Download - Madis Tiik CEO Estonian e-Health Foundation Baltic Congress in Laboratory Medicine 16 September 2010
The Estonian Electronic Health Record System
Madis TiikCEO
Estonian e-Health Foundation
Baltic Congress in Laboratory Medicine 16 September 2010
Information SocietyBy 2013
All public services are digitaly availablePublic infrastruture is service oriented (x road)Digital authorisation of users, based on the ID
card, is the best available in the worldData is stored were it is collected and
exchange of the data is available thous who need it
Lifestyle
Self-help
Tele-advice AppointmentNotification
Prescription
Campaigns
PublicServices
Policy-making
Analysis
Diagnostics
Treatment
Guidlines
Follow-up
EHR
Workflow
Family doctors
Hospitals
Founders of the Estonian eHealth Foundation
End users
Strategy and Architecture Development
Marketing and Channel Management
Ministry of Social
Affars
East Tallinn Central Hospital
Tartu University
Clinic
Society of Family Doctors
North Estonian Regional Hospital
Management Board
Estonian eHealth Foundation
Board
EHR Operation
Estonian Hospital
Association
Union of Estonian Medical
Emergency
Nursing Care
Patient Portal
Health Authorities
Governance
Our tasksManagement of E-Health projectsStandardisation and development of medical
digital documentsMaintenance of the Estonian EHR system International cooperation and scientific
cooperation with universitiesDevelopment of new services for citizens and
doctors
Financed from the State budget (1.5 mln € – 2010)5
X-ROAD
SS
HEALTH CARE BOARD- Health care providers- Health professionals- Dispensing chemists
STATE AGENCY OF MEDICINES- Coding Centre
- Handlers of medicines
SS
SS
HEALTH INSURANCEFUND
Prescription Centre2010 january
HEALTH INFORMATION SYSTEM ( EHR)
17.12.2008
SS
SS
- Citizen Registry- Company Registry
SS
Pharmacis2010 january
Doctor’s and pharmacies
software solutions
Hospitals 2009
Family doctors2009
Emergency Medical Service
2011School nurses
2010 september
SS SSSS SS
Healthcare Provider
SS
Monitoring portalPatient portal
Goverment’s e-service frameworkwww.eesti.ee
KIT Citizen view
EIT Enterprice view
AIT Official’s view
W-SS
Estonian national eHealth infrastructure
Lab referalÜldandmed
Mari-Liis
47595064059
Männi 1-2
Tallinn
Diagnoospunetised
Allergiaõietolm
Swineflu notice
ÜldandmedMari-Liis
47595064059
Männi 1-2
Tallinn
Diagnoospunetised
Allergiaõietolm
Message
Timecritical reports
Demographics
Health recordInfection notice
ÜldandmedMari-Liis
47595064059
Männi 1-2
Tallinn
Diagnoospunetised
Allergiaõietolm
Discharge letterDemographics
Mari-Liis
47595064059
Männi 1-2
Tallinn
Diagnosischickenbox
Allergypollen
Demographics agentAddress: Männi 1-2, Tallinn
Infection decease agentDiagnosis: chickenbox
Timecritical report agentAllergy: pollen
Health record agentEvent: Medication,
Diagnosis, Procedure
HPIservices
Document processing
Statistics queryOutbreak report
Data integrationDemographics, health statusHPI
Health Portal DevicesInformation
Systems
Standards and Services
Processes and Integration
WSDL
XSD
Public IT Infrastructure
ConcentDocument
archive
Health record
StatisticsDecision Support
ReportsHealth status
Ambulance
Demo-graphics
Booking
EHR Central Functions
Storage ( long time archive)Metadata/ universal viewer
Current Situation 15.09.2010There are 1 858 541 documents in the Estonian
EHR Discharge letters (epicrises) 233 338 Out-patient consultation notes 338 922 Dispensed medication information 770 704 DICOM images ( index) 264 488 Image reports 243 797
More than 400 000 citizens have digital medical records in EHR , it is 30% of the population
Availability of Discharge LettersYear 2009
North Estonian Regional Hospital
Tartu University Clinic
East Tallinn Central Hospital
27661 31914 24038
82% 74% 84%
These 3 hospitals cover more than 60% of in-patient cases in Estonia
ePrescriptionsPrescription centre was launched 1st of January 2010
January February
March April May June July August
Number of e-prescriptions issued
278 957 407 609 520 000 387 000 381 836 408 713 386 493 435431% from prescriptions issued*
40% 58% 74% 55% 55% 58% 55% 62%
Purchasedprescriptions
150 009 221 800 322 000 288 000 292 207 318 968 314 414 333018% from purchased prescriptions*
21% 31% 46% 41% 42% 46% 45% 48%
*estimation based on 2009 numbers - 700 000 prescriptions monthly** 13.04 recomendation not to use e-prescription to the doctors
eLab projectTranslation of 10 000 LOINC termsImplementation LOINC and RELMA program's in all
labs Mapping of Lab’s test’s with LOINC standard.Influence to the other projects:
Enables data exchange between labs and healthcare providers
Enables statistical analyzes and comparisonsTest results are seen to all users of EHREnables patient’s to see lab testMore info for decision support Automatic exchange data with Infectious diseases register
Workflow of lab test’sDoctors IT system
Sample logistic
Lab
EHR
1.-2. Referal (patient ID, test specifikation, index number)
3. Referal (test specifikation, index number)
5. Lab test result(index number)
6. Report, alerts, lab test results
Referal centre
4. Sample + index number
Lab test standard
<observation classCode="OBS" moodCode="EVN"> <!-- eristab mis liiki Observation kirjega on tegemist--> <code code="ANA" codeSystem="1.3.6.1.4.1.28284.6.2.2.5.1" codeSystemName="Observation liik" displayName="Analüüsi tulemused"/> <!-- staatus: lõplik--> <!-- <statusCode code="completed" codeSystem="2.16.840.1.113883.5.14" codeSystemName="ActStatus"/> --> <statusCode code="completed"/> <!-- analüüsi vastuse rea aeg--> <effectiveTime value="20060501134139"/> <!-- analüüsi tulemus --> <value xsi:type="ED"> 9.2 </value> <specimen typeCode="SPC"> <specimenRole classCode="SPEC"> <specimenPlayingEntity classCode="ENT" determinerCode="INSTANCE"> <!-- analüüsi parameeter--> <code code="tO2" codeSystem="OIDnr" codeSystemName="Analüüside parameetrid" displayName="tO2"/> <!-- ühik --> <!-- code="" codeSystem="2.16.840.1.113883.6.8" codeSystemName="UCUM", kui võimalik--> <desc>Vol %</desc> </specimenPlayingEntity> </specimenRole> </specimen> <referenceRange typeCode="REFV"> <observationRange classCode="OBS" moodCode="EVN.CRT"> <!-- referentsväärtus--> <text>10 Vol %</text> </observationRange> </referenceRange></observation>
Analüüs, v2
Pakett: DL mallid
Detailid: Created on 30.08.2007. Last modified on.27.01.2010.
Selgitus: Lisatud analüüsi koht: targetSiteCode Lisatud SNOMED klassifikaator vers 2: Lisatud seos mallidega Toimingu teostaja asutus (0..1), Toimingu teostaja isik (0..1), lisatud analüüsi koodi klassifikaatoriks HK teenuste hinnakiri.
Seosed Atribuut Kordsus ja seos Selgitus referentsväärtus või väärtuste vahemik
0..1 ObservationRange text.
Reegel: väärtus või väärtuste vahemik
staatus (tehniline) 1..* Observation statusCode.
Klassifikaator: Staatus
vastuse tulemus 0..* Observation value.
observation liik (tehniline) 1..* Observation code.
Struktuur: vastavalt klassifikaatorile Klassifikaator: Observation kirje liik (tehniline) Reegel: code = "ANA" (analüüs) OID: Observation liik algusega 1.3.6.1.4.1.28284.6.2.2.5
parameetri mõõtühik 0..1 PlayingEntity desc.
analüüsi parameeter 0..1 PlayingEntity code.
analüüsi kood 1 Procedure code.
Klassifikaator: LOINC OID: LOINC : 2.16.840.1.113883.6.1 või: Klassifikaator: SNOMED OID: 2.16.840.1.113883.6.96 või: Klassifikaator: HK teenuste hinnakiri OID: 1.3.6.1.4.1.28284.6.2.1.6 codeSystemVersion: verisooni nimetus
http://pub.e-tervis.ee/standards2/Standards/3.0
Life Cycle of Digitization of Medical Document 12
mo
nth
s3
mo
nth
s3
mo
nth
s6
mo
nth
s
Task Setup Ministry of Social Affairs, EeHF, Professional Society’s
Content Related Standardization The Estonian eHealth Foundation (EeHF)
Technical Standardization – CDA documentDeveloper (Outsourcing)
Development of Central System Services Development of Health Care Service Providers’ Developer (Outsourcing) Information Systems
Health Care Service Provider’s ICT partner
Installation Standard to the Test Environment (EeHF)
Testing and Acceptance ServicesDeveloper, EeHF, Health Care Service Provider’s ICT partner
Ministerial degree naming the date for Health Care Providers when standard and new documentation is obligatory - Ministry of Social Affairs
Standard published, installed to working environment, new service in portfolio of EeHF- EeHF
Patient’s Portal → Personal Health Record (PHR) 2010-2011
• PHR – one view for citizens– Illness data from healthcare system (Patient’s Portal)– Self-monitoring data– Wellness data from third parties– Data from social system– Patient forums– Screening remainders
• Decision support – Self-care– Virtual health check
Future of EHR
Interactive Services
Viewing Prescriptions
Viewing Health Record
E-consultation
Immunization Passport
Virtual Health Check
Citizen Health Record
Collecting Personal Health Information
Self-help
Personal Data Management
Informational Services
Reminders
Invitation for Screening
Booking Service
Supporting Services
Rights Management
Authorizations
Expressions of Will
Access Rights
Log Archive
EHR Portal Services for Citizen
TIS
EHR
TIS
Decision Support
Knowledge Digitalization
Suggestions and
Reminders Decision Support Service
Decision Scripts
Health RecordsDigital Library
Health Records Service
DecisionSupport
CoreEngine
EBMeDS Local ServiceEstonian NHIS
HCIworkspace
EHRDocument
Service
Global, National & Local Scripts
Evidence Links
Function Library
Patient Data
Forms & Calculators
Response Messages
Drug Information• Best Practice• Contraindications• Interactions
Con
vers
ion
filt
ers
”Glu
e”
com
pon
en
t
EHR DecisionSupport
Web ServerApplication
EBMeDSEvidence-Based Medicine electronic Decision Support
HTTP
Web Resources• EBM Guidelines• Cochrane Library• Essential Evidence• EBMeDS Home Page
Script Editing Tools EBMeDSDatabase
EBMeDSMaster FilePackage
EBMeDS Central Service
Administrator Tools
TestingApplications
TestingApplications
Table Editing Tools
CompilingTools
JavaScriptInterpreter
Data Tables
FTP
LogFiles
UpdateService
Application Maintenance
Server, Storage & Network Management
Database management
Monitoring help desk
Application Operations
Hardware and Data Center
Application Development
Business Processes
Partners
eHealth
eHealth
Partners
ITIL
Maintenanceof Estonian EHR System
Application Development
Server, Storage & Network Management
DataBase Management
Monitoring, Help Desk
Application Operations
1
2
3
4a
4b
5
6
7
Hardware & Data Center
Maintenance of the EHR
Application Maintenance and Support
Business ProcessesBusiness Processes Doctor
s portal
Patient Portal
W-SSEHR
reguest servicis
Patient summary
Medication history
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