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Implementation of Estonian EHR system and roadmap to the future

Implementation of Estonian EHR system and roadmap to the future . Madis Tiik CEO Estonian eHealth Foundation. ESTONIA. Population 1.32 million Area 45 000 km2 Compulsory h ealth i nsurance pa i d by employer Health insurance tax 13% Health care costs make up 5% of GDP

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Implementation of Estonian EHR system and roadmap to the future

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  1. Implementation of Estonian EHR system and roadmap to the future Madis Tiik CEO Estonian eHealth Foundation

  2. ESTONIA • Population 1.32 million • Area 45 000 km2 • Compulsory healthinsurance paid by employer • Health insurance tax 13% • Health care costs make up 5% of GDP • Income tax 21% (flat tax) • Healthcare providers are private, municipal or governmental. • Family doctors (private companies) • Hospitals (shared companies or foundations) • Wide range of e-services • e- election (Parliament election march 2011– 25% electronically) • e- tax board (2010 – 94% electronically) • e- school • e- commercial registri, etc • More than 3000 different services

  3. Areas of e-Health? • Electronic Health Record • Collects data from multiple healthcare organisations • Patient summary: allergies, prescriptions, recent events • Applications based at facilities • Computer-based patient records for hospitals • Electronic medical records for primary-care physicians • PACS and other digital imaging systems • Business intelligence and financial management • Telemedicine • Remote diagnosis: Teleradiology, teledermatology etc • Remote consultation: Video visits, e-visits • Remote monitoring: Home and mobile All three areas are important!

  4. EMR Analysis Follow-up Policy-making Treatment PHR Guidlines Estonian EHR =EMR+PHR PublicServices Diagnostics Campaigns Tele-advice Appointment Workflow Notification Self-help Prescription Lifestyle

  5. Founders of the Estonian eHealth Foundation Ministry of Social Affars Society of Family Doctors Tartu University Clinic East Tallinn Central Hospital Union of Estonian Medical Emergency North Estonian Regional Hospital Estonian Hospital Association Estonian eHealth Foundation Board Management Board Strategy and Architecture Development Marketing and Channel Management EHR Operation Governance Family doctors Hospitals Nursing Care Patient Portal Health Authorities Endusers

  6. Foundation tasks • Develop new services for citizens and doctors • Maintanance of EHR system • Standardisation and developing digital documents • International cooperation • Scientific cooperation with universities • Project management of EU projects

  7. Situation in 25.05.2011 • There are 2 164 807 documents in the Estonian EHR • Documents which are Obligatory • Discharge letters (epicrises)– availability more than 90% • Out-patient consultation notes – availability around 15% • Documents which are voluntary at the moment Immunization note; Day surgery notes; Referrals; Birth epicrises • Today more than 80% of prescirptions are issued as ePrescriptions • 100% of Radiological images (excl. dental) are digital and stored in the picture archiving and communication system (PACS) • 47% of the citizens have digital medical records in EHR • 29 705 citizens have viewed his/her data in EHR (Patient Portal)

  8. Architecture of Estonian healthcare IT STATE AGENCY OF MEDICINES - Coding Centre - Handlers of medicines HEALTH CARE BOARD - Health care providers - Health professionals - Dispensing chemists POPULATION REGISTER BUSINESS REGISTER HOSPITAL ( HIS) integration 2009 FAMILY DOCTORS 2009 PHARMACIS 2010 january SCHOOL NURSES 2011 september EMERGENCY MEDICAL SERVICE 2012 X-Roads, ID-card, State IS Service Register eHealth FoundationEHRSYSTEM2009 Health InsuranceINSURANCE REGISTERCLAIMS & REIMBURSMENTPRESCRIPTION CENTRE 2010 january PATIENT PORTAL 2009HCP PORTAL 2011 XROADS GATEWAY SERVICE2009 PHARMACIS AND FAMILY DOCTORS2009

  9. Distribution of costs and benefits of Estonian e-Health platform (Digimpact study 2010) : Total cost of EHR system development (2005-2010) has been around 10M€ - it is 7.5€ per citizen • http://eng.e-tervis.ee/digimpact-final.html

  10. Estonian roadmap for eHealth Impact Simulation Environment Tracking Behaviour Tracking Online Intervention Lifestyle Value Added Shared care Personal Guidelines Care Paths Service Brokering Integrated Statistics Social Networking Decision Support Central EHR Health Portal Registries IntegrationStandardization Information Exchange • Local EMRs • Digital Claims & Reimbursement Time 1992 2010 2015 2020

  11. However If you ask me... ...what could we done better ...and what have we learn Clear governance Decide who is responsible for whole ehealth development Do not change it during the process Guarantee strong political support Find enthusiastic leaders Find best services start with Set realistic timeschale for projects • Start with analyzing business processes in healthcare • Optimization of the processes, before standardization • Pick-up a right technology to support the process • Without knowing the process – >do not start any projects Process->Standardization-Services/technology • Support endusers with financial iniciatives

  12. Thank you! e-Health=healthcare management of 21st century e-Health ≠ICT project madis@etervis.ee wwww.etervis.ee

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