Connected Health & Me - Raul Mill - Nov 24th 2014
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The document discusses Estonia's eHealth system. It provides information on: - Key statistics on Estonia's economy and healthcare expenditures. Healthcare spending as a percentage of GDP has increased from 5.9% to 6.9% from 2011-2013. - The development of Estonia's eHealth infrastructure from 2000-present, including the establishment of the eHealth Foundation in 2005 and launch of the national health information exchange platform in 2008. - The main components of Estonia's eHealth architecture including electronic health records, digital prescriptions, patient portals, and standards for data exchange. Over 1.3 million Estonians have medical data accessible through the patient portal.
Connected Health & Me - Raul Mill - Nov 24th 2014
- 1. Estonian eHealth System Raul Mill Estonian eHealth Foundation
- 2. Hello!
- 3. GDP: Agriculture 3.9% Industry 29,7% Services 66,4% Estonia Area - 45 000 km2 1.33 mlj. inhabitants
- 4. Healthcare expenditures in Estonia - 6.9% from GDP 2013 – 1.12 bln eur - 5.9% from GDP 2012 – 1.03 bln eur - 5.9% from GDP 2011 – 0.94 bln eur - 6.3% from GDP 2010 – 0.91 bln eur
- 7. 8 main softwares (totally 20) 752 associated juridical persons 21 main hospitals 73 stationary healthcare institutions (hospitals) 479 family doctors (juridical persons)
- 8. 2000 2002 2004 2006 2008 HIE platform history Planning initiated Project preparation (2003-2005) Funding decision by Ministry of Economic Affairs Electronic Health Record Digital Prescription Digital Registration Digital Images eHealth Foundation established (2005) eHealth Projects (2006-2008) National HIE
- 9. Standards management IT management Ministry of Social Affairs East Tallinn Central Hospital Tartu University Clinic Society of Family Doctors North Estonian Regional Hospital Management board Estonian e-Health Foundation Board ENHIS Operation Estonian Hospital Assosiation Union of Estonian Medical Emergency Organization Services management Communication management Medical Advisory Board
- 10. PHARMACIES AND FAMILY DOCTORS 2009 X-Road, ID-card, State IS Service Register HEALTHCAREBOARD -Healthcareproviders -Healthprofessionals -Dispensingchemists STATEAGENCYOFMEDICINES -CodingCentre -Handlersofmedicines POPULATIONREGISTER PHARMACIS 2010january BUSINESSREGISTER HOSPITALS 2009 FAMILYDOCTORS 2009 SCHOOLNURSES 2010september EMERGENCYMEDICALSERVICE 2011 NATION- WIDE HEALTH INFORMATION EXCHANGE PLATFORM 2008 december PRESCRIPTION CENTRE 2010 january PATIENT PORTAL 2009 X-ROAD GATEWAY SERVICE 2009 E-health architecture
- 11. The main security principles of Estonian eHealth system – Opt Out 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. Encrypted database that allows to remove the confidentiality risk 5. Monitoring of all actions together with the corresponding counter- measures (both organizational and technical)
- 12. Central System– Database and related services Data Exchange level different e-services Institutional level– users cooperation model • Healthcare processes • User needs • Training programs • Partnership • Communication The structure of Estonian Health Information System • Set of data • Data Standards • Search criterias • Legal Framework • Software • Hardware • User software • User interface • Data input • Data Visualisation • Searching information • Data transmission standards (HL7)
- 13. EHR services for patient Services for Social Insurance Fund Services for dental care 2015 Services for blood center 2016 Services for registers 2015 Services for nurse 2016 M-and tele- health services Health information services for patient E-learning services for medical staff Analytics services Data and statistics services A medical certificate services Digital laboratory services 2015 eAmbulance services 2014 Cross Border Data Exchange services 2013 (EPSOS) Digital archiving (x-ray images) eConsultation services Digital registration 2016 EHR services for physician Main services of the eHealth in Estonia Subservices - Completed - Development - Planning Infrastructure services External services Supporting services Connecting Health
- 14. Acceptance • All bigger hospitals use central system on a regular base • The central system has over 10 300 medical users • ePrescription covers 98% of issued prescriptions • 98% of family doctors are sending documents to the central system • Over 97% of stationary case summaries have sent to the central DB • Ambulatory case summaries sending – No certain rules for sending ambulatory case summaries! • 1.35 mio persons have documents in central system (98% of the population) • 0.74 mio persons information in the central DB have used by medical professionals
- 15. 0 50000 100000 150000 200000 250000 300000 350000 400000 450000 Det Jan Veb Mär Apr Mai Jun Jul Aug Sep Okt Nov Det Jan Veb Mär Apr Mai Jun Jul Aug Sep Okt Nov Det Jan Veb Mär Apr Mai Jun Jul Aug Sep Okt Nov Det Jan Veb Mär Apr Mai Jun Jul Aug Sep Okt Nov Det Jan Veb Mär Apr Mai Jun Jul Aug Sep Okt Nov Det Jan Veb Mär Apr Mai Jun Jul Aug Sep 2008 2009 2010 2011 2012 2013 2014 Retrieval of medical documents by healthcare professionals 2009 - 2014 0 50000 100000 150000 200000 250000 Queries from patient portal
- 16. 0 20000 40000 60000 80000 100000 120000 140000 JAN FEB MAR APR MAY JUN JUL AUG SEPT OKT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEPT OKT NOV DEC JAN FEBR MAR APR MAY JUN JUL 2012 2013 2014 Sent documents by family doctors 2012 – 2014 – before and after realizing digital stamp
- 17. PATIENT PORTAL (UPGRADE) – 1.3 mio persons medical data
- 18. Standards
- 19. 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 https://www.riigiteataja.ee/akt/12910889
- 20. Standardization process Create data set Formalize and merge Approve and publish Data set document Classificators Examples Specialty assotiations OID-s XML schemas Description documents UML model Healthcare providers EeHF standardization specialists Social ministry Stylesheets UML+HL7 experts Fixed version of artifacts in publishing centre Terminology experts HIS developers Health Insurance Fund Changes in NHIS documents regulatory act
- 21. eHealth availability and use Indicator 2012: by country
- 22. LEARNING POINTS
- 23. Healthcare is a reactive, rather than proactive industry. Solve one specific problem in healthcare, not ten of them. In healthcare you need to have a business model from the start. Healthcare is very interdependent: you have the doctor, the pharmacy, the patient, the insurance provider, and a dozen other stakeholders that any one service has to coordinate with.
- 24. EHR systems: more like plain than mobile phone …
- 25. FUTURE OUTLOOK
- 26. Data and services integration Apps for medical specialties UI standards Single sign on Hardware independent Inter- operability Graphical solutions Collecting information Location independent
- 27. Conclusion: • Comperhensive planning – investments, processes and standards, legislation. • Usability – fast and simple solutions, balance between security and usability • Implementation – central training programs • Service update – continuous feedback
- 28. Thank you!