eH ealth Technologies for Lithuanian Health Care

1. eHealth Technologiesfor Lithuanian Health Care Prof. Arūnas Lukoševičius Biomedical Engineering Institute Kaunas University of Technology, , eBaltic Forum Riga 2006 04 06

2. Biomedical Engineering Institute Kaunas University of Technology • Activities: • Telemedicine support centre • eHealth architecture and implementation • Clinical decision support systems • Signal and processing methods and software • Ultrasonic medical diagnostics • Prototyping of hardware, sensors and transducers • Wireless technologies Studentų street. 50, Kaunas, LT-51368, tel. 407118, ISDN: 407114-407119 http://www.bmii.ktu.lt

3. Topics • Why eHealth? Lithuanian statistics and arguments • Principles of proposed architecture: patient centered • Principles of implementation: standard based • Electronic Health Record • Data mining and clinical decision support • Building bricks: international projects • Efficiency of eHealth: user benefits and functionalities • Cross - boarder cooperation and networking

4. Why eHealth? Lithuanian statistics and arguments

5. Citizens, specialists and facilities: figures

6. Statistics of health transactions

7. 3 9 19 Network of GP offices in Lithuania 12 17 0 21 3 3 4 2 0 10 7 6 7 13 11 12 1 4 3 13 4 26 4 4 37 3 17 9 11 8 5 17 4 2 4 10 10 20 7 16 44 0 10 8 121 14 6 0 13 16 17 4 13 10 14 17 13

9. Summary of data volumes generated at healthcare institutions

10. Year 2015 USA = 100 % ”Balls” rise steadily!! mc = management cost Cost = demand x unit price + mc Units = operative care, diagnostics, medication.. Value of a unit stays roughly equal Unit price raises Demand stays equal or grows due to relative aging !

11. ICT assistance is necessaryProposed eHealth system

12. Development of the Lithuanian Electronic Health Services Infostructure (EHSI): Implementation of an official health and healthcare information sharing and exchange system, to support lifelong continuity-of-care for healthcare professionals and citizens. (expert team lead by Dr. Dimitris Kalogeropoulos)First part - WB financed pilot national eHealth project 2005-6 • The project submitted in 2004 by MoH of Lithuania

13. Principles of proposed architecture: patient centered

14. Components of eHealth system with patient and his EHR in the centre

15. Person/ Machine user interface Contributions Services Stakeholders EHR Phase I Passive EHR EHR Phase II Active EHR Citizen Patient SPF   GP    Continuity of Care Pharmacy Polyclinics   Hospitals II level Hospitals III level E H R based billing Core E.H.R. (Episodes of Care, Diagnosis, Services) Security Layer Analytical E.H.R. (Diagnostic Service Departments) Decision Support Logic Middleware Layer Billing Clinical, Management & Communication Logic Data Processing Statistical Information Knowledge base MoH  State Public Health Ins. Service  Lithuanian Health Inform. Centre  Care Policy Planning State Drug Control Service/ State Pharmacy Department   State Patient Fund   Government registries – Pop Reg. Social Ins. Fund Legacy IS

16. Electronic Health Record

17. Continuous episode oriented health record

18. Principles of implementation: standard based

19. Middleware of common services

20. Medical Technology ADT, Logistics, Scheduling other Hospital systems EHR Instance Registry Citizens GPs/ FMPs Specialists Contributors Consumers MessagingEngine (CEN/TC251, ENV 13606-3 & 4, 13607, 12612, EN WI 130(SSR-MES)) Control – rules etc. H M Ds Information model Patient Data Collection, Ordering & Review Decision Support Healthcare (Business) Process/ Logic Modelling (ENV 12967, SAMBA) Communication Process Modelling Swimlane Healthcare Delivery & Decision Making Task Domain Development (metadata, rules, control) Care services Management Process Modelling Swimlane (healthcare mandate, decisions) Clinical Process Modelling Swimlane (perceived patient condition, health issues) Care Mandate (direct mandate, referral) Semantic Relationship Modelling (EN WI 133/DOM & ENV 12967: 2003 parts 1-3) Information Modelling (EN WI 133/DOM & ENV 12967: 2003 parts 1-3) Continuity of Care Concepts (CEN/TC251 ENV 13940) (Standard Controlled Medical Vocabularies, classification systems and registries) Low Level Record Components (Standard Controlled Medical Vocabularies, classification systems and registries – ICPC-2, ICD-10, ATC, GP registry, Citizens registry, Institutions registry, etc.) Primary Care Secondary Care Tertiary Care

21. Data mining and clinical decision support • Rationale • Technologies

22. Philadelphia Inquirer Sunday, September 12, 1999 Helping AVOID costly clinical errors

23. World population

24. Re-calculated statistics of deaths caused by medical errors (rough estimate, no direct evidence)

25. Rules Engine Alert/Reminder beeper fax email database Trigger Gather data Common Data Repository Add data Event Monitor System of Clinical Decision Support Clinical Workstation select patient record observation enter order

26. New cases with diagnostic parameters Decision tree Data Mining Data with known diagnosis Other medical testing (histology) Diagnosis New data with known diagnosis By D.Jegelevicius, Biomedical Engineering Institute, KTU. Generation of decision tree (example)

27. Example of decision tree automatically generated to support decision about differential diagnostics of intraocular tumours

28. Decision support: from the patient to knowledge bank and back Knowledge, rule bank Rules Knowledge General information Personalization Generalization Decision support Information Personal information Intervention, Health service Patient Data

29. Expert foresights Gartner Group: Predicts through 2002, >75% of healthcare organizations will implement rule-based technologies Beginning in 2000, computer-based patient record systems and data repositories that do not support an Arden Syntax-based, user-definable rules-processing system will lose market share. Vendors using Arden: Siemens McKessonHBOC Eclipsys IBM

30. Building bricks: international projects

31. Kaunas eHealth cluster • Medical Component - KaunasMedicalUniversity, Biomedical Research Institute, University hospital (largest in Lithuania, 2000 beds) other Kaunashospitals and polyclinics, Society of GP of Lithuania • Technological Component – Kaunas University of Technology, (KTU), ( the greatest technical university in Baltic countries, with 11 faculties, it’s Biomedical Engineering Institute having Telemedicine Support Center, (TSC), Biomedical Engineering Master Program, other Kaunas universities (5 in total); • Industry component – SMS companies Kardiosignalas[7], Elinta[8], Elintos prietaisai[9], Elsis[10]and other.

32. EU FP 5 PROJECTTELEMEDICARE • "The TelemediCare system permits advanced home care with maintained medical safety. The result is increased quality of life without increased costs." • -         Bo Lundell, Acting Division Manager,Astrid Lindgren Children's Hospital. •      New Market Possibilities •     Advances on modern information and communication technology have together with miniaturization of health diagnostic equipment given birth to a new revolution within health care. •     Body sensor technology facilitating mobile, multi-modal and wireless functionality will be key components to future intelligent and user friendly medical monitors. •     The integration of such sensors with new wireless network technology has given life to new possibilities for cost-efficient patient treatment.

43. Efficiency of eHealth: user benefits and functionalities

44. Users (beneficiaries) of eHealth srevices • Patients • Citizens • General Practitioners (GP) • Primary Care Centers • Specialists • Polyclinics • Hospitals • Health Information Centre (HIS) under the State Public Health Service (SPHS) • State Patient Fund (SPF) • Dept. of Pharmacy, State Drug Control Office (SDCO) • Software industry

45. Benefits and rationale categories • Benefits and rationale are already discussed evident enough to be structurised and even numbered !!! • HL7 EHR System functional Model and Standard Release 1.0., August, 2003, Why rationale categories, v.1.2

46. 1 To serve: (HL7 EHR System functional Model and Standard Release 1.0., August, 2003, Why rationale categories, v.1.2)

47. 2 To promote

48. 3 To ensure and ascribe

49. 4 To facilitate and enable

50. 5 Based on