet FRNA

Dipak Kalra EuroRec

Danielle Dupont DMI

Ariel Beresniak DMI

Diane Whitehouse EHTEL

Zoi Kolitsi RAMIT

Veli Stroetmann Empirica

Charly Bunar Empirica

Marcello Melgara Lispa

Natalia Allegretti Lispa

Project co-funded by the European Commission within H2020-PHC-2014-2015/H2020_PHC-2014-single-stage

Dissemination Level

PU Public X

PP Restricted to other programme participants (including the Commission Services

RE Restricted to a group specified by the consortium (including the Commission Services

CO Confidential, only for members of the consortium (including the Commission Services)

Revision history, status, statement of originality

Revision history

Revi-

sion Date Author Organisation Description

0.1 22/09/15 Jeremy Thorp HSCIC First outline

0.2 28/09/15 Michèle Thonnet FRNA First revision

0.3 18/10/15 Jeremy Thorp HSCIC Edits following internal meeting

0.31 21/10/15 Dipak Kalra EuroRec Edits

0.4 28/10/15 Diane Whitehouse

Editorial review

0.5 12/11/15 All Review

1.0 21/11/15 Veli Stroetmann

Charly Bunar

empirica Layout edits

Final 25/11/15 Jeremy Thorp HSCIC Final version for submission

Date of delivery Contractual: 30.09.2015 Actual: 23.11.2015

Status final /draft

Abstract (for dissemination)

This report describes the process by which use cases have been identified and the criteria for classification have been derived

Keywords use case identification, criteria for classification and selection

Statement of originality

This deliverable contains original unpublished work except where clearly indicated

otherwise. Acknowledgement of previously published material and of the work of others

has been made through appropriate citation, quotation or both.

D1.1 Example use cases and classification scheme

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Table of Contents

1 Introduction ....................................................................................................................... 5

2 Background ...................................................................................................................... 6

3 Identification of use cases ................................................................................................. 8

3.1 Initial set of use cases ............................................................................................. 8

3.2 Health and care priorities ......................................................................................... 9

3.3 Refinement of use cases ....................................................................................... 12

3.4 Description of the use cases .................................................................................. 12

4 Classification scheme ..................................................................................................... 14

4.1 Identification of potential measures ........................................................................ 14

4.2 Proposed criteria.................................................................................................... 17

Annex I: Candidate use cases ............................................................................................. 18

Annex II: Criteria (with examples) ........................................................................................ 22

Annex III: References .......................................................................................................... 24

List of Figures

Figure 1: Worcestershire Health Strategy .............................................................................10

Figure 2: Stages in Personalised Medicine ...........................................................................11

Figure 3: User requirements .................................................................................................11

Figure 4: Tiers of stakeholders .............................................................................................13


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List of Abbreviations

CEF Connecting Europe Facility

EC European Commission

eHGI eHealth Governance Initiative

eHN eHealth Network

eID Electronic identification

EU European Union

HP Health Professional

HTA Health Technology Assessment

ICT Information and Communication Technology

IHE Integrating the Healthcare Enterprise

JAeSHN Joint Action Supporting the eHealth Network

MS Member States

SDO Standards Development Organisation

SHN Semantic Health Net

SME Small and Medium-sized Enterprise

VeH VALUeHEALTH

WP Work Package


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1 Introduction

This document is deliverable D1.1 from VALUeHEALTH, “Selection of Use Cases and

Classification Scheme”. The background to VALUeHEALTH is described in section 2. This

report then describes the process by which use cases have been identified (section 3) and

the criteria for classification have been derived (section 4).

While the document identifies a number of use cases, an early finding is that for any given

user (for instance a Member State), the business priorities and local context will be the main

determinants of which use cases are most relevant. The outcome of the task of selecting

and classifying use cases is therefore be more about the process of defining use cases and

applying criteria, rather than the specific details of any individual case.

The immediate next steps, following the end of the work described in this deliverable, will be

as follows:

The involvement of stakeholders to enable more detailed consideration of the use cases, including further description of the parties involved in each case, and considerations of actors, payers and beneficiaries

Informed consideration of the classification scheme, which is likely to highlight the relative importance of the criteria in determining which of the use cases to take forward for more detailed consideration.

These actions and their associated outputs will be written up in D1.2 and will then act as input to the work package 2 activity to select the top use cases for detailed analysis, and then deliver worked examples of business model based on these cases.


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2 Background

The purpose of the VALUeHEALTH project is to establish how, over the period 2015-2020,

the Connecting Europe Facility (CEF) support for cross-border eHealth services can mobilize

private and public funding streams to implement and sustain the infrastructures needed

through appropriate investment and pricing mechanisms. The project will pursue this

objective by demonstrating how eHealth interoperability can identify and deliver value for all

stakeholders in order to create a sustainable market when scaling up cross-border

interoperability. The project will develop an evidence-based business plan for a sustainable

digital infrastructure, with revenue streams for developing and operating self-funding top

priority pan-European eHealth Services beyond 2020.

The objectives of the VALUeHEALTH Work Package 1: Prioritised eHealth Services and Use

Cases are to identify and agree on a roadmap of use cases that should be deployed on large

scale. Whilst the focus of the CEF is on cross-border use cases, Member States will wish to

implement other use cases as well. There are already candidate use cases from epSOS,

SemanticHealthNet and other European projects, and the number of use cases will grow

over time. It is neither possible nor desirable to attempt to be explicit at this stage about the

use cases to be implemented up to 2020 and beyond, given societal, political and technical

developments. Therefore the aims of Work Package 1 will be three-fold:

1. to identify a first set of known or expected use cases

2. to classify and categorise the types of use case and

3. to define the process through which all stakeholders can bring forward proposals for

use cases that can be progressed.

There are several factors that could determine which use cases are taken forward in

subsequent work packages:

those cases given high priority (e.g. through the eHealth Network’s Multi-Annual Work

Programme, those from specific projects or those identified in different Member State

ehealth strategies);

those deemed to add particular value (and hence good candidates for consideration

of large-scale roll-out). This could be through swift return on investment or through

added quality and safety for patients (e.g. Picture Archiving Systems in the UK

achieved far more benefits and goodwill than expected. On-going dialogue with

health professional and patient groups will be one mechanism for gathering

information on applications which work effectively;

those which are necessary enablers (which could be infrastructure services such as

eID or reference data / terminology services).

The first task of Work Package 1 (WT 1.1) is to identify examples, types and characteristics

of use cases. This will include the identification of candidate use cases will include gathering

information from:

The four potential eHealth services eligible for CEF funding (as described in the

following section);

Health priorities such as: integrated person centred care; chronic disease

management; population health and research

Roadmaps: CALLIOPE, eHGI, SemanticHEALTH


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Use cases input from the eHealth Interoperability Framework study, Antilope,

EXPAND, PARENT and eSENS

The identification of example use cases will inform the classification of types of use case

(e.g. by priority, value, dependence, etc.) to be considered in subsequent tasks.

Alongside this WT1.2 will consult on approach to identifying and prioritizing candidate use

cases through the application of a responsive, learning-fed, evidence-based methodology.

The initial prioritisation of use cases will be based on prior knowledge and desk research

followed by an iterative process in which the use cases with the best prior knowledge

business plans are validated (in cooperation with PHC 34 Topic (iv) WP2 and WP5), data is

gathered to test and revise assumptions.

The prioritisation task will be supported by unique expertise in multi-criteria risk assessment

and prioritization methodologies establishing the most relevant portfolio of use cases. By

defining a list of selection criteria (e.g. probability of success, level of investment, risks,

European priority, level of evidence, geographies, etc.), a multi-criteria assessment will be

conducted. This business modelling approach takes into account quantitative and qualitative

criteria to assist decision-making, and enables prioritizing different options using a scientific

and standardised approach which considers both the strategic aspects and the financial

value in order to decide and prioritize the best business opportunities.

Validation is likely to lead to revision of business case premises, and hence to change the

expected outcomes for key stakeholders. As a result, the priority ratings of the various use

cases are likely to change, possibly with the identification of new use cases.

This robust methodology will enable identifying and prioritizing the biggest business

opportunities for the deployment of eHealth services in Europe, thus contributing to

optimizing resources and to maximizing business success and sustainability.

WT 1.3 will agree a revised set of target use cases and an approach for the handling of

follow-on use cases. This task will apply the above analysis to help identify and agree on a

portfolio of use cases that will support the Member States in better planning their own

national deployments, together with an approach to on-going maintenance, review and

refreshing of the list of use cases. This will also include proposals regarding the supporting

information needed to define uses cases in order to support the next steps in WP3 and WP4

and the input to the business model in WP2.

Finally WT 1.4 (use case consolidation) will revise the use cases under the perspective of the

other WPs achievements and consolidate them in a new version of D1.2.


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3 Identification of use cases

This section discusses the identification of use cases.

3.1 Initial set of use cases

The Description of Work for VALUeHEALTH identified an initial set of candidate use cases

based on recent projects:

“The four potential eHealth services eligible for CEF funding identified as follows:

1. Cross-border ePrescription and eDispensation service1: ePrescription and

eDispensation as piloted by epSOS extended by additional core services like

eSignature and eIdentification

2. Cross-border patient summary service2: Patient Summary as described in the

guidelines of the Network extended by additional core services like eIdentification and

eAuthentication

3. eHealth services for European Reference Networks : Virtual communication tools and

telemedicine services for low prevalence, rare and complex diseases including

telemonitoring, virtual clinical boards, shared patient and knowledge data bases,

training

4. Infrastructure services for interoperable Patient Registries: Registry of registries,

registry assessment tools, repository of common data and process models for building

patient registries, open source software components … to support data exchange

between registries

Strategic priorities: eHN Multi-Annual Work Programme and Health priorities such as

integrated person centred care, chronic disease management and population health and

research

Use cases input from the eHealth Interoperability Framework study

Cross-border

o e-Prescription and e-Dispensation for cross-border information sharing for citizens

travelling in Europe

o patient summaries for cross-border information sharing for citizens travelling in

Europe

o patient having access to his or her patient summary.

National/Regional

o Request and results (imaging results, diagnostic examinations) sharing workflow for

radiology in inter-hospital setting on national/regional scale

o Request and results (laboratory reports, test results) sharing workflow for laboratory

in inter-hospital setting on national/regional scale

o Cross-Enterprise Sharing of Medical Summaries IHE Integration Profile: Ambulatory

Specialist Referral

1

Denmark, Finland, Greece, Italy, Spain and Sweden are currently piloting the ePrescription service in epSOS. Croatia and Hungary are going to join shortly.

2

Austria, Estonia, France, Italy, Luxembourg, Malta, Portugal, Slovenia, Spain and Switzerland are currently piloting the patient summary service in epSOS. Hungary are going to join shortly.


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o Cross-Enterprise Sharing of Medical Summaries IHE Integration Profile: Acute Care

Discharge to Ambulatory Care Environment

Intra-Hospital

o Request and results (imaging diagnostics tests) distribution workflow for radiology in

intra-hospital setting

o Request and results (clinical laboratory tests) sharing workflow for laboratory in

intra-hospital setting

Citizens at home and on the move.

o Involvement of patient in documentation of his/her specific chronic disease and

making it available via PC or web based applications to healthcare provider (e.g.,

diabetes, cardiac diseases, chronic obstructive pulmonary disease, hypertension)

o Involvement of patient in documentation of his/her specific chronic disease and

making it available via mobile monitoring devices and mobile phones to healthcare

provider (e.g., diabetes, cardiac disease, …)

o For ever-present care outside conventional care facilities, involving the

interoperability necessary from sensor devices to monitor activity.”

Whilst these use cases make good examples, they do not in themselves provide sufficient

context to be able to consider business impact. Discussion of these cases within the

VALUeHEALTH team highlighted some important aspects:

The scope of many of the use cases is narrow; for the purposes of developing a

business justification, it is unlikely that any Member State would wish to build an

investment proposal at this level

Achievement of the use cases is often dependent on other functions or capabilities

being in place, hence will very according to local context

More importantly, it will be necessary to demonstrate how a specific use case

supports local business goals and health objectives.

It was agreed, therefore, that it would be better to start with consideration of the business

goals, based on health and care priorities.

3.2 Health and care priorities

The aim, within VALUeHEALTH, is construct a business model which can be used by

Member States to underpin eHealth investment decisions that are sustainable and not

dependent on short-term EC funding. The starting point is a focus on the intended

investment outcomes, based on the current context within the Member State. Whilst there

are many similar challenges faced by Member States, there are specific differences

depending on context and policy and hence one size does not fit all.

Across Europe, most Member States have identified similar challenges of ageing population,

increasing prevalence of chronic disease and cost pressures. There are also strong

commonalities among countries in the aims of improving health and wellbeing, empowering

patients to play a greater role in their care, focussing care activities more appropriately

according to best evidence, leading to improved safety, increased quality and hence better

outcomes. Three examples illustrate the point:


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The Republic of Ireland published its corporate plan for health in early 2015 in

“Building a high quality health service for a healthier Ireland, Health Service Executive

Corporate Plan 2015-2017”. This document identified the following goals:

o “Goal 1: Promote health and wellbeing as part of everything we do so that people

will be healthier

o Goal 2: Provide fair, equitable and timely access to quality, safe health services that

people need

o Goal 3: Foster a culture that is honest, compassionate, transparent and accountable

o Goal 4: Engage, develop and value our workforce to deliver the best possible care

and services to the people who depend on them

o Goal 5: Manage resources in a way that delivers best health outcomes, improves

people’s experience of using the service and demonstrates value for money.”

In England, local communities have been encouraged to develop their own strategies, often covering both health and social care. Typically involving a wide range of organizations, these strategies set out a shared vision and a common set of objectives. The figure below summarizes the strategy for Worcestershire, a county in England, in which the vision for health and care in the area, enabled through a set of shared values, is seen as leading to a set of agreed health outcomes such as improvements in safety and quality of care and improved care for those with long-term conditions.

Figure 1: Worcestershire Health Strategy

A further example from England relates to the development of “personalized medicine” (or precision medicine in the US). The downward-facing triangle indicates


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the stages in the management of disease, with the aim that early intervention leads to fewer people becoming ill and hence costs being reduced and outcomes and quality of life both being improved.

Figure 2: Stages in Personalised Medicine

An analysis of user requirements is shown below.

Figure 3: User requirements


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3.3 Refinement of use cases

The common features of three examples above and other national and regional plans have

informed the selection of fourteen candidate use cases for consideration. The candidate list

from the VALUeHEALTH Description of Work provided a useful starting point, but the

consideration of health goals has helped the consortium to focus on particular scenarios. It

is worth noting that these scenarios are based on current knowledge and experience. No

claim is made that the list is exhaustive; indeed it is expected that new use cases to be

identified, and stakeholders will be encouraged to suggest more.

The current set of use cases has been grouped into several categories and are as follows:

A. Health services

Online medication profile (“My meds anywhere”)

Integrated care and self-management for long-term conditions (“Individual disease

management”)

Online continuity of care health summary (“Individual personal data anywhere”)

Coordinated cancer care

My care plan

Help keep patients at home (“Enable me to stay at home”)

A. Public health

Prevention plan

Safe prescribing

Population health comparisons

B. Research

Cross-border pharmacovigilance (which could also be categorised as public health)

Clinical trial matching

C. Education

Key care facts

Diagnosis support (“Diagnosis outside the box”)

D. Administration

Care services directory

3.4 Description of the use cases

In order to understand the use cases, and to assess them fairly and objectively, it is

necessary to provide a common set of descriptors. The aim is to answer a set of key

questions:

Is the use case relevant ? (e.g. What is the intended outcome ?)

Is it sustainable ?

Who is the user ? (There may be more than one)

Who benefits ?

Who provides / runs the service ?

Who pays ?


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What are the opportunities / threats ?

Building on this set of questions, each use case has been described using these headings:

Title (plus Sub-title if this helps to clarify the meaning)

Description

Main beneficiary

Pre-requisites

Benefits

Barriers

Incentives

Annex A provides outline descriptions for each of the selected use cases.

The consideration of beneficiaries, users and payers raises the question of stakeholder

engagement. The approach to business modelling adopted by VALUeHEALTH has

identified four tiers of stakeholder, defined by their role in the environment.

Figure 4: Tiers of stakeholders


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4 Classification scheme

4.1 Identification of potential measures

This section introduces a potential classification scheme that can be used to characterise the

use cases, identifying a set of dimensions and accompanying measures. In the previous

section, a set of possible use cases was identified, together with a set of descriptors. The

descriptors outline the actors involved, their roles, and potential outcomes. It is clear that

consideration of use cases requires a multi-dimensional approach, and that the elements

need to be combined to offer a composite score. Based on discussions within the project

team, seven dimensions or themes were identified, and measures proposed.

The first two themes focus on the potential impact on patient care and on health systems and

services.

Potential impact on patient care

Growing health service cost (e.g. ageing population)

Care plans rely significantly upon shared (integrated) care

Helps to incorporate self-management and mobile apps / devices

Helps shift care from an acute to home setting

High prevalence and high cost (long-term) condition

Current practice is variable, poorly co-ordinated or includes unnecessary care

interventions

Patient safety concerns that could be improved (e.g. safer prescribing)

Connects centres treating rare diseases

Contributes to preventive measures and health promotion


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Potential impact on health systems and services

A recognised priority for improved outcomes

Likely to avoid hospital admissions or prolonged lengths of stay

Likely to improve health service efficiency

Likely to reduce healthcare costs and/or optimise resource utilisation

Helps to grow capacity to cope with increasing healthcare demand

Likely to reduce test duplications or treatment delays

Likely to improve equity of access to health services

Enables better evidence for service planning

The next two themes address alignment, with overall policy and with health ICT.

Policy alignment

Aligns with clinical research priorities e.g. rare diseases, personalised medicine

Stimulates growth in the health ICT market e.g. for devices, for secure cloud solutions, for big data analytics

Helps Member States to tackle societal priorities on health service quality, safety and capacity

Facilitates better integration of health and social care

Offers a dual benefit to within border and cross-border care

Supports public health and HTA programmes e.g. evidence on comparative effectiveness

Contributes to healthcare quality monitoring e.g. to quality registers

Generates income or reduces costs to other sectors

Informatics and health ICT alignment

Easily operationalised / put into practice

Takes account of and makes good use of existing health ICT deployments and data

Makes use of the early CEF building blocks

Has expandability to support a cluster of related use cases

Has reusability to underpin other use cases


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The third pair of themes looks at the European dimension, including cross-border

applicability, and the likelihood of the use case successfully being scaled up.

Likely to be successful at scaling up

Has been undertaken successfully before in at least one Member State or Region

Builds on components or similar use cases that are already working well

Few known barriers to adoption

Helps to avoid or mitigate well-recognised barriers to information sharing

Societally acceptable e.g. confidentiality of data, in-home privacy, dignity

Stakeholders who benefit the most are in a position to support and drive the change e.g.

patient groups

Delivers benefit to multiple stakeholder, who will align to support adoption

Scales up existing cross-border initiatives between countries

European dimension

Supports cross border emergency care

Supports cross-border planned care

Enables comparative benchmarking

Enables alignment of care pathways and standards of care across Europe

Makes the case for the planned CEF services

Contributes guidance and a business model for future CEF services

Helps to detect and/or prevent fraud, especially in cross-border services


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The final theme was developed in the context of obtaining sufficient evidence and underlying

data to facilitate the analysis process in VALUeHEALTH.

Easier for VALUeHEALTH

Good availability of data to underpin the business modelling

Good availability of experts to advise on organisational change management and incentives

Relevant and well-aligned standards and products to enable accurate costing of adoption

Can be specified to a detail sufficient to develop the business case

Build on existing European use cases e.g. Antilope: medication, radiology, laboratory, patient summary, referral and discharge reporting, participatory healthcare, telemonitoring, multidisciplinary consultation e.g. SHN heart failure shared care

Specific returns on investment can be projected, within a reasonable time frame.

4.2 Proposed criteria

Based on the seven factors described above, a multi-dimensional set of criteria has been

selected for prioritising use cases.

1. Potential positive impact on individual patients

2. Potential positive impact on number of individuals (patients, family, carers)

3. Improved health outcomes

4. Improved health system productivity

5. Reduced healthcare costs

6. Improved access (to services)

7. Technical and semantic feasibility

8. Applicability across all 28 countries

9. Capital costs avoided/contained

10. Potential impact on health professionals

11. Market stimulation

12. Legal achievability

13. Political acceptance

14. Existing experience

These criteria could then be applied to specific use cases.


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Annex I: Candidate use cases

Drafting notes

This set of use cases is not exhaustive. Work Package 1 will maintain a register of use cases

to which others can be added. This register will be published at the end of the project, along

with the methodology, as a tool for Member States.

Use cases

A. Health services

1. Online medication profile

Sub-title: My meds anywhere

Description: Secure online access to the patient's current and recent medications,

available to the patient and authorised health and care professionals, anywhere globally.

Main beneficiary: Patients

2. Integrated care and self-management for long-term conditions

Sub-title: Individual Integrated disease management

Description: Condition-specific, semantically-interoperable, information sharing between

actors involved in the healthcare, social care and self-care of a patient's portfolio of long-

term conditions.

Main beneficiary: HPs

3. Online continuity of care health summary

Sub-title: Individual personal data (securely available) anywhere

Description: A consolidated online health and care summary that would meet the needs of

emergency or unplanned care but also support planned care (continuity of care for a

patient's long-term conditions), available to the patient and authorised health and care

professionals, anywhere globally.


4. Coordinated cancer care

Sub-title: as above

Description: To connect the actors involved in diagnosing, treating and supporting a

patient with cancer, providing them with distributed access to detailed (not just summary)

cancer records from each care setting and coordinating their activities through an

integrated distributed care plan.



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5. My care plan

Sub-title: as above

Description: This personalised care plan could range in focus from a single condition to

the complete portfolio of health issues, care issues and prevention matters relevant to a

patient, in each case documenting the problems, goals, and actors involved and

scheduled care activities, with reminders.

Main beneficiary: Health professionals, citizens

6. Help keep patients at home

Sub-title: enable me to stay at home

Description: Primarily targeted at frail individuals, commonly the elderly, who might either

have recently been discharged from hospital or be at risk of deteriorating health at home.

Sensors and monitoring devices in the home or worn, integrated and monitored through

smart algorithms and remote call centres, might help early detection and prevent

escalation of a health or care need.

Main beneficiary: Citizen/ Patient if integrated system, HPs if set of sensors

B. Public health

7. Prevention plan

Sub-title: My prevention plan

Description: This use case focuses on health promotion, illness prevention and health

screening programmes that might be developed through multi-stakeholder collaboration at

a regional or national level, and delivered to citizens through mobile and wearable

applications and personal health systems.

Main beneficiary: citizen/ patient

8. Safe prescribing

Sub-title: as above

Description: This use case aims to ensure that decision support algorithms for prescribing

(which already exist) are able to access safety-critical information that may be held in the

systems of multiple health care providers who are caring for the patient: other current

medication, allergies and intolerances, clinical conditions, significant family history,

relevant bio-markers etc. It extends the Medication Profile use case, enriching the

information content to form a kind of medical summary.

Main beneficiary: healthcare professional

9. Population health comparisons

Sub-title: as above

Description: European Member States want to share information about population health

characteristics and health status, illness prevalence, comparative effectiveness, clinical

outcomes, reduction in adverse patient-safety incidents and early detection of outbreaks


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etc. In order to improve the quality, sensitivity and accuracy of the presently-available

benchmarks (e.g. as published by OECD), there is a need to run data analyses on fine-

grained electronic health record information, in a standardised way so that the results are

consistent across equivalent sub-populations and countries, whilst safeguarding personal

confidential data.

Main beneficiary: decision making person (including HPs/organisation)

C. Research

10. Cross-border pharmacovigilance

Sub-title: as above

Description: There is recognised under-reporting of drug safety issues (such as significant

adverse reactions), possibly due to the effort involved by clinical practitioners in filing a

report, and at times the lack of awareness that a clinical event might be caused by a drug.

Decision support systems embedded within EHR systems and clinical applications can be

designed to prompt clinicians to consider whether a drug has caused a clinical

observation such as a symptom, and can semi-automatically generate most of the

necessary report, for quick review and electronic submission.


11. Clinical trial matching

Sub-title: Match me to a local clinical trial

Description: More patients may wish to have the opportunity to take part in a clinical trial

related to their condition. Systems can take the criteria for a new clinical trial and match

them to eligible patients within an electronic health record repository. There is a need to

scale-up such systems across Europe, in a standardised way, and also to enable patients

themselves to provide their health history and disease situation into an online environment

that can search for relevant trials in their geographic vicinity.

Main beneficiary: specific patient

D. Education

12. Key care facts

Sub-title: My key facts

Note: this is intended for health and care professionals (but not about making the

diagnosis)

Description: A well-indexed, searchable, user-friendly and up-to-date compendium of

clinical knowledge covering a comprehensive set of clinical conditions. This is needed

because of the rapid advances in medical knowledge and the sheer volume of such

information. It is difficult for practitioners to keep up-to-date, especially about conditions

they rarely see; this should link to EHRs so the most relevant care facts can be presented

to the clinician.



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13. Diagnosis support

Sub-title: Diagnosis outside the box

Description: A pattern matching medical knowledge service that can take the presenting

clinical profile of the patient (symptoms, signs, investigation results, past history) and

provide a probabilistic differential diagnosis. This use case is envisaged to be primarily

delivered as a background service to clinicians, to prompt them to consider a diagnosis

that appears not to have been made in the patient but is highly likely.


E. Administrative

14. Care services directory

Sub-title: as above

Description: A searchable on-line directory, across Europe, of health and care services

including contact information. This might be used when referring a patient who needs

treatment or when issuing an urgent electronic request for background information if the

patient is seen in an unplanned care setting.

Main beneficiary: patient


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Annex II: Criteria (with examples)

Potential positive impact on individual patients

a change in quality of care or outcome is likely

a change in quality of life impact of the condition is likely

a change in the lifestyle impact of undergoing treatment or monitoring is likely

Potential positive impact on number of individuals (patients, family, carers)

a high-prevalence condition or a frequently-occurring issue

a rare disease but where there may be wide-scale impact on a high proportion of

patients with the condition across multiple member states, or if the solution can be

generalized to multiple rare diseases

Improved health outcomes

a recognized priority for improved outcomes

a recognised area of poor outcomes or prognosis that could be improved

where current practice is variable

a patient safety risk or concern that could be improved

Improved health system productivity

helps to grow capacity to cope with increasing healthcare demand

helps to cope better with ageing population

where current practice is poorly co-ordinated

facilitates better integration of health and social care

enables better evidence for service planning

Reduced healthcare costs

likely to reduce healthcare costs and/or optimise resource utilisation

reduce test duplications, to avoid hospital admissions or prolonged lengths of stay

Improve access

i.e. enables a wider range of patients to access the required care services

Technical and semantic feasibility

easily operationalised / put into practice

takes account of and makes good use of existing health ICT deployments and data

leverages and supports the use of international health informatics standards

builds on existing eHealth Network / EIF use cases

makes use of the early CEF building blocks

Applicability across all 28 countries

i.e. is a relevant area for improvement and possible to implement in all Member

States

supports cross-border planned care

supports cross border emergency care


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enables alignment of care pathways and standards of care across Europe

Capital costs avoided/contained

able to re-use existing health service physical infrastructure without new investments

able to re-use existing health care workforce skills without major re-training

able to re-use or easily build on existing or in-progress national health ICT

infrastructures

Potential impact on health professionals

expected to reduce workload of care professionals

expected to improve working conditions of care professionals

expected to improve job satisfaction, enhance careers

Market stimulation

stimulates growth in the health ICT market for devices, secure clouds, big data

analytics

generates income or reduces costs to other sectors

Legal achievability

legal frameworks exist (or are not needed) to permit the required co-operation

between agencies and MS

legal frameworks exist (or are not needed) to govern any changed responsibilities

and accountabilities

societally acceptable confidentiality of data, in-home privacy, dignity

there are few known barriers to adoption

Political acceptance

offers a dual benefit to within border and cross-border care

helps MS to tackle societal priorities on health service quality, safety and capacity

delivers benefit to multiple stakeholders, who will align to support adoption

contributes guidance and a business model for future CEF services

makes the case for the planned CEF services

existing experience {minimal, within border, cross-border}

has been undertaken successfully before in at least one MS or Region

scales up existing cross-border initiatives between countries

builds on components or similar use cases that are already working well.


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Annex III: References

[1] “Building a high quality health service for a healthier Ireland, Health Service Executive

Corporate Plan 2015-2017”, March 2015, Republic of Ireland Ministry of Health

[2] “National Electronic Health Record”, August 2015, Health Service Executive, Republic

of Ireland

[2] Five Year Health and Care Strategy, June 2014, Worcestershire County Council,

http://www.worcestershire.gov.uk/download/downloads/id/4645/integrated_care_and_the_bet

ter_care_fund_plan_parts_1_and_2.pdf

[3] “Personalised medicine strategy”, September 2015, NHS England

http://www.worcestershire.gov.uk/download/downloads/id/4645/integrated_care_and_the_better_care_fund_plan_parts_1_and_2.pdf

http://www.worcestershire.gov.uk/download/downloads/id/4645/integrated_care_and_the_better_care_fund_plan_parts_1_and_2.pdf

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