Country Brief: Belgium - EHealth Strategies
Country Brief: BelgiumAuthors: J. Devlies, U. Walossek, J. Artmann, S. Giest, J.DumortierOctober 2010European Commission,DG Information Society and Media,ICT for Health Unit
BelgiumAbout the eHealth Strategies studyThe eHealth Strategies study analyses policy development and planning, implementation measuresas well as progress achieved with respect to national and regional eHealth solutions in EU and EEAMember States, with emphasis on barriers and enablers beyond technology. The focus is oninfrastructure elements and selected solutions emphasised in the European eHealth Action Plan of2004.DisclaimerNeither the European Commission nor any person acting on behalf of the Commission isresponsible for the use which might be made of the following information. The views expressed inthis report are those of the authors and do not necessarily reflect those of the EuropeanCommission. Nothing in this report implies or expresses a warranty of any kind.AcknowledgementsNeither the European Commission nor any person acting on behalf of the Commission isresponsible for the use which might be made of the following information. The views expressed inthis report are those of the authors and do not necessarily reflect those of the EuropeanCommission. Nothing in this report implies or expresses a warranty of any kind.ReviewerLuc NicolasContactFor further information about this Study or eHealth Strategies, please contact:empiricaGesellschaft fürKommunikations- undTechnologieforschung mbHOxfordstr. 2, 53111 Bonn,GermanyFax: (49-228) 98530-12eHealth Strategiesc/o empirica GmbHOxfordstr. 2, 53111 Bonn,GermanyFax: (49-228) 98530-12eHStrategies@empirica.comEuropean CommissionDG Information Society andMedia, ICT for Health UnitFax: (32-2) 02-296 01 81eHealth@ec.europa.euinfo@empirica.comRights restrictionsAny reproduction or republication of this report as a whole or in parts without prior authorisation isstrictly prohibited.Bonn / Brussels, October 20102
BelgiumTable of contents123Introduction to the report . 61.1Motivation of the eHStrategies study . 61.2Survey methodology . 71.3Outline. 8Healthcare system setting . 82.1Country introduction . 82.2Healthcare governance . 92.3Recent reforms and priorities of health system/public health . 122.4eHealth setting in the country. 13eHealth Strategies survey results . 143.1eHealth policy action. 153.1.13.2Administrative and organisational structure. 173.3Deployment of eHealth applications. 183.43.53.3.1Patient summary and electronic health record (EHR). 193.3.2ePrescription . 213.3.3Standards . 223.3.4Telemedicine. 24Technical aspects of implementation. 263.4.1Unique identification of patients . 263.4.2Unique identification of healthcare professionals . 273.4.3The role of eCards . 28Legal and regulatory facilitators. 313.5.14Current strategy/roadmap. 15Patient rights. 323.6Financing and reimbursement issues . 343.7Evaluation results/plans/activities. 35Outlook. 36List of abbreviations . 375Annex . 39Annex 1: Compound Indicators of eHealth use by GPs . 39Annex 2: List of SUMEHR contents. 396References . 413
BelgiumExecutive summaryBelgium has no official national eHealth strategy, but several laws and policy decisions havecontributed to the shaping of the general developments towards eHealth use. These laws and officialdocuments do not mention nor refer to the EU eHealth Action Plan, as most of them preceded itspublication, but they still address many of its aims. The coordination of the Belgian eHealth approachcame from a commission for “Norms related to telematics in support of the healthcare sector“ whichwas installed in 1999 by Royal Decree. Following that a government agreement in 2004 “BeHealthplatform” was created which was then built upon in 2008 by the founding of a new public organisationcalled "eHealth-platform", which was created by law. The “eHealth-platform” took over the functionand tasks of the above mentioned health telematics commission, and is intended to address andcoordinate issues related to eHealth.In order to consider Belgium’s position regarding eHealth interoperability objectives the followingeHealth applications have been examined: patient summaries and electronic health records,ePrescription, standards and telemedicine. In overview Belgium’s situation is as follows::The official start of dealing with the contents of electronic medical records was marked by the Law on“Social Affairs” in 1999, empowering the king to define minimal (quality/functional) criteria for medical /healthcare software in order for it to be approved for compatibility by the Ministry of Health. Thecontents of the Belgian patient summary, SUMEHR (Summarised Electronic Healthcare Record), weredefined in 2003-2004. Certification schemes for interoperability levels of authorised software systemshave been in operation in Belgium since 2002. Since 2005, the certification criteria for EHR systemsfor general practitioners require them to be able to export the SUMEHR patient summary. Now, morethan 80% of all GPs across Belgium use certified EHR systems with this capability.In Belgium electronic production of printed prescriptions has been available since the early ninetiesand a decision support facility is available in all primary care EHR applications. However, electronictransmission of prescriptions is so far limited to in-house prescriptions in hospitals. A newePrescription pilot is currently underway and the first field tests are scheduled for 2011.The Belgian eHealth-platform, created by law in 2008, has competencies regarding standards. It ismandated to “define ICT related useful functional and technical norms, standards, specifications andbasic infrastructure required to support [the eHealth] vision and strategy”. However, the eHealthplatform is not the only institution dealing with standards, the Ministry of Health and The NationalHealth Insurance Institute are also involved. Although Belgium is not a member of IHTSDO it isconsidering it and international and semantic standards such as ICD10-ICPC2 are in use.Most telemedicine projects are privately initiated and are generally home care services for elderlypeople or patients with chronic diseases. Telemonitoring exists in terms of Tele-surveillance or Telealarm services and Teleconsultation is used to a limited extent, although services for teledermatologyand telepathology exist. There is no specific policy or implementation programme regarding telecareand telemonitoring, but recently the National Health Insurance Institute initiated a call for proposalsregarding telemonitoring. Also, a number of mobile monitoring projects are currently being piloted.4
BelgiumList of figuresFigure 1: Important features of primary healthcare organisation in Belgium. 12Figure 2: eHealth use by GPs in Belgium . 14Figure 3: Belgian policy documents related to eHealth. 17Figure 4: Patient summary in Belgium . 21Figure 5: Telemedicine services in Belgium . 26Figure 6: eCards in Belgium . 315
Belgium1Introduction to the report1.1Motivation of the eHealth Strategies studyFollowing the Communication of the European Commission (EC) on “eHealth – makinghealthcare better for European citizens: An action plan for a European eHealth Area”,1Member States of the European Union (EU) have committed themselves to develop andissue national roadmaps – national strategies and plans for the deployment of eHealthapplications addressing policy actions identified in the European eHealth Action Plan.The 2004 eHealth Action Plan required the Commission to regularly monitor the state ofthe art in deployment of eHealth, the progress made in agreeing on and updating nationaleHealth Roadmaps, and to facilitate the exchange of good practices. Furthermore, inDecember 2006 the EU Competitiveness Council agreed to launch the Lead MarketInitiative2 as a new policy approach aiming at the creation of markets with high economicand social value, in which European companies could develop a globally leading role.Following this impetus, the Roadmap for implementation of the “eHealth Task Force LeadMarket Initiative” also identified better coordination and exchange of good practices ineHealth as a way to reduce market fragmentation and lack of interoperability.3On the more specific aspects of electronic health record (EHR) systems, the recent ECRecommendation on cross-border interoperability of electronic health record systems4notes under “Monitoring and Evaluation”, that “in order to ensure monitoring andevaluation of cross-border interoperability of electronic health record systems, MemberStates should: consider the possibilities for setting up a monitoring observatory forinteroperability of electronic health record systems in the Community to monitor,benchmark and assess progress on technical and semantic interoperability for successfulimplementation of electronic health record systems.” The present study certainly is acontribution to monitoring the progress made in establishing national/regional EHRsystems in Member States. It also provides analytical information and support to currentefforts by the European Large Scale Pilot (LSP) on cross-border Patient Summary andePrescription services, the epSOS - European patients Smart Open Services - project.5With the involvement of almost all Member States, its goal is to define and implement aEuropean wide standard for such applications at the interface between national healthsystems.Earlier, in line with the requirement to “regularly monitor the state of the art in deploymentof eHealth”, the EC already funded a first project to map national eHealth strategies – theeHealth ERA "Towards the establishment of a European eHealth Research Area" (FP6Coordination Action)6 - and a project on "Good eHealth: Study on the exchange of good1European Commission 20042European Commission 20073European Communities 20074European Commission 20085European Patients Smart and Open Services (epSOS)6eHealth Priorities and Strategies in European Countries 20076
Belgiumpractices in eHealth"7 mapping good practices in Europe - both of which providedvaluable input to the present eHealth Strategies work and its reports. Member States’representatives and eHealth stakeholders, e.g. in the context of the i2010 Subgroup oneHealth and the annual European High Level eHealth Conferences have underlined theimportance of this work and the need to maintain it updated to continue to benefit from it.This country report on Belgium summarises main findings and an assessment ofprogress made towards realising key objectives of the eHealth Action Plan. It presentslessons learned from the national eHealth programme, planning and implementationefforts and provides an outlook on future developments.1.2Survey methodologyAfter developing an overall conceptual approach and establishing a comprehensiveanalytical framework, national level information was collected through a long-standingEurope-wide network of national correspondents commanding an impressive experiencein such work. In addition, a handbook containing definitions of key concepts wasdistributed among the correspondents to guarantee a certain consistency in reporting. ForBelgium, relevant information on policy contexts and health system situation, policies andinitiatives as well as examples for specific applications was collected by the overallproject lead - empirica in Bonn, Germany.The key tool to collect this information from the correspondents was an online surveytemplate containing six main sections:A. National eHealth StrategyB. eHealth ImplementationsC. Legal and Regulatory FacilitatorsD. Administrative and Process SupportE. Financing and Reimbursement IssuesF. EvaluationUnder each section, specific questions were formulated and combined with free text fieldsand drop-down menus. The drop-down menus were designed to capture dates andstages of development (planning/implementation/routine operation). In addition, dropdown menus were designed to limit the number of possible answering options, forexample with regard to specific telemedicine services or issues included in a strategydocument. The overall purpose was to assure as much consistency as reasonablypossible when comparing developments in different countries, in spite of the well-knowdisparity of European national and regional health system structures and services.Under Section B on eHealth implementation, questions regarding the followingapplications were formulated: existence and deployment of patient and healthcareprovider identifiers, eCards, patient summary, ePrescription, standards as well astelemonitoring and telecare.7European Commission; Information Society and Media Directorate-General 20097
BelgiumThe data and information gathering followed a multi-stage approach. In order to create abaseline for the progress assessment, the empirica team filled in those parts of therespective questions dealing with the state of affairs about 3 to 4 years ago, therebydrawing on data from earlier eHealth ERA reports, case studies, etc. to the extentmeaningfully possible. In the next step, national correspondents respectively partnersfrom the study team filled in the template on recent developments in the healthcare sectorof the corresponding country. These results were checked, further improved andvalidated by independent experts whenever possible.Progress of eHealth in Belgium is described in chapter 3 of this report in the respectivethematic subsections. The graphical illustrations presented there deliberately focus onkey items on the progress timeline and cannot reflect all activities undertaken.This report was subjected to both an internal and an external quality review process.Nevertheless, the document may not fully reflect the real situation and the analysis maynot be exhaustive due to focusing on European policy priorities as well as due to limitedstudy resources, and the consequent need for preferentially describing certain activitiesover others. Also, the views of those who helped to collect, interpret and validate contentsmay have had an impact.1.3OutlineAt the outset and as an introduction, the report provides in chapter 2 general backgroundinformation on the Belgian healthcare system. It is concerned with the overall systemsetting, such as decision making bodies, healthcare service providers and healthindicator data.Chapter 3 presents the current situation of selected key eHealth developments based ondetailed analyses of available documents and other information by nationalcorrespondents and data gathered by them through a well-structured onlinequestionnaire. It touches on issues and challenges around eHealth policy activities,administrative and organisational structure, the deployment of selected eHealthapplications, technical aspects of their implementation, legal and regulatory facilitators,financing and reimbursement issues, and finally evaluation results, plans, and activitiesThe report finishes with a short outlook.2Healthcare system setting2.1Country introduction8Belgium is a small, highly developed and densely populated country (approximately 11million inhabitants). It is one of the founding members of the EU and its capital, Brussels,is also the capital of the European Union. It is a federal state with three relativelyautonomous regions: Flanders in the north where Flemish (Dutch) is spoken, Wallonia in8Evidence-based support for the design and delivery of user-centred online public services8
Belgiumthe south where French is spoken, and Brussels in the centre which is officially bilingual.As well as the three regions, Belgium is divided into ten provinces: Antwerpen, BrabantWallon, Hainaut, Liège, Limburg, Luxembourg, Namur, Oost-Vlaanderen, VlaamsBrabant, and West-Vlaanderen. There are three levels of government: federal, regionaland linguistic community, which leads to a complex division of responsibility.Belgium has a healthcare system based on a compulsory social health insurance model.Healthcare is publicly funded and mainly privately provided. Patients have free choice ofprovider, hospital and sickness fund. The Federal Government regulates and supervisesall sectors of the social security system, including health insurance. However,responsibility for almost all preventive care and health promotion has been transferred tothe communities and regions.In 2007, public health expenditure accounted for 9.9% of Belgium's Gross DomesticProduct (GDP). A fixed annual budget for compulsory health insurance and sectoraltarget budgets are set at federal and community level. Private sole GPs and specialistsdeliver most primary care. There is no mandatory referral system. The Belgian healthcaresystem provides comprehensive healthcare to almost all the population while maintaininga wide degree of choice for the insured and the providers. Since the 1980s, the BelgianGovernment's two main objectives hav
Belgium 6 1 Introduction to the report 1.1 Motivation of the eHealth Strategies study Following the Communication of the European Commission (EC) on “eHealth – making healthcare better for European citizens: An action plan for a European eHealth Area”,1 Member States of the European Union (EU) have committed themselves to develop and
Switzerland 6 1 Introduction to the report 1.1 Motivation of the eHealth Strategies study Following the Communication of the European Commission (EC) on “eHealth – making healthcare better for European citizens: An action plan for a European eHealth Area”,1 Member States of the European Union (EU) have committed themselves to develop and
page 2. A vision for national eHealth. A key element of the Toolkit is a national eHealth vision. This explains why a national approach to . eHealth is needed, what a national eHealth plan will need to achieve, and how it will be done.
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EHR-like systems: The eHealth Action Plan set the objective to "focus on deploying eHealth systems, setting targets for interoperability and the use of electronic health re-cords." Such systems are a prominent element in virtually all national strategies and roadmaps. But usually they are not well defined, often (implicitly) referring only .
A common language and understanding : 2.40 – 3.00 pm. eHealth care of individuals. Prof Branko Celler. 3.00 – 3.10 pm. eHealth care of populations and environment. Dr Nick Osborne: 3.10 – 3.20 pm. Social enterprise, citizen engagement & addressing the digital divide: Prof Teng Liaw . 3.20 – 3.40 pm. Address & launch of WHOCC-eHealth .
VLER Health is the IPO program through which the Departments, as participants in the eHealth Exchange, share expertise and capabilities for the Direct Project. FY 2012 IPO eHealth Exchange and Direct Project Activities include the following: 1. Assisting HealtheWay, Inc., a partner in eHealth Exchange, with new interoperability specifications
Toolkit.6 International developments in the eHealth arena The production of the eHealth Strategy was not an initiative unique to South Africa, but was consistent with developments globally. Over the seven-year per
RUMINANT ANIMAL NUTRITION ANN 503 BY Prof. C. F. I. Onwuka Dr. O.A.Isah *Dr. A.O. Oni Dr(Mrs) R.Y. Aderinboye *Course coordinator. COURSE OUTLINE Course introduction , preview and expectation The Nature of ruminant Stomach Physiology, microbiology and biochemistry of rumen Utilization of roughages in ruminant feeding The use of agro industrial by-products in ruminant feeding Importance and .
