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LATEST NEWS
UEHP
UEHP Elective General Assembly – Brussels, 8 February
Last 8 February 2019, UEHP held its elective General Assembly at UEHP premises in Brussels.
On this occasion, Dr Paul Garassus was re-elected for a second biennial mandate as President of UEHP.
As for the UEHP Board of Directors, please find here below the new team:
BOARD MEMBERS 2019-2021
President: Paul Garassus, France
Vice-President: Cristina Contel, Spain
Vice-President: Jens Wernick, Germany
Secretary: Andrzej Sokolowski, Poland
Treasurer: Guy Nervo, Monaco
Member: Gabriele Pelissero, Italy
Member: Paolo Silvano, France
Member: Grigoris Sarafianos, Greece
From l. to r.: Paolo Silvano, Guy Nervo, Andrzej Sokolowski, Jens Wernick, Paul Garassus, Cristina Contel, Gabriele Pelissero, Grigoris Sarafianos.
The General Assembly also approved the candidature of the Group SHAM, as correspondent member. SHAM is a Hospital Mutual Insurance Company – European leader in hospital risk, with which UEHP has already had the chance to cooperate in the organisation of the UEHP-SHAM Master Class on “New Generation of Risk Management”, held in Brussels in November 2018.
For the next mandate 2019-2021, the most important projects and initiatives on UEHP agenda are: active lobbying towards the European elections; the cartography of private hospitals in Europe, an interactive map of private health facilities in EU Member States, which demonstrates with visual immediacy the irreplaceable role of our sector for the protection of citizens' health and the sustainability of European health systems; the new edition of the UEHP Factbook 2019. The main topics chosen by UEHP members for this second edition are efficiency, patient satisfaction and investment in the private sector.
The organisation of other Master Classes is also foreseen, after the success of the first one on Risk Management.
The next UEHP Council Meeting will take place on 7 June 2019 in Romania, in Bucharest, kindly hosted by our Romanian member PALMED.
We congratulate Dr Garassus on his re-election and we wish him another brilliant biennial mandate, always on the frontline of the main battles at EU level!
UEHP
UEHP brings the CEOs from the leading private hospitals groups in Europe to the highest level of EU policy making in healthcare
On 28th January 2019, UEHP had the honour to be received by the EU Commissioner for Health & Food Safety, Vytenis Andriukaitis together with four CEOs from the leading private hospitals groups in Europe.
The meeting was held at the European Commission, Berlaymont Building, in Brussels at the presence of the Commissioner and two members of his Cabinet, for UEHP, the President, Dr Paul Garassus, and the Secretary General, Ms Ilaria Giannico, for the CEOs: Mr Rafal Szmuc (EMC, Poland), Mr Fady Chreih (Regina Maria, Romania), Mr Thierry Chiche (Elsan, France), Mr Ludovic Guillaume (Orpea, France).
From l. to r.: Fady Chreih, Thierry Chiche, Ludovic Guillaume, Vytenis Andriukaitis, Dr Paul Garassus, Rafal Szmuc, Ilaria Giannico
The day started with a brainstorming breakfast held at UEHP premises where each CEO had the opportunity to present himself, his hospital group, priorities and vision for the future of healthcare.
The meeting with EU Commissioner Andriukaitis started with an introduction of UEHP, its mission and its activities by the President Garassus while the Secretary General handed over the Commissioner the UEHP Factbook “Private Hospitals in Europe: supporting Sustainable Health Systems”, launched at the European Parliament in November 2017.
After this introduction, each participant presented himself, his hospital group, activities and priorities in the form of a tour de table.
The Commissioner said that he was pleased to meet the hospitals managers leading the way in healthcare in Europe and UEHP, a pan-European federation representing so many different Health systems in Europe. He shares our view of being on the frontline of the major “battles” EU is currently facing and he stressed that the Commission needs more best practices coming from the private providers to help member States improve their Healthcare systems and reach cost effectiveness.
Then he continued stating what his priorities are, in particular:
- Universal coverage and accessibility for all (reduce social inequalities in societies)
- The need to work as a system
- Chronic situation about Investments in healthcare
- Integration of care and new technologies
- Disease prevention and health promotion
Always bearing in mind that the patient has to be at the center, the Commissioner clearly said that there is a need for excellent cooperation and for reducing the disproportion between public and private sectors: we must rationalise cooperation, not compete!
The Governments are paying the price of hospital reduction, that is the reason why we must develop subsidiary branches, different in each country, to increase efficiency and attain resiliency of our Health systems. Hospitals and other facilities have to adapt to the new challenges (moving patients, population ageing, reduction of hospital beds ans shift to daycare, etc.).
Also, new technologies must be used to reducing the number of hospital adverse events and to enhance daycare, in the current transition from hospital care to new ways of care. One important goal for the Commission is the Health Technology Assessment in each country, in order to understand how these technologies and data help us to achieve better results.
The Commissioner also pointed out the importance of prevention of disease and promotion of healthy lifestyles: the single market is worrying about consumption of sugar, salt, alcohol, etc. which cause diseases, disorders and lead to multimorbidity. Private hospitals should play a key role not only in the treatment of patient, but also in promoting prevention and early screening of diseases, as well as in fighting antimicrobial resistance.
Another important component of the healthcare systems in Europe is the workforce: the Commissioner called for a more rational planning and training of healthcare professionals and motivation of care providers and young students. There is a lack of general practitioners in Europe: how can we solve this problem? And what about the human factor, the combination of ethic-art-science, the empathy that the GP creates with his patients?
Then the discussion continued with some specific questions from the hospital managers on the role of Europe in healthacre and how the European Commission can support their work on the ground.
Europe must help the national Ministries in facing the big challenges of our time and help lowering the social injustice by developing social fair and affordable prices for all, increasing transparency of costs on the services provided and developing better incentive models. However, the European Commission acts as a facilitator to foster cooperation, advancements and dialogue across EU, it cannot “force” Member States to take actions, if they are not willing to.
Finally, talking about the Implementation of the Directive 2011/24/UE on cross-border healthcare, the Commissioner encouraged UEHP in strengthening cooperation with the European Reference Networks, whose main objectives are applying EU criteria to tackle rare diseases requiring specialised care, serving as research and knowledge centres treating patients from other EU countries, ensuring the availability of treatment facilities where necessary.
After Commissioner’s speech, President Garassus added some comments on his statements in an open discussion, confirming UEHP engagement in EU sustainable healthcare model and confirming the necessary change of hospital organisation, for example day care units and coordination with all health professionals, as recently published by UEHP in the “Parliament Magazine”, introducing the “Smart Hospital” concept.
The Commissioner also gives importance to reducing disproportion between public and private sector, a major problem shared by all UEHP members. UEHP aims at making politicians, stakeholders and citizens understand that the private sector offers a service wich is complementary to the public and that only a fair competition between public and private providers can be source of innovation, research and rationalisation of costs with the patient at the center of every single step in healthcare.
In the afternoon, the CEOs and UEHP had the chance to be received at DG CNECT, for a private meeting with Mr K. Rouhana, Deputy Director General DG CNECT, together with Mr M. Marsella, Head of Unit eHealth, Well-Being and Ageing, and Ms C. Huet, Deputy Head of Unit Robotics and Artificial Intelligence, who came straight from their offices in Luxembourg to attend the meeting.
Mr Rouhana welcomed the participants and made an introduction on the DG CNECT current priorities, with a focus on:
- secure access to health data
- new data and genomycs
- personalised medicine
- robotics and AI
- Digital Single Market strategy and Investments for the next financial framework
After this introduction, each participant presented himself, his hospital group, priorities and vision for the future of healthcare, stressing that private hospitals have already put in place different partnerships with companies working on ehealth in order to be there where the innovation is.
Mr Rouhana then expressed the openness of DG CNECT to work with private hospitals stating that “private hospitals are on the lead to implement digital solutions!”.
The discussion continued with open questions from the CEOs to understand where the digital agenda of the EU goes, and how Europe can support hospitals in uptaking and implementing innovation and telemedicine.
Important topics debated where the new EU Regulations on medical devices, the use of robotics in operating rooms, the ePrescriptions and exchange of EHR.
Finally, the EU Commission’s team advised UEHP and the CEOs on the actions 2019-2020, the calls for proposal that will be published in 2019, the funds available and the topics.
Mr Rouhana concluded that they are open to ideas and that they would like to see a greater involvement and participation of European private hospitals in all EU actions and projects for the benefit of our common patients across Europe.
UEHP
Is there a European health project? Interview with UEHP President
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Dr. Paul Garassus, Chairman of the Scientific Council of BAQIMEHP, Vice President of the French Society for Health Economics, has been re-elected President of the European Union of Private Hospitals (UEHP) for a third two-year term.
This interview has been published in the FHP-MCO (French Federation Private Hospitals) weekly newsletter, on 11 February 11 2019.
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Is there a European health project?
Half of the world spending in social protection is European even though we are only 500 million people. Our unique European model is very rich in terms of social protection, and only Japan is comparable to us. Within this bubble of welfare that attracts so much, the difficulties of access to care are minimal while they are major elsewhere, either because of the structuring of the system, or for financial reasons. However, the bubble is not homogeneous and even if we share the same humanistic values, we can observe differences: the rules of access to care are not identical between England and France for example or depend on the type of contribution scheme as in Germany.
Each European member state is in fact extremely protective of its own model, sheltering behind its social history, without really opening up to other experiences and in fact the borders remain watertight in terms of common initiatives. We recently met the Polish Secretary of State for Health, who acknowledged that he had learned more about Health in Europe in an hour with us than in a year in his ministry.
In fact, the Lisbon Treaty is very clear and the principle of subsidiarity as it relates to healthcare remains within the competence of each member state; this was clearly reminded to us last week by the European Commissioner for Health who received us. Europe can therefore issue principles and produce directives, but each member state remains master of its health system via this principle of subsidiarity. There will therefore not be "one" European health system, however coordination across member states must be put in place.
The European patient, wherever he lives, won´t he be seeking a Europe of quality in health?
On the issue of quality of care, the European approach is necessary but not sufficient. The key idea that will remodel the provision of care is the application of equivalent quality indicators in all member states. The patient will probably accept different coverage rates but the Hungarian patient will not accept to be treated worse than the German patient. The gradual homogenization of health systems will be achieved through equitable access to equivalent care. Naturally, it will require quality definition rules based on scientific data and common indicators but ultimately there is no reason for them to be different from one state to another. Health systems will evolve under this pressure induced by the European citizen who expects international standards of equivalent quality. We travel to Europe for professional, family or tourist reasons: we hope to have access to the same services everywhere.
What is the role of UEHP?
It is a platform of professional exchange. It helps reinforce approaches in terms of innovation and stabilize expertise through cross-contact. Above all, it creates a community that also needs reassurance in the face of a changing regulatory environment, but especially in response to economic pressure that limits relevant initiatives.
For developed countries, it is useful to understand that private health provision represents a useful tool for the optimization of health systems. It brings managerial performance, strategic investments and provides the quality of care expected in accordance to the level of social protection promised. At the same time, this platform facilitates the development of quality services in less developed European countries such as Romania and Bulgaria, but also in countries and regions wishing to join us, such as Moldova or the Balkans. Growth potential exists for private health provision because in these countries public funding alone is not sufficient to restore the supply of care services. In these countries there is a significant tendency in delegating pragmatic tasks by liberalizing private initiatives under contract with public social insurance.
Furthermore, UEHP is an essential lever for disseminating information from Brussels concerning directives and regulations, but also on possible funding. Two fields have opened up: innovation and digital (optimize your own digital systems and innovate) and training, with the creation of new professional degree programs related to personal assistance and patient pathway coordination. Europe has a structuring role on these issues and wants to play its part against GAFA or China. Private hospitals, highly eligible for programs, can take part.
How do you address this re-election?
I am re-elected for another two-year term. I am a physician first and foremost and my motivation is to use my experience as a caregiver and transpose it to the scale of positive regulation of all health systems. It is the same function at two different scales. The patient has to be feeling better when he leaves my doctor´s office, and he has to be feeling better when he leaves a European clinic. In 1974, I joined the Faculty of Medicine and since then I have travelled all over Europe, my personal investment is at the service of this fantastic progress that is the Europe of the citizens. But without a co-construction with committed health professionals, the regulator will not be able to find the right «fit». In this debate, even if I am not invited to take part, I will always invite myself to join!
UEHP
UEHP on National Spanish and Italian TV!
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Last 26 January, the Spanish TV channel Mediaset España, broadcasted a joint reportage with the Italian TV channel Mediaset Italia on Medical travel and the EU Directive 2011/24 on patients’ rights in cross-border healthcare. Our Secretary General, Ms Giannico, had the honour to be interviewed and take part to this interesting reportage.
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Watch the full video (UEHP from 14'40): here
UEHP
Falsified Medicines Directive (FMD)
Last 9 February the Falsified Medicines Directive (FMD) entered into force with a set of new rules on safety features for prescription medicines sold in the EU.
Almost 8 years after its adoption in 2011, the implementation of the Falsified Medicines Directive is now complete thanks to the introduction of the end-to-end verification and safety features on prescription medicines. In other words, every pharmacy and hospital in the EU is now required to have a system that makes the detection of falsified medicines easier and more efficient.
Medicines produced before Saturday 9 February 2019 without safety features may also remain on the market until their expiry date. But the new end-to-end verification system requires authorised persons (and in particular pharmacists and hospitals) to verify, throughout the supply chain, the authenticity of the products.
The new system allows Member States to better trace individual medicines, in particular if a concern is raised for one of them.
UEHP has been solicited by some of you (on the initiative of our French member, FHP) about some serious concerns on the implementation of this Directive and the huge costs for equipment and/or workforce related to this new end-to-end verification system that all hospitals must put in place. Some Countries have had an “extension” from their Governments of the period by which every hospital should be fully equipped for the end-to-end verification system without any sanctions, if the hospital officially demonstrate that it is doing all the necessary to adopt the system as soon as possible.
Yesterday, I attended the very first event on the implementation of FMD, organised by the European Alliance for Access to Safe Medicines and the EPP Group at the EU Parliament. As you will see from the programme attached, the event was a useful platform of discussion among the different stakeholders involved (hospitals, hospitals pharmacists), as well as institutions like the European Medicine Verification Organisation (EMVO), the European Commission DG SANTE and the European Parliament.
During the event all parties involved stated that the situation is very patchy in Europe since deadlines for implementation differ among Countries, but progress is there! Of course there are Countries which are more advanced (Finland, Germany) and other Countries where the state of readiness is really low (France, Spain).
The different hospitals invited in the panel presented their experiences, all stressing the same problems and challenges hospitals face in the implementation of the FMD, and in particular:
- The aggregated code: the aggregated code is the reference to all serial numbers in a shipment unit. BUT the problem is that neither the database structure of the EMVO nor that of the individual National system had been designed to process aggregated codes;
- Non-universal scanning infrastructure and/or scanning infrastructures already existing in hospitals not compatible with FMD;
- Limited information available on hospital-specific FMD scenarios (inter-hospital supply of packs, emergency dispensing, etc.);
- Volume of medicines (a hospital handles much higher volume of medicines than a community pharmacy);
- Decommissioning (hospital pharmacists mostly decommission at receipt of goods – but who can perform the decommissioning? Is a pharmacist physically required?);
- High-risk/High-value medication handling.
To be noted: the speaker form NHS Wales clearly stated that should BREXIT happen with a no-deal, they will simply STOP complying to FMD!
To be noted: in Spain only private hospitals have connected to the National verification system!
Finally, the DG SANTE perspective: the speaker from the EU Commission reminded the audience that FMD was the result of an initiative of some Members States who called for a EU actions after registering a huge number of serious accidents on medicine supply and utilisation in hospitals in Europe! Between 2013 and 2017, 400 falsification incidents were reported in the EU and only in 2017 nearly 7 million € of counterfeit medicines were seized at the EU border. This is a serious public health concern for the EU.
When asked about the huge costs involved for hospitals, the DG SANTE speaker replied that all stakeholders involved have to look at the money spent to comply with FMD has a long term investment which will bring a lot of benefits, such as patient safety, streamline procedures and optimisation in hospitals (more efficiency, reduce redundancy and waste), utilisation of a unique identifier to easily track narcotics, bio medicines, improve stock management, assure an uninterrupted medical treatment procedure.
To conclude, I really encourage you to read this report of the European Alliance for Access to Safe Medicines and the Alliance for Safe Online Pharmacy: see here
The purpose of this report is to highlight best practices amongst Member States that have an objective to educate the public from the growing threat of illegally operating websites selling medicines and related healthcare products.
UEHP will be continuing monitoring the implementation of FMD.
UEHP
ECDC Survey about antibiotics and antibiotic resistance
As announced in December 2018, here is a link to an ECDC-funded survey to assess healthcare workers knowledge and attitudes about antibiotics and antibiotic resistance:
The aim of the survey is to have a robust return of 10,000+ responses across the EU/EEA member states with representation from healthcare workers (doctors, nurses and midwives, dentists, pharmacists, other healthcare workers such as hospital managers, allied health professionals, and technicians). ECDC is also seeking responses from health students.
The overall objectives of the study for ECDC are:
- To fill in gaps in terms of evaluation of communication campaigns targeting healthcare workers, and
- To gain a better understanding of their knowledge and perceptions to provide a base to support future needs in terms of policy and education changes.
UEHP is member of the Project Advisory Group (PAG) lead by ECDC; therefore we have been involved in the drafting of the survey from the beginning, together with other umbrella associations representing the most important stakeholders in the healthcare sector.
Please take a moment to participate to the survey! The survey, which takes 5 to 10 minutes to complete and is available in all EU/EEA languages: https://antibiotic.ecdc.europa.eu/en/healthcare-workers/new-europe-wide-survey-healthcare-workers-perceptions-about-antibiotic-use-and
We hope for the maximum participation to this survey from our members to give a consistent contribution in the field of knowledge and attitudes about antibiotics and antibiotic resistance.
EU
Recommendations on a European Electronic Health Record Exchange format
The European Commission adopted on 6 February 2019 its Recommendation on a European Electronic Health Record Exchange format. You can access the full document HERE.
Member States have already started to make some parts of electronic health records accessible and exchangeable across borders. Since 21 January 2019, Finnish citizens can buy medicines using their ePrescriptions in Estonia and Luxembourgish doctors will be soon able to access the patient summaries of Czech patients.
This document proposes that Member States extend this work to three new areas of the health record, namely to laboratory tests, medical discharge reports and images and imaging reports.
As a result, access to complete and personal health records across the EU can offer immense benefits to European citizens, such as the following:
- If someone has an accident while travelling in another EU Member State, doctors will have immediate access to information about the patient (e.g. details of chronic conditions, allergies or intolerances to certain medications). This can significantly increase their ability to provide the most effective and timely treatment.
- Increasing the quality and ensure continuity of care for citizens as they move around the EU.
- Boosting medical research into major health challenges such as chronic and neurodegenerative diseases, by easing the sharing of data. This is subject to the citizen's consent, in a meaningful manner and in full compliance with European data protection rules.
- Supporting the efficiency and sustainability of health systems by, for instance, sharing patient's recent laboratory or radiology tests of a patient. In this manner, a hospital in another Member State will not need to repeat similar tests, saving time and reducing hospital costs.
Next steps
To further develop this exchange of information, a Joint Coordination Process between the Commission and the Member States will be set up. This will allow for contributions and input from stakeholders such as industry representatives, health professionals and patients representatives at both EU and national level.
The Joint Coordination Process will ensure that all the relevant parties are involved in the process of developing the European Electronic Health Records (EHR) exchange format. The Member States, within the eHealth Network, will establish practical guidelines for the implementation and monitoring of its progress.
EU
The European Health Data & Evidence Network (EHDEN) – opportunities to be part of the project for UEHP members!
A new European collaborative project aims to change how we conduct outcomes and similar research at scale, and to support hospitals and similar institutions to generate insights from their own data with internationally recognized standards and tools
Conducting research across multiple data sources to evaluate real world outcomes, and to generate insights into disease natural history and management, is complicated, slow and challenging today, despite technical and methodological advances. We are challenged that we likely miss important insights at a patient and population level, and as such we are not able to optimise healthcare provision, organisation, and understand real world outcomes for patients.
In response to this, EHDEN is a new Innovative Medicines Initiative 2 (IMI2) project, which commenced on 1st November until 2024, and it aims to create a common architecture, infrastructure, research methodologies, education and community supporting observational, real world research in Europe. It commenced on 1st November 2018, will operate as an IMI project until 2024, and has twenty-two partners, 11 public, led by Erasmus Medical Center, Rotterdam, and 11 Industry, led by Janssen Pharmaceutica NV.
Figure 1: The EHDEN consortium partners
IMI is the largest public private partnership in healthcare internationally, with over 100 diverse projects over the last decade, with some EUR6bn in joint funding between the EU Commission and the Pharmaceutical Industry.
Based on this long heritage, EHDEN is a bold project to create a 21st century network for 21st century research, and it is concentrating on the following areas:
- To establish an open source, open science community of hospitals, primary care networks, integrated regional databases, and similar, based on an infrastructure meeting common needs for real world, outcomes research
- EHDEN has established a harmonisation fund, to which e.g. hospitals and other providers will be able apply to via open calls for a grant to support mapping of their electronic health data to the OMOP common data model, which is rapidly becoming the de facto standard for real world data harmonisation. The initial, pilot call will be in mid-June 2019, with a series of calls through the lifetime of the project, based on specific criteria per call. As such grants will not be automatic, and will be based on criteria being met per application
Figure 2: How the EHDEN project calls process will work
- To support harmonisation at scale, and to ensure consistency in mapping data, EHDEN will certify and qualify Small to Medium Enterprises (SMEs) for their ability to provide a quality mapping service to data sources who have obtained a grant from the harmonisation fund. This grant will cover the cost of the mapping, via the SME, and only certified and qualified SMEs will be eligible for such work. Parallel open calls for SMEs will commence with a pilot call at the end of April 2019
- EHDEN will also be conducting outcomes-based research, using the International Consortium for Health Outcomes Measurement (ICHOM) standards (ICHOM is also an EHDEN project partner), as well as use cases from within the project, as well as with collaborating entities, such as the European Medicines Agency (EMA), to validate and verify EHDEN’s work
- To ensure sustainable change, one significant element of the project will be education, and an EHDEN Academy is being set up to support a common approach to real world research in Europe, provide educational support and materials, and to further foster the EHDEN research community for all who participate
- A key international partnership with EHDEN is the Observational Health Data Sciences & Informatics (OHDSI) international collaboration, which developed the OMOP common data model, and numerous open source tools for conducting real world research. EHDEN is a formalisation of the work by OHDSI in Europe, and it will form the European link to OHDSI counterparts in North America and Southeast Asia. To date approximately 550 million health records have been harmonised to the OMOP CDM globally, and this is growing rapidly. Considerable elements of EHDEN will also be based on a prior project, the European Medical Information Framework (EMIF), and other programmes, such as a data catalogue, research tooling, and methodologies
Figure 3: Outlining the OMOP common data model harmonisation technical process, and OHDSI tool suite
- EHDEN is creating a ‘federated’ network, which means all data harmonised will remain local and protected by institutional firewalls, effectively ‘privacy by design’ under the General Data Protection Regulation (GDPR), enforceable since May 2018. As such, each hospital or clinic will remain in control of how their own data is used, by whom, and all such harmonised data will be used for anonymised, population-level research. In a federated model, data stays local and it is the query that is distributed, resulting in aggregated results
EHDEN aims to collaborate with hundreds of hospitals, and similar, throughout Europe, with an aim to harmonise at least 100 million European electronic health records to the OMOP common data model, supporting outcomes and other research at scale. We believe that there is a quid pro quo for collaborating, as EHDEN will be able to facilitate from single hospitals and larger networks to conduct their own research, audits and benchmarking, in a wider community.
If you as an UEHP member would like to know more, please contact Ms Giannico ( secretarygeneral@uehp.org) and indeed visit the EHDEN website, http://www.ehden.eu/ for further information as the site is developed.
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