estonian health information system raul mill estonian ehealth foundation
DESCRIPTION
Estonian Health Information System Raul Mill Estonian eHealth Foundation. Estonia. Estonia - 45 000 km2 1.29 mlj . i nhabitants GDP: Agriculture 2,7 % Industry 26,3% Service 74,5 %. HEALTHCARE IN ESTONIA. 3 5 hospitals 491 family doctors ( juridical persons ) - PowerPoint PPT PresentationTRANSCRIPT
Estonian Health Information System
Raul MillEstonian eHealth Foundation
Estonia - 45 000 km21.29 mlj. inhabitants
GDP:Agriculture 2,7%Industry 26,3%Service 74,5%
Estonia
306.02.2013
406.02.2013
HEALTHCARE IN ESTONIA
35 hospitals491 family doctors (juridical persons)
Healthcare expenditures- 5.9% from GDP 2011- 6.3% from GDP 2012
5
E-STATE ARCHITECTURE
706.02.2013
SECURITY & AUTHENTICATION
8
PHARMACIES AND FAMILY DOCTORS2009
X-Road, ID-card, State IS Service Register
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10 ja
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BUSI
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09
FAM
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OCT
ORS
2009
SCHO
OL
NU
RSES
2010
sept
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EMER
GEN
CY M
EDIC
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ERVI
CE20
11
NATION- WIDEHEALTH INFORMATION EXCHANGE PLATFORM2008 december
PRESCRIPTION CENTRE2010 january
PATIENT PORTAL2009
X-ROAD GATEWAY SERVICE2009
Architecture
2000 2002 2004 2006 2008
HIE platform historyPlanning initiated
Project preparation (2003-2005)
Funding decision by Ministry of Economic Affairs
Electronic Health Record
Digital Prescription
Digital RegistrationDigital Images
eHealth Foundation established (2005)
eHealth Projects (2006-2008)
National HIE
Standards management
ITmanagement
Ministry of Social Affars
East Tallinn Central Hospital
Tartu University Clinic
Society of Family Doctors
North Estonian Regional Hospital
Management board
Estonian e-Health Foundation Board
ENHIS Operation
EstonianHospital Assosiation
Union of Estonian Medical Emergency
Organization
Services management
Communication management
Medical Advisory Board
1106.02.2013
35 hospitals491 family doctors
8 main softwares (20 totally)
12
The main principles of security of Estonian eHealth system – Opt Out
1. A secure authentication of all users with ID-card or Mobile ID2. Digital signing or stamping of all medical documents3. A maximum accountability (transparency): all actions will leave an
unchangeable (and unremovable) secure trail4. Encrypted database that allows to remove the confidentiality risk
from the technical administrators5. Monitoring of all actions together with the corresponding counter-
measures (both organizational and technical)
13
STANDARDS
14
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
15
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
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• Search information
• Data transmission standards (HL7)
EHR services for patient
Services for Social
Insurance Fund
Services for dentaal care
Services for blood center
Services for registers
Services for nurse
Services for homecare
Health information services for
patient
E-learning services for
medical staffAnalytics
services for participants in
treatment process
Data and statistics services
A medical certificate services
Digital laboratory
services
eAmbulance services
Cross Border Data Exchange
services
Digital archiving services
eConsultation services
Digital registration
services
EHR services for physician
Main services of the e-health in Estonia
Infrastructure services External servicesCentral System– Database
and related services
Data Exchange level different e-services
Institutional level– users cooperation model
Supporting services
Subservices
Patients Public Register
BusinessRegister
Dental care
Blood center
Military Forces
Homecare
Genome Center
Nursing careMedical statistics
Medical Registers
Emergency Medical
Departments
eAmbulance
Social Insurance
Board
Health Insurance Fondation
Family Doctors
Health Care Board
HospitalsMain e-health participants on the x-road
Infrastructure services
External servicesCentral System– Database
and related services
Data Exchange level different e-services
Institutional level– users cooperation model
Supporting services
Subservices
19
Documents total – 12.8 mio
1.2 mio persons medical data (growth 20% during 2012 and 15% during 2013)
PATIENT PORTAL (UPGRADE)
20
Acceptance
• ePrescription covers 94% of issued prescriptions.• Over 90% of Hospital discharge letters – digital• Over 97% of stationary case summaries have sent to the central DB• Ambulatory case summaries sending
– No certain rules for sending ambulatory case summaries!• 1.2 mio person have documents in central system (92% of population)• 92% of family doctors are sending documents on a regular base• All bigger hospitals use central system on a regular base• The central system has over 8700 medical users
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2009 2011 2015 2017 20191999 2003 2005 20072001
You are here
Family doctors who are sending documents 52% 92%Queries in a month 60 000 260 000
Visits of the patient portal in a month 40 000 160 000
Rate of sent stationary treatment cases 97%
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ePrescription (94%)
jaan.10
veebr.1
0
märts.10
apr.10
mai.10
juuni.10
juuli.10aug.10
sept.10okt.
10nov.1
0
dets.10
jaan.11
veebr.1
1
märts.11
apr.11
mai.11
juuni.11
juuli.11aug.11
sept.11okt.
11nov.1
1dec.1
1jan.12
feb.12
mar.12apr.1
2
may.12
-
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
ISSUED SOLD
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Retrieval of Medical Documents by Healthcare Professionals
Mar
chAp
ril
May
June July
Augu
stSe
ptem
ber
Oct
ober
Nov
embe
rDe
cem
ber
Janu
ary
Febr
uary
Mar
chAp
ril
May
June July
Augu
stSe
ptem
ber
Oct
ober
Nov
embe
rDe
cem
ber
Janu
ary
Febr
uary
Mar
chAp
rilM
ayJu
ne July
Augu
stSe
ptem
ber
Oct
ober
Nov
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rDe
cem
ber
Janu
ary
Febr
uary
Mar
chAp
rilM
ayJu
ne July
Augu
stSe
ptem
ber
Oct
ober
Nov
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rDe
cem
ber
Janu
ary
Febr
uary
Mar
chAp
rilM
ayJu
ne July
Augu
stSe
ptem
ber
Oct
ober
Nov
embe
rDe
cem
ber
2009 2010 2011 2012 2013
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
220,000
240,000
260,000
280,000
24
Patient portal Number of queries 12.2008 – 10.2013
DETS 2
008
VEEBR 2009
APR 2
009
JUUNI 2
009
OKT 2
009
DETS 2
009
VEEBR 2010
APR 2
010
JUUNI 2
010
AUG 2
010
OKT 2
010
DETS 2
010
VEEBR 2011
APR 2
011
JUUNI 2
011
AUG 2
011
OKT 2
011
DETS 2
011
VEEBR 2012
APR 2
012
JUUNI 2
012
AUG 2
012
OKT 2
012
DETS 2
012
VEEBR 2013
APR 2
013
JUUNI 2
013
AUG 2
013
OKT 2013
DETS 2013
VEEBR 2014
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
eHealth availability and use Indicator 2012: by country
26
E-health approximate expenditures untill 2012Country ExpendituresExpenditures per
capitaEstonia 12 mil EUR
9,1 Ireland 56 mil EUR
12,2Portugal 69 mil EUR
6,5
Norway 105 mil EUR 20,8Scotland 117 mil EUR
22,5Denmark 183 mil EUR
32,7Finland 203 mil EUR
37,4Sweden 347 mil EUR
36,2Netherland 430 mil EUR
25,7Spain 713 mil EUR
15,5
Germany 1 352 mil EUR 16,8UK 1 980 mil EUR
31,3Australia 4 976 mil EUR225,1US 30 712 mil EUR
97,2
2706.02.2013
LEARNING POINTS
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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.
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• Comperhensive planning – processes and standards, legislation. • Usability – fast and simple solutions• Implementation – central training programs• Service update – continuous feedback• Balance between security and usability
– PIN for every document …– PIN or ID-card?
30
January
February
March AprilMay
JuneJuly
August
September
October
November
December
January
February
March AprilMay
JuneJuly
August
September
October
November
December
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
Medical document sent to Health Information System by General Practitioners 2012-2013
Impact of the digital stamp since 2013Documents sent by family doctors in a month have increased up to
4x!
vocations
vocations
3106.02.2013
FUTURE OUTLOOK
Data and services
integrationApps for medical
specialties
UI standards
Single sign on
Hardware independent
Inter-operability
Graphical solutions
Collecting information
Location independent
Voice recognition
and text input
assistant
33
Thank you!