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Tanja Mate,M.D., Marjan Suselj

On-line Access to Health Data in Slovenia - Experience and Perspectives. Tanja Mate,M.D., Marjan Suselj. Contents. Slovene health care system eHealth strategy in Slovenia – MoH perspective Bases and objectives Re-thinking health care Priorities

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Tanja Mate,M.D., Marjan Suselj

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  1. On-line Access to Health Datain Slovenia -Experience and Perspectives Tanja Mate,M.D., Marjan Suselj Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  2. Contents • Slovene health care system • eHealth strategy in Slovenia – MoH perspective • Bases and objectives • Re-thinking health care • Priorities • Past development and infrastructure in place • Development towards integration and online access for health care workers and patients Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  3. Slovenia • AREA: 20 000 sq km2(0.5% of the total EU-25 area) • POPULATION: 2 000 000 (88% Slovenes) • (0.5% of the total EU-25 population) • FORM OF GOVERNMENT: • Parliamentary democratic republic; • Unicameral national assembly (Državni zbor) • HEAD OF STATE: President (elected directly) • INDEPENDENCE: 1991 • GDP PER CAPITA: €10 900 • (47% of the EU-15 average) • UNEMPLOYMENT RATE: 6%(EU-15 average: 9%) Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  4. Health Status • Life expectancy at birth • Total population 77 years (M 73, F 80.5, gender diff. 7,5 years) • EU-15 average: 79 years (M 75,5, F 82, gender diff. 6,5 years) • Infant mortality 3,8 • Disease burden (%) • Neuropsychiatric disorders 26 • Cardiovascular diseases 17 • Malignant neoplasms 16 • Causes of death (%) • Cardiovascular diseases 41 • Malignant neoplasm's 26 • Injuries 8 Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  5. eHealth Players – HC Providers (1) Hospitals: 27 (16 general hospitals) Physicians: 4500 Dentists: 1200 Nurses and other profs.: 14200 Total health expenditure as % of GDP: 8.6 Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  6. eHealth Players (2) Health Insurance Institute of Slovenia (HIIS) • Promotion and sponsoring of IT in HC • Establishing infrastructural databases • EDI • National health insurance card system Public Health Institute – national (PHIS) and regional (PHI) • Health statistic • Prenatal information system • Register of sick leaves Ministry of Health • Health Sector Management Project Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  7. Starting Point • Objectives and activities in field of e-health in Slovenia are deriving from *Action plan for a European e-Health Areaand from experiences and current status of health informatics in Slovenia. *Communication on e-Health - making healthcare better for European citizens: An action plan for a European e-Health Area, COM(2004)356, (30 Apr. 2004) http://europa.eu.int/information_society/doc/qualif/health/com2004_356_ehealth.pdf Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  8. Bases • EU action planwill enable progress in field of e-health, system solution and individual services. In the field of e-health there are 3 main fields of activities in EU members: • Defining of common basis and implementation of supporting environment for e-health • e Health pilot projects • Information for all about education and prevention • Connection of health information networks • Promotion of electronic health cards • Exchange of experiences and progress measurements • Dissemination of best practices in EU • Benchmarking • Active international cooperation Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  9. Slovenia’s Health Care SystemStrategy • Quality, Performance and Effectiveness: • improving health status and outcomes, • improving safety or reducing errors, • ensuring that clinical decisions are based on best current practice or • best available evidence • (avoiding over-use und under-use) • Equity and Access: • ensuring that the same quality of care is provided to all, • raising responsiveness of the system: providing timely services CITIZEN Efficiency and Costs: improving efficiency and contain costs Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  10. Approach • Harmonisation of the national policy with EU guidelines • Health policy – reference framework for eHealth • Affirmative experience of past projects (HSMP, HIC, …)shall be supplemented with implementation action elements • Partnership and consensus - Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  11. Objectives • Till 2005 every EU member has to prepare national and regional e-health plans, • Use of standards, inclusion of open code initiative • Introduce personal identifiers • Connectivity of the patients’ electronic records • Ensure mobility of patients and health care workers • Advance infrastructure and technology • Introduce testing and accreditation for eHealth • Increase investment in eHealth • Make regulations and legal bases. Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  12. eHealth = Re-thinking Health Care • eHealth ≠ only/mainly information and communication technologies project in health sector • eHealth => change management in health sector “We have nothing to loose but our chains …” Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  13. eHealth = Re-thinking Health Care Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  14. Key Words of our “Re-thinking Health Care” Key words: • Access • Equity • Efficiency • Quality The citizen/patient centred care is a result of a growing trend towards more effective management and collaborative work of health professionals i.e. we have to support “Shared Care”. Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  15. Future Development • Electronic patient record • Standardization of the elements of electronic records of medical data and of the interchange of data between different HC providers: • Referral notes, dismissal notes, laboratory results, invoices • Telemedicine • Bedside PC • National health portal • Information support to standardisation through data dictionary • Access to general and private HC related information. • Direct communication between the citizens and HC providers - Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  16. Major Development Steps in the Past • Extensive proliferation of computer literacy of HC providers (acquisition of 2700 PC’s) • Infrastructural databases (insured persons, HC providers, drugs, obligors, …) • EDI • Introduction of the health insurance card system (HIC, HPC, SST network, unified API’s, upgraded application environment at HC providers) • Health Sector Management Project 1992/19931993/1996 1994/1996 1996/2000 2000/2004 Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  17. Health insurance contribution obligors Office of statistics of RS Ministry of Health Data on registering into CHI Reports, statistics Applications for the registering into CHI Institute of Pension and Invalidity Insurance Institute of Public Health of RS Data on regist. into CHI Statistics, data on HC service providers HIIS database Institute of Employment Research Institutes Data on regst. Into CHI Reports, statistics Tax office of RS Business register CHI data AJPES invoices CHI data Central population register Ministry of internal affairs Health care service providers Police, Court Building the IT Base in HC • Full local IT support, limited integration • Continuous investment and development: • virtually all HC work postscomputerized • EDI • HI databases • IT literacy • HIC project - a step in the stream of continuous development efforts Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  18. Slovene HIC System Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  19. Informatics Support for DRG (1) e-SPP project Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  20. GPRS laptop ADSL, T A L K / D A T A Public network T A L K R S C S T R R D T D C D cable HKOM links Workstation LAN VPN LAN Firewall LAN Firewall Remote Governmental network Local networks router laptop Informatics Support for DRG (2) • All hospitals connected to the governmental network • Secure ID cards • Digital certificates Communications: • Sending data: • in XML format • every 3 month (later monthly) • upload through web application Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  21. Development in Progress • e-SPP • On-going adjustment of methodological instructions • Establishing a data warehouse • Support to coding, clinical paths and quality indicators • National waiting lists • Monitoring, efficient use of capacities, transparency, planning, priorities … • e-Prescription and national drug database • Improved procedure (issuing of prescription, issuing of drug, data processing in the pharmacy), • Access to expert information on drugs • Data on the portal accessible to patients as well. - Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  22. Objectives: Completion of the system  support to drug prescribing, issuing and accounting Safe medication Elimination of information flow bottlenecks in health care Advanced information tools for professional work Containment of expenditure on medication Two-phase approach: Phase 1: Z-KZZ Project  recording of drugs issued on prescription onto the health insurance card Phase 2: e-Prescription Project  Substitution of paper prescription forms for an electronic form, implementation of expert information systems Development in Progress (2)Medication Management Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  23. ePrescription Central database(users: doctors, Pharmacists) HIIS EDI invoices and reports Expert IS Recording of issued drugs on HIC Upgraded SW SW SW ePrescription Generation of ePrescription HIC Support toprescribing Paperprescription Doctor Pharmacy Printing Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  24. On-line Access – Technical Perspective HIIS DATABASE E-Prescription VS TKS VOLUNTARY INSURANCE PROVIDERS INTERNET SERVER HC PROVIDERS Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  25. Next Steps - Challenges • Integration of solutions (links between technologies and HC levels, application and upgrading of infrastructure in place and knowledge) • Extension of IT services to the support of quality (support to professional medical work, knowledge databases, key role of medical experts in the development/selection of solutions) • Limited development resources, need for joining efforts, need for amendment of regulations • Active role of the patient (access to personal data, responsibilities, interactivity, involvement in decisions, access to knowledge databases) • Promotion of international interoperability of solutions Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  26. The methods and tools that cause the problem cannot be used to solve the problem.(Albert Einstein) Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

  27. Thank you for your attention! Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj

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