D2.1 White Paper on IT skills for healthcare workforce in the EU and USA and cooperation opportunities
Teresa Meneu (UPVLC), Vicente Traver (UPVLC), Stathis Konstantinidis (NORUT), Panagiotis Bamidis (AUTH), Nabil Zary (KI)
Competence: Demonstrated ability to apply knowledge, skills and attitudes to achieve observable results. 
eHealth: EU term applicable to Health related information and communication technology. In US, the synonymous term is health IT. 
Healthcare workforce: all people engaged in actions whose primary intent is to enhance health according to the World Health Organization's World Health Report 2006.  Human resources for health are identified as one of the core building blocks of a health system . They include physicians, nurses, midwives, dentists, allied health professions, community health workers, social health workers and other health care providers, as well as health management and support personnel – those who may not deliver services directly but are essential to effective health system functioning, including health services managers, medical records and health information technicians, health economists, health supply chain managers, medical secretaries, and others.
Health IT: US term applicable to Health related information and communication technology. In EU, the synonymous term is eHealth. 
Health IT skills: eHealth IT skills: ability to carry out managerial or technical tasks in the ehealth/IT health field. Any competency and knowledge deficiencies among all staff in healthcare delivery, management, administration and support to ensure universal application of ICT solutions in health services. 
Role: Normally expressed as a role profile: a specialised combination of skills or competences with specific responsibilities to fulfil a specific type of tasks and to produce pre-defined deliverables, mostly used in engineering, especially SW-engineering models. 
Skills: ability to carry out managerial or technical tasks. Managerial and technical skills are the components of competences and specify some core abilities which form a competence. 
Whitepaper: A white paper is an article that states an organization's position or philosophy about a social, political, or other subject, or a not-too-detailed technical explanation of an architecture, framework, or product technology. Typically, a white paper explains the results, conclusions, or construction resulting from some organized committee or research collaboration or design and development effort. In information technology, a white paper is often a paper written by a lead product designer to explain the philosophy and operation of a product in a marketplace or technology context. In government, a white paper is often a policy or position paper. 
1.1. Project description
Addressing IT skills for healthcare workforce is seen as an important element of achieving greater social inclusion as identified in EU and National policy areas. Digital skills offer a gateway to supportive networks, expert patient groups, advice, information and new learning opportunities, social networks and more. Providing the means and the guidelines of sharing, re-using, and repurposing technologies of new educational material and programs for IT-skilled workforce in healthcare applied in different contexts, different languages and cultures in the EU and USA, the CAMEI project  will allow new ways of boosting knowledge and provide IT skills to healthcare workforce of EU and USA. CAMEI aims to coordinate research activities and policies towards the development of renewed educational material and programs, to boost new trends for acquiring new knowledge in respect of the implementation of eHealth systems in practice, foster trans-national access to research infrastructures from both EU and USA partners and establish a network of best practices in Medical Education Informatics. The partners of CAMEI are experts in providing IT skills to healthcare workforce by means of different technologies and learning approaches. CAMEI will contribute to improving the health services offered by a wide range of health care professionals. There are a number of barriers that hamper the wider uptake of eHealth including the lack of awareness of, and confidence in eHealth among healthcare workforce.
1.2. Goals of the project
CAMEI will contribute towards innovation in eHealth in Europe by providing the ground for IT-Skilled healthcare workforce and its results are aimed to be used by the the upcoming Health Programme 2014-2020 and Horizon 2020 under “Health, demographic change and wellbeing”.
1.3. Goals of WP2
• Identify common challenges and opportunities on providing IT skills for healthcare workforce
• Assess the cooperation potential among the EU and USA 
• Benchmark in detail policy priorities of USA on IT skills for Healthcare workforce and research sub-areas with those of EU (i2010, FP7-ICT strategic priorities, Horizon 2020)
• Identify the means and the guidelines of sharing, re-using, and repurposing technologies of new educational material and programs for IT-skilled workforce in healthcare applied in the different context, different languages and cultures in the EU and USA.
• Locate a prominent base of cooperation where mutual benefits can be generated for both regions
2. State of the art about the IT skills education for the healthcare workforce in the EU and USA
2.1. Major socio-economic factors and trends
“Health care is changing. Ageing populations, new therapeutic possibilities and rising expectations have made the provision of health care much more complex than in the past. Many countries are responding to this challenge, introducing new ways of delivering health care. At the heart of these changes are the health professionals. They must acquire a range of new skills. Some are technical, such as how to get the most from new information systems or advances in technology. Some are organizational, such as how to work in multi-disciplinary teams. Yet the new landscape requires more than this. It also demands new attitudes, finding ways in which the health professional can engage in effective partnerships with both their patients and the organizations that purchase care on their behalf and who look beyond the individual patients to understand the needs of the population.” European Observatory on Health Systems and Policies
Healthcare is concerned with the provision, distribution and consumption of healthcare services and related products. It is a complex sector because differences in subsectors and between countries are often significant. In line with NACE classification, the sector includes human health activities (hospital, medical and dental practice), residential care (residential nursing, residential care for mental retardation, health and substance abuse for elderly and disabled) and social work activities. As European and US society ages, healthcare and related social services are becoming increasingly important. In Europe, this growing demand for services, provided by the public sector in many Member States, is creating unprecedented pressures on health and social care systems.
In 2000 the US healthcare system was declared “broken,” and the analysis ten years after brings out that the situation has not improved. Furthermore, premiums for insurance are rising as hassles for patients and physicians do and nearly 45 million citizens are uninsured. Over the next decade, these problems are expected to worsen and new challenges will arise. With this scenario, many stakeholders, from the government to the professional associations and the citizens themselves are looking for opportunities for a big change in how healthcare is organized, however, this issue is still a very controversial discussion topic in the US.
Demographic predictions for 21st century build a new scenario characterized by a modest increase in life expectancy, but a significant greater burden of disability, which will impact both in terms of healthcare specific demands and of sustainability of costs. Furthermore, according to the last Global Burden of Disease (2010) the ageing of the population is one of the two more relevant factors (jointly to the growing of the population) in generating the increase in DALYs due to non-communicable diseases, 2) there is a shift to burden older ages and 3) there is a tendency to a greater weight of years lived with disability, it is forecasted an increasingly relevant role for chronic diseases that generates disabling conditions on the burden of disease. This way, the proportion of people over 65 is expected to be almost double by 2050 and this population will require more resources devoted to prolonged medical care and assistance to ensure that they live independently and with an adequate quality of life.
The world is experiencing a rapid rise in chronic health problems to the extent that chronic conditions now account for over half of the global disease burden. Previously, acute infectious diseases were the primary focus of the health care workforce in every country. However, during the last century, advances in medical science, technology and public health, such as immunizations, sanitation, housing and education, have contributed to a decrease in acute diseases. As a result, life expectancy has risen during this period. Because people are living longer, they have the opportunity for extended exposure to risks that promote the development of chronic conditions. Non-communicable diseases (NCDs) – mainly cancers, cardiovascular diseases, diabetes, and chronic respiratory diseases – are responsible for about two-thirds of deaths worldwide. The impact of conditions such as chronic heart failure on Western economies due to prolonged absence from work and disability can be measured in billions of euros. There is an urgent need for policies and strategies that prevent NCDs by reducing their major risk factors. Six out of the seven (smoking excluded) most important risk factors for premature death (blood pressure, cholesterol, Body Mass Index, inadequate fruit and vegetable intake, physical inactivity, excessive alcohol consumption) are related to diet and physical activity. Unhealthy diet and the lack of physical activity are therefore the leading causes of avoidable illness and premature death in Europe. Worldwide, the prevalence of lifestyle related diseases is expected not only to continue but to increase dramatically. A large part of the health budgets are directly and indirectly being spent on the care of chronic diseases. But it is also well known that NCDs can to a large extent be prevented if citizens followed current guidelines on diet, alcohol, physical activity and smoking.
On the other side, according to the OECD, the healthcare sector employs almost 10% of the total workforce and corresponds to almost 9% of gross domestic product (GDP) in the European Union. Moreover, health expenditure is increasing at a faster rate than the GDP, with an estimation to rise in OECD countries up to the 16% of GDP in 2020. With this framework, the situation is challenging, as the system won’t be sustainable unless the appropriate changes at all levels to how healthcare is delivered and how resources are employed are made.
This ageing population in combination with a fast increasing prevalence of chronic conditions challenges the sustainability of EU and US health systems. Care is costly and all member states face budget constraints; problems cannot be solved by spending more money. Policy makers and health professionals alike agree that the solution lies in an active and healthy ageing. Care systems should prolong the time elderly individuals can live autonomously by providing services customized for each individual’s whole-person needs. A chronic condition is not just an episode of illness; it affects the life-world of a patient for the rest of his or her life. It is widely recognized in the literature that to create a seamless continuum of care the perspectives and resources of various stakeholders, and the competencies and capabilities of caregivers, should be integrated.
Most countries are trying to reduce the duration of hospital stay, shifting focus gradually to out-patient care. The way out-patient care is organised varies from country to country but it is becoming more important in all countries. This is a trend toward individualised treatment using generalised care pathways. Healthcare approaches, not just hospitals, emphasise ‘whole patient care’ both before and after hospitalisation. This demands more specialised medical skills.
This raises the question of how to organise a healthcare system which follows the patient, rather than having the patient follow the system. The key is integrated care and integrated management, with consideration of how to train staff to fulfil the tasks associated with such integrated care. As doctors become more specialised, and more than one doctor is needed, patients need guidance through the system to get proper and appropriate care and treatment.
Staff at different skill levels need to focus on how to guide patients through the system.
Integration is similar to an investment where knowledge assets and specific skills must be brought together to develop a solution to each individual case. Failure to do so may result in fragmented care and unnecessary costs. In practice, however, integration is difficult to organize. In many cases administrative obstacles prevent the participation of non-professional caregivers, such as family and neighbours. The problem is most apparent when the delivery of care requires integration of services across boundaries of professions, disciplines, systems, cultures, or countries.
If integration is poorly managed there will be a lack of common understanding of the situation and thus the care plan may be incomplete or misguided. The execution of the care plan through coordinated processes and routines suffers, resulting in a lack of adequate goals for performance measurement, control, and continuous improvement. Patients and the public are served when healthcare practitioners collaborate and cooperate. This is facilitated when those practitioners possess competencies that provide the knowledge and skills to work with practitioners from other fields and disciplines to them in integrative clinical care settings. The upcoming EU Directive on application of patients’ rights in crossborder healthcare and the increase in patient mobility could also lead to structural changes in healthcare organisation and delivery.
Besides the global burdens of developed societies (ageing of the population, sustainability, increase of chronic conditions and life expectancy, etc), the US system faces several extra problems due to the way the system is organized:
- Citizens have a diminishing access to healthcare: 47 million Americans are without health insurance, around 15% of the population, 25% of which are children (nearly 12 million children) and over 18,000 Americans die each year because they lack health insurance. In parallel, there is a race bias in insurance coverage, causing discrimination in the accessibility to health (32.7% Hispanic Americans are without a health insurance compared to 19.7% African Americans, 16.8% Asian Americans and 11.3% Caucasian Americans). Besides, even those with health insurance are at risk, as health insurance is linked with employment, so many times, debilitating illnesses or injuries can lead to the loss of a job and thus loss of insurance.
- Health Care cost is rising enormously, currently over 15% of GPD, which constitutes twice the amount per capita than other industrial nations, and to obtain a lower quality, much less accessible system. Furthermore, wastes in Healthcare are also much bigger, with around 1/3 of the budget spent in bureaucracy and ancillary costs not directly related with health care delivery, causing huge overheads in the whole system.
- Medical bills cause financial hardship on patients and their families, being the first cause of personal bankruptcy. Nearly 40% of the terminally ill report financial hardship and suffering at the end of their life
- Quality of care and health related indicators are suboptimal: The health care system of the United States is ranked 37th in the world by the WHO, the infant and maternal mortality is higher and the life expectancy is lower in the U.S. as compare with other industrialized countries and there is a huge problem of Overcrowding in Emergency and Urgent Care situations
- However, Health Care Industry is Profitable despite poor health care markers, diminished access to care and financial hardships of general public
To cope with these pressures, the sector needs an adequate workforce both in numbers and with the right skills and competences. However, nowadays Europe and the US are facing skills shortages in healthcare positions such as nurses, medical specialists, and health technicians, especially in certain countries. According to the World Health Organisation (WHO) there was a world shortage of 2.4 million doctors, nurses and midwives in 2006. Before the economic crisis, healthcare labour markets were very dynamic. And although a huge amount of issues have been temporarily stopped or lagged due to this situation, the healthcare systems still have to cope with a changing environment influenced strongly and rapidly by the abovementioned demographic change, the general economic conditions, the health sector reforms ongoing in different countries, the issues of funding and sustainability, and regulatory changes, such as worktime directives.
Data from the WHO database illustrate current health worker variations across Europe. Data on distribution of physicians per 100 000 population show significant variations in staff availability in different European countries. Simply looking at numbers of health workers is not sufficient; the size and direction of flows also have to be monitored. In addition, there is a need to contextualise international migration; other flows might be more important. Trends must be assessed over time Migration within the EU, prior to 2004 expansion, was relatively low in relation to the number of health workers in EU countries. Cross-border flows were related to shared culture, language, etc. (France/ Belgium, within Scandinavia, UK/Ireland) or supply imbalances (Spanish nurses to UK). In the latter years, the economic situation has caused increased migrations from countries suffering more from the crisis effects towards those regarded as more stable (e.g. Germany).
The number of private healthcare providers is growing, for instance in aesthetic surgery or for specific treatments like hip operations. In some cases there is response to demands for care which cannot be adequately met by public providers. Public hospitals and providers in some countries, are in big economic difficulties, making it more difficult for public healthcare systems to offer all the care needed.
Most governments, social partners and professional bodies are working towards improving education and training for healthcare workers. As healthcare workers - especially medical specialists, but also many nursing and technical professionals - need many years of training before they are fully qualified, investment in training is critical for developing high-quality health services. Development of training usually goes hand-in-hand with development of job classification and qualification systems. Of course, basic Medical Education and Research lays the foundation for advancing and offering proper healthcare delivery. There is no doubt that deep knowledge of pure medical topics like for example anatomy is mandatory for successful MD practice e.g. surgery. Also, comprehensive knowledge of physiology is essential for grasping the principles of pathology, to avoid incorrect and inadequate practice of medicine. Similarly, medical informatics is not just a subject to be learnt and forgotten after the first graduation. In view of the fast changing world of medical/clinical practice, it is of utmost necessity for every medical student not only to become a good user but also an expert for advancing medical knowledge base through medical informatics. In addition, health care practices continue to evolve with technological advances integrating computer applications and patient information management into telemedicine systems. To this end, telemedicine has become a core component of any Medical Informatics course with a pivot role in the envisaged course’s learning outcomes.
While the world is experiencing a rapid escalation in chronic health problems, training of the health care workforce has, generally, not kept pace. However, training, education, and skill set of today’s health care personnel is not adequate to manage patients with chronic conditions . Moreover, while providers currently treat patients with diabetes, asthma and heart disease as a matter of routine, they report that their preparation for coordinating care and educating patients with chronic conditions is inadequate, especially with multimorbidity. The reason for the ill-prepared workforce is straightforward: caring for patients with chronic conditions is different from caring for patients with episodic illnesses, and the workforce is better prepared to care for the latter. According to the WHO, patients with chronic health problems need care that is coordinated across time and centred on their needs, values and preferences. They need self-management skills to ensure the prevention of predictable complications, and they need providers who understand the fundamental difference between episodic illness that is identified and cured, and chronic conditions that require management across many years.
On the other side, political demand for accountability and control can require healthcare staff to carry out far more administrative tasks than in the past. Examples of this are: treatments need to be specified and labelled with different codes before they can be invoiced; costs need to be specified according to different accounting structures; referral systems for specialised or follow-up treatment are more formalised and complicated; archiving and filing use different systems and programmes. These tasks are time-consuming and often become a burden. Better organisation should provide a skills mix that frees up medical staff time for patient treatment. Generally, the finance, management and economic aspects of healthcare have grown to a point where medical considerations are not always seen as the main priority.
Due to the emergence of the new information and communication technologies (ICT), it is necessary that health providers develop new skills in the use of ICT. Physicians, nurses and other professionals interact with patients every day, and ICT, especially the internet, can enhance the communication processes among them, providing timely information to patients about disease prevention, health promotion, as well as treatment of diseases. The new ICT skills can enable greater interaction between health personnel and patients through email, SMS, chat, forums, websites, Facebook, Twitter and other media. ICT skills are: access to health science information, management of health information and knowledge, generation and dissemination of health knowledge. The development of the new ICT skills required that people are digital literate. ICT skills are essential for success in the Network Society.
Internet has emerged as a new mechanism and channel for the medical practice and, within current medical daily activities we can find examples of multiple interactions with technology. Healthcare industry is also using these tools comparatively, starting with the use of internal productivity tools such as the electronic healthcare record and moving in the last years towards newer opportunities such as social networks or telemedicine.
2.2. Analysis of programmes for providing IT skills across EU and USA
This chapter summarises preliminary findings of the project and provides some insights into how EU Member States and the USA are providing training for their medical workforce in the wide thematic area of IT skills. A description of the available context, including policy, funding arrangements, background situation, such as delivery methods and delivered skillsets, on both national and supranational level is outlined for both EU and the US. After that we review specific, critical, implemented initiatives for both US and EU states and nations respectively, followed by a critical discussion of emerging directions for the future.
188.8.131.52 Policy and Governance
The European Commission has acknowledged the challenge in meeting healthcare demands by adopting skill needs for health professionals. In relation to technologies, the Action Plan for the EU Health Workforce (2012) ( ) indicates that the growth of new technologies, medical appliances and diagnostic techniques, as well as the expansion of e-health and telemedicine/telemonitoring is leading to a new form of healthcare delivery which requires technical and e-skills. Member States are prompted to adjust their education and training curricula in order to equip people with the required skills for the future healthcare sector. However, such changes require increased coordination between training providers and employment. The EU has undertaken several actions, such as EU skills council in the area of nursing and care, pilot health care assistants expert network and database and Joint Action on Health Workforce Planning and Forecasting in order to develop European guidelines on forecasting methodologies and analyze future skill needs in the healthcare sector (ref[p2] ).
The US federal government has also acknowledged the demand for adopting IT for meaningful skill building in healthcare. Towards that end it conceptualized a general Federal Health IT Strategic Plan (ref[p3] ) with five specific goals/axes: Federal Health IT Strategic Plan Goals: I Achieve Adoption and Information Exchange through Meaningful Use of Health IT, II Improve Care, Improve Population Health, and Reduce Health Care Costs through the Use of Health IT, III Inspire Confidence and Trust in Health IT IV Empower Individuals with Health IT to Improve their Health and the Health Care System V Achieve Rapid Learning and Technological Advancement. In that strategic plan while the focus is on the proliferation of the electronic health record, several strategies are aligned towards standardization and IT skill building both for healthcare professionals and healthcare consumers.
In the context of such significant interest and in the spirit of cooperation between EU and the US as strategic first world partners, there are initiatives (ref[p4] ) that reveal common ground in the efforts towards IT skill building in healthcare. These endeavors produced a set of common priorities that could be identified as the common goals for a transatlantic common policy framework. Specifically:
- A first priority is the establishment of the shared building blocks that would support interoperability for a few use-cases that can be broadly expanded. This first building block concerns terminology and the exchanging of information between systems.
- A second priority is to use the relevant technology to empower patients and citizens towards gaining access to information regarding them, while not solely focusing on technology, but mainly on the aforementioned empowerment that technology provides to the people. This is a process that needs to bring patients at the centre of the healthcare system (or eHealth) and see them not as consumers of healthcare but as partners even in the formulation of policies.
- A third priority/goal is aimed both at increasing participation of the public and second fostering ideas that would retain the workforce in the face of the introduction of new technologies with the required paradigm shifting in established work habits.
In light of these priorities it becomes apparent, as it is an expressed, specific goal in the aforementioned ad hoc policy framework, that IT skill building in the health sector is a significant area of EU-US collaboration, a notion that is supported from several funding initiatives across both parties.
184.108.40.206 EU-US programmes so far
In Europe, during FP7, there have been specific programme objectives for strengthening the EU-U collaboration. Namely:
- IT skills for healthcare workforce
- Interoperability of patient summary between EU and US and
Thus, in the recent past, there have been several EU initiatives supporting the EU-US process. These are documented in the following projects:
- The epSOS project, which has developed an interoperability framework which will serve as a basis for the EU-US roadmap
- The eHealth Governance initiative, which is composed of member states and various stakeholders in order to establish a governance structure for eHealth within Europe
- SemanticHealthNet, which is a network of excellence composed of academia, SDOs and other stakeholders to define a governance structure for semantic interoperability in Europe
- Antilope, a thematic network supporting the adoption and testing of existing eHealth standards and specifications
- Other EU semantic interoperability projects including eContentPlus projects like for example mEducator, which despite the indirect involvement of US partners, it nevertheless produced good enough practices where EU-US collaboration on healthcare IT skills may be based upon.
More recent EU-US activity in this domain is marked with two (2) EU support actions (resulting FP7 ICT Call 10) which were launched in the past few months. CAMEI is obviously one of them (which addresses digital skills for the healthcare workforce), but it is also the TRILLIUM BRIDGE project which focuses on international interoperability of EHRs. More specifically, it attempts to extend the European Patient Summaries and Meaningful Use II, Transitions of Care in the United States to establish an interoperability bridge that will benefit EU and US citizens alike, advancing eHealth innovation and contributing to the triple win: quality care, sustainability and economic growth (http://www.trilliumbridge.eu/).
220.127.116.11 Funding and Delivery
The most common method of financing IT skills programmes is usually a mix of public-public/european or national as there is considerable public funding of skills training programmes conducted in partnership with academic institutions/universities.(ref[p5] )
On the other hand, the US government declares its expressed role as a “worthy steward of the country’s money and trust.” In that capacity, it aims to use its resources judiciously through reliance, to the extent possible, on private markets to accomplish important societal objectives, acting to correct market failures when necessary through open and transparent governmental policies. (ref[p6] )
Aligning these funding approaches for transatlantic cooperation in the sector of IT healthcare skill building is a significant challenge. Through official European delegates there is also an expressed declaration that eHealth is an important lever for job creation and growth stimulation. In order to utilize this leverage, it is imperative that best ideas are open to the most people possible. Before specifics, however, it has been expressed that a crucial prerequisite is the deepening of the trade ties between EU and the US, tackling the more complex obstacles to international trade. After that a second necessary step is the harmonizing of regulatory guidelines in order to be able to collaborate on joint initiatives from a zero base. (ref[p7] )
18.104.22.168 Relevant funding opportunities for EU-US collaboration on healthcare IT
The announced Horizon 2020 (H2020) programme with its International Cooperation schemes aims at:
• Strengthening the Union’s excellence and attractiveness in research and innovation
• Strengthening its economic and industrial competitiveness
• Tackling global societal challenges
H2020 is open to 3rd countries (including the USA) thereby expecting:
• Good capacity in science, technology and innovation
• Close economic and geographic links
• Good track record of participation
The following Table provides some related information regarding likely funding opportunities in H2020 with respect to EU-US educational collaboration in healthcare IT.
Science with and for Society
SEAC.2.2014 - Responsible Research and Innovation in Higher Education Curricula1
Specific challenge: This topic will raise the importance and uptake of Responsible Research and Innovation (RRI) in Europe and beyond, via the design, production and dissemination of educational material and curricula for use by Higher Education Institutions and other higher education establishments, and their incorporation into educational programmes for science and engineering studies. The embedding of RRI in curricula will help Higher Education Institutions to shape more responsible and responsive researchers, able to better frame their research in a societal context, necessary for tackling societal challenges more effectively and in a more transdisciplinary manner.
ICT 20 – 2015: Technologies for better human learning and teaching
Specific Challenge: The development and integration of robust and fit-for-purpose digital technologies for learning are crucial to boost the market for and innovation in educational technologies. This requires an industry-led approach in close cooperation with academia to defining the frameworks and interoperability requirements for the building blocks of a digital ecosystem for learning (including informal learning) that develops and integrates tools and systems that apply e.g. adaptive learning, augmented cognition technologies, affective learning, microlearning, game-based learning and/or virtual environments/virtual worlds to real-life learning situations. This challenge also encourages public procurement of innovative solutions to address the needs of the digital learning ecosystem in making better use of educational cloud solutions, mobile technology, learning analytics and big data, and to facilitate the use, re-use and creation of learning material and new ways to educate and learn online.
ICT: ICT 38 – 2015: International partnership building and support to dialogues with high income countries
Specific Challenge: The challenge is to provide for discussions with third countries on areas of common interest and to provide support to collaboration within the ICT research and innovation domains.
Scope: The twofold target is:
•to support dialogues between the European Commission/the EU and strategic high
income partner countries and regions,
•to foster cooperation with strategic high income third country organisations in
collaborative ICT R&D both within the EU's Framework Programmes (Horizon 2020)
and under relevant third country programmes.
There exist also SME opportunities for EU-US collaboration in Horizon 2020 (Workforce/eSkills – US and EU approaches to health IT).
In addition, the announced Erasmus+ programme has also several likely opportunities for EU-US collaboration. These are presented in the following table:
KEY ACTION 1–MOBILITY OF INDIVIDUALS
Joint Master Degrees: high-level integrated international study programmes delivered by consortia of higher education institutions that award full degree scholarships to the best master students worldwide;
Joint Master Degrees aim to:
foster quality improvements, innovation, excellence and internationalisation in HEIs;
increase the quality and the attractiveness of the European Higher Education Area (EHEA) and supporting EU external action in the higher education field, by offering full degree scholarships to the best Master students worldwide;
improve the level of competences and skills of Master graduates, and in particular their relevance for the labour market, through an increased involvement of employers.
In this regard, Joint Master Degrees are expected to contribute to the objectives of the Europe 2020 Strategy and of the Education and Training strategic framework 2020 (ET2020), including the corresponding benchmarks established in those policies. JMDs will continue and strengthen the successful experience initiated with the Erasmus Mundus Master Courses (EMMCs) in raising the attractiveness of the EHEA worldwide and demonstrating the excellence and high level of integration of the joint study programmes delivered by European HEIs.
KEY ACTION 2–COOPERATION FOR INNOVATION AND THE EXCHANGE OF GOOD PRACTICES
Strategic Partnerships aim to support the development, transfer and/or implementation of innovative practices at organisational, local, regional, national or European levels
address policy objectives, challenges and needs of a specific field (i.e. higher education, vocational education and training (VET), school education, adult education, youth);or
address policy objectives, challenges and needs relevant to several fields of education, training and youth.
In addition, in line with the annual Work Programme adopted by the Commission, priority will be given to Strategic Partnerships that aim to:
foster the assessment of transversal skills and promote the take-up of practical entrepreneurial experiences in education, training and youth work;
promote the professional development of staff and youth workers in ICT methodologies and support the production and adoption of OER in diverse European languages;
facilitate the validation of non-formal and informal learning and its permeability with formal education pathways;
§ pursue one or more of the priorities describedin the introduction chapters "Education and Training" and "Youth" in Part B of this Guide.
KEY ACTION 2–COOPERATION FOR INNOVATION AND THE EXCHANGE OF GOOD PRACTICES
Knowledge Alliances between higher education institutions and enterprises which aim to foster innovation, entrepreneurship, creativity, employability, knowledge exchange and/or multidisciplinary teaching and learning
Especially with the aim to facilitate the exchange, flow and co-creation of knowledge.
In addition, in line with the annual Work Programme adopted by the Commission, priority will be given
KEY ACTION 2–COOPERATION FOR INNOVATION AND THE EXCHANGE OF GOOD PRACTICES
Sector Skills Alliancessupporting the design and delivery of joint vocational training curricula, programmes and teaching and training methodologies, drawing on evidence of trends in a specific economic sector and skills needed in order to perform in one ormore professional fields;
Sector Skills Alliances shall aim at tackling skills gaps, enhancing the responsiveness of initial and continuing VET systems to sector-specific labour market needs and demand for new skills with regard to one or more occupational profiles.
This should be achieved by:
-modernising VET and exploiting its potential todrive economic development and innovation, notably at local and regional levels, increasing the competitiveness of the sectors concerned;
-strengthening the exchange of knowledge and practice between vocational education and training institutions and the labourmarketintegrating work-based learning;
-facilitating labour mobility, mutual trust and increased recognition of qualifications at European level within the sectors concerned.
KEY ACTION 2–COOPERATION FOR INNOVATION AND THE EXCHANGE OF GOOD PRACTICES
Capacity Building projects supporting cooperation with Partner Countries in the fields of higher education and youth. Capacity Building projects aim to support organisations/institutions and systems in their modernisation and internationalisationprocess. Certain mobility activities are supported in so far as they contribute to the objectives of the project;
-foster cooperation and exchanges in the field of youth between Programme Countries and Partner Countries from different regions22 of the world;
-improve the quality and recognition of youth work, non-formal learning and volunteering in Partner Countries and enhance their synergies and complementarities with other education systems, the labour market and society;
-foster the development, testing and launching of schemes and programmes of non-formal learning mobility at regional level (i.e. within and across regions of the world);
-promote transnational non-formal learning mobility between Programme and Partner Countries, notably targeting young people with fewer opportunities, with a view to improving participants' level of competences and fostering their active participation in society.
-In addition, in line with the annual Work Programme adopted by the Commission, priority will be given to projects that pursue one or more of specific priorities.
2.3.2 Further Background Situation Details
To understand the related background situation, one needs to also review material concerning delivery methods and the involved attributes of delivered skill sets. To consider skill sets for IT on healthcare workforce we need to study:
- Volume of employment in selected occupations both in EU and US
- Changes in employment volumes (as a matter of crisis)
- Characteristics of workers in the selected occupations (including Trends in the gender of workers in occupations and countries; trends in age profiles in occupations; Levels of education in occupations and countries)
- Recruitment, training and qualifications in selected occupations (including Recruitment methods, Training and qualifications in the selected occupations (such as any Variations in qualification requirements by occupation; Variations in training content and duration by occupation
- Skill shortages and skill gaps in the selected occupations (including Skill shortages by occupation and reasons for them; Actions taken by employers to mitigate skill shortages; Skill gaps among new recruits or existing workers in each occupation; Predicted changes in types of skill needed)
- Learning and training for provision of skills in view of future skill and gap demands (including Extent of training provision and nature of training practices; examples of Training provision in various-skilled (selected) occupations; Problems and challenges for training provision)
22.214.171.124 Policy and Governance Brief on Skill sets
To make a short policy brief on creating conditions for adapting skills to new needs & lifelong learning we consider the points below:
- There is a variety of IT skills programmes among EU and US member states through the vocational education, also known as career and technical education (CTE). Due to the different social, economical and environmental conditions, each member state promotes many national initiatives in order to enchance IT skills improvement in healthcare workforce
- IT skills programmes tend to be driven by employment needs and often due to the healthcare staff weakness to follow ICT technologies development. The content of training and programmes usually focuses on the basic IT skills and is rarely tailored to specifc demands on the public sector. On the other hand, private sector provides support in specific opportunities and challenges which may advance the workplace.
- The most common method of financing IT skills programmes is usually a mix of public-public/European or national as there is considerable public funding of skills training programmes conducted in partnership with academic institutions/universities.
Overall, the needs and requirements of the labour markets in combination with best practices shows that training programmes across EU and USA should target to the exchange IT skills experiences, not only between public sectors of member states but also between companies and private sector in general.
EC believes that it is crucial to meet the new demands of health care and there it is essential to anticipate future skills needed for health professionals which are reformed because of: (i) the shift from care in hospitals to the provision of care closer to home - to cope with elderly patients with multiple chronic conditions, such as heart disease and diabetes; (ii) the growth of new technologies, new medical appliances and diagnostic techniques which requires technical know-how in addition to clinical knowledge; and (iii) the expansion of e-health, which enables distant diagnostics services, requires new ways of working (ref p8).
Thus, it has established
- An EU skills council in the area of nursing and care to review the competence profiles of the nursing and care sector (ref [p9])
- a pilot health care assistants expert network and database to examine the scope of skills and competences required for healthcare assistants (ref [p10]) and
- a Joint Action on Health Workforce Planning and Forecasting (ref [p11]) to develop European guidelines on forecasting methodologies and analyze future skills need in the healthcare sector.
Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST (FP7 EU funded project) aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care.
In the Human health and social work activities sector, as shown in the figure below, adults participating in education and training are increased in Northern Europe, while decreased in the UK, and remain stable in most European countries.
Sector: Human health and social work activities
Map of change in all adults participating in education and training (18-64 age group, 2009-2012)
2.3.3 Other Educational programmes
126.96.36.199 WHO programmes on education and production of health workers
Electronic Health initiatives at WHO are co-ordinated by its eHealth unit which works with partners at the global, regional and country level to promote and strengthen the use of information and communication technologies in health development, from applications in the field to global governance. The unit is based in the Department of Knowledge Ethics and Research in the cluster of Health Systems and Innovation.
WHO's work in eHealth includes programmes and projects in areas such as policy and governance, standardization and interoperability, research and global surveys, eLearning and capacity building, networking and South-to-South collaboration, as well as eHealth applications.
The following Table presents some of these programmes that might be relevant for the EU-US case too.
Programmes and projects
Global Observatory for eHealth
The Global Observatory for eHealth works to improve health by providing Member States with strategic information on effective practices in eHealth.
The Health Academy aims to improve knowledge about good health through the use of eLearning. In particular, it targets school-age children aged 12-18 through multi-media presentation of its health content.
Compendium of online and CD-ROM eLearning resources, available for download and by order. The list also includes blended learning degree programmes available through our partner institutions.
Governance - Health internet
eHealth Governance is concerned with eHealth services and the health Internet, which are changing the context of health information privacy, security and safety in the networked world
National eHealth strategies
To support national eHealth strategy development, WHO is working with representatives from ministries of health and ICT through workshops and online training. With ITU, WHO has also developed a National eHealth Strategy Toolkit.
The adoption of eHealth standards is critical to the implementation of health care information systems, promoting interoperability and enabling the effective, consistent, and accurate exchange of data.
2.2.2. IT Skills for Healthcare Workforce Facts
Many countries are seeking to improve health care delivery by reviewing the roles of health professionals. Developing new and more advanced roles could improve access to care in the face of a limited or diminishing supply of doctors. It might also contain costs by delegating tasks away from more expensive doctors.
At an undergraduate level there are also studies that show that there is a further need of providing IT skills to healthcare workforce. For example attitude, experience and competence (broadly covered by the European Computer Driving Licence syllabus) in information technology (IT) were assessed in 846 1st-year Medical Sciences Division undergraduates (2003–06) at the start of their first term. Among the results showed that in all years, some students showed a fundamental lack of understanding of basic IT skills.
To this extent, according to HIMSS there is a healthcare workforce growing shortage of health information technology workers that is becoming significant as the industry aims to expand the use of electronic health records (EHR), health information exchanges and other health information technology. Rachel Fields identify one of the top ten challenges that fact of healthcare workers being limited or with not enough access to technology. As healthcare organizations struggle to implement technology while maintaining efficient operations, their workers may be suffering from this technology illiteracy or non-accessibility. Twenty-three percent (23%) of healthcare professionals felt they had insufficient access to technology; the number was slightly higher for registered nurses at 29 percent. Around half of all employees felt that their organization offered technology training indeed; interestingly enough though, this perception was more common among employers than employees. Only 38 percent of employees thought their facility offered technology training .
Within this notion, the CAMEI (www.camei-project.eu) FP7 coordination action aims, among other objectives, to record strengths, weaknesses and competencies of the means that the healthcare workforce acquires IT skills in the EU and USA. While the “Memorandum of Understanding between EU and US” and the “Transatlantic eHealth/health IT Cooperation Roadmap” aim to build a common framework between EU and US for skilled eHealth/health IT workforce and eHealth proficiencies.
2.2.3. Existing Resources of IT skills for Healthcare Workforce
Different type of resources could provide an IT skills registry and those include: Competency Models and Frameworks, Certifications, Education Program Models, Skills Standard, Skills map, Career Lattice, Assessment, Curriculum Model and Apprenticeship. Some of those resources come from academia, while other comes from industry.
As far as we know, there is no specific resource which identifies the IT skills for healthcare workforce, but there are numerous resources that include IT skills among the general skills that different proficiencies of healthcare workforce should have.
There is an ongoing effort from the “EU-US eHealth Cooperation Initiative” Workforce Development Work Group in which individuals and organizations across the two sides of the Atlantic aiming to identify role based competencies and skills for the healthcare workforce. Despite the fact that this group manage to bring together EU and US initiatives, the work of this group do not focus on the creation of an online “live” registry for IT skills of healthcare workforce.
Frameworks like the European Qualifications Framework for lifelong learning (EQF) concerns eight reference levels describing what a learner knows, understands and is able to do – 'learning outcomes'. EQF is a tool based on learning outcomes rather than on the duration of studies. The main reference level descriptors are: skills, competences and knowledge. Based on EQF, each European country develops its national qualification framework. The European e-Competence Framework (e-CF) is a reference framework of 36 ICT competences and could act as a well formed example for the description of the IT skills for the healthcare workforce. However the EQF, the e-CF as well as the Australian Qualification Framework are not targeting at the healthcare workforce.
International Medical Informatics Association (IMIA), American Health Information Management Association (AHIMA) and American Medical Informatics Association (AMIA) provided a list of skills and competences, but they focus to health informatitians or to skills related to HER , . The “UK Health Informatics Career Framework” is focusing also at the same healthcare workforce role, while the U.S. Department of Labor has released an Electronic Health Records (EHR) Competency Model which cover competences regarding EHR.
Frameworks focused on healthcare workforce skills and competencies but not specific in IT skills include the Workforce Competencies for Patient-Centered Health Care Delivery through Health IT, NHS Knowledge and Skills Framework, Public Health Skills and Career Framework (PHSCF). Assessments description like the Texas Health Information Technology Employer Needs Assessments could also revel a list of required IT skills for healthcare workforce.
2.3. A framework for a Social Semantic Registry of IT skills for healthcare workforce
The healthcare workforce needs the skills to use available technologies to support care of patients. Information systems (from paper and pencil records to sophisticated electronic databases) are essential for organising and monitoring patients' responses to treatments and outcomes. Communication systems (from fixed line telephones to mobile devices to the internet) allow the exchange of information on patients with other providers, who may be in other settings or distant locations.
European Commission eHealth Action Plan 2012-2020 - Innovative healthcare for the 21st century also states that from 2013 the Commission shall promote policy inclusions on eHealth at a global level to foster interoperability, the use of international standards, develop ICT skills, compare evidence of the effectiveness of eHealth, and promote ecosystems of innovation in eHealth.
There are a few existing qualification frameworks and more guidelines for IT skills for healthcare workforce created by different organisations and entities as described in the background section. However, to the best of our knowledge there is no framework providing unified IT skills for healthcare workforce registry that can be updated and synchronized along with the new technological trends.
Thus, in CAMEI we propose a framework for a social network based registry where the users (healthcare workforce), the institutions and the policy makers, collaboratively could shape the required IT skills and competences for each healthcare profession. At the same time all the knowledge created at the registry could be shared through semantic web and linked with existing silos of knowledge.
The framework is comprised of 3 different concepts: (i) the social network concept; (ii) the skills input, analysis and presentation concept; and (iii) the semantic concept.
2.3.1. Social and Semantic Era
During the last decade the users are becoming more and more literate with social media techniques and collaborative technologies altogether. We are now in the era where users are capable of seeking for them in many different systems, from everyday life to health education.
To this extent, the World Wide Web has been changing towards linked data and semantified information to lead to the “Web of Data” . A set of best practices for publishing data on the web, known as “Linked Data principles” where identified by the Tim Berners-Lee . Exchange of knowledge and information have been changes since then. The Linked Open Data (LOD) cloud holds an enormous number of triples and connects together different datasets across many disciplines.
2.3.2. The Social Network Concept
The social aspects of the concept relay to the needs of a live registry and collaborative creation between individuals, organisations and policy makers that are part of the healthcare workforce.
Those collaborators will act as three basic users which interact between them by reviewing inputs of other users and commenting on inserted skills for a profession and sharing their personal experiences in the form of case studies. Social networks actions, like the exchange of messages and the correlation with organisations will also exist. Another aspect of social networking is the user defined professions and IT skills, which would allow a common collaborative definition of all the existing healthcare workforce profession, but also the pairing between the professions having a different name across different countries.
2.3.3. The Skills Input, Analysis and Presentation Concept
In order to break the procedure of inserting IT skills in simple steps, the structure that is depicted in fig 1 (top box) is followed. A list of healthcare workforce professions is depicted in there, whereby each profession has a list of IT skills required for it, which is further divided in three levels: Basic, Intermediate and Advanced. The division in 3 categories is made according to the skills themselves. Basic skills (B-Skills) include basic IT skills that can be found across most of the healthcare workforce professions, while the Intermediate skills (I-Skills) list contains the skills that are more complex and are not met in all the professions. The Advanced skills (A-Skills) list consists of high level IT skills, that only specific healthcare professions should have. This distinction between skills will allow the easier identification of commonalities on IT skills between different healthcare professions.
The Framework proposes a two level analysis of the IT skills inserted by users (fig 1 Box: Analysis of Skills). First is the automatic categorization of the IT skills that match with the insertion of IT skills from previous users (aka “skills match rate”). For example, if a user enters Skill-1 into a profession, the framework will provide a matching percentage of the skill with the amount of previous insertion of users of this skill. So if 80% of the user has inserted the same skill in the specific profession then the skill will automatically remain in the profession. If the percentage of users which support that this skill belongs to that profession is less than 80%, then a review by the community is required.
So, the second level of IT skills analysis follows the aforementioned review of the skills by the community of users. According to the matching percentage of the skill, a Minor, Middle or Major Review is required by the community. The different levels of Review show the required amount of change of opinion by the community that are related with this profession. All the specific profession community members will be called to vote whether this skill has to be included or not. The different levels of Review also prioritize and sort the selection process from minor review of IT skills-first to major review of IT skills-last.
The "Presentation of Results" component of this concept will depict the results for each profession. All the skills with a match rate over 80% will be included directly to the IT skills of the profession. The skills with match rate between 50% and 80% will be depicted as “Common Additional Profession Skills”, while the skills with match rate between 20% and 50% will be depicted as “Semi Common Additional Profession Skills”. As “Rare Additional Profession Skills” the skills with a match rate of less than 20% will be depicted. As each IT skill will belong to a specific level (Basic, Intermediate, Advanced), the provision of the skill in this level will occur. The "Presentation of Results" component will be a live registry, which will be modified according to the users’ decision of inclusion or exclusion of IT skills from the healthcare workforce professions.
Fig. 1. Abstract notions of the IT skills Registry.
2.3.4. The Semantic Concept
The Semantic Concept is comprised of: (i) an ontology that describes the IT skills and their connections with the different healthcare professions in order to provide a coherent structure of IT skills for healthcare workforce depiction; (ii) a SPARQL endpoint in order to make available all the registry information to all interest parties; and (iii) links with Linked Open Data cloud Datasets in order to enable the connectivity of information that exists in the registry.
2.3.5. The framework for a Social Semantic Registry of IT skills for healthcare workforce expansion
However, this framework has got the fundamental limitations of any social network. Although participation of the users (individuals, organisations, policy makers) is the key to its successful implementation, and a key element for creating any registry of IT skills for healthcare workforce, it suffers from "validity cross-checks". To this extent, the “dummy” data that each user may enter could create a non-valid registry. The review processes that exists in this framework, obviously decreases this possibility. Despite the fact that the technologies that this framework will use are not new, their combination for a creation of a social semantic registry is nevertheless innovative, since it allows both the collaborative creation of a registry and the sharing of the created knowledge.
A detailed determination of the ontology describing the IT skills needed with respect to existing standards and further expansion to include the competencies associated with the skills should be foreseen. The future actions should also include more accurate definition of the “skills match rate” percentages, which will result through the actual use of the system. Advances of social and semantic web will foster the record of IT skills for healthcare workforce professions and enable a “live” presentation of them that will act as a tool for policy makers to form the curricula of Medical Education in the new shaped era of Medical Education Informatics.
2.4. SWOT analysis (of programmes for the provision of IT skills)
- Teachers with a vast knowledge and expertise in the field
- Awareness and willingness from stakeholders to participate in those initiative and provide feedback for improvement
- Most of the programmes are focused on a single topic (what is not so bad) but withouth showing or taking into consideration the whole picture.
- Lack of a common language
- IT skills demands are changing, so there is a need for fast adaptation and fine-tuning of such programmes. Material needs to be updated periodically
- Establishing accreditation standards that require competencies in IT skills for healthcare workforce, and related areas will help facilitate interprofessional education among health care providers
- Time for dissemination and awareness activities concerning competencies and white books regarding this topic
- Marketing activities
- Assessment to make personalised education based on existing previous modules
- Multiple courses and platforms attempting the same goal without a clear winner.
- Frustration feeling to check validity of training at other territories
- Multiple stakeholders, difficulties to reach agreements
- Requested skills change when roles are not the same in each country for the same professional (GP or nurse play different roles depending on the country)
3. Recommendation plan
Including results from T2.2 Mapping Cooperation opportunities between EU and USA for providers of IT skills for the healthcare workforce (KI, support from all partners)
This task will map the opportunities, highlight the benefits and provide key recommendations on how
USA organisations and communities can cooperate with EU organisations in order to empower sharing, reuse, repurposing and creation of educational material applied in different context and promote renewal of programmes. In this task CAMEI will map and prioritise the respective ICT market segments in both EU and USA that show significant exploitation potential for training healthcare workforce on IT.
3.1. Prioritise ICT market segments that show significant exploitation potential for training healthcare workforce
- Standards for IT skills for the Healthcare workforce
- Scalable training approaches
- Implementation strategies
- Certification approaches and policies
3.2. Make recommendations on educational technologies, training methods and programmes
1. Joint opportunities
# Standards in Healthcare education
# Models for shared and scalable training
# Implementation strategies
# Accreditation standards
- There is strong tradition of developing standards both at the EC and USA. Collaboration between the communities exists and, if encouraged, would create an excellent self-sustained joint collaboration.
- EC and USA have funded several projects that investigated methods for sharing educational content. A joint enterprise would create a sustainable high quality educational offering. Furthermore both the EC and the USA have started to invest on open education (such as MOOC). This is an area that have been flagged as strategic by both parties and where we’ve found similar priorities in the healthcare education.
- Both the EC and USA have indicated the need to achieve an efficient and effective impact on the personel IT skills. The research have reported similar challenges and barriers in implementation.
- Accreditation is a strong driver but remains at its infancy both in the EC and USA. Sharing the knowledge and the investment would create a standard.
3. Key recommendations
- Work on standards is often replicated and a synergy of the expertise between the EU and the USA is strongly recommended.
- Create open access sustainable educational offerings using MOOCs
- EU and USA share similar implementation challenges and barriers, co-develop a cost-effective and efficient implementation model for a life-long educational program
- Create a common standards of accreditation
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