Ericsson e-health solutions
contents Ericsson healthcare portfolio E-Health implementation in Croatia E-Prescription Process Ericsson E-Health Solutions Commercial in confidence July 2013 Page 2
Ericsson healthcare portfolio Health Information Exchange Health related information exchange among all stakeholders in healthcare system on national or regional level Ericsson Healthcare Exchange (EHE) Hospital Information Systems Improve efficiency of business processes in hospitals with proactive management Increase quality of patient medical care Ericsson Hospital Information System (EHIS) Mobile health platform Improve efficiency of patient medical care Improve quality of patient care without pressure on medical staff, Better quality of life Ericsson Mobile Health (EMH) Ericsson E-Health Solutions Commercial in confidence July 2013 Page 3
Ericsson healthcare exchange (EHE) H ealth insurance Public health patient Ministry of h ealth PORTAL messaging BI Electronic Healthcare record EHE is comprehensive Health Information Exchange platform that supports various healthcare delivery processes Ericsson E-Health Solutions Commercial in confidence July 2013 Page 4 Physician office l aboratory hospital Community pharmacy polyclinic Home care SUPPORTED SERVICES EHR eprescriptions ereferrals ebooking Health Insurance Reporting Public Health Reporting Resources Administration Medical and administrative KPI s Patient and Healthcare Professional Portal
The road to successful implementation 2000 E-HEALTH STARTED AS A RESEARCH PROJECT 2003 CONTRACT WITH THE MINISTRY OF HEALTH(CARE) 2007 2011 SYSTEM IN NATIONWIDE OPERATION E-PRESCRIPTION/E-REFERRAL IN FULL OPERATION 2012 SYSTEM ENHANCEMENTS (E- BOOKING, PHR, ETC) Ericsson E-Health Solutions Commercial in confidence July 2013 Page 5
E-health in croatia Project goals System works comprehensive Provide help in healthcare system management Make primary healthcare (PHC) system role stronger Most of the problems must be handled in PHC (70-80%) Dramatically lower costs comparing to hospitalization Shorter admission waiting time Empower public health institutions Drug consumption optimization Physician and nurse working hours optimization Improve overall healthcare system quality Empower patients System (1st phase) is in nationwide operation since 20. February 2007 All 2300 physician offices integrated Over 4 million patients registered in the system Major system upgrade (2nd phase) 2009-2010 Integration of additional 2500+ primary health specialists, 1100+ pharmacies, 100+ PHC laboratories Major system upgrade (3rd phase) Q4 2012 HW & MW migration, ebooking, emedicalaids, EHR upgrade Nation wide integration of all most important stakeholders in primary healthcare system Complete coverage of most important business processes on primary healthcare level Integration of appropriate stakeholders/processes from secondary/tertiary level Focus evenly distributed on medical, financial and management domain Ericsson E-Health Solutions Commercial in confidence July 2013 Page 6
Overall system architecture 2,300+ GP offices (8 different vendors) Central ehealth platform 192 pediatrician offices (7 different vendors) Electronic Healthcare Record Patient Register Health Resources Register Portal System Messaging & business logic 180 gynecologist offices (8 different vendors) >2,000 dentist offices (5 vendors) 1,100+ pharmacies (7 vendors) 100+ biochemistry laboratory (5 vendors) 66 hospitals / specialist care offices Ericsson E-Health Solutions Commercial in confidence July 2013 Page 7
eprescription Up to now successful integration is performed for 2300+ GP offices 192 pediatrician offices 180 gynecologist offices 2000+ dentist offices 1100+ pharmacies Status There is positive climate around the eprescription subsystem and feedback from physicians, pharmacists and patients is very good Paper form is used only in emergency cases (power shortage, communication lines interruption etc ) Effects 2 M saved yearly only on removing paper-form Considerable increase in patient safety due to less chance of avoidable errors (wrong medication, wrong dosage ) Avoiding errors and connected hospitalization costs are greater contributor to savings by introduction of eprescription Ericsson E-Health Solutions Commercial in confidence July 2013 Page 8
ereferral (biochemistry laboratory) Up to now successful integration is performed for 2300+ GP offices 192 pediatrician offices 180 gynecologist offices 100+ biochemistry laboratory Status There is positive climate around the ereferral subsystem and feedback from physicians, laboratory staff and patients is very good Process is further improved with blood samples taken immediately within physicians offices and blood sample info sent electronically too Lab results are sent back from laboratory both in structured electronic form and pdf Effects Considerably simpler procedure for patients (1 to 3 less contacts with healthcare system) Standardized and error resilient transfer of referrals and lab results No lab result not picked up Capability for automatic warnings if results are out of normal range Ericsson E-Health Solutions Commercial in confidence July 2013 Page 9
E-referral / e-booking specialist care / hospitals All physicians are sending referrals both in paper and through IT system There is constant increase in both retrieving referrals and sending results back Central ebooking for all 66 hospitals Central ebooking ~1000 specialist care offices In progress Ericsson E-Health Solutions Commercial in confidence July 2013 Page 10
Administrative / Medical services Reports / discharge letters Millions od discharge letters/summaries from primary health offices exchanged each month Malignant & infectious diseases reports Foundation for analytics for Ministry of Health / Croatian Institute for Health Insurance and Public Health Institute Foundation for electronic health record Administrative services Insurance status query and demographics query ebooking Angina pectoris incidence Visits per age Ericsson E-Health Solutions Commercial in confidence July 2013 Page 11
Next big step Electronic Healthcare record (EHR) Scheduled for Nation-wide EHR Access for physicians within Primary Healthcare, Hospitals and ER service Consolidate and present data already exchanged through EHE eprescriptions, ereferals, lab results, discharge letters (all structured) Sources of data not limited on EHE data 3pp systems integration through ETL mechanisms and external links Huge potential for BI (lifelong EHR for 4.5M patients) Ericsson E-Health Solutions Commercial in confidence July 2013 Page 12
How is it implemented What were/are issues during implementation What matters the most: standards, processes, education, motivation, applications? Organizational & regulatory preconditions Precisely defined use cases Example for process of prescribing and dispensing drugs eprescription process Technical preconditions (Internet connections, appropriate PC s) Appropriate applications (physician, pharmacy) Proper education Integration platform Rationale for the users to use the system Ericsson E-Health Solutions Commercial in confidence July 2013 Page 13
Use cases For integration platform (e.g. Ericsson s EHE) Send, retrieve, take-over prescription, Send prescription response (dispense information), send prescription report (financial information) Data specifications, data types, validation rules, timers Overall What are the business rules for physician application What should be validated on eprescription by GP When it should be sent (what if there is no accept ack after 20 sec?; what if ) - these questions did not exist with paper process - Everyone knows how it is done syndrome What are the business rules for pharmacy application Does pharmacist expects perfect eprescription What is the relevant time for health insurance validation (time of prescribing or time of dispensing) Recommendations Project manager (management team) with authority Cooperation among government bodies can be difficult or at least slow Dedicate special team for specifications (with commitment & responsibility) Include professional associations into process Do not merely transform paper to e- processes Rather reengineer according to new capabilities Always keep in mind what new process means for the end user Ericsson E-Health Solutions Commercial in confidence July 2013 Page 14
Appropriate applications Ekran preuzet iz aplikacije FITIS dopuštenjem autora Ekran preuzet iz aplikacije ESKULAP 2000 s dopuštenjem autora Certification? Ericsson E-Health Solutions Commercial in confidence July 2013 Page 15 Ekran preuzet iz aplikacije Softmed 2 s dopuštenjem autora
Integration platform Physician office patient hospital H ealth insurance PORTAL messaging BI polyclinic Public health Electronic Healthcare record Home care l aboratory Community pharmacy Ministry of h ealth Ericsson E-Health Solutions Commercial in confidence July 2013 Page 16
Rationale for using the system What s in it for me? Benefits for using application (faster, easier, allows me to perform my activities even better) Who will explain it to me? Why should I work harder in transition phase? Will it introduce changes in my processes and which ones First 10 seconds of waiting What if there is no power Some reasons for using eprescription in Croatia For pharmacists, among others, is less percentage of returned invoices toward insurance company compared to paper process Physicians do not see much benefits (in the beginning) Avoiding unnecessary visit for chronic patients Combined with having laboratory results directly on their computers Nurses are thrilled due to the big administrative burden taken away Activities Four big conferences for all the pharmacists in Croatia Active participation of Pharmacist Chamber in all the workshops Pharmacist apps vendors included in the process Stick & carrot for physicians (in pilot work) Monthly funding for physicians if they connect Fines if they not Pharmacist are paid per dispensed drug Ericsson E-Health Solutions Commercial in confidence July 2013 Page 17
Proper education Now I know why, but how? Many users are trained to use particular application and has no high level of IT literacy It is logical, But is almost the same application as before, I thought that it is implied is not good attitude Large number of users and business processes that can not stop due to education Whose responsibility is to train the end users Vendor of local applications - Are they familiar with bigger picture Vendor of integration platform - Does not know specificalities for each of application Recommendations Organize basic IT literacy education as part of mandatory professional education path Establish contractual relationships with end-user vendors Ericsson E-Health Solutions Commercial in confidence July 2013 Page 18
Technical preconditions Connectivity With proper equipment within network ADSL does not crashes when phone rings or Mobile broadband is OK only when there is no strong wind blowing outside Proper HW equipment PC, smart cards and smart card readers, cables Proper SW equipment Sufficient version of MS Windows Drivers Not having Skype which might interfere with VPN client Ericsson E-Health Solutions Commercial in confidence July 2013 Page 19
Organizational preconditions Every change is faced with resistance Introducing eprescription is major change in process of prescribing and dispensing drugs Process, legal and bylaws changes Usual way how it was done changes Proper project organization from customer side is of utmost importance Who will operate the system Cost, competence, legal factors Is it mandary to use eprescription Manage user expectations Each new major process required several months of initial (pilot) work in order for local applications to support processes, end users to get educated, overall processes to be fine tuned, local technical issues to be resolved Ericsson E-Health Solutions Commercial in confidence July 2013 Page 20
Regulatory issues Current situation Introducing ICT into healthcare domains requires significant intervention into existing legislation. Examples are: laws that regulates digital signature, electronic documents, information privacy rights even higher number of bylaws that regulates processes within different stakeholders needs to be adapted: e.g. prescribing & dispensing medication bylaws, medical documentation management bylaw When introducing ICT, majority of stakeholders is unaware of needed changes, and do not have sufficient competences in order to legally handle e part of the processes Actions Ericsson team emphasized this issue from the early project beginning, and actively participated in suggesting and commenting required changes in legislation Ericsson E-Health Solutions Commercial in confidence July 2013 Page 21
Conclusion Implementing e-health solutions into the healthcare system is a continuous process that spans over multiple years It takes experience, ability to learn and adapt both the solution and the implementation strategy to the local situation, whilst still keeping the best practices from around the world With our: Experience and expertize in the domain Long term company tradition in ICT Close presence Willingness and knowledge to act not only as a solution supplier, but rather as a solution builder Ericsson supports croatia on its way towards an efficient e-health solution Ericsson E-Health Solutions Commercial in confidence July 2013 Page 22
Ericsson E-Health Solutions Commercial in confidence July 2013 Page 23