european ehealth considerations

PETR NOVOTNY European Commission, DG Information Society, eHealth Unit

E-HEALTH IN CENTRAL AND EAST EUROPEAN COUNTRIES with focus on Czech Republic, Hungary, Poland and Slovenia

Brussels 29.2.2004

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PREFACE AND THANKS...............................................................................................................................................................................................4 EXECUTIVE SUMMARY ...............................................................................................................................................................................................5 1. TELEMEDICINE IN EUROPE ...................................................................................................................................................................................12

1.1 Situation in EU 15........................................................................................................................................................................................12 1.1.1 Longer-term trends........................................................................................................................................................................12 1.1.2 The European healthcare ICT market...........................................................................................................................................12

1.2 Situation in Central and Eastern Europe ....................................................................................................................................................13 1.2.1 Introduction to Central and Eastern Europe (CEE)......................................................................................................................13 1.2.2 Demographic Data ........................................................................................................................................................................13 1.2.3 Health Indicators ...........................................................................................................................................................................14 1.2.4 Telemedicine Implementation ......................................................................................................................................................14 1.2.5 Economic and Information Technologies (IT) indicators ............................................................................................................15 1.2.5.1 GDP Gross Domestic Product ................................................................................................................................................15 1.2.5.2 IT penetration.............................................................................................................................................................................15 1.2.6 IT Spending...................................................................................................................................................................................17 1.2.6.1 Investment in IT (excluding telecommunications) compared to GDP......................................................................................17 1.2.6.2 ICT market shares in 2002 (Relative IT market size) ...............................................................................................................18

1.3 Online Search for health information Europe .............................................................................................................................................18 2. COUNTRY PROFILES..............................................................................................................................................................................................19

2.1 Czech Republic.............................................................................................................................................................................................19 2.1.1 Government Action Plans (AP) ....................................................................................................................................................19 2.1.2. List of National Information Society Related Websites..............................................................................................................19 2.1.3 Ministry of Health.........................................................................................................................................................................20 2.1.4 The use of the Internet in Czech Health Institutions in 2002.......................................................................................................20 2.1.5 Survey of the Information Systems (IS) in the Czech Hospitals 2003.........................................................................................20 2.1.6 Telemedicina.CZ - Telemedicine Projects in Czech Republic.....................................................................................................21 2.1.7 ROSCH Foundation ......................................................................................................................................................................22 2.1.8 IZIP Internet Medical Database.................................................................................................................................................22 2.1.9 MEDTEL & NetC@rd..................................................................................................................................................................23 2.1.11 Czech Society of Nuclear Medicine ...........................................................................................................................................23 2.1.12 PET center in Nemocnice Na Homolce hospital ........................................................................................................................24 2.1.13 IKEM CZ Institute for clinical and experimental medicine....................................................................................................24 2.1.14 Euromise .....................................................................................................................................................................................24 2.1.15 Branch Contact Organization - Healthcare (BCO).....................................................................................................................25 2.1.16 Coordination Center for Departmental Medical Information Systems ......................................................................................26 2.1.17 National Health Registers ...........................................................................................................................................................26 2.1.18 Central registry of R&D projects................................................................................................................................................27

2.2 Hungary........................................................................................................................................................................................................28 2.2.1 Ministry of Health.........................................................................................................................................................................28 2.2.2 Ministry of Informatics and Communication ...............................................................................................................................28 2.2.3 List of National Information Society Related Websites...............................................................................................................28 2.2.5 National Institute and Library for Health Information .................................................................................................................29 2.2.6 GYOGYINFOK Center for Healthcare Information.................................................................................................................29 2.2.7 Hungarian Office for Research and development ........................................................................................................................29 2.2.8 Institute of Experimental Medicine ..............................................................................................................................................29 2.2.9 OTKA National Research Institute............................................................................................................................................30 2.2.10 Computer and Automation Research Institute, Hungarian Academy of Sciences ....................................................................30 2.2.11 PROREC.HU & WIDENET.......................................................................................................................................................30 2.2.12 PRIMACOM...............................................................................................................................................................................30 2.2.13 RETRANSPLAT ........................................................................................................................................................................30 2.2.14 MiM Medical Info Media ........................................................................................................................................................31 2.2.15 VARIMED ..................................................................................................................................................................................31 2.2.16 List of Contacts ...........................................................................................................................................................................31

2.3 Poland ..........................................................................................................................................................................................................32 2.3.1 Ministry of Health.........................................................................................................................................................................32 2.3.2 List of National Information Society Related Websites...............................................................................................................32 2.3.3 ePolska (ePoland)..........................................................................................................................................................................32 2.3.4 National Health Care Programme.................................................................................................................................................33 2.3.5 Registry of Medical Services ........................................................................................................................................................33 2.3.6 National Pharmaceutical Portal ....................................................................................................................................................34 2.3.7 Informatization of hospitals in the Malopolskie province, 2002 .................................................................................................34 2.3.8 Telemedicine at University Hospital in Krakow ..........................................................................................................................34 2.3.9 Telemedicine in Poland.................................................................................................................................................................34 2.3.10 Research and Development Units...............................................................................................................................................35 2.3.11 The Role and Advantages of Using the Tele-ECG System in Daily Medical Practice - Telemedicine Project .......................35 2.3.12 Tele-ekg - CARDIAC MONITORING SYSTEM .....................................................................................................................36 2.3.13 Telewelfare.com..........................................................................................................................................................................36 2.3.14 PIONIER.....................................................................................................................................................................................37 2.3.15 Krakow Center of Telemedicine.................................................................................................................................................38 2.3.16 PRO-ACCESS ............................................................................................................................................................................40 2.3.17 The University Hospital in Krakow............................................................................................................................................42

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2.3.18 Telemed.......................................................................................................................................................................................43 2.3.19 E-rejestracja ................................................................................................................................................................................43 2.3.20 List of Contacts ...........................................................................................................................................................................44

2.4 Slovenia ........................................................................................................................................................................................................45 2.4.1 Governments Action Plans ..........................................................................................................................................................45 2.4.2 Ministry of Information ................................................................................................................................................................45 2.4.3 Ministry of Health.........................................................................................................................................................................46 2.4.5 List of Other National Information Society Related Websites.....................................................................................................46 2.4.6 Institute of Public Health ..............................................................................................................................................................46 2.4.7 Institute of Biomedical Informatics ..............................................................................................................................................46 2.4.8 Slovene Medical Informatics Association....................................................................................................................................47 2.4.9 SIZN - Nursing Informatics Interest Group .................................................................................................................................47 2.4.10 Telemedicine in Slovenia report .................................................................................................................................................47 2.4.11 Telemedicine Projects .................................................................................................................................................................48 2.4.11.1 Transtelephonic transmission of ECG.....................................................................................................................................48 2.4.12 InfoNet Healthcare Information Systems Company ...............................................................................................................50 2.4.13 Nova Vizia (New Vision) ...........................................................................................................................................................53 2.4.14 List of Contacts ...........................................................................................................................................................................53

Annex I................................................................................................................................................................................................................54 Telemedicine Implementation in CEE region Brief Overview..........................................................................................................54 Plans and organisations for Telemedicine implementation in CEE......................................................................................................57

SIBIS report (abstract) .................................................................................................................................................................................59 Annex III .............................................................................................................................................................................................................62

The use of the Internet in the Czech health institutions in 2002 .................................................................................................................62 Annex IV .............................................................................................................................................................................................................65

Survey of the Information Systems (IS) in the Czech hospitals 2003.........................................................................................................65 Annex V...............................................................................................................................................................................................................73

Telemedicina.CZ - Telemedicine Projects in Czech Republic..............................................................................................................73 Annex VI .............................................................................................................................................................................................................77

IZIP Internet Medical Database, Czech Republic ....................................................................................................................................77 Annex VII............................................................................................................................................................................................................80

MEDTEL & NetC@rd, Czech Republic .....................................................................................................................................................80 Annex VIII...........................................................................................................................................................................................................82

National Health Registers, Czech Republic.................................................................................................................................................82 Annex IX .............................................................................................................................................................................................................87

E-HEALTH CARE IN HUNGARY, REPORT NO. 1..........................................................................................................................................................87 Annex X...............................................................................................................................................................................................................89

EHEALTH CARE IN HUNGARY, REPORT NO. 2 ...........................................................................................................................................................89 Annex XI ...........................................................................................................................................................................................................131

Department Of Informatics, National Institute And Library For Health Information, Hungary ..............................................................131 Annex XII..........................................................................................................................................................................................................134

Regional and International Integrated Telemedicine Network for Organ Transplant, Hungary ..............................................................134 Annex XIII.........................................................................................................................................................................................................135

Health care on-line abstract from ePolska Action Plan, Poland.............................................................................................................135 Annex XIV.........................................................................................................................................................................................................138

Informatization of hospitals in the Malopolskie province, Poland ...........................................................................................................138 Annex XV ..........................................................................................................................................................................................................148

Telemedicine at University of Krakow hospital, Poland...........................................................................................................................148 Annex XVI.........................................................................................................................................................................................................150

Telemedicine in Poland..............................................................................................................................................................................150 Annex XVII .......................................................................................................................................................................................................156

Research and Development Units, Poland.................................................................................................................................................156 Annex XVIII ......................................................................................................................................................................................................159

Tele-ekg - CARDIAC MONITORING SYSTEM, Poland.......................................................................................................................159 Annex XIX.........................................................................................................................................................................................................163

Telemedicine in Slovenia MESS report..................................................................................................................................................163 Annex XX ..........................................................................................................................................................................................................167

Telemedicine in Slovenia...........................................................................................................................................................................167 Annex XXI.........................................................................................................................................................................................................180

Health Insurance Card Project Health Insurance Institute, Slovenia .....................................................................................................180 Annex XXII .......................................................................................................................................................................................................182

InfoNet healthcare information systems company, Slovenia .................................................................................................................182

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Preface and Thanks This report was done during my stage with eHealth Unit of Directorate General (DG) Information Society at European Commission from October 2003 to February 2004. It was done in order to compliment my previous experience in the telecommunication sector and to broaden my views in one of the leading industries of the near future that will be very dependent on information and communication technologies. The aim of this report is to give an overview about countries basic indicators, governments action plans for eHealth, and provides a collection of different telemedicine projects and studies that have been conducted in Central and Eastern Europe. The focus is on the following 4 countries: Czech Republic, Hungary, Poland and Slovenia. Telemedicine work in these four countries is presented in separate chapters. The overview is divided into short introduction on EU 15 eHealth market situation, general information about Central and Eastern Europe (CEE) and more detailed description of above mentioned four countries. The latter consists of presentation of official policy of each country, and eHealth and telemedicine projects/ pilots in the various medical fields where telemedicine is already of increasing importance. The projects and studies presented here do by no means cover the whole area of what is currently going on in the field of telemedicine. They represent a selection made by the author based mainly on the availability of the information on the Internet and response to the queries done by the author. Many more articles would also have been suitable for presentation, but due to the limited amount of space and time for collection as well as due to the lack of information in English on Internet, this was not possible. The sources from which the articles were obtained were the Internet and the contributions from public and private institutions.

I would like to thank the following people for helping me during creation of this report: Within the European Commission, eHealth unit: - Ilias Iakovidis (advisor) - Jean-Claude Healy - Silas Olsson - Andreas Lymberis - Octavian Purcarea - Sigurd von Ingersleben - Benedicte Vasseur-Tries - Jacqueline Teller Within the accessing countries - Jiri Valek the Czech Republic - Jana Zvarova the Czech Republic - Sandor G. Vari Hungary - Tamas Gergely Hungary - Pal Simon Hungary - Mariusz Duplaga Poland - Witold Poniklo Poland - Bostjan Bercic Slovenia - Livia Tusar Slovenia Petr Novotny

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Executive Summary Objective: The main focus of the report is to describe current situation on eHealth and telemedicine (these two (2) terms will be used interchangeably) in Central and Eastern European Countries, namely Cyprus, the Czech Rep., Hungary, Poland, Romania, Slovakia and Slovenia. Methods: Information was collected primarily from available internet websites as well as by contacting relevant experts by e-mail and phone. Information was translated, analysed and classified in several categories and tables. The main report (53 pages) includes European Information Technologies market overview, Central and East European (CEE) countries basic indicators and separate chapters on eHealth situation and more detailed collection of pilots in 4 countries: Czech Republic, Hungary, Poland and Slovenia. The supporting materials such as complete surveys reports, detailed articles mentioned in the report, contributions from the other authors and other material are contained in the Annexes (130 pages). Findings: There are many pilots, especially in Central European Countries, that are mostly local in nature and often without any government or Health Authority commitment. All of the countries studied have eHealth action plans that often stems in different ministries than Ministry of Health. In some cases, such as the Czech Republic, Poland, and Slovenia, the competency and sometimes co-funding lies within Ministry of Health. Majority of the development and set up of pilots have been financed from private sources, but without follow up. The pilots are predominantly telemedicine services such as teleconsultation. Slovenia has made significant progress in deployment of electronic health record and health cards and has the only viable eHealth service that the author found in his research. Several countries are following that example of insurance based health data system. Also, the region of Krakow (Malopolskie) has made significant progress in planning and deploying eHealth systems and services. The findings of author lead to one major conclusion: creation of favourable environment for all the players (ministries, users, industries and social insurance players) to have common understanding and objectives through open dialog and optimising of resources. The national and regional plans should draw from the experiences and best practices that were developed elsewhere and that were supported by the EU research and development programmes in eHealth. More extended summary of the report follows: Telemedicine Todays worldwide aging of the population is a direct consequence of the ongoing global fertility transition (decline) and of mortality decline at older ages, population aging is expected to be among the most prominent global demographic trends of the 21st century. Population aging is progressing rapidly in many industrialized countries, but those developing countries whose fertility declines began relatively early also are experiencing rapid increases in their proportion of elderly people. This pattern is expected to continue over the next few decades, eventually affecting the entire world. Population aging has many important socio-economic and health consequences, including the increase in the old-age dependency ratio. It presents challenges for public health (concerns over possible bankruptcy of Medicare and related programs) as well as for economic development (shrinking and aging of labour force, possible bankruptcy of social security systems). [1] The challenge for the health sector is to improve the standard of living through increased technology utilization reducing the costs of healthcare. It is clear that such technologies are changing the face of healthcare. For example, the Internet already offers society the opportunity to become better informed on health issues. This could eventually result in major changes in the relationship between doctor and patient. The UK Foresight Programme provides one vision of this future: By 2020 [] the first point of contact with health care will be through a virtual cyber-physician (CP). Accessed through a TV screen, the CP system will replace other forms of triage such as the telephone and give access to information about professionals, hospitals and other aspects of health care. (OST, 2001, p. 18)

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Changing patterns of information sharing and patient/doctor relationships will bring some fundamental changes to health organizations and the working relationships of health personnel. For instance, ICT systems are set to revolutionize information sharing between health professionals, e.g. through the development of seamless electronic patient records. It is widely anticipated that clinicians will have access to information and decision support at the point of care. This could occur by using a computer screen in offices and surgeries, or through a personal digital assistant (PDA) or mobile phone on wards and in other circumstances, including emergencies. Of course, changes in information-sharing patterns will bring different security concerns onto the health agenda. The security of health information is likely to be provided by a range of procedures and technologies, such as smart cards or biological identifiers. Telematics is the use of ICT to solve any type of problem remotely. Telemedicine is the application of telematics to facilitate healthcare delivery, and is defined by the EU Telemedicine Project as the investigation, monitoring and management of patients, using systems which allow ready access to expert advice and to patient information, no matter where the patient or relevant information is located. The major benefits of telemedicine applications are the improvements in the speed and cost of health services as well as an expected increase in the quality of patient care. Despite the high initial costs of investing in hardware and software, this should ensure considerable savings in the long term. [2] Central and East European Countries This report is primarily dealing with Central and East European countries and the telemedicine situation including Governments Action Plans for eHealth, telemedicine pilots and projects that are planned for the near future or that has already taken place on national or regional level. It also contains surveys concerning IT state and plans in the hospitals of the respective countries. The countries covered in the report are Cyprus, Czech Republic, Hungary, Poland, Romania, Slovakia and Slovenia with special focus on Czech Republic, Hungary, Poland and Slovenia. The total population of these countries is 89.5 M people with Poland being the most (38.5 M) and Cyprus the least (745 K) populated. The projected population in 2030 is 86.5 M people. The number of the people with the age structure 65 years and older is on average 13% of the population at the moment. This number is expected to increase. Life expectancy is 74 years on average with Cyprus (77.27 years) having the longest and Romania (70.62 years) having the shortest life expectancy. The average health expenditure in region is around 6% of GDP with Slovenia having the highest (8.2 %) and Romania the lowest (3.9%) expenditure. The Czech Republic claims to have 0.4% investments into health informatics as part of the total health expenditures (7.24% of GDP). The total GDP of the selected countries is almost 937 billion USD. This figure can be compared to the GDP produced by Spain in 2002 (850.7 billion USD). The leading GDP in the region has Poland (368.1 billion USD). The purchasing power per capita is on average 13800 USD but there are big differences in the region. The highest figure is showed by Slovenia (18000 USD) and the lowest by Romania (7400 USD). Regarding IT penetration although, on average, 77% of households in the candidate countries now have a fixed telephone service as compared to 86% in the EU-15, the penetration rates for fixed telephone services in some countries hide large differences in penetration between urban and rural areas. From the observation that mobile penetration is starting to overtake fixed penetration in some Candidate Countries (CCs) and considering that technological innovations in mobile transmission (2.5 G and onwards) allow mobile networks to become Internet delivery platforms, it follows that these mobile networks have the potential to become the main Internet and voice delivery platform in the CCs, at least in those areas with poor fixed terrestrial infrastructure. (IPTS, No.77 JRC Seville, September 2003) At the end of 2001, 11% of the population in the Central and Eastern Europe (CEE) accessed the Internet an average of once a month, compared with 39% for West Europe as a whole (EITO, 2002). The low PC and Internet

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penetration in general, particularly at home, limited by the access charges and high cost of PCs, the low level of fixed-line penetration, and low penetration of alternative access technologies, may represent a potential bottleneck for short to medium term Internet development in the region. (IPTS, No.77 JRC Seville, September 2003) As far as IT spending number of the countries still invest about 2% of GDP annually into IT, which suggests that it still will take couple of years for the region to reach IT penetration and spending levels of current EU15 states. The highest IT spending is reported in the Czech Republic (4%) and the lowest in Romania (1.5%). Per capita spending is reported highest in Slovenia (257 EUR) and lowest in Romania (30 EUR). Across the CEE region there are key differences in terms of current ICT market development, demand for specific technologies and the growth potential of individual country markets. The largest ICT spending has been reported in Poland (15.049 M EUR) and the Polish market represents 37.6 % of all region. The average ICT spending for the region is 4 M EUR. A survey carried out in 2002 shows that nearly 30% of Internet users in CEE reported online search for health-related information during 12 months period. Compare to EU15 (36,4%) its quite a satisfactory number but still low compare to U.S. (58.3%). Unfortunately the survey doesnt contain success rate of searching for CEE countries. The success ration in the other countries was about 80 %. Czech Republic In the Czech Republic Ministry of Informatics (www.uvis.cz) is in charge of development of national action plan for information society. The projects dealing with health (Zdravotnictvi online) are in the competency of Ministry of Health (www.mzcr.cz) and are set for 2001 2005 with the total budget around 9700 EUR. The use of the Internet in the health institutions survey that was conducted in 2002 by the Institute of health information and statistics showed the following results: 51.5% of the institutions responded to the survey 86.3% of the institutions that have responded and have access to the Internet use it for gaining of the

information mostly legislative and then pharmaceutical information respectively. 74% use it for communication with insurance companies and then other administration respectively. 99% have access only from health institution, 38% only from home, 23% from the institution and home The survey hasnt given any result about how many institutions are connected to the Internet, it only shows the purpose of using of the Internet. Another survey conducted by Ministry of Health shows the state of hospital information systems (HIS) in the Czech hospitals in 2003. The return rate of the sent questionnaires was 24% and it revealed the following results: 70% of the institutions that have responded have complete or at least half-way to complete HIS. Only 3% of the institutions with complete HIS consider change of the system. 17% of the institutions with incomplete HIS are satisfied, 40% look for change. 61% of the institutions with incomplete HIS consider lack of finances as main barrier for completion. Czech doctors show preference for future implementation of PACS-type solutions but very low interest in

management support systems and public solutions. The IT personnel in Czech hospitals are without any influence on management decisions. There are few telemedicine projects already working in Czech hospitals. A good start for the overview is a portal www.telemedicina.cz with list of project and pilots already running or planned in Czech hospitals. Some of the projects done are Interventional teleradilogy, Acute neurotraumatology, Telepathology, etc. The platform was until recently supported by Czech Telecom. Another two big projects that are done in cooperation with VZP the biggest health insurance company in the Czech Republic are IZIP medical record online and NetC@rd - EHR. Most of the telemedicina.cz projects where possible due to the sponsorships and donations of private organizations such as Czech Telecom that unfortunately stopped recently its support and at present most of the planned projects are on hold. In the case of VZP the project results are available only to the patience covered by this insurance company.

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In the future is will be necessary that these projects are done with support of entity such as Ministry of Health is we want to avoid failures of the projects due to the withdrawal of private sponsors that currently they are dependant on. Or that they are only available to the patience covered by sponsoring insurance company. There are also many institutes dealing with telemedicine. They are for example: - Czech Society of Nuclear Medicine - IKEM CZ Institute for Clinical and Experimental Medicine - Euromise Education and Research in Medical Informatics - Branch Contact Organization in Healthcare - or Coordination Center for Departmental Medical Information Systems Hungary In Hungary Ministry of Informatics and Communication (www.ihm.hu) is in charge of eHungary, an action plan for information society for the years 2004 2006. eHealth is one of the sectoral responsibilities for the AP. A survey made in 2001 by GKI Economic Research Inc. (http://www.gki.hu) has revealed that while all of the Hungarian outpatient centres possess and operate computer systems, only three-quarter of them is able to systematically lead the medical history of the patients by a suitable software system. A survey conducted in 2001 by GKI Economic Research Inc., Westel Mobile Communication Inc. and Sun Microsystems Hungary Ltd. on hospitals, outpatient stations, general practitioners and other health care institutions has revealed the following facts: 9/10 of hospitals and 1/3 of outpatient stations had an Internet access. Electronic communication between different institutions is rather an exception Internet is used mainly for searching for professional information, developing contact with Hungarian or foreign

clinics and scientific centers and libraries. of GPs are able to access the Internet from work 4% of GPs have their own website to spread medical information and consultancy According to the survey the development of Internet access and webpage creation among general practitioners has a very positive tendency. It was expected to double in 2003. Local outpatient centres with Internet access are searching for the following information: social security rules laws, decrees and other regulations professional articles description of drugs Moreover, local outpatient centres with Internet access regularly make electronic contacts with the Ministry for Health, the Social Security Fund, other hospitals and laboratories. There are no local outpatient centres, which operate a service empowering patients to check in via Internet for a medical examination. Another survey shows that 64% of the IT assets owned by the healthcare institutions (incl. software/hardware) are more than 3 years old. This ratio is 66% for PCs and terminals, 67% for software, and 52% for mainframes, network and accessories. There is a wide selection of Government sponsored tenders in order to disseminate digitally based devices, methods and activities in the field of e-Health care. For example there are regularly repeated Government tenders with the aim of providing direct support for doctors, nurses, social care workers and others in the form of granting for them PCs, Internet access or ISDN connection cheaply or for free. In some case the co-financing of the tenders by private companies is available.

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A way for overview about telemedicine projects in Hungary is a health care portal Varimed (www.varimed.hu). It lists the projects especially from international cooperation such as PROREC.HU & Widenet, Primacom or Retransplant. E-health care is also promoted by various professional organizations such as: - Hungarian Foundation for Medical Informatics - Hungarian Society for Medical Informatics - GYOGYINFOK Center for Healthcare information of MoH - National Institute and library for Health Information - Institute of Experimental Medicine Poland In Poland Ministry of Scientific Research and Informatization technology (www.kbn.gov.pl) is in charge of development of national action plan for information society. The document ePoland for 2001 - 2006 follows the approach of eEurope+ and contains specific tasks for Health care on-line projects such as Creation of a uniform electronic data base on medical establishments and facilities available via the Internet, Creation of database on patients covered by health insurance, etc. The positive message is that MoH (www.mz.gov.pl) is usually the source of financing for these projects. The survey about Informatization of hospitals in Malopolskie province in 2002 with 98% questionnaire return showed the following results: All hospitals have IT personnel. 47% are permanent employees, the rest are contractors, external firms or mix of

the two 18% have complete network, 56% have at least half-way to completion network, 8% have absence of network! 18% states full or near the integration of the software. The rest are long way from software integration. 61% is declaring 3 years to be horizon for planned informatization. 45% of hospitals plan to spend max. 65.000 EUR on IS building. Another 45% plans to spend funds beginning

from 100.000 EUR, which is more realistic. There is a range of telemedicine projects already implemented in Poland as they can be seen for example in Telewelfare.com (telezdrowie.pl), portal offering interactive service for diagnosis and rehabilitation of senses responsible for communication. Krakow Center for Telemedicine is also a center for telemedicine projects mainly focused on teleconsultation, telemonitoring and tele-education. Other examples can be also tele-ecg project that has been running in Poland from mid. 90s or project called Improvement of Care Delivery for Severe Asthma Patients co-financed by MoH and Ministry of Scientific Research and Informatiozation Technology www.astma.web.pl. Slovenia In Slovenia Ministry of Information (http://www2.gov.si/mid/mideng.nsf) is in charge of development of national plan for information society. Health is 1 of 12 e-services for citizens and 1 of 15 areas of Action Plan up to 2004. Responsibility for health area projects is in domain of Ministry of Health (http://www2.gov.si/mz/mz-splet.nsf). Ministry of Information runs Slovenian eGovernment portal since 2001. It provides range of e-services & government information for citizens, businesses and civil servants. Ministry of Health is responsible for National Health Sector Management Project and others like e-Waiting lists and E- SPP projects which the Health Sector Management Project initiated. Report of Ministry of education, science and sport (http://www.mszs.si/eng/) includes some interesting data regarding budgets allocated for research in Slovenia. Slovenia has investments in healthcare 8.6% of GDP = 1.877.3 M EUR. The proposed Slovenian direct investment in healthcare informatics (MoH) for 2004 is 4.3 M EUR. As far as telemedicine Slovenia is very successful with the implementation of EHR when all Slovenian residents have this card for at least one year. HIC includes basic information on the health of the particular person. The project was done in cooperation with ZZZS Institute of Health Insurance in Slovenia. Other telemedicine projects

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implemented in Slovenia are - just to name few for example transtelephonic transmission of ECG used regularly by health institutions, PRIMACOM as international project, RETRANSPLANT or WIDENET. There are also many institutes dealing with telemedicine. They are for example: - Health Informatics Standards Board - Health Informatics Council - Centre for Health Informatics - Institute of Biomedical Informatics - Slovene Medical Informatics Association - or Nursing Informatics Interest Group SIZN Conclusion eHealth Activity There is need for eHealth, mostly personal endeavours, lot of interest Lack of Health Authority commitment and leadership Most of the contries have some sort of eHealth action plan but it often stems from other ministries than Ministry

of Health (MoH). Although it is sometimes co-funded by MoH and/or the responsibility rests with MoH. There is certainly telemedicine activity in the CEE region. Most of the projects are introduced by doctors or

businesses but they are rarely supported by official government sources. The result is that they are rather individualistic not systematic projects.

Doctors in the countries of focus were not aware of any national eHealth plans. This means that Ministries of Health in the surveyed countries should improve their communication to the medical staff.

National versus Regional Pilots and Implementation In the large countries regional differences in the level of telemedicine can be expected (Poland) while in the

small countries the activities can be easier implemented nationally (Slovenia). Without a favourable environment of cooperation between state and private sector the projects will be rather

standalone than national. Funding and sustainability Majority of the projects has been financed from private sources, which carries the danger of sudden termination

of partner from the projects (Czech Telecom) and causing the projects to be on hold before another strategic partner is found. MoH should play more active role in the promotion granting and implementation of telemedicine projects to avoid this danger in the future.

Challenges To find a solution by defining common goals and cooperation between state and private sectors. This is

important for the systematic approach to eHealth and it will be important especially in the larger countries. To help to improve the communication to the doctors and to increase the number of professionals involved and

interested in the matter through these partnerships. Trends for the near future Governments will be forced to adopt certain eHealth strategies accompanied by concrete actions if they want to

keep up with the future demands on health care and reduce increasing costs in the long run. State sector will need to cooperate with private sector for implementation of successful nationwide projects. The growth of the nationwide initiatives will enable use of electronic health record (EHR). In case there is a 1 health insurance institute in the country than the projects as Electronic Health Card (EHR) is

done to cover the whole population (Slovenia). In case there are more than 1 health insurance providers then it is done to cover primarily the insured persons of the sponsoring insurance company (Czech Republic).

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Hospitals are going to be more interconnected for running the telemedicine solutions using ISDN connection in short/medium timeframe and broadband connection, as it becomes available and financially feasible.

All hospitals are going to have access to the Internet using dial-up or fixed connection. Medical professionals will continue to use Internet for searching for information concerning their field of

specification. They will use the Internet as a main instrument for correspondence. As the number of the households connected to the Internet grows, the number of the websites/portals dedicated

to patients with certain decease (for ex. diabetes) will grow as well. It will also increase online communication between doctors and patients - email exchange, on-line booking systems.

Solutions

Addressing common challenges Health authorities leadership Creation of favourable environment for all players to have common understanding and objectives Interoperability of health information systems Constant enhancing of the information and communication technologies infrastructure Leveraging investments Accelerating beneficial implementation Information to citizens and authorities for health education and disease prevention Integrated health information networks

Facilitating synergies and monitoring Disseminating best practices Benchmarking International cooperation

Source: [1] http://longevity-science.org/Population_Aging.htm;

[2] http://www.emcc.eurofound.eu.int/publications/2003/sf_hss_1.pdf

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1. Telemedicine in Europe 1.1 Situation in EU 15

1.1.1 Longer-term trends Population ageing is consistent across the globe. At the start of the twenty-first century, the world population included about 600 million people aged 65 and older (10% of the world population), triple the number recorded 50 years earlier (or 8% of the world population in 1950). By mid-century, there will be some 2 billion older persons (21%), once again a tripling of this age group in a span of 50 years. An ageing population has considerable implications and expected impacts on a wide variety of socio-economic factors and processes, such as economic growth, capital markets, pension systems, but also on technical progress and innovations, education and human capital, family and household structures - and last, but not least, on the health and social care system. It implies that the prevalence of chronic diseases will grow and the numbers of disabled persons rise. Evidence of age-related rationing of health interventions has been documented in some countries in the European Region. [1] For example Liz Lloyd discusses the nature of health and social care interventions in the care of older people dying in Britain. [2] The health sector is today already one of the leading sectors of all industrialized societies. It is to be expected that health in a wider, holistic sense - by encompassing wellness, personal development, environmental protection, biotechnology and the like - will further develop into the new leading industry of the 21st century. Source: [1] ICT&e-Business in the Health and Social Services Sector, the European e-Business Market Watch, sector report No.7 II/January 2003 [2] LLOYD, L. (2000). Dying in old age: promoting well-being at the end of life. Mortality, 5, 171 188.

1.1.2 The European healthcare ICT market It was estimated that the European Healthcare Information Society Technology (HIST) market amounted to approximately 11 billion Euro in 2001, which would account for less than 2% of the total western European ICT market of about 643 billion Euro p.a. Considering the economic relevance of the health sector for the EU with total expenditure of more than 8% of GDP, this HIST market value is very low and amounts to about 1.6% of the overall EU healthcare market estimated at 700 billion Euro for 2001. In the hospital sector, for example, the level of total annual IT investment is estimated at only 1.2% of all expenditures as compared to 2.5% in the USA and up to 10% (for ICT) and more in other information-intensive sectors such as financial services. Also for the USA, it is estimated that with a 50% penetration, Healthcare has the lowest penetration of Internet business solutions, but at the same time it is assessed that this sector may have the greatest upside with regards to cost savings in the future. Considering the relevance of the health sector for economic activity and employment, this state of affairs may be surprising. But when reflecting on the earlier discussions, a variety of factors come to mind which help to explain this situation: the wide variety and complexity of national healthcare systems, the varying and shifting public/private mix of delivery and financing, the size structure of the establishments, the complexity of communications relationships, the wide variety of business partners and the particular type of customers. All of these and additional factors render an analysis of the sector particularly challenging, and the dearth of detailed information and hard facts on ICT and e-business applications in this sector confirms this. Source: ICT&e-Business in the Health and Social Services Sector, the European e-Business Market Watch, sector report No.7 II/January 2003

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1.2 Situation in Central and Eastern Europe

1.2.1 Introduction to Central and Eastern Europe (CEE) From early nineties, Central and Eastern Europe countries (CEEC) have undertaken considerable efforts to include themselves in the main activities related to research and development in health telematics in Europe. Countries of this region demonstrate diversified environment of economy transformation and healthcare system status. The process of market economy development brings essential risks to the healthcare system performance. What is also important, healthcare is particularly sensitive domain of social expectations. It seems that efforts of developing e-health environment in CEEC may be substantially accelerated by the co-operation with partners in current member states of European Union. [1] The use of e-health solutions may bring increased benefits for candidate countries with transforming economies. The reforms in healthcare systems are usually considerably delayed when compared to mainstream of changes taking place in these countries. The funds spent for healthcare are limited and the expectations of the society in this area are still growing. The implementation of telemedical applications may result in augmented effects in terms of quality of care and access of the patients to advanced diagnostic and therapeutic procedures. Source: [1] Mariusz Duplaga, Technologies to Central and Eastern European Countries, E-He@lth in Common Europe, Pro Access 2003

[2] Mariusz Duplaga, MD, PhD; II Chair of Medicine, Jagiellonian University, Krakow, Poland, The Promotion of E-Health Initiatives in Central and Eastern Europe Countries 1.2.2 Demographic Data Country Name

Total Population 1995 [1]

Projected Population 2030 [1]

Median Age 1995 [1]

Total Population (latest figure) [2]

Age Structure

(65 y.) [2]

Life Expectancy[2]

Cyprus

745,000 970,000 31.8 771,657 11.1% (male 37,345; female

48,284)

total population: 77.27 years male: 74.94 years female: 79.71 years

Czech Republic

10,230,060 9,412,000

35.8 10,249,216 14% (male 554,922; female 884,576)


Hungary

10,106,000 8,448,000 37.4 10,045,407 14.9% (male 544,099; female 952,775)


Poland

38,557,000 39,939,000 33.7 38,622,660 12.7% (male 1,879,445; female 3,044,636)


Romania

22,728,000 20,732,000 33.8 22,271,839 14% (male 1,290,343; female 1,837,339)


Slovakia

5,338,000 5,441,000 32.4 5,430,033 11.7% (male 238,912; female 396,582)


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Slovenia

1,925,000 1,687,000 36.4 1,935,677 14.7% (male 105,837; female 179,177)


Source: [1] Demographic Year Book, 1995 edition, UN

[2] CIA fact book, July 2003

1.2.3 Health Indicators Country Name

Health Expenditure as % of GDP [1]

General Practicioners per 100.000 in primary healthcare

No. of physicians / Physicians working in hospitals in % per 100.000 [2]

No. of hospitals / No. of hospitals per 100.000 [2]

No of nurses/ Number of

Nurses working in hospitals per

100.000 [2]

Cyprus

5.7% (2000) EUR 200,2 million

- - - -

Czech Republic

7.24 % (2000) Investment in health informatics 0.4% of total health expenditure

68.2 307,8 / 25.9 364 / 3.54 892,3 / 68.0

Hungary

5.7 % (2001)

67.0 361.4 / 32.5 172 / 1.71 385,1 / 85.0

Poland

6.2 %

- 233.0 / - 746 / 1.93 527 / -

Romania

3.9 %

81.3 191.4 / 50.7 425 / 1.89 404 / 58.3

Slovakia

5.7 % (2001)

44.4 322.2 / 60.1 134 / 2.48 723,3 / 68.7

Slovenia

8.2 % (2001)

45.0 215.2 / 52.8 26 / 1.32 693,1 / 53.9

Source: [1] Telemedicine Glossary September 2003: Luciano Bolchi (editor); [2] http://www.reformazdravotnictva.sk/pril/RZ_Data.pdf

Relevant data can be also obtained from WHOs HIT profiles at http://www.observatory.dk.

1.2.4 Telemedicine Implementation The following information was extracted from Telemedicine Glossary September 2003 edited by Luciano Beolchi and can be found in Annex I of the report. It contains information about: Brief overview about telemedicine implementation Plans and organization for the telemedicine implementation

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in Cyprus, Czech Republic, Hungary, Poland, Romania, Slovakia and Slovenia. 1.2.5 Economic and Information Technologies (IT) indicators

1.2.5.1 GDP Gross Domestic Product Country Name

GDP purchasing power parity (PPP)

GDP per capita PPP GDP real growth

Cyprus

Greek Cypriot area: - $9.4 billion (2001 est.); Turkish Cypriot area: - $787 million (2002 est.)

Greek Cypriot area: - $15,000 (2001 est.); Turkish Cypriot area: - $6,000 (2002 est.)

Greek Cypriot area: 1.7% (2001 est.); Turkish Cypriot area: 2.6% (2002 est.)

Czech Republic

- $155.9 billion (2002 est.)

- $15,300 (2002 est.) 1.5% (2002 est.)

Hungary

$134.7 billion (2002 est.) $13,300 (2002 est.) 3.2% (2002 est.)

Poland

$368.1 billion (2002 est.) $9,500 (2002 est.) 1.3% (2002 est.)

Romania

$166 billion (2002 est.) $7,400 (2002 est.) 4.5% (2002 est.)

Slovakia

$66 billion (2002 est.) $12,200 (2002 est.) 4% (2002 est.)

Slovenia

$36 billion (2002 est.) $18,000 (2002 est.) 3% (2002 est.)

Source: CIA fact book, July 2003

1.2.5.2 IT penetration Country Name

Telephones - main lines in use

Telephones mobile :

Telephone system: Internet users:

Cyprus

427,427 lines, 61.69lines/100 inhabitants (2002) [1]

417,933 60% penetration (2002) [1]

general assessment: excellent in both the Greek Cypriot and Turkish Cypriot areas domestic: open-wire, fiber-optic cable, and microwave radio relay international: tropospheric scatter; 3 coaxial and 5 fiber-optic submarine cables; satellite earth stations

150,000 (2002)

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Czech Republic

3,869,000 (2000) 37 lines/100 inhabitants [5]

9,342,200 (2003) [2] 91 mobiles/ 100 inhabitants [6]

general assessment: privatization and modernization of the Czech telecommunication system got a late start but is advancing steadily; growth in the use of mobile cellular telephones is particularly vigorous domestic: 86% of exchanges now digital; existing copper subscriber systems now being enhanced with Asymmetric Digital Subscriber Line (ADSL) equipment to accommodate Internet and other digital signals; trunk systems include fiber-optic cable and microwave radio relay international: satellite earth stations

2,690,000 (2001)

Hungary

3,095,000 (1997) 31 lines/100 inhabitants[5]


general assessment: the telephone system has been modernized and is capable of satisfying all requests for telecommunication service domestic: the system is digitalized and highly automated; trunk services are carried by fiber-optic cable and digital microwave radio relay; a program for fiber-optic subscriber connections was initiated in 1996; heavy use is made of mobile cellular telephones international: Hungary has fiber-optic cable connections with all neighboring countries; the international switch is in Budapest; satellite earth stations

1,200,000 (2001)

Poland

8,070,000 (1998) 21 lines/ 100 ihhabitants [5]

13,000,000 (2002) 34 mobiles/ 100 inhabitants [6]

general assessment: underdeveloped and outmoded system in the process of being overhauled; partial privatization of the state-owned telephone monopoly is underway; the long waiting list for main line telephone service has resulted in a boom in mobile cellular telephone use domestic: cable, open-wire, and microwave radio relay; 3 cellular networks; local exchanges 56.6% digital international: satellite earth stations

6,400,000 (2001)

Romania

4,174,000 (2002) [4] 18 lines/100 inhabitants [5]


general assessment: poor domestic service, but improving domestic: 90% of telephone network is automatic; trunk network is mostly microwave radio relay, with some fiber-optic cable; about one-third of exchange capacity is digital; roughly 3,300 villages have no service international: satellite earth station - 1 Intelsat; new digital, international, direct-dial exchanges operate in Bucharest;

800,000 (2002)

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Slovakia

1,934,558 (1998) 36 lines/ 100 inhabitants [5]


general assessment: a modernization and privatization program is increasing accessibility to telephone service, reducing the waiting time for new subscribers, and generally improving service quality domestic: predominantly an analog system that is now receiving digital equipment and is being enlarged with fiber-optic cable, especially in the larger cities; mobile cellular capability has been added international: three international exchanges (one in Bratislava and two in Banska Bystrica) are available

700,000 (2000)

Slovenia

722,000 (1997) 38 lines/ 100 inhabitants [5]


domestic: 100% digital (2000) 600,000 (2001)

Source: CIA fact book, July 2003,

[1] Cyta Annual Report 2002, www.cyta.com.cy, [2] www.eurotel.cz, www.t-mobile.cz, www.ceskymobil.cz, [3] http://www.templetonthorp.com/en/news349, [4] http://www.alcatel.com/newslink/0302/pdf/latitude.pdf [5] Formula: IT penetration.Telephones-main lines in use/Demographic Data.Total population [6] Formula: IT penetration.Telephones-mobile/Demographic Data.Telephones-mobile

1.2.6 IT Spending

1.2.6.1 Investment in IT (excluding telecommunications) compared to GDP Country Name

IT Spending EUR million

Share in % Ration IT/GDP in %

Per capita IT spending in EUR

Cyprus

NA NA NA NA

Czech Republic

2602 22.5 4 252

Hungary

1910 16.5 3.2 187

Poland

4093 35.4 2.1 106

Romania

680 5.9 1.5 30

Slovakia

729 6.3 3.4 136

Slovenia

510 4.4 2.4 257

Total CEE *

11574 100 2.6 110

* Includes Bulgaria, Estonia, Latvia, Lithuania Source: European Information Technology Observatory - EITO 2003

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1.2.6.2 ICT market shares in 2002 (Relative IT market size) Country Name

IT Spending EUR million

Share in %

Cyprus

NA NA

Czech Republic

6422 16

Hungary

6111 15.3

Poland

15049 37.6

Romania

3916 9.8

Slovakia

2296 5.7

Slovenia

1688 4.2

Total CEE * 40023 100 * Includes Bulgaria, Estonia, Latvia, Lithuania Source: European Information Technology Observatory - EITO 2003

1.3 Online Search for health information Europe The following data were acquired from SIBIS 2003 report. The full abstract can be found at Annex II. This report focuses primarily on presenting some statistics and indicator results from the SIBIS benchmarking surveys. The survey fieldwork was carried out in April May 2002 and January 2003. A representative General Population Survey (GPS) was conducted in 2002 in all 15 EU Member States, as well as Switzerland and the US, involving a total achieved sample size of 11,832 and in the above 10 Newly Associated States in 2003, involving a total sample size of 10,407. A representative survey of establishments the Decision Maker Survey (DMS) - covered 7 EU Member States, including the five largest Member States (Germany, Spain, France, Italy and the UK) as well as Finland, expected to be an information society frontrunner, and Greece, expected to be less well advanced. This involved a total achieved sample size of 3,139 establishments. It contains results of: Online search for health-related information (% of all Internet users) Online search for health-related information (% of population) Success in finding suitable health-related information on the Internet (% of Internet users who have searched online for health-related info in the last 12 months) Sibis website can be found at http://www.empirica.biz/sibis/.

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2. Country Profiles

2.1 Czech Republic 2.1.1 Government Action Plans (AP) Ministry of Informatics (http://www.uvis.cz) has developed their action plan for state information policy implementation for the years 2002 and 2003. The AP contains National AP eEurope+ CR that can be found in the Information democracy section of the AP. The part of point 3 The support of Internet use contains subsection Zdravotnictvi on-line (Health on-line). Zdravotnictvi on-line can be found in both APS for 2002 and 2003. Zdravotnictvi on-line can be found among 2003 AP projects. Following is the relevant abstract: Project Name Target

(Outputs) Competency Associate Partner Deadline Financial

Costs CZK Zdravotnictvi on-line

Registers, telemedicine, medical documentation

Health Ministry CR

ZIS R, KS RZIS, VIS (coherent with KI ISVS)

2001-2005

119.830 (2001) 71.000 (2002) 51.000 (2003) 35.000 (2004) 35.000 (2005)

Financial costs are in Czech korunas. At the time of the report 1 EUR = 32 CZK. The coherent steps with eEurope+ To build up telematic infrastructure in the health domain including regional networks for primary and secondary health care providers. To implement on national and regional level the basic qualitative criteria for web pages with the relation to health created in the EU member states. To interconnect the networks and databases of EU public health care. The coherent indicators of eEurope+ The percentage of the health professionals connected to the Internet. The use of various categories of information as web content by health professionals.

2.1.2. List of National Information Society Related Websites The Office of the CR Government (http://www.vlada.cz/): Comprehensive information on Members of the Cabinet and their program, links to the respective Ministries, search function (in government decisions), records from press conferences, etc. It also includes information of the CR Government Council for State Information Policy (http://www.vlada.cz/1250/eng/vrk/rady/rady.htm). Available in English.

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The Office for Public Information Systems (http://www.uvis.cz/): New website, currently under preparation. Access to basic documents related to State Information Policy, standards, and information from abroad, links to information resources. Available in English. Czech Forum for Information Society (http://www.info-forum.cz/indexe.html): The Forum is intended as a public dialogue on information society issues. Available in English. Czech Telecommunication Office (http://www.ctu.cz/index_a.htm): Site presents the origins of the Czech Telecommunication Office, its mission and activities. List of legal acts and implementing provisions. International activities. Available in English. Central website address (http://www.centralni-adresa.cz/cadr/index.htm): The official information system on public procurement and auctions. Link to the Public Administration portal (Prototype version) which is to become an integrated site to get information and/or use the services of public administration bodies. Available only in Czech. Source: eEurope+ 2003, Action Plan, June 2001 http://www.kbn.gov.pl/cele/eeurope/eeurope.pdf

2.1.3 Ministry of Health The official Ministrys web site can be found at www.mzcr.cz. The specialized section for Health informatics can be found at http://www.mzcr.cz/kat/8 (Czech version only). 2.1.4 The use of the Internet in Czech Health Institutions in 2002 The following data were acquired from the information bulletin no. 13 from 3.4.2003 of UZIS CR (Institute of health information and statistics CR). For the complete information see Annex III of the report. The report consists of the data concerning: The purpose of communication over the Internet. The purpose of acquiring information over the Internet. The use of the Internet in pharmacies and at GP office in 2002 The use of the Internet for gaining the Information 2.1.5 Survey of the Information Systems (IS) in the Czech Hospitals 2003 The survey was conducted by Ministry of Health CR and IPVZ (Institute of postgraduate education in health), Prague. For the complete report please go to Annex IV of the report. The following data come from Anketa informatiku ceskych nemocnic, vysledky jaro 2003 (Survey of IT personnel in Czech hospitals, results spring 2003), edited June August 2003, MuDr. Miroslav Seiner, IPVZ Prague. Note: HIS = Hospital information system The report consists of the data concerning: Return of the sent our questionnaires Types and size of the health institutions State and perspective of building IS

Current state of building of integrated HIS in the health institution Satisfaction with complete HIS Satisfaction with unfinished HIS The reasons for not implementing HIS

The opinions about the perspective of the various types of applications Interest in further IS

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HIS personnel Position of head of IT dept. Status of the position Education level of heads of IT dept.

Information and their relation to the institutions The requests to Ministry 2.1.6 Telemedicina.CZ - Telemedicine Projects in Czech Republic There has been an interesting project of Information platform organized by Prof. Rosch Foundation with the support of Czech Telecom. The aim of this project was a support of new technologies through the pilot project that were mainly focused on the clinical applications (teleconsultations of the doctors during the surgery or the transmission of these surgeries for the purposes of distant education and training of the doctors). The site is available at http://www.telemedicina.cz. You can see the list of individual projects that were executed or are planned in the Annex V of this report. Below is the map of the Czech Republic with the regional location of the projects. The picture shows that most of the telemedicine activity of the planned or executed projects within Telemedicina.CZ is located in: Prague region Southern Moravia, mainly in Brno Northern Moravia and Silesia, mainly in Olomouc and Ostrava There is also bigger activity in Eastern Bohemia, mainly in Hradec Kralove. Lower activity can be seen in all the regions of the Czech Republic. The biggest activity is in the regions neighbouring with Poland and Slovakia, centrally the biggest activity is in the Prague region.

Name of project/pilot Number Interventional teleradiology 1 Acute neurotraumatology 2 Home (tele-)working for neurosurgeons 3 Telepathology 4

1) 7) 8) 11) 12) 14) 15) 17) 1) 4) 6) 7) 10) 12) 13) 15) 16) 17) 18)

Zlin 8) 11) 12) 14)

1) 5) 7) 8) 12) 15) 17)

2) 3) 4) 7) 8) 12) 16)

4)

11) 14) 12) 11)

12)

4) 7) 9) 12) 15) 17)

4) 12)

10)

12)

13)

4)

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Interconnection of the Olomouc country hospitals 5 Telecardiology 6 Telehematology 7 Teleortography 8 Teleconsultations and treatment of acute myocardial infarction

9

Teleconsultation of laparoscopic executions 10 Interconnection of Brno region hospitals 11 Teletraumatology 12 Teleconsultation in the area of pediatric auxomology and syndromology

13

Interconnection of Injury hospital Brno with cooperating hospitals

14

Teleendoscopy 15 Teledermatology 16 Telearthroscopy 17 Telebronchoscopy 18

2.1.7 ROSCH Foundation Recent Activities Since established in 1998, the Foundation and its partners have participated in the following activities:

Five point-to-point tele-video medical specialty conferences between Prague and Portland, Oregon. Two multi-point televideo medical conferences between Prague, Graz and Portland, Oregon, USA. Regular multi-point televideo conferencing and teleconsutation services between a constellation of five

Czech hospitals in Prague, Hradec Kralove, Olomouc and Brno. Technical planning and performance of more than 20 hours of transmission of live cases and multi-point

panel discussion to the 6th and 7th International Workshop in interventional radiology. Live case transmission with demonstration of new minimal invasive procedures to five international

meetings in Europe and Asia. Performance of a three-hour tele-meeting on advances in minimal invasive treatment with physicians in

Japan. Teleconsultation in neurosurgery between 10 hospitals in Northern Moravia for facilitating diagnosis of

head and spine trauma injury management. Home working via PCs and ISDN services for neurosurgeons at the Ostrava Hospital in the Czech

Republic. Telepathology consultation at 6 Czech hospitals. Telecardiology at several Czech hospitals with successful transmission of echocardiographic studies and

teleconsultations. 2.1.8 IZIP Internet Medical Database For the full text please go to Annex VI of this document. You can find complete info about the project at the project website: http://www.izip.cz. The abbreviation IZIP in Czech language means Internet Access to Patient's Medical Information. The objective and substance of the IZIP project is to place the medical database of the insured patient into the public information network - the Internet.

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The database consists of selected parts of medical documentation written into IZIP by the attending physicians. Both the doctor and the patient may at any time use a computer with internet access to view the results of clinical examinations, laboratory tests and X-ray pictures as well as a list of prescribed and used medicaments. The IZIP project is executed by a private company IZIP Ltd., Prague, with the support of General Health Insurance Fund of the Czech Republic (VZP CR) and other partners such as IBM, Czech Telecom, Eurotel, Komercni banka and others. The application solution, software and implementation are supplied by IBM, and the Czech Telecom and Eurotel look after the data transfer. Initiators Initiators of the projects were Pavel Hronek otorhinolaryngologist, Milan Cabrnoch pediatrician and Miroslav Ouzky rehab doctor. Demo version Available at http://www.izip.cz/demo/ 2.1.9 MEDTEL & NetC@rd For the full text concerning MEDTEL and NetC@rd project, please go to Annex VII of this document. You can find complete info about the project at the project website: http://www.medtel.cz/index_e.php. MEDTEL, o.p.s. is a non-profit organization. MEDTEL is a member of EHTEL. NetC@rd project Czech Republic prepares countrywide introduction of new health insurance cards for the ensured persons of VZP (70% of population) at the middle of 2004. The card reverse will have European health insurance card (EHIC) format and CR will be one of the first countries where EHIC will be implemented. Goal of the pilot project The goal is to securely identify the insured person and to create the pre-requisite for the automated authorization of the transactions. Costs related to the Czech part: 310,000,- EUR 2.1.10 MeDiMed Regional Centre for Archiving and Interhospital Exchange of Medical Multimedia Data The website can be found at http://www.mou.cz and http://www.muni.cz. The goal of the project is to create shared outsourced medical multimedia data archiving and communication center which can serve as a Trustworthy Neutral Exchange Point for all participants of this project. More can be found at http://www.ten.cz/doc/2003/zprava/medimed.html (Czech only). 2.1.11 Czech Society of Nuclear Medicine The website of the Society can be found at http://www.csnm.cz/. PACS = Picture Archive and Communication System

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PET = Position Emission Tomography The website describes telemedicine, PACS and PET systems in particular with the links to the PET center in Prague at Nemocnice Na Homolce hospital: http://www.homolka.cz/nm/. However in the time of writing this document there has been a second PET center opened in Brno at Masaryk Oncology Institute hospital: http://www.moi.cz/. The web site also contains various statistics for Czech Republic nuclear medicine data.

2.1.12 PET center in Nemocnice Na Homolce hospital For the information about position emission tomography (PET) center, go to the official website: http://www.homolka.cz/nm/index-e.html. PET Center Prague is located in a separate building within the complex of Na Homolce Hospital. The Department of Nuclear Medicine is located on the first floor of PET Center Prague. It is equipped with dedicated PET camera CTI/Siemens ECAT EXACT and with Siemens SPECT camera (E.CAM).

2.1.13 IKEM CZ Institute for clinical and experimental medicine You can find out more about IKEM at http://www.ikem.cz IKEM hosts CZI MEDICON, Healthcare Informatics Center for the development and operation of application and communication environment of the healthcare data network in the Czech Republic. It is a valuable resource for public, health outcome researchers, and academicians both in and outside of the Czech Republic. OVID System Ovid Web Gateway is an instrument for searching and working with bibliographical and full text information from the area of biomedicine. It is accessible to all employees of the member institutions of the consortium on the address: http://gateway.ovid.com/autologin.html Data Network of Health Department (dSRZ) medicon.cz DSRZ is multifunctional network of selected health institutions that are the base for future infrastructure of National Health Informational System (NZIS) and serve for informational and communicational needs of health department with country coverage, especially in the area of selected Informational System of NZIS framework DSRZ is realized on the base of TCP/IP protocol using the public network infrastructure of TCP/IP EUnet on top of which is built non-public network infrastructure of VPNs with the use of encrypted IP/IP tunnels. The traffic is separate from public Internet, at the same time there is a possibility to access Internet from the individual virtual private network (VPN). DSRZ is defined as a framework of mutually separated but interconnected independent VPNs of health sector with variable but controlled level of required level of security. This network infrastructure will enable other controlled, reliable and secure interconnection on other non-public and public networks, including the relationship on informational system of chip cards.

2.1.14 Euromise Euromise represents Education and Research in Medical Informatics and it can be found at http://www.euromise.cz and http://www.euromise2004.org. The European Center for Medical Informatics, Statistics and Epidemiology of Charles University and Academy of Sciences (EuroMISE Center) was set up in 1994.

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Development of interdisciplinary postgraduate and lifelong education, mostly of university teachers, has been the main goal of the European project Teaching Methodology for Heath Care under the TEMPUS program and development of interdisciplinary research has started with the cooperation on the project Managing Uncertainty in Medicine - MUM under the program COPERNICUS. The main targets of EuroMISE Center are: To create an European teaching network for higher education in medical informatics, statistics and

epidemiology; To organize and initiate graduate and postgraduate education on international level. To start international research and development programs in the interdisciplinary field of medical informatics,

statistics and epidemiology; to cooperate closely with the healthcare resort. Further development of the EuroMISE Center of Charles University and Academy of Sciences is based on close

cooperation with European universities, research and health organizations and on recommendations of the international committee.

Research Research activities of theEuroMISE Center are focused on the development of interdisciplinary research. It concentrates on methods of statistical data analyses, methods for extracting relevant information for decision making and managing uncertainty, methods for decision support, study of risk factors of diseases, mathematical methods in genetics and epidemiology. The research cooperation of the EuroMISE Center with other academic and health institutions is stimulated by Czech grant agencies (Grant Agency of the Czech Republic, Grant Agency of Charles University, Grant Agency of Ministry of Health of the Czech Republic) and by European projects MUM (COPERNICUS) and I4C - TRIPLEC (4th Framework Programme). Some research results are applied by programme prototypes, for example E. T. (quick processing of data from epidemiological studies), CORE (reduction and constitution of data) and HYPERTENZE (optimization of decision support in therapy of arterial hypertension). The results are published in both Czech and international journals. The EuroMISE Centre is also involved in editorial boards of journals (International Journal of Medical Informatics, Physician and Technology) and in scientific societies (IMIA, EFMI, Czech Medical Society of J. E. Purkyne, Society for cybernetics and Informatics of the Academy of Sciences of the Czech Republic). 2.1.15 Branch Contact Organization - Healthcare (BCO) Oborov kontaktn organizace - zdravotnictv (OKO) - Branch Contact Organization Healthcare (BCO) in English. The web site can be found at http://www.oko-zdravotnictvi.cz. Helps to involve Czech health care research subjects into the network of European institutions using shared

activities and programmes, especially with focus on the 5th Framework Programme of Research and Technological Development of EU (and prospectively on the 6th of Framework Programme),

Is a small organization based on the common project of the Czech Medical Association J. E. Purkyne and the consulting of the Econsult and the financing with the grant support of the programme EUPRO by the Czech Ministry of Education,

Reports the information about the programmes from the sphere of the international cooperation in the research and development at the health services of the Czech Ministry of Education,

Is situated close to the secretariat of the Czech Medical Association in the Medical House in Prague (addr. Praha 2, Sokolsk 31),

Supports communication, coordination a cooperation among interested parties in the Czech Republic, especially healthcare researchers, small and medium-sized enterprises aimed on the health services and related partners in European Union,

Organizes special informative events, looks for suitable partners for international projects of healthcare research and development,

Assists and consults relevant project proposals, Creates thematic database for healthcare research and innovation on Internet, Opens up the Czech medical research and development on the Internet.

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Branch Contact Organization for healthcare closely collaborates with Technolog

european ehealth considerations

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