Estonian e-health. Artur Novek Estonian ehealth Foundation Implementation manager / Architect

Transcription

1 Estonian e-health Artur Novek Estonian ehealth Foundation Implementation manager / Architect

2 Estonia Estonia km mlj. Inhabitants GDP: Agriculture 2,7% Industry 26,3% Service 74,5% 2

3 E-STATE ARCHITECTURE 3

4 HEALTHCARE IN ESTONIA 30 hospitals 512 family doctors (juridical persons) Healthcare expenditures % from GDP mlj. EUR

5 Estonian ehealth history Planning initiated Project preparation ( ) ehealth Foundation established ehealth Projects ( ) eprescription Funding decision by Ministry of Economic Affairs National HIS Electronic Health Record Digital Images Digital Prescription Digital Registration 5

6 EU funded projects Estonian ehealth Foundation Electronic Health Record (1.6 mln ) Digital Registration (0.2 mln ) Digital Images (0.2 mln ) Health Insurance Fund Digital Prescription (0.24 mln ) 6

7 ehealth Foundation organization Ministry of Social Affars Society of Family Doctors Tartu University Clinic East Tallinn Central Hospital Union of Estonian Medical Emergency North Estonian Regional Hospital Estonian Hospital Association Estonian ehealth Foundation Board Standards development Services development Management board ENHIS Operation Communication management IT management Helpdesk Administrators

8 Development levels of Estonian Health Information System Institutional and user level cooperation Partnerships User needs Training programs Process Descriptions Notifications Data Exchange level different e-services User Interface User software Data input Data Visualisation Data filters (within user software) Web-interfaces Data transmission standards (HL7) Central System Database and related services Data set Data Standards Data filters relating to the central system Legal Framework

9 STANDARDS 9

10 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 act 10

11 Standardization process Specialty assotiations Healthcare providers Social ministry Terminology experts EeHF standardization specialists Health Insurance Fund UML+HL7 experts HIS developers Create data set Formalize and merge Approve and publish Data set document UML model Classificators XML schemas Description documents Changes in NHIS documents regulatory act OID-s Stylesheets Examples Fixed version of artifacts in publishing centre 11

12 Main services of the e-health in Estonia Digital registration services econsultation services EHR services for physician EHR services for patient Services for Social Insurance Fund Digital archiving services Cross Border Data Exchange services eambulance services Digital laboratory services A medical certificate services Data and statistics services Supporting services Infrastructure services vi External services Subservices Analytics services for participants in treatment process Services for dentaal care 12 Services for blood center Services for registers Services for nurse Services for homecare Health information services for patient E-learning services for medical staff

13 Major architectural decisions of HIS Integration through Central system (Opt-out) XML based HL7 v3 (extended) messages Documents are kept in XML format (HL7 CDA R2) All structured data fields have OID-s Only final versions of clinical documents are sent into central system Reuse of national infrastructure ID card for authentication and digital signature Xroad for secure communication 13

14 STATE AGENCY OF MEDICINES - Coding Centre - Handlers of medicines HEALTH CARE BOARD - Health care providers - Health professionals - Dispensing chemists POPULATION REGISTER BUSINESS REGISTER HOSPITALS 2009 FAMILY DOCTORS 2009 PHARMACIS 2010 january SCHOOL NURSES 2010 september EMERGENCY MEDICAL SERVICE 2011 Architecture X-Road, ID-card, State IS Service Register PATIENT PORTAL 2009 X-ROAD GATEWAY SERVICE 2009 PHARMACIES AND FAMILY DOCTORS 2009 NATION- WIDE HEALTH INFORMATION EXCHANGE PLATFORM 2008 december PRESCRIPTION CENTRE 2010 january 14

15 SECURITY & AUTHENTICATION

16 The 6 main principles 6 whales of security of Estonian ehealth system 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. Coding of personal data: separating of personal data from medical data 5. Encrypted database that allows to remove the confidentiality risk from the technical administrators 6. Monitoring of all actions together with the corresponding countermeasures (both organizational and technical) 16

17 HIS integration through X-Road HL7 CDA document Digidoc HL7 interaction Healthcare provider IS National Central HIS X-Road message 17

18 Document processing Lab notice Swineflu Üldandmed notice Mari-Liis Infection Üldandmed Mari-Liis notice Männi 1-2 Üldandmed Mari-Liis Tallinn Männi 1-2 Demographics Mari-Liis Diagnoos Tallinn Männi punetised Diagnoos Tallinn Männi Allergia punetised 1-2 Tallinn Diagnoos õietolm Allergia punetised Diagnosis õietolm chickenpox Allergia õietolm Allergy pollen Discharge letter Agents Health record agent Event: Medication, Diagnosis, Procedure Infection disease agent Diagnosis: chickenpox Demographics agent Address: Männi 1-2, Tallinn Timecritical report agent Allergy: pollen Health record Demographics Timecritical reports 18

19 Query processing Query Patient Mari-Liis Record type Diagnosis Agents Health record agent Find all diagnosis type records Health record Patsient Mari-Liis Diagnosis Diagnosis Diagnosis Diagnosis: chickenpox Document no: 103 Hospital: PERH Security agent Document open? Consolidate records Warning, some documents are closed! 19

20 Client systems withoud Xroad server Technical solution Client systems X-road gateway X-roads security Validation and surveillance data collection Business Logic Data Services Data Storage Segmented LAN Activity Surveillance Portals VPN access gate Monitoring Statistics Client systems - HIS, GPIS Patient portal - Oracle Portal, 2013 change to Tomcat xroad Gateway MISP (Tomcat) Activity Surveillance - Tomcat, Sybase IQ, Webfocus Business Logic - Webmethods Integration Server and Broker Data Services - Oracle DBMS with Advanced Security and Database Vault Monitoring - Nagios, Cacti Statistics Iway Service Manager, Sybase IQ, Webfocus 20

21 PATIENT PORTAL (UPGRADE) 21

22 Acceptance eprescription covers 94% of issued prescriptions. Over 90% of Hospital discharge letters digital Over 95% of stationary case summaries have sent to the central DB Ambulatory case summaries sending No certain rules for sending ambulatory case summaries! person have documents (82% of population) 22

23 eprescription (94%) ISSUED SOLD 23

24 March May July September November January March May July September November January March May July September November January March May July September November January March May July September November Retrieval of Medical Documents by Healthcare Professionals

25 jaan.09 märts.09 mai.09 juuli.09 sept.09 nov.09 jaan.10 märts.10 mai.10 juuli.10 sept.10 nov.10 jaan.11 märts.11 mai.11 juuli.11 sept.11 nov.11 jaan.12 märts.12 mai.12 juuli.12 sept.12 nov.12 jaan.13 märts.13 Patient portal Number of queries Number of queries

26 26 26

27 LEARNING POINTS

28 Resources were planned only for central development. Usability. Developing process has to include medical competence users Data quality is important Complete and quality data give value. Balance between security and usability PIN for every document 28

29 Digital stamp for family doctors Documents Sent by GPs in 2012 and 2013 (1st Quarter)

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31 Better services Faster data input Voice recognition, statistics based text input assistant Faster and better output Important information on one screen Combining information from multiple sources Graphical solutions Precaching Single sign on 31

32 App Store Tablet PC PC Mobile Integration platform Notebook ehealth central system Hospital information system RIS / PACS 32

33 App Store Speciality based applications

34 FUTURE OUTLOOK

35 Thank you! 35