WEEK 12: NI in Europe

European Union

Includes most of Europe, with 28 member countries and a population of beyond half a billion

28

How many member countries are in European Union?

European Union

• Their initiatives towards healthcare focuses on specific developments and actions that focus on equality, quality, and safety among healthcare services for citizens in every country in the European Union.

• They play an integral part in supporting research and development activities through initiatives and programs

National Finnish Nursing Documentation

A project that is described as an example of implementing a standardized nursing terminology into an electronic health record (EHR) System.

1. Healthcare is organized differently substantially from country to country

2. Their different national health systems face similar sets of challenges

3. Population growth has decreased

   1. Increasing the demand for health and social services

   2. Demand of health professionals is increasing

4. Shortages of skilled nursing personnel

5. Increasing cost of healthcare services

Discrepancies with Healthcare in Europe

1. Healthcare is organized ____ substantially from country to

   country

2. Their ____ national health systems face similar sets of challenges

3. Population growth has ____

   • _____ the ____ for health and social services

   • Demand of health professionals is _____

4. _____ of ____ nursing personnel

5. Increasing ____ of healthcare services

Health Informatics

Offer solutions to promote the use of information and communication technology

eHealth

Has been defined as health services and information delivered or enhanced through the Internet and related technologies

1. eHealth Action Plan

2. eEurope Initiative in 2000

3. eEurope 2002 Action Plan

4. eEurope 2005 Action Plan

eHealth in European Union Policy Frameworks

eHealth Action Plan

eHealth in European Union Policy Frameworks

• Published in 2004 by the Commission of the European Communities

• States that “eHealth is today’s tool for substantial productivity gains, while providing tomorrow’s instrument for restructured, citizen-centered health care systems and, at the same time, respecting the diversity of European traditions.

eEurope Initiative in 2000

eHealth in European Union Policy Frameworks

• Its purpose is to enable an information society for all Europeans and

  to ensure that the European Union was ready for the development of

  the information society.

• Aims to create a fully integrated, interoperable, and modernized health system using digital technologies.

eEurope 2002 Action Plan

eHealth in European Union Policy Frameworks

• Aims of this plan, is extending Internet connectivity and helping the member states adopt an existing legal framework

eEurope 2005 Action Plan

eHealth in European Union Policy Frameworks

• Focused on utilization of broadband technologies, electronic health

  services, and improvement of the quality and cost-effectiveness of

  public services

Commission of the European Communities

Who published in 2004 the eHealth Action Plan?

Noted :))

Noted the ff:

Central points of the first eHealth Action plan includes:

• Information transfer

• Health and patient information

• Patient identifiers

• Mobility of patients and health professionals

• Infrastructure and eHealth Information networks

• Monitoring the effects of new interventions

Europe’s eHealth Action Plan

Includes recommendations for disseminating best practices and experiences regarding eHealth applications across the European Union

2 years; 2004 to 2010

The progress of eHealth application implementation was measured every ____ years during the period of ____ to ____

eHealth Benchmarking Study

funded by the European commission, aimed to analyze existing benchmarking sources

2008

During what year did the European Commission publish a recommendation on cross-border interoperability of EHR systems to support the goals of the eHealth Action Plan?

1. Establish elements of EHRs that should be exchangeable between systems.

2. Enable health data to be shared among different

   healthcare systems

3. Build appropriate networked systems and services covering all healthcare areas

Objectives presented by Commission of the European Communities

1. Establish ____ of EHRs that should be _______ between systems.

2. Enable health _____ to be shared among _____ healthcare systems

3. Build ____ _____ systems and services _____ all healthcare areas

1. Establish elements of EHRs that should be exchangeable between systems.

2. Enable health data to be shared among different healthcare systems

3. Build appropriate networked systems and services covering all healthcare areas

Objectives presented by Commission of the European Communities:

eHealth European Interoperability Framework (EIF)

• Meant to be an operational toolkit for stakeholders who partake in the deployment of eHealth Systems.

• Note, that interoperability between information systems is not only a technical issue

  • Health data are always sensitive and trustworthy

  • Patient confidentiality and security are important.

  • Legal, ethical, economic, organizational, and culture need to be considered.

1. Governance

2. Principles

3. Agreements

4. 4 Levels of Interoperability

   1. Legal

   2. Organizational

   3. Semantic

   4. Technical

5. High level use Cases

Components of the eHealth EIF

eHealth Network

• Interoperability issues are one of the key aims of eHealth network

• Established under the directive on the application of patient’s cross-border healthcare

• Is a group of voluntary network of national authorities responsible for eHealth in European Union member states

• Purpose: is to make guidelines in the area of eHealth in order to enable continuity of care and to ensure access to safe and quality healthcare.

Interoperability

One of the key aims of eHealth network

National eHealth Strategy

The eHealth Action plan included a requirement for each member state to develop what to identify their current state and map a plan for future development?

Monitoring National eHealth Strategies study

Published in 2010, showed that almost all European Union member states have detailed documents concerning eHealth goals, implementation, and achievements

2007

When did Finland introduce its eHealth Strategy?

1. Secure the access to information for those involved in care regardless of time or place

2. Enable the involvement of citizens and patients, increasing the citizens’ access to information and offering a high quality of health information

Main Objectives of Finland eHealth Strategy

1. Secure the _____ to ____ for those involved in care regardless of ____ or _____

2. Enable the involvement of ____ and ____, increasing the citizens’ access to information and offering a high quality of health information

1. Secure the access to information for those involved in care regardless of time or place

2. Enable the involvement of citizens and patients, increasing the citizens’ access to information and offering a high quality of health information

Main Objectives of Finland eHealth Strategy

1. Interoperability between public & private providers

2. Later extended to health and social welfare systems

Goals of Finland eHealth Strategy

1. _____ between public & private providers

2. Later extended to ____ and ____ ____ systems

1. Interoperability between public & private providers

2. Later extended to health and social welfare systems

Goals of Finland eHealth Strategy

Finnish Nursing Diagnoses

Example of adopted classification systems in Finland?

National E-Archive

In Finland, what stores core patient data enabling access to personal health data and e-prescriptions?

Hyvis Portal

Finland

• Free service district that complements regional health services and promotes the welfare of inhabitants by offering reliable information about healthcare services

National Health Services

The UK government is investing billions of pounds in developing information and communications technology within the ___ ____ ____ to ensure that modernization and utilization of eHealth becomes a reality

1. England: NHS Connecting for Health

2. Wales: Informing Healthcare

3. Scotland: eHealth Program

4. Northern Ireland: HPSS ICT

Identify the country and national ICT programs of the UK

NHS Connecting for Health

Identify the national ICT program of the ff UK country:

England

Informing Healthcare

Identify the national ICT program of the ff UK country:

Wales

eHealth Program

Identify the national ICT program of the ff UK country:

Scotland

HPSS ICT

Identify the national ICT program of the ff UK country:

Northern Ireland

1. i2010 Framework

2. Digital Agenda for Europe

3. eHealth Action Plan 2012-2020 (eHAP)

4. Cross-Border Healthcare

Toward eHealth Action Plan 2020

i2010 Framework

Toward eHealth Action Plan 2020

• in 2005, the European union introduced a new strategic framework for information society and media

• Main Objectives:

  • Improve quality and accessibility of healthcare services

  • Support the cost effectiveness of eHealth systems and services

  • Facilitate and contribute the implementation of the eHealth Action Plan.

1. Improve quality and accessibility of healthcare services

2. Support the cost effectiveness of eHealth systems and services

3. Facilitate and contribute the implementation of the eHealth Action Plan.

Main Objectives of the i2010 Framework

Digital Agenda for Europe

Toward eHealth Action Plan 2020

• followed the i2010, focusing on the utilization of the economic and social potential of Internet technologies in all fields of society

• Emphasis was placed on ambient assisted living (AAL)

  • Technologies which makes ICT-based services accessible for all

  • Allows home-based care and point-of-care info management.

Ambient Assisted Living (AAL)

What did the Digital Agenda for Europe emphasize, which are technologies that makes ICT-based services accessible for all and allows home-based care and point-of-care info management?

eHealth Action Plan 2012-2020 (eHAP)

Toward eHealth Action Plan 2020

• Aims to innovate healthcare for the 21st century

• Provides smart, safe and patient-centered healthcare

• Addresses the barriers and aims to fulfill the following objectives

  • Achieving wider interoperability of eHealth services

  • Support research and development and innovation in eHealth

  • Facilitating uptake and ensuring wider development

  • Promoting policy dialog and international cooperation.

Cross-Border Healthcare

Toward eHealth Action Plan 2020

• Enables citizens of European Union to seek health services from other EU country

• Guarantees the continuity and safety of care

Safe health information transfer

Is a basic principle of cross-border healthcare

1. epSOS (Smart Open Services for European Patients)

2. epSOS Participation & Infrastructure

3. Pilot Phase - Key Services

4. Project Extension (2011) - Additional Services Tested

Cross-Border Activities in eHealth

epSOS (Smart Open Services for European Patients)

Cross-Border Activities in eHealth

• Pilot project duration: 2008–2014

• GOAL: Achieve interoperability of electronic health records across EU countries.

• AIM: Seamless health information exchange to improve care quality and safety during cross-border movement

epSOS Participation & Infrastructure

Cross-Border Activities in eHealth

• 23 countries involved in developing a common eHealth framework.

• Focused on enabling data transfer between national healthcare

  systems

Pilot Phase - Key Services

Cross-Border Activities in eHealth

• Patient Summary

• e-Prescription

1. Patient Summary

2. e-Prescription

What were the key services provided in the pilot phase?

Patient Summary

Key service in pilot phase

• Contains essential clinical information for safe treatment.

• Useful in emergency and scheduled care.

e-Prescription

Key service in pilot phase

• Prescriptions made in the patient’s home country (with consent).

• Enables medication retrieval abroad.

Project Extension (2011) - Additional Services Tested

Cross-Border Activities in eHealth

• Patient access to their health data

• Medication-Related Overview

• Healthcare Encounter Report

• Integration of 112 emergency services

• Integration of European Health Insurance Card

• Patient access to their health data

• Medication-Related Overview

• Healthcare Encounter Report

• Integration of 112 emergency services

• Integration of European Health Insurance Card

What were the additional services tested in Project Extension (2011)

1. Evaluation of eHealth Deployment in EU (2008-2011)

2. Main eHealth Applications Identified (2008 Report)

3. Country-Level Highlights

4. ENS5 Care Project (2014)

eHealth Applications

Evaluation of eHealth Deployment in EU (2008-2011)

eHealth Applications

• Key Evaluation bodies or Organizations

  • Finnish National Institute for Health and Welfare (STAKES)

  • eHealth ERA Project

  • Monitoring National eHealth Strategies Study (2011)

• Finnish National Institute for Health and Welfare (STAKES)

• eHealth ERA Project

• Monitoring National eHealth Strategies Study (2011)

What were the key evaluation bodies or organizations for eHealth deployment in the EU?

Main eHealth Applications Identified (2008 Report)

eHealth Applications

• EHRs

• Patient Identifiers

• Health portals (for citizens and professionals)

• Citizen Health Cards

• Telemedicine

• EHRs

• Patient Identifiers

• Health portals (for citizens and professionals)

• Citizen Health Cards

• Telemedicine

What were the main eHealth Applications Identified (2008 Report)

Country-Level Highlights

eHealth Applications

• Finland: Only country with activities in all 14 areas

• 11 Countries with activities in more than 10 areas:

  • Austria, Belgium, Denmark, Greece, Hungary, Italy, Poland, Slovakia, Sweden, UK

Finland

What is the only country with activities in all 14 areas?

• Austria,

• Belgium,

• Denmark,

• Greece,

• Hungary,

• Italy,

• Poland

• Slovakia,

• Sweden,

• UK

What are the 11 countries with activities in more than 10 areas?

ENS5 Care Project (2014)

eHealth Applications

• EU-Funded thematic network

• Coordinated by the European Federation of Nurses Association (EFN)

• Aims to develop evidence based ICT guidelines for nursing a care

• Focused on:

  • Healthy lifestyle and prevention

  • Early intervention & integrated care

  • Skill development for advanced roles

  • Nurse e-prescribing

European Federation of Nurses Association (EFN)

Who coordinated the ENS5 Care Project (2014)?

1. Transactional

2. Interactive

3. Linear

Basic Models of Communication

Transactional

Basic Model of Communication

• refers to the continuous exchange of information in which both sender and the recipient are engaged and take turns communicating messages.

Interactive

Basic Model of Communication

• refers to the two-way method of communication with feedback

Linear

Basic Model of Communication

• is a model that proposes communication only moves in one direction.

• The Sender encodes a Message and then sends it via a specific

  Channel to a Receiver.

People’s Needs for Nursing Care

Nursing Terminology Development in Europe

• First effort to have standardized nursing data

• A multinational study from 1976 to 1985

• Nursing process model used as a framework

• Assessment of nursing needs.

• Planning of care

• Implementation of nursing actions

• Assessment of nursing outcomes.

In People’s Needs for Nursing Care, what were the 4 phases nurses mainly adopted?

True

True or False: In the early 1980s, many European countries decided not to use the term “nursing diagnosis” and named the important conclusion after the assessment phase “nursing needs” or “nursing problems”.

European Union

Nursing Terminology Development in Europe

• Played an important role in supporting research and development activities with various activities and programs since the 1980s

Danish Institute for Health and Nursing Research

Nursing Terminology Development in Europe

• Elected to coordinate the Concerted Action on Telematics for Nursing: European Classification on Nursing Practice with regard to

  • Patient’s problems

  • Nursing Interventions

  • Patient Outcomes

  • Educational Measures

International Council of Nursing (ICN)

Nursing Terminology Development in Europe

• Started the development of the International Classification for Nursing Practice (ICNP) in 1989

• Since 1991: this and TELENURSING consortium worked together to support the development of the ICNP

TELENURSE Project

Nursing Terminology Development in Europe

• 1995 to 1998

• The central focus of the project was on clinical nursing’s aim to offer advanced ways of handling both nursing classification of problems, interventions, and results as part of the registration of clinical data and collecting the information necessary to enhance the quality of clinical practice in nursing

NANDA International Classification

Nursing Terminology Development in Europe

• Translated into many European Languages, but some are not in active

  use in nursing documentation

VIPS Model

Nursing Terminology Development in Europe

• Focuses on Patient’s functioning in daily-life activities rather than on pathophysiologic problems

• Has good content validity in different areas of model care

• Well-being

• Integrity

• Prevention

• Safety

VIPS is the acronym for the Swedish spelling:

International Classification of Functioning, Disability and Health (ICF)

Nursing Terminology Development in Europe

• Formerly known as the International Classification of Impairments,

  Disabilities, and Handicaps (ICIDH)

• Highlights the terms “health” and “disability”

  • Every human being can experience a decrease in health and

    thereby experience some degree of disability

True

True or False: During the early 2000s, the National Health Service in England and other countries of the United Kingdom decided to use a single, multi disciplinary terminology across healthcare.

Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT)

Nursing Terminology Development in Europe

• The National Health Service in England and other countries of the United Kingdom decided to use this single, multi disciplinary terminology

• Nurses have been involved in the crucial task of ensuring that nursing content is adequately represented in this large, multi-disciplinary

• Of English language origin so there is a major translation challenge for European countries adopting and implementing it into electronic information systems

Nursing Information Reference Model (NIRM)

Nursing Terminology Development in Europe

• Widely used in other countries to accommodate both the information needs of nurses at the clinical level and for aggregating data at higher levels

Nursing Minimum Data Set (NMDS)

Nursing Terminology Development in Europe

• Along with the NIRM, have been used to indicate nurses’ contribution

  in healthcare from administrative and economic perspectives

Belgian Nursing Minimum Data Set (B-NMDS)

Nursing Terminology Development in Europe

• First attempt among European nurses to show a nursing contribution since 1988

• Consists of 23 nursing interventions, medical diagnoses, patient demographics, nurse variables, and institutional characteristics’

Irish Nursing Minimum Data Set (I-NMDS)

Nursing Terminology Development in Europe

• The development of this for general nursing and mental health nursing has advanced data collection for multiple purposes

Finland Nursing Minimum Data Set (FiNMDS)

Nursing Terminology Development in Europe

• Nationally defined core nursing data in Finland

• Includes nursing diagnoses, nursing interventions, nursing outcomes, patient care intensity, and nursing summary

  • Nursing Summary

    • Consists of the four former items

    • Will be among the first nursing representatives stored in the National Archive of health information in autumn 2014

RN4CAST

Nursing Terminology Development in Europe

• One of the largest nursing workforce studies in Europe by researchers from 12 different European countries

• Aimed to provide innovate forecasting methods addressing not only volume, but also quality of nursing and patient care

• Ambition of this → produce a policy breakthrough commensurate scientific strength of the project’s findings and the accumulated evidence in the sector

• Included producing both technical and scientific publications, as well as liaising with the mass media

• Found that improved work environments were associated with quality of care and patient satisfaction

Stakeholder Collaboration

Nursing Terminology Development in Europe

• Maintained with a stakeholder panel consisting of 13 healthcare

  nursing administration related organizations to raise awareness of the

  project

Patient Safety Research

Nursing Terminology Development in Europe

• Focused on “non-traditional” areas, as the recognition of the

  interaction between human action and health systems has developed

  the idea of identifying the elements of healthcare procedures

  creating “packages” of care that can be more readily defined

  trained-for, and monitoredB

• Based on national research programs, and it is also on European

  Commission Directorates’ in Europe

Bologna Declaration 1999

Developments in NI Education

• Signed by European ministers responsible for higher education

• Objective is to develop a European higher education area by 2010

• Quality Assurance

• Two Cycle System

  • First Cycle Degrees

  • Second Cycle Degrees

• Degree Recognition

Key Objectives for Member Countries of the Bologna Declaration 1999

First Cycle Degrees

Two Cycle System (Bologna Declaration 1999)

• Bachelor level

• To provide access to second cycle programs

Second Cycle Degrees

Two Cycle System (Bologna Declaration 1999)

• To provide access to doctoral programs

Nightingale Project

Developments in NI Education

• Helped shape the structure and materials for NI courses

• Its work has been used as a model for enhancing NI curricula in subsequent years

European Summer School in Nursing Informatics (ESSONI) Consortium

Developments in NI Education

• Organized eight summer schools in various European countries

• Program aimed to promote collaboration and advance NI education

• However, due to changes in EU funding mechanism has been unable to continue

University of Eastern Finland

Developments in NI Education

• Offers a Health and Human Services (HHSI) master’s program

• Degree is multidisciplinary

• Became first certified master’s degree program in the world by the International Medical Informatics Association (IMIA) in 2012

University College London + Whittington Hospital NHS Trust

Health Informatics in the UK

• Offers multi-professional courses in health informatics.