EUPHIX meetings

Attendance and focus

Attendance

Hagit Eliyahu (RIVM), Maartje Harbers (RIVM), Finn Kamper-Jørgensen (Dk-NIPH), Csilla Kaposvari (Hu-EgeszsegMonitor), Hans Kerschbaum (A-GÖG/ÖBIG), Pieter Kramers (RIVM), Monique Kuunders (RIVM), Bernard Ledésert (F-FNORS), Marieke van Middelaar (RIVM), Rutger Nugteren (RIVM), Hans van Oers (RIVM), Roel Schreurs (RIVM), Anna Seatter (RIVM), Bjorn Heine Strand (N-FHI), Eveline van der Wilk (RIVM).

This meeting had the following main issues on the agenda

• June release, new content and features
• Documentation and project reporting
• User panel evaluations and visitor numbers
• EUPHIX Expert Network: status quo and progress
• Developments at DG SANCO regarding public health information systems
• Future opportunities

June release, new content and features

Instant Atlas and interactive figures

EUPHIX has introduced a new feature: Instant Atlas. It provides interactive maps and graphs. Currently the feature is available for Life expectancy, Healthy life expectancy and Breast cancer.

Beside the interactive maps, there are interactive figures which already existed. Within this interactive figure, people have the option to export the data to an Excel file (this is not possible yet for Instant Atlas).

EUphoci

In the June release, four new EUphoci have been added. These are Children’s health and the Environment (based on ENHIS data), Diabetes prevention and care (based on EUCID data), Health inequalities, and Food, Nutrition, Physical activity and Cancer (based on the WCRF report). The EUphocus is developed as a cross-cutting health topic that links a number of different EUphacts. Now it is often used as a platform for other projects to present their results.

Several options were discussed for improved readability and printing of a complete EUphact or EUphocus.

Literature list

Finally the literature list at the bottom of each EUphact is demonstrated. In this list people can find all the references which have been used for the relevant EUphact. As this list can be quite long, there were several suggestions on how to improve this:

• Put main references at the top of the list;
• Add the main references to the document ‘Relevant databases, organizations and projects’;
• Display the list in year of publishing instead of alphabetical order.

Documentation and project reporting

Final report

A final report needs to be written to make the system transferable. The report will contain the following items:

• Executive Summary (following format SANCO; this includes some process information)
• Objectives and background
• References to the Work Plan (annex)
• Approach and methods
• Contents of the system and the working process for generating content.
• Technical structure
• Network building and communication with external contributors
• Communication and dissemination of the system

• Building the website: steps towards the present application
• Status of the deliverables by June 30, 2008
• The websites EUPHIX.org and EUPHIX.info, the connection with the Portal
• The technical realization
• The EUPHIX expert network and other connections
• Perspectives for the future
• Documentation of work processes
• The EUPHIX publishing protocols (short description, referring to annex)
• The technical application (short description, referring to annexes)

User panel evaluations and visitor numbers

User panel evaluations

So far seven evaluations have been received. Generally it can be said that the grades are very positive. The evaluators’ expectations are met. The interactive tool was accepted as very useful, as well as the presentations on policies. The following actions have been done according to their suggestions;

• New homepage;
• Downloadable information sheets;
• Newsletter;
• Downloadable ‘how to use EUPHIX’ presentation.

Remaining task is to update the older topics. This is the priority for the coming half year. Furthermore the project team needs to improve the visibility and user-friendliness of the website, make it possible to open an entire EUphact in once and to seek feedback from external parties on how to improve the interactive tool.

The possibility to include a short survey on the EUPHIX website will be explored.

Visitor numbers

Especially in March and April the EUPHIX team has requested several organizations to place a link to EUPHIX on their website. In these months the number of visitors per day rose considerably.

To promote EUPHIX the project team will write an article for the Scandinavian Journal of Public Health.

EUPHIX Expert Network: status quo and progress

Two functions

The Expert Network has two functions; they need to provide the expertise and fill the site, and have to find commitment among the target audience and users. People who are involved in this network are project partners, external authors and reviewers, EU PHP projects, specialized EU agencies, user panel, DG SANCO and the RIVM editorial team. The Expert Network so far consists of 16 members; 10 authors, 4 reviewers and 6 representatives. The Expert Network is separate from the EUPHIX consortium, which is responsible for editing, implementation and maintenance.

Developments at DG SANCO regarding public health information systems

Indicator development

The presentation started by highlighting the legal basis connected to indicator development in the EU public health policy. Elements of this include the new health strategy ‘Together for health’, the new Health Programme 2008-2013 and its strand on ‘Health Information and Generation of Knowledge’, and the forthcoming Eurostat regulation on data collection. The development of the ECHI indicators is an explicit part in the Strategy. Within the Health Programme, the ‘development of a sustainable health monitoring system with mechanisms for the collection of comparable data and information’, is a major component.

Development of population surveys and health reports

Other elements relevant to EUPHIX are the development of several population surveys and health reports. EHIS is a general survey on health, health determinants and use of health care and preventive services; surveys in children, on mental health and on food consumption. Also the SANCO presentation mentions the production and planning of several health reports. It does not mention the option of electronic reporting by a EUPHIX-like system, next to the production of printed books.

Future opportunities

Joint Action

Finland (KTL) is asked to draw up a proposal for a Joint Action on EC health indicators. Part of this Joint Action is to develop a web based system for electronic and interactive reporting of data related to the ECHI shortlist. EUPHIX is proposed as a system for this. The Dutch ministry of health will co-finance the Joint Action. This proposal only includes the data-reporting part of EUPHIX.

IN-EUPHIX

To increase the written content of EUPHIX, the project team has sent a proposal for IN-EUPHIX. IN-EUPHIX stands for ‘Intelligence Network for EUPHIX’. So far IN-EUPHIX has 11 associated partners and 12 collaborating partners (including RIVM). IN-EUPHIX is submitted as a normal project. The difference with a Joint Action is the funding mechanism. For a complete system we would need both proposals.

Other possibilities

Additional possibility to expand and strengthen EUPHIX is to use EUPHIX as a forum for European Health projects. EUPHIX can serve as a medium for the outcome of results of other projects. Finally it is also important to increase and improve the content of EUPHIX and public relation efforts.

Technical improvements and demonstration of the Content Management System

Technical improvements to the site

A new technical improvement to the EUPHIX website is the newsletter, which people can subscribe to. The intention is to send a newsletter at least with every new release.

Another improvement is the possibility to export data from the EUPHIX site to an Excel file, with the interactive data export button.

During this session, there was some discussion around the difficulty to distinguish countries from one another in graphs when all countries are displayed in the figure. A solution for this problem is offered by the possibility within the interactive figure to select or deselect countries. All project partners agreed that this tool needs to be better explained.

Demonstration of the Content Management System

This demonstration gave an insight into the technology behind the EUPHIX website. The different kinds of objects within the Content Management System (CMS), such as a subject, document, and paragraph were presented. Thereafter, the group was shown how each document goes through several different stages and what role each of the many team members (editor, author, content coordinator) has in the overall publishing process.

EUPHIX Publishing Protocols

The process

This presentation explained what takes place behind the scenes before a EUPHIX presentation is published. It shows that the publishing process for a EUphact or EUphocus can be divided into four steps:

1. Selection and appointment of an author for a EUphact or EUphocus
2. Drafting of text and data presentations
3. Internally editing of text and data presentations and entering into CMS
4. Publishing text and data presentations on the EUPHIX website.

Gemini

All agreements reached between the editor and the author are recorded in Gemini, an electronic tracking system. The system gives everyone within the project team the possibility to view the status of and deadlines for a specific EUphact or EUphocus.

Once all agreements have been recorded, the author can start drafting the text for a EUphact or EUphocus.

The editor is then responsible for:

• reviewing and commenting on the draft text
• creating tables, figures and maps
• editing the data presentations on the basis of feedback received from the author
• entering the final version of text into CMS.

Before text and data are officially published on the website they are internally reviewed by an editor-in-chief, language editor, content coordinator and project manager, before undergoing additional scrutiny in two test website releases. These test releases allow the EUPHIX team to check everything in web-format before it goes live.

EU Health Portal developments & links to EUPHIX

Newsletter

During the last six months DG SANCO focused their activities on the newsletter which is produced in many different languages and which is created with the intention to inform people about the new content of the Portal. All newsletters contain information on a specific theme and report the latest press releases, upcoming events and new publications. In one of their future newsletters DG SANCO will ask people to give feedback about the EUPHIX website. Furthermore EUPHIX will be announced in their promotion campaign.

Future improvements

DG SANCO has the intention for the near future to improve the search functionalities, interactive tools, news/events, RSS feeds, publication by topics and legislation by topic. Other topics they consider are information campaigns, e-library, citizens section and RSS online translation tool.

Linking to EUPHIX

A number of different links to the EUPHIX website have now been added to the EU Health Portal. However, both the project partners and the EUPHIX team agree that a confusing double-up is created by the Portal often including two web-links for one public health topic- one link being to the EUPHIX site and the other to additional indicator data. It was agreed that continued discussion was needed to find a solution for this problem.

During the last meeting there was a proposal to include the EUPHIX logo on the homepage of the EU Health Portal, which when clicked on would take people directly to the EUPHIX website. Currently people need to click through several web-pages on the EU Health Portal before they get to the EUPHIX website. DG SANCO decided not to implement this logo, as it did not want to show preferential treatment to one EU project over another.

User-panel evaluations

The following comments, questions and suggestions were included in the user-panel’s feedback in relation to improving and maintaining the content quality and currency of the EUPHIX site:

• Add a link to the PORGROW project. This link has now been implemented.
• Update the list of stroke/heart/cancer/respiratory disease-related European umbrella organisations. This will be implemented in the May 2008 release.
• How does the EUPHIX site select its resources and evidence-base? This is selected by the external authors, based on their expertise in the field. The EUPHIX team will consider including additional information on the site about the publishing process and the role of external authors.
• Increase the visibility of the interactive tool. EUPHIX plans to highlight the interactive tool in one of its future newsletters.

• The structure-division into ECHI indicators and EUphacts is experienced as confusing. Explanatory pop-ups do not seem to be sufficient. The EUPHIX team will review the overall site structure and consider how it can be improved to make it less confusing for visitors.
• One evaluator felt the website would not provide valuable information for all citizens due to the language of the site being too complicated for a number of non-native English speakers. No immediate solution was identified- currently there is no budget for translating texts into other languages and the text is already kept as simple as possible.

Project partners were asked to think of new members for the user-panel as this group needs to be enlarged. EUPHIX seeks new members who would like to actively participate in the target panel as the evaluations are proving extremely valuable.

1.7 release – date and planned content

The next release is planned for the end of May, 2008. The EUphacts, EUphoci and indicators, which are planned for this release may not all be implemented if there proves to be insufficient funds. The project officially ends at the end of June. After the website release at the end of May 2008, the EUPHIX team would very much like to focus on promotional activities.

Network Formation – goals for 2008

The primary objective is to establish a network of organizations and experts that will maintain the application in a sustainable manner. As EUPHIX is now approaching the final stage of the project it is important to see what has been accomplished so far.

Two functions

The EUPHIX network currently fulfills two functions, namely providing the required expertise (content function) and gathering support from the target audience and users for the continuation of the site (support function). The target group panel (user panel) is part of this overall network and helps fulfill the content function, by evaluating the usefulness and appropriateness of the website.

The partner group will need to be extended in the near future to allow it to competently fulfill its support function. All member states could become involved and DG SANCO could evaluate the product.

Future actions

In the near future the following actions will need to be taken: the establishment of a network of authors and reviewers, a mapping exercise to link potential authors to all subjects, the enlargement of the target group panel and the enlargement of the editorial partner consortium.

Comments by partners

• It would be wise to separate the target panel into two groups, into a group that could critically review the content and a group that could review the site as target users.
• It is important to have evaluators from different kind of target groups, such as political decision makers, students etc.
• The editorial board (the steering group) should be distinguished from the editorial committee (the broader group).

EUPHIX as a platform for other projects and organising sustainability

Serving as a platform for other EU project results

A project can produce interesting data which can be incorporated in Indicators, EUphacts or especially EUphoci. The EUphocus ‘Children’s health and the environment’, which is based on the ENHIS project, is a current example of how EUPHIX can act as a publication medium for other EU projects.

Organising and financing sustainability

The following options to help ensure the sustainability of EUPHIX were discussed:

• Hosting the system in Luxembourg, which would involve DG Sanco maintaining the technical side of the system, and having the editorial activity shared by many, with a content coordinator or secretariat acting as the spider-in-the-web.
• Using the present partner group as the starting point for an editorial consortium.
• Keeping the EUPHIX secretariat at the RIVM for a limited time span of at most one year, without Commission financing.
• The consortium carrying the responsibility to seek financial support for a first continuation, to provide basic ‘political support’ for the sustainability of EUPHIX and to supervise the process of filling or updating of the website.

During discussions the following agreements were reached, namely that:

• There is a need to first find out what particular Member States are interested in participating in an editorial network.
• The RIVM will together with DG SANCO try to discover and then pursue the most suitable manner to submit a new proposal (project or otherwise), based on the above consortium approach, so that within limited time hopefully the consortium can receive appropriate co-financing.
• Beyond the editorial network, there is a need for a wider network of experts consisting of (possible) authors and reviewers, and representatives of relevant EU PHP projects. A specific strategy will be proposed to develop a sustainable authoring and reviewing network.
• An evaluation needs to be made at the end of the project period, for both the product as it is and of the editing process. This evaluation should serve in shaping the further maintenance of the system and possible changes therein.

PR Strategy

General approach

The first step outlined in the EUPHIX PR-strategy is to inform all relevant groups about the existence, qualities and potential of EUPHIX. To achieve this it is necessary to use a variety of information products and actively engage all current project partners in the PR-strategy.

As a final step the EUPHIX team would like to organize a ‘conference’. The aim of the conference would be to officially transfer the EUPHIX pilot to DG SANCO (at least to have explored the possibilities for this) and to communicate the achievements of EUPHIX and the system’s future potential. Additionally the EUPHIX team will try to incorporate EUPHIX into other conferences which are being planned by other organizations or institutes for 2008.

Time plan

• End of November 2007
• Discuss PR strategy with project partners
• Seek commitment with DG SANCO

• First half of January 2008
• PR-strategy finalized
• Relevant PR-material ready
• First e-mails, surface mailings, sending folders, etc.

• Second half of January 2008
• Contact made with major organizations; agreements about their intervention or commitment to EUPHIX
• DG SANCO commitment to conference or workshop

• First half of February 2008
• Final plan for EUPHIX conference ready
• Publications about EUPHIX appear in journals etc.

• Second half of March 2008
• First results known from SUSTAINABILITY strategy
• EUPHIX known in EU Parliamentary circles....

• Half-end June 2008
• EUPHIX conference

Pictures

Demonstration and discussion of the 1.4 test release

The access to the 4th test release was given to the project partners one week prior to the meeting.

The members of the RIVM team gave an on-line demonstration of the website, focusing on new and revised features:

• A sitemap, showing to the visitor the filled parts of the site and giving an outline of the website structure
• An additional tab “Literature and data sources” in the top menu. It offers a quick overview of the literature and data sources used throughout the system
• Thorough revision of old EUphacts in an advanced stage (3 EUphacts completely finalized)
• Five new ECHI indicators implemented, not yet peer-reviewed
• Regional maps (on infant mortality and obesity) made in cooperation with the ISARE project
• An improved search function
• Another background colour for the EUphoci to distinguish them clearly from the EUphacts and indicators.
• EUphoci have been redefined: the EUphoci ‘Obesity’ and ‘Smoking’ have been removed from the website since they resembled too much the corresponding EUphacts. The EUphocus ‘Mental Health’ is the only EUphocus now and serves as the example of the principle of a EUphocus as a cross-cutting issue. Future EUphoci might be ‘Socio-economic health differences’ (in cooperation with the Eurothine project) and ‘Rare diseases’. EUphoci will always include already existing EUphacts and Indicators.

EUPHIX Database, revised map tool

Database

The database of EUPHIX was presented. The database stores data along with (descriptive) metadata. The most important advantages of the system are the possibility to use (and store) a workflow and the possibility of version control.

In Austria a big database has been built, containing all the raw data behind the indicators. The EU is preparing a strategy document on health information. From the Austrian partner’s point of view, EUPHIX should play a key role in this with her database. However, the EUPHIX database is not equipped and not intended to serve as a general database underlying all indicator calculations, but rather for supporting presentations in EUPHIX.

Map tool

Also a new map tool was presented, which will be used by EUPHIX. The tool is based on importing shape files (Geo classes) which can be easily uploaded and managed. The shape files can be defined at different NUTS levels. An editor can easily design the map. The map tool provides a zoom option and is transferable.

Update on the status of the Public Health Portal and options for linking EUPHIX to the Portal

The EU Public Health Portal (HP), its current activities and progress were presented.

Of relevance for EUPHIX:

• EUPHIX was demonstrated in the HP editorial board meeting of November 2006. This platform can be used for further developing ideas on how to incorporate EUPHIX into the Portal or prioritise areas to be included in EUPHIX.
• At this moment a project makes an inventory of the possible links in the HP between research information (DG Research) and health-related EU-projects (DG SANCO). The health information sector is the next one, which also implies linkage with EUPHIX.
• There is an external evaluation on the HP going on. A summary of the final report will be available at the HP and member states representatives will get a letter report.
• Looking at visitor statistics, the portal is primarily visited by health professionals, ministries and health organisations. In future this would also have to be citizens (the intended primary goal group).

Meeting EUPHIX- DG SANCO in January 2007

Last January, there was a meeting between EUPHIX and DG SANCO. The most important issues were:

• DG SANCO expressed the wish to have more visibility of EUPHIX, by linking the HP to the EUPHIX test site soon.
• DG SANCO wanted to avoid disappointment of people traveling through a largely empty site. However, the EUPHIX project has promised to build a prototype, not a fully filled website
• Agreements during the meeting included: both parties will work on concrete proposals for linkage and EUPHIX will try as much ‘filling’ as possible during the last year

Linkage HP – EUPHIX website

HP’s policy is to link directly to information, i.e. using deep links to the content (and not to show EUPHIX as a project). From four proposals made by DG SANCO to link the EUPHIX website to the Health Portal one was selected. This would imply to place, at the relevant HP pages, a separate heading ‘EUPHIX health information’ (wording later to decide) with the listed deep links.

Displaying the EUPHIX website after deep linking

There were two options discussed about displaying the EUPHIX website when visitors arrive there by deep links:

1. the actual test release, with many empty fields but showing the intended scope;[sitemap and shading show what is filled, proper statements on development status can be made]
2. a separately made ‘light’ version which only shows the implemented issues.[some extra maintenance work, no view on empty boxes but also no view on intended scope]

Most participants were in favour of option 1, including clear warnings/explanations about the empty parts. Under these conditions, having empty parts were not seen by most as a major problem.

According to DG SANCO implementation can be done within the next few months. It is not necessary to wait for a new release of the HP.

Sustaining EUPHIX

The needs for sustainable hosting of EUPHIX were explained

Hosting EUPHIX would need a permanent and dedicated team of minimally some 3-4 fulltime professionals (public health expertise, data specialists, IT specialists), located in a public health professional environment. This capacity is necessary for maintaining the external network, expanding and updating reviewed content. Without continuity, the effort invested into EUPHIX would soon be lost.

Extension of the contract period

Extension of present contract period to 30 June 2008 has been asked and will probably be accepted. The EUPHIX RIVM team at the moment will not apply for a follow-up project. However, RIVM is open for other ways of future co-operation, i.e. hosting the system under other types of agreements. Other possible ways to finance a continued system can be investigated. The crucial question of the ownership of the system in the long run was mentioned.

The partners agreed to prepare a ‘lobbying paper’

The partners agreed to prepare a paper which, on behalf of the entire EUPHIX team, should explain this issue and serve as a support for getting parties interested in a continued existence of EUPHIX.

Data selection and quality

Data selection

A document about data selection and quality was discussed. Starting points on data selection and quality are:

• Data should be ‘reliable’ (trends and differences shown are real) and ‘valid’ (they show what they intend to show)
• EUPHIX wants to use data from existing international compilations (Eurostat, WHO-HFA, OECD; specialized networks; authoritative reviews; PHP projects), not directly from national sources.
• There may be different ‘valid’ definitions of indicators, connected with different data sources

In general:

• EUPHIX quite often has used specialized sources (like EMCDDA).
• Sometimes the choice of data is arbitrary.
• Most importantly, the data selection is guided by the story to be told, even with different sources.

Comments by partners on data selection:

• The partners agreed on the document on data selection.
• Another issue concerned the reviewing of Indicators as presented in EUPHIX. EUphacts have been or are in the process of being reviewed, for indicators this is not yet the case. The partners agreed to start this reviewing process by a feedback round among themselves.

Cooperation with other PHP projects

There is already cooperation (proposed) with other PHP projects (e.g. ISARE, SUPPORT, EUGLOREH, EUCID, POMONA). In future there could be a possible cooperation with the URHIS project on indicators in big cities.

Work for the last year of EUPHIX

Plans for the final year:

• The website is technically almost final: some improvements are still needed in graph and map tools
• Increase the production of new content, in all three categories
• Expand the expert network, implement working procedures; consult target group panel
• Establish linkage with the EU Health Portal
• Establish collaboration with other PHP activities/projects
• Prepare for handover of the system: appropriate manuals to be written, exploring financing and hosting

For the new EUphacts, ECHI indicators and EUphoci, this implies:

• New Indicators: work with ECHIM
• New EUphacts:
• Ischaemic heart disease; stroke; breast cancer;
• depression, suicide, social support, within EUphocus Mental Health
• Using Dutch Kompas content more as starting point for building EUphacts

• New EUphoci: to host results from other projects

Pictures

Attendance and focus

Attendance

Mr. Arpo Aromaa (Finland), mr. Eckardt Bergmann (Germany), mr. Ola Ekholm (Denmark), mr. Gerhard Fülöp (Austria), mr. Wolfgang Hellmeier (Germany), mr. Bernard Ledésert (France), mr. Jørgen Meisfjord (Norway), mr. Krisztian Nagy (Hungary), mr. Magnus Stenbeck (Sweden), ms. Denise Walckiers (Belgium), mr. Peter Achterberg (RIVM), ms. Sanja Kaiser (RIVM), mr. Pieter Kramers (RIVM), mr. Rutger Nugteren (RIVM), ms. Carla Sanderse (RIVM), mr. Roel Schreurs (RIVM), ms. Eveline van der Wilk (RIVM), mr. Vincent Draguet, mr. Artur Furtado, mr. Daniel Mann (all DG SANCO)

This meeting had the following three main issues on the agenda:

• Demonstration and discussion of the 2nd EUPHIX test release
• EUPHIX Working experiences over the past 8 months
• The EU Public Health Portal and its connection with EUPHIX
• Future work.

Demonstration and discussion of the second EUPHIX test release

The access to the 2^nd test release was given to the project partners one week prior to the meeting. Compared to the 1^st test release (February 2006), the website has been improved according to the remarks made in earlier meetings and the experience of the RIVM team.

Changed features include:

• An entirely new look-and-feel of the website (as well as of the Work-in-Progress website).
• Easier access to documents, tables, graphs and maps.
• Documents are named ‘EUphact’ and ‘EUphocus’ instead of ‘Topic’ and ‘Theme’.
• The editing and reviewing process involving external and partner reviewers is established.
• In addition to the six ‘EUphacts’, five ECHI indicators have been implemented (tables/graphs only).
• The lay-out for a new EUphocus on Mental Health has been included.
• Publishing protocols have been developed and implemented.
• An interactive graphics module connected to an underlying database available on the website.
• A search function has been implemented.

The members of the RIVM team gave an on-line demonstration of the website, focussing on:

• The homepage links to the three content elements of the site, ECHI indicators, EUphacts and EUphoci.
• The existing six EUphacts, each in a different status peer review, including the new approach to predefined structural elements and tables/figures/graphs.
• The creation of five ECHI indicators, presenting the tables/figures only, with a ‘remarks section’, providing minimal information needed to understand the data.
• The extra features of EUphoci, containing basic information for the policy maker, as well as the broader context.
• The CMS (Content management System) behind the website. This system has been specifically designed at the RIVM for the Dutch Public Health Compass, and is now the basis for six websites of this type, including EUPHIX. The system enables a fluent content creation process involving several editing and reviewing stages that can be managed by editors without particular technical knowledge.
• The presentation of interactive graphs. End users now can (1) highlight a line or bar within the graph and see the name of the line by mouse over and (2) select sex, time period and/or countries..

In the first round, comments and discussion items included:

• For basic data, the frequency of updating should keep pace with the updates in the original databases.
• The selection of data for a given indicator should be based on quality considerations.
• There is a wish for presenting data at a sub national level (e.g. NUTS2). Although this is appreciated, it will considerably enhance the load and complexity of the work. In some instances it will be done. Interaction with the ISARE project will be exploited.
• As to the ECHI indicators presentation, there is at present some duplication between EUPHIX and the DG SANCO website. In due course, EUPHIX may become the medium for the presentation of the ECHI indicators.
• There is apparently also some redundancy with the printed EU public health reports. An attempt is being made to combine the authorship on relevant issues.
• The interactive graphics tool will be followed by a tool for generating tables from the database. Still, it is not the intention to produce an analytical tool, only a tool to flexibly present the existing information.

The group was then split in a ‘content group’ and a ‘technical group’. Further elaboration of the discussion provided a number of interesting issues:

(1) Content group

• Concerning the user-friendliness of the website, suggestions were made about printing options, import and export of data, as well as for adaptations on the home page.
• Concerning the structure, partners had remarks about: making EUphacts and EUphoci more distinctive by appearance; prioritizing the filling of the ECHI indicators; keeping to the goal of producing a prototype, i.e. not attempting a full coverage; proposal of a EUphocus on ageing and a EUphact on e-health (DG SANCO).
• Concerning the data handling, remarks covered: the best way to ensure data quality (role of SANCO, Eurostat and ECHIM); the choice of reliable sources; keeping to the principle of the critical appraisal of data according to the message given.

(2) Technical group

• It was restated that EUPHIX should be an information tool, not an analytical tool; i.e., for doing calculations of the original data, people should be referred to original data sources. Simplicity is the key word here.
• As to sustainability, it is crucial to recognise that after the end of the project, the system should be hosted and maintained somewhere, and that trained experts should be available to perform these tasks.
• This applies to technical issues as well as to the filling and updating the system with validated documents and data. For the latter, a functioning expert network is needed, co-ordinated by permanent public health professional staff.

EUPHIX working experiences over the past 8 months

(1) Content production

The EUPHIX team is developing and applying procedures to obtain and maintain consistency in the working process and results. A publishing protocol has been developed for that purpose. Within the RIVM team, final editors are assigned separately for: ECHI indicators (Eveline van der Wilk), EUphacts (Sanja Kaiser/Martin Gommer) and EUphoci (Peter Achterberg). Reviewing of documents is assigned to two different reviewers (an external and a partner reviewer). When a EUphact is chosen, an author is selected (mostly external) and an editor assigned (within the EUPHIX team).

Data are generally derived from existing (international) databases or review sources, not from the separate countries. An assessment of the best (most reliable, comprehensible and up-to date) data for a certain indicator is performed. The ‘remarks’ section accompanying each data presentation indicates the essentials of the data source and other issues needed to understand the data. Regional data may be of interest but would generate an additional workload.

(2) Data handling

A structured data repository is being built to store data derived from primary sources, from which (interactive) presentations on the website can be generated. A set of metadata has been devised that is needed for proper storage and retrieval. A document ‘EUPHIX: Functional and technical aspects, version 1.0, October 2006’ gives the full description of this and was available to and discussed in the meeting.

(3) Role of the project partners

Until now the RIVM team has done most of the work on EUPHIX. The project partners have participated by engaging in discussions and giving general and technical comments, mainly during the full project meetings. They also are involved by reviewing documents. Options for future tasks include advising on authors, reviewers and the target group panel.

The EU Public Health Portal and its connection with EUPHIX

Daniel Mann and Vincent Draguet presented the EU Public Health Portal (HP), against the background that a major goal of EUPHIX is to eventually be linked to or incorporated into the Portal, as a sustained enterprise.

The presentation included the Portal’s background, costs (development 600,000 Euro), target audiences (mainly citizens), editorial board, content criteria and structure. Translation in all official EU languages is planned.

Of relevance for EUPHIX were:

• For background information there are currently deep-links to Diseases and conditions information sheets and to the ECHI indicator tables on the Europa Public Health website.
• There is a project which maps the research related to all the themes and topics of the HP.
• A new unit for communication in health will be established next year within DG SANCO. The Portal will be a part of this unit.

After this presentation, a lively discussion developed, covering the following issues:

• There is a logical complementarity between the Portal as a medium for access, and EUPHIX as a body of information. At the end of the EUPHIX project, the Portal may consider EUPHIX to become its main content source if DG SANCO considers it a useful tool for that.
• There is a clear difference in user profile: the Portal is aiming at the citizen, EUPHIX more at the policy maker, the professional, the media and the informed citizen.
• When integrating EUPHIX in the Portal, which are the demands in terms of technical issues, design, etc.? It would have to be translated into 24+ languages. This should be clear soon.
• When not really ‘integrating’ but providing deep-links from the Portal to EUPHIX, difference in software and design may not create problems. This may be the preferred choice.
• The end-product of EUPHIX will be a working prototype. Not all content units will be filled. This end-product is not, as in most projects, a static report, but a dynamic tool that requires maintenance to stay alive. We now need to develop prospects for this, together with DG SANCO.
• In order to facilitate this discussion, the Portal representatives will have a closer look at the EUPHIX release and forward their remarks.

Future work

Considering the fact that the website structure is almost final, we plan to focus on:

• Generating new content, in all three categories (ECHI indicators, EUphacts, EUphoci)
• Expanding the contributing expert network and implementing working procedures
• Establishing collaboration/integration with related activities/projects in the Public health Programme (a.o. ECHIM) and EU Health Portal
• Establishment of the underlying database and presentation tools
• Establishing and consulting the target group panel

For new EUphacts, ECHI indicators and EUphoci this implies:

• New Indicators: quick expansion; work with ECHIM and SANCO; procedure to be established
• New EUphacts: 12 new topics selected to give substance to the EUphoci
• New Euphoci: limited capacity; start on Mental health
• To keep in mind: EUPHIX’ ambitions are to develop the prototype, not the completely filled website; new proposals by DG SANCO will be considered (ageing, e-health).

The project partners agree with the proposed document. They agree to quickly expand the indicators and also to implement more EUphoci (since this shows the added value of EUPHIX), but at a slower pace.

Target Group Panel

The proposal for the establishment of the Target Group Panel is on the table. The tasks would include giving structured feedback on user-friendliness, apprehensiveness, policy relevance and on the scope/priorities of the system. A list of names is proposed from the following groups: policy makers at EU, national and regional level; stakeholders at EU level, public health professionals, and the media.

In the discussion, it was argued not to involve too many policy makers in the panel. Public health professionals and academics may be a more important user group, although younger policy makers are increasingly using internet. DG SANCO should have a special position beside the Panel, but participate in its meetings. Otherwise, the group supports the Target Group Panel and will give additional suggestions for names. It is considered that the present test release could be used to consult the Panel, provided some minor improvements suggested by this meeting could be implemented. It was also considered that he Target Group Panel would contribute to creating commitment.

In a final round, the participants stressed (again) the following issues:

• There is a general support for the site, its approach and implementation
• We should develop a prospect for EUPHIX, its maintenance after the end of the project, in relation with the Portal
• Clarification of the ambitions with regard to sub national data is needed
• The interaction with other projects under the Public Health Programme should be further considered
• We should increase the commitment within the EU by engaging more countries and have the Target Group Panel raise new ideas

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Attendance and focus

Mr Marco d'Angelantonio (HIM), Mr Arpo Aromaa (Finland), Mr Eckardt Bergmann and Mr Helmut Brand (Germany), Mr Gerhard Fülöp (Austria), Mr Oyvind Hesselberg (Norway), Ms Susanne Holland (Sweden), Ms Csilla Kaposvári (Hungary), Mr Bernard Ledésert (France), Mr Herman van Oyen (Belgium), Mr Remigijus Prochorskas (WHO-Euro), Mr Peter Achterberg, Ms Maartje Harbers, Mr Pieter Kramers, Mr Rutger Nugteren, Mr Roel Schreurs, Ms Sabine Silva, Ms Nicoline Tamsma and Ms Eveline van der Wilk (RIVM). Apologies were received from: Mr Finn Kamper-Jörgensen (Denmark), Mr Martin McKee/Ms Ellen Nolte (UK), Mr Arthur Furtado (DG SANCO), Ms Sanja Kaiser (RIVM),

This meeting focused on two key issues: (1) the test release of EUPHIX' first integrated pilot application, and (2) the EUPHIX draft Work Plan.

The Pilot application

The first version of the application has four main features:

1. The information approach mode. Health information is structured and presented in two different ways: a concise format ('topics'), and a broader format ('themes'). The information can be accessed via either of these modes;
2. The structured way in which the topics are ordered and presented: the 'topic tree';
3. Six elaborated examples of content, presented in 'topic' format and structured within the 'topic tree'; two elaborated examples of 'themes'.
4. A range of technical functionalities (internal links, links to references, definitions, etc.)

The project team demonstrated the application on-line, and then presented the technical aspects in detail. This included the possibilities to generate tables, graphs and maps from a database. Thereafter, Remis Prochorskas from WHO-Euro presented the DPS system developed at WHO.

Several points were raised during the discussion.

• A general agreement on the 'look and feel' of the application, and on the idea of structuring and presenting the information in a more concise ('topics') as well as in a broader, more reflective format ('themes') was attained. However, there were some concerns about the suitability of the chosen terms to represent these formats. A range of options for clear and user-friendly access, including various search options, were also discussed.
• Gathering, structuring and presenting good quality, reliable information is a key challenge. EUPHIX aspires to build on the 'best available data'. This includes identifying the most reliable and adequate data for each indicator. An important role of the expert authors arises here. This calls for well-defined protocols necessary to facilitate objective reporting.
• Given the importance of regional responsibities for public health and health policy in several EU member states, the project may have to incorporate information on health and policy at sub-national level.
• In reporting on policies, information on priorities and intended measures may have to be checked against the actual state of affairs regarding the implementation.
• Various elements of the the database tool developed at the WHO (DPS-2) may be helpful in the further development of the EUPHIX tool.
• When authors and editors opt to rely on secondary data, easy access to the original database or other source (e.g. WHO-HFA) must be provided.
• In developing the Content Management System (CMS), particular attention will be paid to user-friendly aspects so that the system can be used by external authors and be handed over after the ending of the project.
• The added value of EUPHIX among other EU activities should be better defined.
• The sustainability of the project output (i.e. the application as well as the content) after the end of the project is of paramount importance. This also implies good links with the EU Health Portal.

The Work Plan and Time Table

The main features of the work plan and the time table were introduced. Highlights from the discussion were:

• EUPHIX is to build a prototype for web-based health reporting, and to develop a cross-section of the type of the health information that could be presented via the system. Hence, there is no need to aim for complete coverage of health issues. Instead, a more elaborate work on a selected numer of complex health themes would be useful for demonstration purposes.
• The project will benefit from increased exposure in the European public health arena in order to maximize its added value and sustainability. Once the key pillars of the system have been designed and a fair range of content has been developed, large-scale European conferences, such as the EUPHA conference or the European Health Forum Gastein could provide good opportunities to receive more specific feedback from the intended user group.
• EUPHIX aspires to incorporate results from a broad range of activities funded through the EU Public Health programme.
• EUPHIX has started work on tobacco and obesity in teh EU as the first two priority 'themes'. Once the information on these two themes has been incorporated, work on the Mental health theme will begin, as agreed at the first project meeting in June 2005. Alcohol, Injuries, and Child health were identified as future policy relevant themes.

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Further statements and agreement

• The core business of EUPHIX is adding intelligent and objective interpretation to the adequate presentation of reliable data.
• EUPHIX should learn from current national or regional web-based health reporting initiatives.
• EUPHIX should use the ECHI structure as a model, but evolve and elaborate beyond that.
• Setting up EUPHIX will be a challenge, maintaining and updating it even more so. This needs attention throughout the development of the project.
• There is a need for an overview of the organisation of public health and of the public health policies in the Member States in a descriptive manner.
• The relationship between EUPHIX and other health information systems, both national and international, has to be addressed more clearly.
• The EUPHIX project brings together partners from ten EU member states and Norway. Yet, EUPHIX will need to incorporate information about all EU member states.
• Health care should not be given too much attention.
• Offering information in solely English language may limit the accesibility of EUPHIX.

• The content should reflect a ‘salutogenic’ point of view, as opposed to the often illness-oriented health statistics.
• In the first phase, pilots on two or three themes will be developed. Suggestions included: tobacco/smoking, injuries, obesity, cancer, mental health and health inequalities.
• Criteria to be used for such choices were discussed and include: policy relevance, availability of evidence based data, including those on successful interventions.
• Information about the EUPHIX project will also be presented via a ‘work in progress’ website.
• A target group panel could serve two purposes: their input can help improve EUPHIX’ quality and policy relevance; and the members of the panel could promote the project’s sustainability and relevance across various user groups and countries.
• The next Full Project Meeting is planned for February 2-3 2006 in the Netherlands.