madis tiik md, phd - futurescot | events madis tiik...e-mail: [email protected] contact...
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Tartu University, Medical Doctor, 1996
Tartu University, Family Doctor, 2000
Nordic School of Public Health (Sweden) -
Diploma in Public Health, 2003
Estonian Business School, ICT Management,
2001-2003
Tallinn University of Technology, PhD
(Healthcare Engineering) 2012
Scripps Translational Science Institute (San
Diego, USA), Digital Medicine intern, 2014-
2015
EDUCATION
Family doctor 1998-
Estonian Society of Family Doctors, Chairman 2001-2008.
Estonian eHealth Foundation (EEHF), Board member, 2005-2007
Terviseagentuur Ltd. CEO, Owner, 2006-…
Estonian eHealth Foundation, CEO, 2007-2011
Scientific adviser of the President of the Estonia. Preparing report for EU
Commission, how to improve ehealth after 2020. 2011-2012
Tallinn University of Technology (TUT), eHealth Lab, lecturer 2014-
Sitra (Finnish innovation fund), Senior Adviser, 2012-
CAREER
FACTORS INFLUENCING SUCCESSFUL IMPLEMENTATION
Common infrastructure
Standards
Access rights
National leadership
INFORMATION SOCIETY STRATEGY (2002)
By 2013
All public services are digitaly available
Public infrastruture is service oriented (x road)
Digital authorisation of users, based on the ID card,
is the best available in the world
Data is stored were it is collected and exchange of
the data is available thous who need it
CURRENT SITUATION IN ESTONIA
X-Road launched in Estonia in 2002
More than 170 databases are offering services via X-
Road (producer certificates)
More than 3000 services are available
More than 900 organisations are using X-Road daily
(consumer certificates)
More than 70% of citizens are using X-Road via
Citizen portal
Most of companies (~160 000) are used X-Road via
Entrepreneur portal
INFORMATION SOCIETY INDICATORS
100% of schools and government organisations have broadband
connection
75% of homes have broadband connection
99% of bank transfers are performed electronically
95% of income tax declarations made via the e-Tax Board
E-census (2012) 815,467 persons completed the questionnaire -62%
26% of votes were cast over the internet on 2015 (Parlament elections)
99% of prescriptions are digital
100% citizens has a digital medical record
ALL PUBLIC SERVICES ARE DIGITAL (2013)
HEALTH INFORMATION EXCHANGE PLATFORM
Operational since 01.01.2009
Implementation strategy (2009-2013)
step by step implementation
User groups in different timeframe
Documents in different timeframe
Only standardized medical documents accepted (HL7v3)
No previous history (before 2009)
Only agreed amount of medical information
Opt out approach for citizens and equal access for all
medical professionals
E-HEALTH SERVICES IN ESTONIA
Nation-wide health information system
Available documents
Time critical data (allergy, chronic diseases)
General practitioners and hospital visits
Summary of ambulatory and stationary case
Link to medical images
Referral letter
ePrescription
Digital images - available all over the county (for physicians only)
eReferral
eAmbulance
eSchool
eConsultation
Patient Portal
ACCESS RIGHTS FOR EHR
All healthcare providers must send data to EHR
Regulated by the law
Access only to licensed medical professionals
The attending doctor concept
ID card for authentication and digital signature
Patient has the right to close his/her own data collected to
the central database (opt out)
Citizen can access their own data
Citizen can declare their intentions and preferences
Citizen can monitor visits to their EHR
ORGANIZATION AND FINANCING OF E-HEALTH
Estonian eHealth Foundation
Standardization
Development of new services
Maintenance of the HIE system
Financed from the state budget
1/3 of the maintenance cost (HIE) is coming through
healthcare providers
Each price in the Estonian Health Insurance Fond
price list contains a ehealth components
Investment cost for ehealth
Maintenance cost
DISTRIBUTION OF COSTS AND BENEFITS OF ESTONIAN
E-HEALTH PLATFORM (DIGIIMPACT STUDY 2010)
Total cost of EHR system development (2005-2010) was
around 10M€ - it is 7.5€ per citizen
EU 2.8 M€EHR 1,599,705
IT SOLUTION 18%
STANDARDIZATION 34%
PUBLIC RELATIONS 15%
ETHICS AND LEGISLATION 12%
PROJECT MANAGEMENT 21%
DIGITAL PRESCRIPTION 218,822
DIGITAL REGISTRATION 188,223
DIGITAL IMAGES 186,479
EDUCATIONAL PROJECT (INCREASING MEDICAL
PROFESSIONALS SKILLS IN COMPUTING)624,254
HEALTHCARE SYSTEM TODAY
Specialist
329 will
meet a
medical
profession
al, e.g.
nurse
1000 citizens
During one
month
800 of
them have
some
medical
concerns
Green, LA. Fryer, GE Jr. Yawn, BP. Lanier, D. Dovey, SM (2001). ‘The ecology of medical
care revisited.’ New England Journal of Medicine, 344(26): 2021–2025
EHR
Laborator
y /other
tests
General
practicion
er
Laboratory
/other tests
IMPACT OF THE BEHAVIOURAL CHANGE
Cardiovascular disease: 73-83% (Nurses Health Study,
NEJM 2000;343:16-22, NEJM 2001;345:790-97)
Diabetes type II: 58-91% (Tuomilehto, 2001 NEJM 344(18):
1343-50 Nurses Health Study, NEJM 2000;343:16-22, NEJM
2001;345:790-97)
Cancer: 60-69% (De Lorgeril, Arch Int Med 1998;158:1181-87)
HALE Project. Knoops JAMA 2004;292:1433- 1439)
HEALTH 3.0
SOC
IAL
MED
IAENVI
RON
-
MEN
TAL
SOC
IAL
GEN
ETIC
OP
EN
DA
TAMY
DA
TA
BI
G
DA
TAHEALT
H
ACCOU
NT
AI
3.0
PHR
3.0
DE
VIC
E 1DE
VIC
E 2
HIE
PERSONALIZATION
25
WORKFLOW WITH VIRTUAL CLINIC
Nurse
Self-care
EH
R
PHR
Symptom checker
Data extraction
Data analytics
Decision making
Advice and
recommendation
Health account
1000 citizens
During one
month
800 of
them
have
some
medical
concerns
Genera
l
practitio
nerSpeciali
st
Laborat
ory640
160
AI
Services for
the person
Health
data
PHR
Health and
wellness
DEVICES
SERVICES
Genomic data
MY
HEALTH
Health
Account
IHAN My
Data
+ +
EHR
Sickness data
Disease episode
information
Medical
services
Open data
VISION OF HEALTH 3.0
ARCHITECTURE OF IHAN
Monitoring and
certification
Mobile App
For person
“Bank”Personal account
IHAN
consortium
UserB
Trust
Services
(CA/RA +
TSA)
Security ServerAdapter
INTERNET
UserC User
D
UserA
UserY
UserX
“Central bank”
Services
TRUST NETWORK
FI
VR
YR
VV
MR EE
RR
MTA
MR
AR
snet Xnet Ynet
Xcountr
NIS
NIS -Nordic Institute for
Interoperability Solutions
E-mail: [email protected]
CONTACT INFORMATION
GET IN CONTACT FOR FURTHER COOPERATION
Key-note presentations
Company and government consultations
Business proposals
Round tables and discussion groups
GSM: +372 510 91 43 Skype: kiitsidam
“Accelerating innovation saves
healthcare”
Madis Tiik
LinkedIn: madistiik
Web: www.madistiik.com