Transcript Document

Estonian
Health Information System
Raul Mill
Estonian eHealth Foundation
Estonia
Estonia - 45 000 km2
1.29 mlj. inhabitants
GDP:
Agriculture
Industry
Service
2,7%
26,3%
74,5%
06.02.2013
3
HEALTHCARE IN
ESTONIA
35 hospitals
491 family doctors (juridical persons)
Healthcare expenditures
- 5.9% from GDP 2011
- 6.3% from GDP 2012
06.02.2013
4
E-STATE ARCHITECTURE
5
SECURITY & AUTHENTICATION
06.02.2013
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X-ROAD GATEWAY
SERVICE
2009
PATIENT PORTAL
2009
PHARMACIES AND
FAMILY DOCTORS
2009
NATION- WIDE
HEALTH
INFORMATION
EXCHANGE PLATFORM
2008 december
2011
EMERGENCY MEDICAL SERVICE
2010 september
SCHOOL NURSES
2010 january
PHARMACIS
2009
FAMILY DOCTORS
2009
HOSPITALS
BUSINESS REGISTER
POPULATION REGISTER
- Health care providers
- Health professionals
- Dispensing chemists
HEALTH CARE BOARD
- Coding Centre
- Handlers of medicines
STATE AGENCY OF MEDICINES
Architecture
X-Road, ID-card, State IS Service Register
PRESCRIPTION
CENTRE
2010 january
8
HIE platform history
Planning
initiated
2000
Project preparation
(2003-2005)
eHealth Foundation
established (2005)
2002
2004
eHealth Projects
(2006-2008)
2006
Funding decision by Ministry
of Economic Affairs
Electronic Health
Record
Digital Images
Digital
Prescription
Digital
Registration
National
HIE
2008
Organization
Ministry
of Social Affars
Society
of Family Doctors
Tartu
University Clinic
East Tallinn
Central Hospital
Union of Estonian
Medical Emergency
Estonian e-Health
Foundation Board
North Estonian
Regional Hospital
Medical Advisory
Board
Management board
Standards
management
IT
management
ENHIS Operation
Services
management
Estonian
Hospital Assosiation
Communication
management
35 hospitals
491 family doctors
8 main softwares (20 totally)
06.02.2013
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The main principles of security of
Estonian eHealth system – Opt Out
1.
2.
3.
4.
5.
A secure authentication of all users with ID-card or Mobile ID
Digital signing or stamping of all medical documents
A maximum accountability (transparency): all actions will leave an
unchangeable (and unremovable) secure trail
Encrypted database that allows to remove the confidentiality risk
from the technical administrators
Monitoring of all actions together with the corresponding countermeasures (both organizational and technical)
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STANDARDS
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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
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Standardization process
Healthcare
providers
Specialty
assotiations
Social
ministry
Health
Insurance
Fund
EeHF
standardization
specialists
Terminology
experts
HIS
developers
UML+HL7
experts
Create data
set
Formalize
and merge
UML model
Data set document
Classificators
OID-s
XML
schemas
Description
documents
Examples
Stylesheets
Approve
and publish
Changes in NHIS
documents
regulatory act
Fixed version of
artifacts in
publishing centre
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The structure of Estonian
Health Information System
Institutional level–
users cooperation model
• Healthcare processes
• User needs
• Training programs
• Partnership
• Communication
•
Data Exchange level
different e-services
Central System– Database
and related services
•
•
•
•
•
•
•
User Software
• User interface
• Data input
• Data Visualisation
• Search information
Data transmission
standards (HL7)
Set of data
Data Standards
Search criterias
Legal Framework
Software
Hardware
eConsultation
services
Main services of the
e-health in Estonia
EHR services
for physician
Digital
registration
services
Institutional level–
users cooperation model
Data Exchange level
different e-services
Central System– Database
and related services
EHR services
for patient
Services for
Social
Insurance
Fund
Services for
dentaal care
Supporting
services
Services for
blood center
Digital
archiving
services
Services for
registers
Infrastructure
services
External
services
Cross Border
Data Exchange
services
Services for
nurse
eAmbulance
services
Services for
homecare
Subservices
Health
information
services for
patient
Digital
laboratory
services
A medical
certificate
services
Data and
statistics
services
Analytics
services for
participants in
treatment
process
E-learning
services for
medical staff
Main e-health
participants
on the x-road
Institutional level–
users cooperation model
Family
Doctors
Public
Register
Business
Hospitals
Register
Supporting
services
Health Care
Board
Health
Insurance
Fondation
Dental care
Blood center
Infrastructure
services
External services
Data Exchange level
different e-services
Central System– Database
and related services
Patients
Social
Insurance
Board
eAmbulance
Military
Forces
Homecare
Subservices
Emergency
Medical
Departments
Genome
Center
Medical
Registers
Medical
statistics
Nursing care
Documents total – 12.8 mio
1.2 mio persons medical data (growth 20% during 2012 and 15% during 2013)
PATIENT PORTAL (UPGRADE)
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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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1999
Visits of the patient portal in a month 40 000
Queries in a month 60 000
260 000
Family doctors who are sending documents 52%
Rate of sent stationary treatment cases
2001
2003
2005
2007
2009
2011
160 000
92%
97%
2015
2017
2019
You are here
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ISSUED
SOLD
may.12
apr.12
mar.12
feb.12
jan.12
dec.11
nov.11
okt.11
sept.11
aug.11
juuli.11
juuni.11
mai.11
apr.11
märts.11
veebr.11
jaan.11
dets.10
nov.10
okt.10
sept.10
aug.10
juuli.10
juuni.10
mai.10
apr.10
märts.10
veebr.10
jaan.10
ePrescription (94%)
1,000,000
900,000
800,000
700,000
600,000
500,000
400,000
300,000
200,000
100,000
-
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March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
Retrieval of Medical Documents
by Healthcare Professionals
280,000
260,000
240,000
220,000
200,000
180,000
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0
2009
2010
2011
2012
2013
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DETS 2008
JAAN 2009
VEEBR 2009
MARTS 2009
APR 2009
MAI 2009
JUUNI 2009
SEPT 2009
OKT 2009
NOV 2009
DETS 2009
JAAN 2010
VEEBR 2010
MARTS 2010
APR 2010
MAI 2010
JUUNI 2010
JUULI 2010
AUG 2010
SEPT 2010
OKT 2010
NOV 2010
DETS 2010
JAAN 2011
VEEBR 2011
MARTS 2011
APR 2011
MAI 2011
JUUNI 2011
JUULI 2011
AUG 2011
SEPT 2011
OKT 2011
NOV 2011
DETS 2011
JAAN 2012
VEEBR 2012
MARTS 2012
APR 2012
MAI 2012
JUUNI 2012
JUULI 2012
AUG 2012
SEPT 2012
OKT 2012
NOV 2012
DETS 2012
JAAN 2013
VEEBR 2013
MARTS 2013
APR 2013
MAI 2013
JUUNI 2013
JUULI 2013
AUG 2013
SEPT 2013
OKT 2013
NOV 2013
DETS 2013
JAAN 2014
VEEBR 2014
Patient portal Number of queries 12.2008 – 10.2013
180000
160000
140000
120000
100000
80000
60000
40000
20000
0
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eHealth availability and use Indicator 2012: by country
E-health approximate expenditures untill 2012
Country
Expenditures
Estonia
Ireland
Portugal
12 mil
56 mil
69 mil
Norway
Scotland
Denmark
Finland
Sweden
Netherland
Spain
105 mil EUR
117 mil EUR
183 mil EUR
203 mil EUR
347 mil EUR
430 mil EUR
713 mil EUR
20,8
22,5
32,7
37,4
36,2
25,7
15,5
Germany
UK
Australia
US
1 352 mil EUR
1 980 mil EUR
4 976 mil EUR
30 712 mil EUR
16,8
31,3
225,1
97,2
EUR
EUR
EUR
Expenditures per
capita
9,1
12,2
6,5
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LEARNING
POINTS
06.02.2013
27
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?
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Impact of the digital stamp since 2013
Documents sent by family doctors in a month have increased up to
4x!
Medical document sent to Health Information System by General Practitioners
2012-2013
90000
80000
70000
60000
50000
vocations
40000
30000
20000
10000
0
vocations
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FUTURE
OUTLOOK
06.02.2013
31
Hardware
independent
Voice
recognition
and text
input
assistant
Single sign
on
Location
independent
Apps for
medical
specialties
Data and
services
integration
Collecting
information
Interoperability
UI standards
Graphical
solutions
Thank you!
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