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Estonian Health Information System Raul Mill Estonian eHealth Foundation

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 )

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Estonian Health Information System Raul Mill Estonian eHealth Foundation

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  1. Estonian Health Information System Raul Mill Estonian eHealth Foundation

  2. Estonia Estonia - 45 000 km2 1.29 mlj. inhabitants GDP: Agriculture2,7% Industry 26,3% Service74,5%

  3. HEALTHCARE IN ESTONIA 35hospitals 491 familydoctors (juridicalpersons) Healthcareexpenditures - 5.9% from GDP 2011 - 6.3% from GDP 2012

  4. E-STATE ARCHITECTURE

  5. SECURITY & AUTHENTICATION

  6. Architecture STATE AGENCY OF MEDICINES - Coding Centre - Handlers of medicines HEALTH CARE BOARD - Health care providers - Health professionals - Dispensing chemists POPULATION REGISTER BUSINESS REGISTER HOSPITALS 2009 FAMILY DOCTORS 2009 PHARMACIS 2010 january SCHOOL NURSES 2010 september EMERGENCY MEDICAL SERVICE 2011 X-Road, ID-card, State IS Service Register NATION- WIDEHEALTH INFORMATION EXCHANGE PLATFORM2008 december PRESCRIPTION CENTRE 2010 january PATIENT PORTAL2009 X-ROAD GATEWAY SERVICE2009 PHARMACIES AND FAMILY DOCTORS2009

  7. HIE platform history Project preparation (2003-2005) eHealth Foundation established (2005) eHealth Projects (2006-2008) Planning initiated National HIE Funding decision by Ministry of Economic Affairs Electronic Health Record Digital Images Digital Prescription Digital Registration

  8. Organization Society of Family Doctors Tartu University Clinic East Tallinn Central Hospital Union of Estonian Medical Emergency North Estonian Regional Hospital Estonian Hospital Assosiation Ministry of Social Affars Estonian e-Health Foundation Board Medical Advisory Board Management board Standardsmanagement IT management ENHIS Operation Servicesmanagement Communication management

  9. 35 hospitals 491 family doctors 8 main softwares (20 totally)

  10. The main principles of security of Estonian eHealth system – Opt Out • A secure authentication of all userswith ID-cardorMobile ID • Digitalsigningorstampingof all medicaldocuments • A maximum accountability (transparency): all actions will leave an unchangeable (and unremovable) secure trail • Encrypted databasethat allows to remove the confidentiality risk from the technical administrators • Monitoringof all actions together with the corresponding counter-measures (both organizational and technical)

  11. STANDARDS

  12. 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

  13. Standardization process Healthcare providers Specialty assotiations Social ministry Health Insurance Fund EeHF standardization specialists Terminology experts HIS developers UML+HL7 experts Changes in NHIS documents regulatory act UML model XML schemas Data set document Description documents Classificators Fixed version of artifacts in publishing centre OID-s Examples Stylesheets

  14. The structureof Estonian Health Information System • Healthcare processes • User needs • Trainingprograms • Partnership • Communication • UserSoftware • Userinterface • Data input • Data Visualisation • Search information • Datatransmission standards (HL7) Institutionallevel– userscooperationmodel Data Exchange level different e-services • Set of data • Data Standards • Search criterias • LegalFramework • Software • Hardware Central System– Database and related services

  15. Main services of the e-health in Estonia • Supporting services • Infrastructure services • External services Institutionallevel– userscooperationmodel Data Exchange level different e-services Central System– Database and related services • Subservices

  16. Maine-health participants on the x-road • Supporting services • Infrastructure services • External services Institutionallevel– userscooperationmodel Data Exchange level different e-services Central System– Database and related services • Subservices

  17. Documentstotal – 12.8 mio 1.2miopersonsmedicaldata (growth 20% during 2012 and 15% during 2013) PATIENT PORTAL (UPGRADE)

  18. Acceptance • ePrescriptioncovers94%of issuedprescriptions. • Over90%of Hospitaldischargeletters – digital • Over97% of stationarycasesummarieshave sent tothecentral DB • Ambulatorycasesummariessending • No certainrulesforsendingambulatorycasesummaries! • 1.2miopersonhavedocuments 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

  19. 160 000 Visits of the patient portal in a month 40 000 260 000 Queries in a month 60 000 92% Family doctors who are sending documents 52% 97% Rate of sent stationary treatment cases 2009 1999 2015 2017 2011 2019 2003 2005 2001 2007 You are here

  20. ePrescription (94%)

  21. Retrieval of MedicalDocumentsbyHealthcareProfessionals

  22. Patientportal Number of queries 12.2008 – 10.2013

  23. eHealthavailability and use Indicator 2012: by country

  24. E-health approximate expenditures untill 2012 CountryExpendituresExpenditurespercapita Estonia 12 mil EUR 9,1 Ireland56 milEUR 12,2 Portugal 69 mil EUR 6,5 Norway105 mil EUR 20,8 Scotland117 mil EUR 22,5 Denmark183 mil EUR 32,7 Finland203 mil EUR 37,4 Sweden347 mil EUR 36,2 Netherland430 mil EUR 25,7 Spain 713 mil EUR 15,5 Germany1352 mil EUR 16,8 UK 1980 mil EUR 31,3 Australia 4976 mil EUR 225,1 US 30712 mil EUR 97,2

  25. LEARNING POINTS

  26. 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.

  27. Comperhensive planning – processes and standards, legislation. • Usability – fast and simple solutions • Implementation – central training programs • Service update – continuous feedback • Balancebetweensecurity and usability • PIN foreverydocument … • PIN or ID-card?

  28. Impact of thedigital stamp since 2013 Documents sent byfamilydoctors in a monthhaveincreasedupto4x! vocations vocations

  29. FUTURE OUTLOOK

  30. Voice recognition and text input assistant

  31. Thankyou!

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