Presentation meeting 2 Kink

eHealth in EstoniaPille KinkEstonian E-Health FoundationFacts about EstoniaEstonia45 227 km2 area of Estonia1.29 mio inhabitants60 hospitals464 GPsHealthcare expenditures5.9% from GDP 20116.3% from GDP 20122Estonian information system platform3eHealth systems in Estonia• Health Information System• Digital Prescription• Health Insurance Information System• Administrative and Product Registries• Public Health and Quality Registries• Telemedicine Tools used in health sector• Service providers information systems4ArchitectureSE EN CICIVRID EE M F O Y C N E G A E T A T Se r t n e C g n id o C - s e n ic id e m f o s r e ld n a H - D R A O B E R A C H T L A E H s r e d iv o r p e r a c h t la e H - s la n o is s e f o r p h t la e H - s t s im e h c g n is n e p s iD - N O IY TR AT LS UI PG OE R P SY SR ET NS I IG S UE BR S L A T IP S O H S R YO LT IMC O AD F S IC A M R A H P LS OE S OR HU CN S L A C ID E M Y C N E G R E M ESX-Road, ID-card, State IS Service RegisterX-ROAD GATEWAYSERVICENATION- WIDEHEALTH PRESCRIPTIONPATIENT PORTAL INFORMATION CENTREEXCHANGE PLATFORM 2010 januaryPHARMACIES AND 2008 decemberFAMILY DOCTORS5Security and authenticationHIE platform historyeHealthPlanning Project preparation Foundation eHealth Projectsinitiated (2003-2005) established (2006-2008)2000 2002 2004 2006 2008National HIEFunding decision by Ministryof Economic AffairsElectronic Health Digital DigitalDigital ImagesRecord Prescription RegistrationFunctionalities of healthinformation system:• Provide services to healthcare providers to simplifytheir every day work• Provide health information topatients• Central secure storage ofhealth data06.02.2013 8eHealth in numbersePrescription covers 97% of issued prescriptions.1.2 mio person have documents (93% of population) in centralsystem~ 97% of stationary case summaries have sent to the centralDB9New Patient Portal released 01.07.201310Number of patient queries11Possibilities for patientIn patient portal:• View and print out medical documents sent by health care providers tothe central system;• View information about their general practitioners and validity of healthinsurance;• Make informed consents;• Provide general information about themselves for health care providers;• Give authorisations for trustees;• Mask data for trustees and health care providers;• Monitor logsGet useful information and read explanations12STANDARDS13Standards• 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 act14Standardization processHealthcareSpecialty Socialprovidersassotiations ministryHealthEeHFInsuranceTerminology standardizationFundexperts specialistsUML+HL7 HISexperts developersCreate data Formalize Approveset and merge and publishXMLUML model Changes in NHISschemasdocumentsDescriptionData set document regulatory actClassificatorsdocumentsOID-s Examples Fixed version ofartifacts inpublishing centreStylesheets15Major architectural decisions of HIS• Integration through Central system (Opt-out)• HL7 v3 (extended)• Documents are kept in XML format (HL7 CDA)• All structured data fields have OID-s• Only final versions of clinical documents are sent into centralsystem• Reuse of national infrastructure– ID card for authentication and digital signature– Xroad for secure communication1166Benefits of eHealth Systems• Greater efficiency• Lower costs• Quality of care• Patient awareness about their health17LEARNINGPOINTS06.02.2013 18• Resources were planned only for centraldevelopment.• Usability. Developing process has to includemedical competence – users• Data quality is important– Complete and quality data give value.• Balance between security and usability– PIN for every document ...19Thank you!20