connected health & me - raul mill - nov 24th 2014
TRANSCRIPT
Estonian eHealth System
Raul Mill
Estonian eHealth Foundation
Hello!
GDP:
Agriculture 3.9%
Industry 29,7%
Services 66,4%
Estonia
Area - 45 000 km2
1.33 mlj. inhabitants
Healthcare expenditures in Estonia- 6.9% from GDP 2013 – 1.12 bln eur- 5.9% from GDP 2012 – 1.03 bln eur- 5.9% from GDP 2011 – 0.94 bln eur- 6.3% from GDP 2010 – 0.91 bln eur
E-STATE ARCHITECTURE
8 main softwares (totally 20)
752 associated juridical persons21 main hospitals73 stationary healthcare institutions (hospitals)479 family doctors (juridical persons)
2000 2002 2004 2006 2008
HIE platform history
Planning initiated
Project preparation (2003-2005)
Funding decision by Ministry
of Economic Affairs
Electronic Health Record
Digital Prescription
Digital Registration
Digital Images
eHealthFoundation established
(2005)
eHealthProjects
(2006-2008)
National HIE
Standardsmanagement
ITmanagement
Ministry of Social Affairs
East Tallinn Central Hospital
Tartu University
Clinic
Society of Family Doctors
North Estonian Regional Hospital
Management board
Estonian e-Health Foundation Board
ENHIS Operation
EstonianHospital
Assosiation
Union of Estonian Medical
Emergency
Organization
Servicesmanagement
Communication management
MedicalAdvisory
Board
PHARMACIES AND FAMILY DOCTORS2009
X-Road, ID-card, State IS Service Register
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NATION- WIDEHEALTH INFORMATION EXCHANGE PLATFORM2008 december
PRESCRIPTION CENTRE2010 january
PATIENT PORTAL2009
X-ROAD GATEWAY SERVICE2009
E-health architecture
The main security principles of Estonian eHealth system – Opt Out
1. A secure authentication of all users with ID-card or Mobile ID
2. Digital signing or stamping of all medical documents
3. A maximum accountability (transparency): all actions will leave an
unchangeable (and unremovable) secure trail
4. Encrypted database that allows to remove the confidentiality risk
5. Monitoring of all actions together with the corresponding counter-measures (both organizational and technical)
Central System– Databaseand related services
Data Exchange leveldifferent e-services
Institutional level–users cooperation model
• Healthcare processes• User needs• Training programs
• Partnership• Communication
The structure of Estonian Health Information System
• Set of data• Data Standards• Search criterias• Legal Framework• Software• Hardware
• User software• User interface• Data input• Data Visualisation• Searching information
• Data transmission standards (HL7)
EHR services for patient
Services for Social
Insurance Fund
Services fordental care
2015
Services for blood center
2016
Services forregisters
2015
Services fornurse
2016
M-and tele-health services
Health information services for
patient
E-learning services for
medical staffAnalyticsservices
Data and statistics services
A medical certificate services
Digital laboratory
services
2015
eAmbulanceservices
2014
Cross Border Data Exchange
services
2013 (EPSOS)
Digitalarchiving
(x-ray images)
eConsultation services
Digitalregistration
2016
EHR services for physician
Main services of the
eHealth in Estonia
Subservices
- Completed
- Development
- Planning
Infrastructure services External services
Supportingservices
Connecting Health
Acceptance
• All bigger hospitals use central system on a regular base
• The central system has over 10 300 medical users
• ePrescription covers 98% of issued prescriptions
• 98% of family doctors are sending documents to the central system
• Over 97% of stationary case summaries have sent to the central DB
• Ambulatory case summaries sending
– No certain rules for sending ambulatory case summaries!
• 1.35 mio persons have documents in central system (98% of the population)
• 0.74 mio persons information in the central DB have used by medical professionals
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
Det Jan
Veb
Mär
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Jun
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Sep
Okt
No
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2008 2009 2010 2011 2012 2013 2014
Retrieval of medical documents by healthcare professionals 2009 - 2014
0
50000
100000
150000
200000
250000
Queries from patient portal
0
20000
40000
60000
80000
100000
120000
140000
JAN
FEB
MA
R
AP
R
MA
Y
JUN
JUL
AU
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SEP
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OK
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NO
V
DEC
JAN
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2012 2013 2014
Sent documents by family doctors 2012 – 2014 – before and after realizing digital stamp
PATIENT PORTAL (UPGRADE) – 1.3 mio persons medical data
Standards
Standards
• HL7 and DICOM (Picture Archive)
• International classification: ICD-10, LOINC, NCSP, ATC
• Estonian eHealth’s OID registry
• Local eHealth classificators
– Published in publishing centre
– Classificators are regulated by government acthttps://www.riigiteataja.ee/akt/12910889
Standardization process
Create data set
Formalize and merge
Approve and publish
Data set document Classificators
Examples
Specialty assotiations
OID-s
XML schemas
Description documents
UML model
Healthcare providers
EeHF standardization
specialists
Social ministry
Stylesheets
UML+HL7 experts
Fixed version of artifacts in
publishing centre
Terminology experts
HIS developers
Health Insurance
Fund
Changes in NHIS documents
regulatory act
eHealth availability and use Indicator 2012: by country
LEARNING
POINTS
Healthcare is a reactive, rather than proactive industry.
Solve one specific problem in healthcare, not ten of them.
In healthcare you need to have a business model from the start.
Healthcare is very interdependent: you have the doctor, the pharmacy,the patient, the insurance provider, and a dozen other stakeholders that
any one service has to coordinate with.
EHR systems: more like plain than mobile phone …
FUTURE OUTLOOK
Data and services
integration
Apps for medical
specialties
UI standards
Single sign on
Hardware independent
Inter-operability
Graphical solutions
Collecting information
Location independent
Conclusion:
• Comperhensive planning – investments, processes and standards, legislation.
• Usability – fast and simple solutions, balance between security and usability
• Implementation – central training programs
• Service update – continuous feedback
Thank you!