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The Way Forward in E-Health: The National Health Insurance Fund Bulgaria Presented by

The Way Forward in E-Health: The National Health Insurance Fund Bulgaria Presented by Dr. Rachelle Kaye Maccabi Healthcare Services. National Health Insurance Fu nd Information System. The National Health Insurance Fund Information System

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The Way Forward in E-Health: The National Health Insurance Fund Bulgaria Presented by

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  1. The Way Forward in E-Health: The National Health Insurance Fund Bulgaria Presented by Dr. Rachelle Kaye Maccabi Healthcare Services

  2. National Health Insurance Fund Information System • The National Health Insurance Fund Information System • Project, in the final stages of completion, consists of 2 • parts: • Kernel 1: The ERP system including Accounting, Inventory, Budget, Contracts • Kernel 2: Management of Medical Service Provider Relations including Claims Management and Audit and National Registries

  3. National Health Insurance Fund Information System • Kernel 2 provides the Infrastructure for the future • development of the system. It contains: • CHIP demographic information • CHIP registry information( GP,infirmary, maternal, child) • Outpatient primary and specialty care including diagnoses and treatment • Medical Diagnostic Services • Outpatient Dental Care • Inpatient hospital care information according to clinical pathways • Pharmacy Information – drugs prescribed and purchased

  4. Central Computerized NHIF Data Base

  5. Central Computerized Electronic Health Record

  6. Major Challenges: From a Data Base to a Central Computerized Medical Record • Complete Electronic Reporting from ALL Medical Service Providers according to required minimum data set • Electronic Reporting of Medical Diagnostic Activity RESULTS • Establishment of Communication Infrastructure and development of online interface with all MSPs • Ongoing transmission of data online in real time • Modification of doctors’ EMR programs to enable them to accept and integrate online input of information regarding patients – test results, medications purchased, visits to other doctors, etc.

  7. Maccabi’s Telecommunications

  8. IT at the physicians’ service

  9. Doctor’s Electronic Medical Record

  10. Physician lab orders are digital, generated by his EMR. Lab test results are sent to the doctor in the shortest time possible. Lab results are integrated into the CMR . The patient has a full access to the information. The information cycle , from start to finish, is fully automated Electronic Medical Diagnostic Referrals and Results: Laboratory Systems

  11. Review of Previous Lab Test Results

  12. Lab Referral Form in the Doctor’s Computer Less frequent tests

  13. Doctor Clinic Lab Tests Request for lab test Consolidation of samples at regional collection hub LAB Self Service Station Distribution of results Patient’s Internet Site

  14. Electronic Prescription

  15. Index of drugs registered in Bulgaria NHIF drugs index Patient information including diagnoses, allergies Preferred therapeutic alternatives Drug Utilization Review Program – checks online for contraindications and provides immediate alerts Access to additional information on drugs Integrated Decision Support Systems for Prescriptions

  16. Drug to Drug Interaction Alert

  17. Alerts for Allergies

  18. Preferred Drug Alert

  19. E-prescribing Maccabi Internet Services patient asking for Renewal prescription via Internet Doctor Receiving the Request Patient Doctor Patient getting the prescription via internet Sending the Prescription to patient

  20. In Maccabi’s Experience An Integrated ICT system is needed as a necessary Infrastructure for most Telemedicine Applications Telemedicine

  21. “...the use of electronic information and communication technologies to provide and support health care when distance separates the participants...” Telemedicine Definition from: Institute of Medicine: Telemedicine: A Guide to Assessing Telecommunications in Health Care

  22. The Beginning of Telemedicine 1876

  23. Why Telemedicine? • Equal access all over the country. • On-Line diagnosis . • Extension of service hours. • Reliable diagnosis due to digital tools. • Quality control and assurance. • Archiving capabilities for future comparison. • Sharing information among physicians for treatment and consultation. • Sharing Information with the patient and patient empowerment • Lower cost.

  24. Tele-radiology Diagnostic backup Center : Haifa Diagnostic Center : Tel Aviv

  25. Ref. Phys. Internet UNIX PACS Tele-Radiology Workflow Self Service HQ (TA) RIS WIN2000 Rpt Rpt Radiologist Clinic Rpt Diagnostic Center

  26. Analysis Center Website Self-Service Station Referral Referral Maccabi Central APP. Service AS/400 UNIX Win2000 SQL Server EGK Archive דוח א.ק.ג דוח א.ק.ג דוח א.ק.ג דוח א.ק.ג אבחנה: -- ------- --- -- -- אבחנה: -- ------- --- -- -- אבחנה: -- ------- --- -- -- אבחנה: -- ------- --- -- -- - ------- --- - - - ---- -- -- -- -- ------- - --- ------ - Tele E.C.G Doctor Referral for ECG at nursing station Policlinic Doctor Community Health Services Nurses’ Room ECG ECG Performed in office

  27. Tele-Ophthalmology 2008

  28. Maccabi Branch

  29. Tele-monitoring Congestive Heart Failure Regional center HUB Phone Lines PCP RF Call center Information Systems • Devices: • BP • Pulse • Weight Maccabi Patient house

  30. Tele-Consultation

  31. Patient's web site • Medical Applications • Lab Results • Radiology Results • Personal Health Situation • Cardiac Risk Factors • Diet & Nutrition • Personal List of Drugs • Administrative Application • - Scheduling • - Demographic Updates • - Account Status • - Visit List • - Health Plans • - Over seas Insurance

  32. On Line Patient Secured Web Site

  33. On Line Patient Secured Web Site

  34. Patient's web site

  35. Patient's web site

  36. Patient's web site

  37. Telemedicine is becoming a routine part of everyday medical care Services will be provided to members, to the extent possible, at the most comfortable and convenient location for them (home, office) via use of the most advanced information and communication technology (web, e-mail, SMS) Servicesthat cannot be provided at home will be provided in the physician’s clinic which will be, to the extent possible, a “one stop shop” for most of the patient’s healthcare needs Telemedicine Tomorrow – The Way Forward Guiding Principles

  38. Telemedicine will not take the place of the patient physician relationship but will strengthen the relationship Telemedicine will not replace the need for face-to-face visits and physical examination when medically necessary Telemedicine will add numerous tools and options that will improve care, provide greater flexibility and comfort, and improve the efficiency, timeliness and effectiveness of health care

  39. Personal Health Records - future Maccabi OnLine

  40. The People “behind” the Technology (doctors, nurses): Availability - Shortages Willingness to Participate Payment Patient Preferences “Therapeutic” Communication Policy Issues: Investment in Infrastructure Reimbursement Privacy Malpractice The Way Forward – Technology is NOT the Issue

  41. Successful Telemedicine Requires: Committed Policy makers Committed Healthcare Professionals Proactive Patients and Families Significant Changes in cultural norms and values “We have to be prepared to do things differently” The Way Forward

  42. Thank you for your attention

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