Telemedicine segment of the Croatian e-Health system Klapan I, Pavelin A, Stevanović R, Katić M.

1. The ICMCC Event June 1-3, 2005NCC, The Hague Telemedicine segment of the Croatian e-Health system Klapan I, Pavelin A, Stevanović R, Katić M.

2. ‘eHealth refers to the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers.’ • excerpt from e-Health Ministerial Declaration 22 May 2003.

3. The usual workplace Shift plan Documentation Lassie Magazine Notes Communication Records Literature

4. ... and another one. List of cost centers Physical stock Telephone Mail and archive Literature Postcards Calculator Patient records Shift plan Lists of capacity load PC(4372) Telephone directory

5. Michael Hammer, Philadelphia1999. “If you create Web pages in front of unsubstantial business processes you will only show the world how unsubstantial your processes really are.” “Before you start perfecting the common external processes it is necessary to efficiently manage the integration of internal businesses.”

6. INTEGRATED information system... ... means a complete integration of ALL business processes and transactions in a way that ensures absolute consistency of data and their up to dateness. FORMS OF INTEGRATION: • integrated data, processes, and organizational elements, • application and • technical integration.

7. as well as all other healthcare subjects. Physician Employees Home care Drugs Patients e-HEALTH Cities Media Insurance companies Ministry of Health Visitors Vendors

8. Health Care systems today...Why ICT should be applied? 20% Health Care budget goes for inadequate curing! 40% of time spent on patient is of information nature!Source: Večernji list, Poslovna srijeda

9. Areas to be Addressed • Primary Care Patient Management • Community Care • Chronic Disease Register • Call and Recall Systems • Population Registers National Clearing Service • Performance Monitoring • Financial Management • Critical Care and Emergency • Admissions, Discharges and Transfers • Appointments and Resource Scheduling • Medical Records Tracking and Coding Systems • Clinical Laboratory and Diagnostic Support

10. Working environment of healthcare employees To access your workplace any place, any time !? IMPOSSIBLE!

11. Pizza-Service O/I To access your workplace any place, any time? My Web Information Source My Mail My Tasks POSSIBLE! My Calculator My Patients My Pizza-to-Order My Reports

12. ICT makes difference:health care services - anywhere, - anytime. Answer: Take a pill, lay down! Question: It hurts... Please, help!

13. 1000 Fixed 900 800 700 Cellular 600 500 Subscribers (millions) 400 Internet 300 200 Mobile Internet 100 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 3x1 billion subscribers/users … + … Telecommunication Trends Connected Globe

14. e-Health ... e-Health ... is a global reform approach with a purpose of promoting the usage of INTERNET by healthcare providers and all other individuals and institutions working with them on a daily basis. e-Health ... IS A SET OF INTEGRATED SOLUTIONS AND SERVICES THAT ENABLE PHYSICIANS, PATIENTS, PHARMACISTS AND VENDORS TO WORK TOGETHER ANY PLACE, ANY TIME WITH THE HELP OF ICT.

15. how do we see Croatian healthcare information system – eHealth ?

16. European information society concept eEurope • eEurope landscape • New EU Regulatory Framework (EU NRF) • ICT sector is a key driver • investments and innovations • ‘broadband everywhere’ strategy • eGovernment, eHealth, eLearning and eBusiness segments

17. Croatian eLearning Croatian eGovernment Croatian eBusiness Croatian eHealth it is the building-block of the eCroatia eCroatia

18. guidelines for creation of the Croatian eHealth • Croatian eHealth • building-block of the Croatian integrated IS - • eCroatia • interactive establishment with soft borders, but well-defined interfaces • seamless associations with related international IS • nationwide ICT infrastructure • technical and legislative framework definition

19. and where is the Telemedicine Segment positioned ?

20. Croatian eHealth it is one of the functional segments of the Croatian eHealth PatientcareSegment Public Information Segment Administration Segment Telemedicine Segment

21. Users' perspective • End user’s (patient’s) perspective • mobile patient • no papers around • no worry about health history • tax money well invested • Doctor’s perspective • less paper work • quicker process around patient • less bureaurocracy towards insurance and public health • Politician’s perspective • tax money well invested (elections) • good basis for undeveloped regions • good basis for foreign tourists • Health administration • perspective • better control over the process • quicker statistical research • financial control in real time Common pers- pective

22. Clinical hospital - informatization layers Special medical devices Radiology Endoscopy Surgery Urology CTd MRId RNGd CTa MRIa RNGa UZVa Anga "Digitalization"(analog-to digital picture conversion) "DICOMization" (DICOM - medical standard for digital images) DICOM HL7 CIMS (Clinical Image Mngm System) = PACS (Picture Archiving and Communication System) (+ RIS) special servers and SAN equipment (capacity cca 2-10 TB) IHIS (Integrated Hospital Information System) standard ERP and HR SW, clinical SW, specialist hospital SW (pharmacy, radiology (RIS), labs...) HL7 Standard SW SOE(Standard Operating Environment);Office(text, spreadsheets, presentation, e-mail, web browser);Anti-virus PC clients Pentium IV 533 MHz, RAM 256 MB, HD 20 GB, graphics 256-bit; COE (Client Operating Environment) Servers and SAN (Storage Area Network) equipment IBIS (DB server 146 GB, appl. serveri); Office (mail, file/print, web); infrastruktura (AD/DNS/DHCP, backup) LAN (Local Area Network) 1 Gb/s optical backbone, 100 Mb/s to the desk

23. Clinical hospital - Value of informatization Special medical devices Radiology Endoscopy Surgery Urology CTd MRId RNGd CTa MRIa RNGa UZVa Anga "Digitalization"(analog-to digital picture conversion) 10% "DICOMization" (DICOM - medical standard for digital images) DICOM CIMS (Clinical Image Mngm System) = PACS (Picture Archiving and Communication System) (+ RIS) special servers and SAN equipment (capacity cca 2-10 TB) HL7 20% IHIS (Integrated Hospital Information System) standard ERP and HR SW, clinical SW, specialist hospital SW (pharmacy, radiology (RIS), labs...) HL7 40% Standard SW SOE(Standard Operating Environment);Office(text, spreadsheets, presentation, e-mail, web browser);Anti-virus 5% PC clients Pentium IV 533 MHz, RAM 256 MB, HD 20 GB, graphics 256-bit; COE (Client Operating Environment) 10% Servers and SAN (Storage Area Network) equipment IBIS (DB server 146 GB, appl. serveri); Office (mail, file/print, web); infrastruktura (AD/DNS/DHCP, backup) 5% LAN (Local Area Network) 1 Gb/s optical backbone, 100 Mb/s to the desk 10%

24. key characteristics and benefits • Telemedicine Segment • videoconference as the key service • intreractive real-time communication • diagnostic, consulting, practice, education • direct patient welfare

25. we have tested videoconferencing over multiple ISDN lines and IP • Test Cases • Polycom (ex. PictureTel) videoconferencing equipment • H.321 and H.323 protocol suite • 4 ISDN BRA lines (512 Kbps) within Croatia and with medical institutions in Germany, USA and Japan • IP over Frame Relay/ATM network (768 Kbps) within Croatia • exchange of video, ECG (color doppler) and other medical data in the form of files containing pictures and/or documents

26. ICT Platform Architecture

27. ICT Platform structure breakdown

28. diverse Applications are supported • ICT Platform – Applications and Quality of Service • medical and business (specific medic apps, videoconference, IP telephony, SAP) • advanced network resource management

29. Data Center Disaster Recovery Site HQ + DRC Service Provider Regional Medical Centers, Service Provider Small Medical Offices, Mobile Units, LANs business continuity must be ensured Distribution Core Distribution Access

30. Internet WAN modular network architecture • ICT Platform – Network Architecture and Technologies • LAN (Ethernet-based, 10/100/1000, VLANs, WLANs) • WAN (Frame Relay, ATM, IP/MPLS VPN - leased from SP) • Remote Access (dedicated or Internet, PSTN/ISDN, ADSL, GPRS, UMTS future) LAN

31. security, standardization and legislative

32. SECURITY IS AN EVER EVOLVING PROCCESS !!! • Security • NOT an ICT segment !!! • NO single-point, single-layer security • comprehensive, proactive proccess • spread accross all ICT layers • BS 7799 standard • HIPAA

33. standardization and legislative should be generators and not obstacles • Standards and Legislative Aspects • equipment, applications • business process standardization • increased efficiency, • decreased costs, • legislative as a strategic stronghold

34. attention must be payed to ... • Key Issues • well-defined framework • converged ICT platform • standardization, legislative • joined efforts and coordinated activities with internal and international subjects

35. Vision of Croatian eHealth network platform

36. . . . with a complete ICT Solution • T-Com in Croatia has • telemedicine experience • internal and DT Group expertise • partnership biosphere • broad range of implemented technologies and services • nationwide network coverage