CASE STUDY A KEY TO A SUSTAINABLE NATIONAL ehealth SYSTEM IN ALBANIA AME International GmbH Hermine Grubinger-Duhazé Director Consulting &ehealth h.grubinger@ame-international.com Olegas Niaksu Project Manager o.niaksu@ame-international.com www.ame-international.com
Agenda Challenges Project Development Process Project Scope Benefits 2 WE CARE
Some facts - Challenges for our Health Systems Pressure on healthcare systems: Citizens expectations for high-quality care Demographic changes How to offer highquality & affordable care? Increased prevalence of chronic diseases Increased mobility of citizens and patients Staff shortages, unequal territorial distribution Reactive model of healthcare delivery Rising healthcare costs 3 3 WE CARE
EC vision for Health : ICT to support a paradigm shift From curative care to preventive care From hospital-based to patient-centred HOW? By using ICT to enable collaborative, personalised care empowering By aiming at sustainability of healthcare systems reengineering ehealth helps! 4 WE CARE
Existing use of IT in Albania Healthcare system Network Fragmented local area networks of different quality Mostly isolated networks Non existing networks in smaller HCI Hardware (computers, servers peripherals) Limited to administration of HCI and statistical operations in the back office In biggest hospitals partial use in receptions No ready server rooms in HCI 5 WE CARE
Existing use of IT in Albania Healthcare system Software applications: National billing related information collecting SW Kosto Spitali Few partial implementations of Open Source Hospital information system Care2x. Yet not full scale implementation Local implementations of specific clinical systems (obs & gyne) Radiology and laboratory related applications, mostly complementing modalities and analyzers 6 WE CARE
Challenges in Albania What cannot be achieved with current state of IT? Current infrastructure limits ability to share information No standards and means for national clinical documents sharing and storing, therefore information doesn t go out of the HCI. No control of patient flow. Lack of Transparency. Lack of data quality control. (e.g. patient data (demographics, statistics) might be incomplete and inaccurate) Healthcare KPI s not accessible in time (e.g length of stay, mortality, epidemiology, diagnoses related statistics) No foundation for patient s lifelong health record. Most of clinical details die in Patient Kartela in the hospital s archive. Lack of consistent statistical reporting. 7 WE CARE
ehealth in Albania Project Development 8 WE CARE
Bilateral Cooperation between Albania & Austria An independent comprehensive feasibility study financed by both Governments was conducted in close cooperation with the respective Albanian Ministries in charge. The areas of e-health e-taxation e-learning and e-property were identified as top priorities and respective projects have been formulated and budgeted. 9 WE CARE
Albanian ehealth strategy outcome of E-Government Feasibility Study ehealth priorities: Priority 1:Implementation of a Nationwide Electronic Health Record Priority 2: Implementation of Hospital Information System 10 WE CARE
Albanian Nationwide ehr- way forward Main Objective To provide a platform for standardized exchange of clinical patient related data. 11 WE CARE
Why start with a nationwide ehr in Albania? Following best-practice to establish the infrastructure first to ensure that an integrated care platform is in place, before significant investments in single health care facilities are made. Relying on a standardized approach, like an IHE infrastructure, gives the freedom to choose different vendors of HIS, without being bound to one specific vendor with a proprietary implementation. The roll out of a standardized Electronic Health Record is very quick and the training phase for the end-users rather short in comparison with the roll out and training for an HIS installation. A decision to use the same architecture solution as in Austria, and Slovenia and to be in line with EU ehealth policies. 12 WE CARE
Priority 1 Nationwide EHR Key requirements Compliance with EU and IHE standards is mandatory Solution must be easy to use and scalable Maximum security for sensitive patient data Solution must operate natively on routers independently from connection to the central data center The solution shall have the flexibility to either integrate to an existing Hospital Information System or provide a front end solution for direct data entry Solution must be nationwide 13 WE CARE
ehealth in Albania Project Scope 14 WE CARE
Scope of Solution Overview The scope of the provided solution comprises network infrastructure, hardware, application solution for integrated electronic health record with a country wide license and related implementation and support services for the following facilities: National Referral Hospitals in Tirana (4) Regional Hospitals (11) District Hospitals (25) Policlinics nationwide (39) MoH organisations (3) 15 WE CARE
ehealth Albania Project Scope Facilities Covered HOSPITALS POLICLINICS No Name Type Beds No Name 1-00 Berat Regional Hospital Regional Hospital 258 1-01 Policlinic of Berat 2-00 Diber(Peshkopi) Regional Hospital Regional Hospital 285 2-01 Policlinic of Peshkopi 3-00 Durres Regional Hospital Regional Hospital 340 3-01 Policlinic No 1 Durres 4-00 Elbasan Regional Hospital Regional Hospital 415 4-01 Policlinic Nr. 1 Elbasan 5-00 Fier Regional Hospital Regional Hospital 421 5-01 Policlinic Nr. 1 Fier 6-00 Gjirokaster Regional Hospital Regional Hospital 184 6-01 Policlinic Gjirokaster 7-00 Korce Regional Hospital Regional Hospital 463 7-01 Policlinic Nr. 1 Korce 8-00 Kukes Regional Hospital Regional Hospital 236 8-01 Policlinic Kukes 9-00 Lezhe Regional Hospital Regional Hospital 162 9-01 Policlinic Lezhe 10-00 Shkoder Regional Hospital Regional Hospital 568 10-01 Policlinic No 1 Shkoder 11-00 Vlore Regional Hospital Regional Hospital 368 11-01 Policlinic No 1 Vlore 1-02 Kucove District Hospital 55 1-05 Policlinic Kucove 1-03 Municipality of Corovode (Skrapar) District Hospital 86 1-06 Policlinic of Corovode 2-02 DH of Burrel District Hospital 148 2-04 Policlinic of Burrel 2-03 DH of Bulqize District Hospital 72 2-05 Policlinic of Bulqize 3-02 Kruje District Hospital 124 3-04 Kruje Policlinic 3-03 Kavaje District Hospital 92 3-05 Kavaje Policlinic 4-02 Librazhd District Hospital 132 4-06 Librazhd Policlinic 4-03 Prrenjas (Librazhd) District Hospital 26 4-04 Gramsh District Hospital 109 4-07 Gramsh Policlinic 4-05 Peqin District Hospital 32 4-08 Peqin Policlinic 5-02 Lushnje District Hospital 215 5-04 Lushnje Policlinic 5-03 Ballsh (Mallakaster) District Hospital 38 5-05 Ballsh (Mallakaster) Policlinic 6-02 Permet District Hospital 98 6-04 Permet Policlinic 6-03 Tepelene District Hospital 98 6-05 Tepelene Policlinic 7-02 Pogradec District Hospital 165 7-05 Pogradec Policlinic 7-03 Devoll (Bilisht) District Hospital 41 7-06 Devoll Policlinic 7-04 Erseke District Hospital 83 7-07 Erseke Policlinic 8-02 Tropoje District Hospital 101 8-04 Bajram Curri Policlinic (Tropoje) 8-03 Has District Hospital 30 8-05 Has Policlinic 9-02 Lac District Hospital 65 9-04 Lac Policlinic 9-03 Rreshen (Mirdite) District Hospital 100 9-05 Rreshen (Mirdite) Policlinic 10-02 Puke District Hospital 85 10-04 Puke Policlinic 10-03 Malesi e Madhe District Hospital - 10-05 Malesi e Madhe (Koplik) Policlinic 11-02 Sarande District Hospital 131 11-04 Sarande Policlinic 11-03 Delvine District Hospital 30 11-05 Delvine Policlinic 12-07 Q.S.U.T. Mother Teresa Central Hospital 1.364 12-01 Policlinic No 1 Tirana 12-08 Shefqet Ndroqi Pulomology Center Central Hospital 120 12-02 Policlinic No 2 Tirana 12-09 SP.OB-GJINEK.NR.1. Mreteresha Geraldine Central Hospital 152 12-03 Policlinic No 3 Tirana 12-10 SP.OB-GJINEK.NR.2. Koco Gliozheni Central Hospital 138 16 WE CARE
Solution Overview Level of care & referral pattern Direct Entry IHE Compliant Patient Registration Visit Summary 17 WE CARE
NATIONAL EHR IN ACTION. USE CASES. Use case 1: HCI without HIS/EMR Use case 2: Hospitals with full HIS usage
HOSPITAL WITHOUT ANY HIS SYSTEM Registration Registration Registration Visit-Doc DATA-Entry Form Outpatient shows up at registration Registration checks if patient is already known to the ehr system If not, she will register the patient Registration creates visit-document (info about: insurance, Clinic,..) And prints the Data- ENTRY-Form Backoffice The DATA-Entry form is entered into the system. DATA-Entry Form Visit-summery Patient walks with the Data-Entry Form to see the doctor Doctor Backoffice An Exception Report is created, using the Visit-Doc and Data-Entry forms entered, to show the outstanding DATA-Entry forms not entered. Nurse/secretaries collect Data- Entry forms and delivery to Back- Office Doctor treats the patient and documents as currently practised. In addition he writes the visit summery into the data-entry- Form DATA-Entry Form Visit-summery
HOSPITAL WITH EXISTING HIS SYSTEM FOR REGISTRATION AND USE OF CLINICAL DATA ENTRY Registration Registration Interface Outpatient shows up at registration Registration checks if patient is already known to the HIS(/eHR) system If not, she will register the patient on the HIS The HIS system send patient registration and Visit-Doc to the ehr system Interface The HIS system sends the Visit-summery to the ehr system Patient to see the doctor Doctor Back office Doctor treats the patient and documents the findings in the HIS system creating a Visitsummery. The HIS system should create a report to verify, that for all visits for the day, a visitsummery has been created.
Solution Highlights The proposed e-health solution is based on IHE Medical Standards which have been adopted by the European Union for Medical Data Exchange and are implemented or under implementation in many EU countries, amongst which is Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Italy, Norway, UK and many others. The compliance with international as well as EU standards will ensure regular updates and upgrades and thus a sustainable investment Due to unique solution architecture, it solves networking infrastructure and EHR solution tasks, utilizing award wining Cisco and Tiani Spirit technologies. Formally Tested and certified solution by leading e-health standardization organisation IHE. 21 WE CARE
ehealth Albania Standards IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards IHE - Test twice in a year by Connect-athon: Europe, US, Australia, Japan) - High investment security for Client Non IHE - Test has to be done by each Vendor (HIS) and client again. - Acceptance test takes a lot of time 22 WE CARE
ehealth Albania Maximum Investment Security Solutions Interoperability Backbone Network Infrastructure & Data Center 23 WE CARE
EU Cross Border ehr Exchange Smart Open Services for European Patients - epsos, an Open ehealth initiative for a large scale European pilot of patient summary and electronic prescription is a Europe-wide project organized by twelve EU-member states, including ministries of health, national competence. epsos has adopted IHE as standard for clinical data. 24 WE CARE
ehealth Albania Solution Architecture 25 WE CARE
Scope in detail - hardware Data Center Blade server Data storage Network switches racks Networking infrastructure Routers Antennas, Wireless access points Computerized working places LCD Thin client Bar code reader / RFID reader Printer 26 WE CARE
Scope in detail - software EHR solution based upon an unlimited nationwide license, including all necessary components including (but not limited to) database management systems, operating systems and other required supporting software; Operating systems for workstations; Additional software, any drivers needed for operation of the ehr solution, meeting technical requirements set out below. 27 WE CARE
Scope in detail - services Network and hardware equipment delivery, installation and configuration on each site; EHR solution customization, deployment and rollout; Documentation; Implementation services, including the provision of support to MoH in setting up local support facilities; End user trainings (on site); GO LIVE support; 2nd and 3rd level support for a period of not less than 24 months, Hardware and software warranty and maintenance services for a period of 48 months. 28 WE CARE
PROJECT TIMELINE Support 48 months Phase 2 roll-out 15 months 71 facilities Phase 1 6 months Application, Data center, 8 facilities
ehealth Albania- Benefits to health care providers and patients Relevant patient information will be timely available, easily accessible thereby enabling improved Patient diagnosis and treatment. The identification and elimination of duplicate patient medical records and procedure results. The patient receiving the right care, in the right place at the right time. Improved preventive patient care. Reduced medical errors. 30 WE CARE
ehealth Albania- Economic Benefits The elimination of unnecessary service requests (e.g. X-Ray, Blood Tests etc.) as a result of improved information sharing of Patient s previous medical history. Cost savings through improved preventive health care measures based on comprehensive clinical and statistical information. Increased transparency and performance measures; Increased IT literacy among health care staff. Secured investment through adherence to international clinical data exchange standards and low risk of vendor independence. Flexible growth of functionalities (e.g. eprescription, edispensing) as infrastructure improves since the license is unlimited and nationwide and can be expanded. Secured investment and growth includes additional functionalities as IHE continues to expand its functionality level. 31 WE CARE
ehealth Albania- Political Benefits Enhancing Albania s position in its EU accession efforts. Possibility to participate in EU ehealth initiatives and gain access to EU funding for further expansion access. First comprehensive coverage of all regions in Albania benefiting from ehealth within a short project cycle (2 years implementation). Fostering the local IT Community Creating a showcase internationally on how ehealth strategies are effectively implemented. 32 WE CARE
Cooperation - Competition Dialog med kommunen/andra vård-grannar Gemensam uppslutning kring mål Oh so you are also implementing ehealth? DK, CZ, FR, ES, GR, AT, IT SE, DE, SL base from Mikael Erlandsson 33 WE CARE
Thank you for your attention! AME International GmbH www.ame-international.com Hermine Grubinger-Duhazé Director Consulting & ehealth h.grubinger@ame-international.com Olegas Niaksu Project Manager o.niaksu@ame-international.com 34 WE CARE