ESTONIA ESTONIA. Estonian E-Health solutions overview (extra-curricular addition for the Tirana seminar on information exchange) Hannes Astok

Transcription

1 Estonian E-Health solutions overview (extra-curricular addition for the Tirana seminar on information exchange) Hannes Astok Based on the presentation of Mr Madis Tiik The Chairman of the E-Health Foundation ESTONIA ESTONIA Population 1.32 millions Area km2 Compulsory Health Insurance payed by employer Health insurance tax 13 GDP for healthcare 5,0% Income tax 21% (flat tax) Healthcare providers are private, municipal or governmental. Family doctors (private companies); Hospitals (shared companies or foundations) 1

2 ehealth Foundation Founded Founded by main stakeholders 3 biggest hospital -North Estonian Regional Hospital (NERH), Tartu University Hospital (TYH), East Tallinn Central Hospital (ETCH) Ministry of Social Affairs The Estonian Society of Family Doctors The Estonian Hospitals Uninon The Assossiation of Ambulance doctors Team- 15 people 3 project managers 1 EU projects 1 Standardization 1 New projects and international collaboration 3 IT managers IT service manager IT development manager IT application maintenance manager 3 Helpdesk analysist / first level service desk 1 specialist Assistant, accountant, finance/personel, PR, CEO Our tasks Standardisation and developing digital documents Maintance of the Estonian ehealth system Digilugu International cooperation, scientific cooperation with universities Develop new servises for citizens and doctors Running costs financed from the State budget (1.2 mln ) 2

3 Background of ehealth projects I 2004 Ministry of Social Affairs applies for aid from the European Union structural funds April 2005 Ministry of Economic Affairs that coordinates allocation of structural funds made the funding decision for four ehealth projects: Electronic Health Record (1.6 mln ) Digital Registration (0.2 mln ) Digital Images (0.2 mln ) Digital Prescription (0.24 mln ) September 2005 Ministry of Social Affairs announces tenders Backround for E-Health projects Relatively consolidated Healthcare software market Electronic Health Records implemented inside hospitals and in most centers of family doctors Major hospitals starting to provide access to their IT systems to external parties Good Internet access Expectations from patients to get e-services Implementation strategy Reuse as much as possible Due to low budgets, lack of skilled people X-road Estonian ID card Minimal changes in the healthcare providers side Cost-effectively adapt to local needs Central system developed in parallel with hospital integration 3

4 Tervise infosüsteem Sertifitseerimiskeskus või pangalink Rahvastiku register Haigekassa E-Kodanik Patsient Ambulatoorne arstiabi ~450 X-tee Apteegid Retseptide register Perearstid ~800 Perearstide kesksüsteem Digitaalne terviselugu Kiirabi ~30 Kiirabiarstid Arstid Haiglad ~50 Statistika Meditsiiniregistrid ~20 Statistika kasutaja Meditsiinilised uuringud DATABASES / INFORMATION SYSTEMS BANKS Population register Health Insurance Register National Pension Insurance Register Vehicle Register Estonian Energy IS Tallinn Water IS SEBbank Svedbank Creditbank Sampo Bank Nordea Bank Internet - X-tee :: :: E-institution Institution view Central server I Monitoring :: E-county county view :: :: E-riik State Portal :: Institutional view of the state Thematic view of the state KIT EIT AIT Citizen view Enterpriser view Public servant view Central server II HelpDesk X-road certification centre National Databases register ID card Tools centrally developed by the State X-road Center Certification Center Legal environment of ehealth The Health Information System Act is being prepared to regulate the development and maintenance of the health information system Lay down the necessary requirements to the patient, health service provider, etc Debate of the bill Government (spring 2007) Parliament (autumn 2007) Accepted Goverment regulary act of Health information system

5 Access rights for EHR Everybody can access their own data Everybody can declare their intentions and preferences Everybody can monitor visits to their EHR The attending doctor concept Patient has the right to close their data collected to the center database (opt out) All healtcare providers must send data to EHR Critical issues The practice regarding access to sensitive personal data today becomes public Mistrust of doctors with regard to other specialities or each other Shortcomings in documenting today become public Need for additional resources In the information systems of health care providers, an analogical central monitoring system of user patterns will be implemented based on logs Requirements for the availability of health care providers are inadequate and extremely varying (capability of infra) Ethics and security issues, training of doctors, managing the paradigm change 5

6 Success factors of e-health Important for all health care providers to interface at the same time The more users, the slower the transition period Former data digitalisation has not been planned for Import of already digitalised data can be carried out with regard to time-critical information (analysis still in process) Digital registration Referral Centre will be launched Every service provider will forward the referral to the Referral Centre Referral based additions to waiting list can be made by the doctor, the person to be added or an employee of the Registration There will be a national central waiting list At first out-patient appointments Future potential to expand to in-patient appointments Digital image PACKS and DICOM formats will be used The images will be made accessible centrally by people themselves by adding a link of the image archive to the central system Image can be viewed through the system, processing will depend on the working station of the doctor Other pictures and multimedia files will be stored from

7 Digital prescription General principles of prescribing and selling medicines in Estonia will not change Prescription Centre will be established Every doctor will compile a digital prescription and forward it to the central Prescription Centre Automated suggestion of correct reimbursement level Any pharmacy can access the Prescription Centre according to granted authority and enter data regarding the purchase to the Prescription Centre Major learning experiences Project setup Governance and decision making Integration scope unknown until much later in project How to involve different stakeholders? How to finance integration costs? Major learning experiences 2 Standardisation 4 versions of standards May 2007, Aug 2007, Dec 2007, Feb 2008 Amount of clinical documents was reduced due to the capabilities of Health institutions 7

8 Major learning experiences 3 Access rights Finding suitable compromise between different stakeholders Controls before Access is provided to all licensed medical professionals only Institutions are responsible for their internal controls Controls after Monitoring based on risk analysis Major learning experiences 4 Transformation from functionality to services How to build up the maintenance structure? 8

9 Questions? Madis Tiik 9