ict projects of turkish moh...cdas was first implemented by turkish ministry of health in 2009. ......

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ICT Projects of Turkish MoHSession #: 78, February 12, 2019

Eray ÖZCAN

Software Projects Coordinator, Turkish MoH

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• e-Nabız PHR System

• Telemedicine/Teleradiology System

• Decision Support System (SINA)

• e-Report

• Centralized Doctor Appointment System (CDAS)

• International Projects

Agenda

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KHYS

SYS

ESİM

e-Triaj

USS

MHRS

İKYS

iKDS

kKDS

SSBS

HSBS

EBYS

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e-Nabız PHR System

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Organ DonationStatement

Blood andBone Marrow

DonationSharing

Access Logs

Messages

Disease Details

Appointments

HospitalVisits

Prescriptions

Reports

Examinations

Images

Allergy Details

Emergency Notes

Injection Calendar

İlaçlarım

Medicine Remainder

Medicine

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e-Nabız Mobile APP

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e-Nabız Stats

10.055.400e-Nabız

User Count

154.940Number of People

Making Organ Donation

Statement on e-Nabız

5.022.778

Number of Access

by Physicians

2.379.267Number of Organs to be

Donated on e-Nabız

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Telemedicine/Teleradiology System

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Greatest Radiology Archive of the World

Rapid sharing of huge endoscopy videos

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Image transmission from all non-DICOM compatible imaging devices


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Sharing of ECG images


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Accessing their own data for patients via e-Nabız


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Teleradiology/Mammography

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Telemedicine Stats

Number of Integrated Hospitals 1.803

Active Users (Physician) 30.151

Active Users (Citizens) 4.234.293

Number of Examination Access Submissions 9.462.040

Number of Examination 139.336.964

Number of Registered Citizens 58.211.302

Number of Reports 93.011.526

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Decision Support System (SINA)

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2015

Beykoz District

Rate of patients

going another

districts:

52,24%

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2017

Beykoz District

Rate of patients

going another

districts:

39,55 %

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34

Türkiye Adım

Ortalaması

5657

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35

Türkiye VKİ

Ortalaması

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36

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Türkiye Nabız

Ortalaması

79

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e-Report

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e-Report

e-Birth Report e-Driver

Reporte-Sportsmen

Report

e-Military

Report

e-Psychotechnics

Report

e-Rest

Report

e-Disability

Report

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Centralized Doctor Appointment System(CDAS)

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First In The World

Centralized Doctor Appointment Systemis a Health Care Solution

CDAS was first implemented by Turkish Ministry of Health in 2009.

It allows patients to book an appointment any from hospital and any

doctor they prefer.

CDAS is one of the 20 fundamental public services approved by EU.

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80MPopulation

1500Hospital

660MExaminations/Year

140KDoctors

Centralized Doctor Appointment System

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CDAS With Numbers

Public Hospitals Within The

Scope of CDAS

60 THOUSAND

110 MILLION

420 THOUSAND

399 MILLION

402 MILLION

15 MILLION

Avalaible Doctors

Avarage Daily Appointment

900

Calls Responsed in 2016

Responsed Calls in Total

Scheduled Appoimtments in

Total

Total SMS Sent

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CALL

182 LINE

Multichannel Services

WEB PORTAL

MOBILE APPLICATION

THERE ARE

3 CDAS

SERVICE

CHANNELS

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Call 182 Line

Call Centers in Seperate

Provinces With Other

3000AGENTS Service

24/7Calls Per Month

9.030.418

Avarage Booking Time

2.2MINUTES

Avarage Booking Time

73SECONDS Daily Unique Visitors

250.000

Web Portal

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International Projects

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International Projects

H2020 Project

Product development for Ty

pe 2 Diabetes Mellitus

patients,online tracking and

patientempowerment

Turkish MoH is the

Coordinator

Budget: 4.8 M €

World Bank Project

World Bank funded Project

for informatics

standardization and

developing integrated

decision making system

Part of a 120 M €

Project cluster

Budget: 11 M €

IPA Project

Chronic disease

management

system

development

Budget: 4.8 M €

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Awards

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Maturity Models Driving Digital Transformation

Session 78, February 12, 2019

Ilker Kose, PhD, Country Director of HIMSS Analytics,

Istanbul Medipol University, Turkey

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Greetings from Istanbul

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• Being a minister of health

• HIMSS- MoH agreement

• Maturity models

• Maturity models of HIMSS

• Maturity models driving digital transformation

Agenda

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Being a minister of healthWhat is he/she supposed to do?

Life expectancy

Accessibility

Equality

Quality

Satisfaction

Productivity

Deaths

Errors

Mal practices

Expenses

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Being a minister of health

Which tools can I use for management?

• Statistics

• Reports

• Scientific papers

• Business Intelligence Systems

• …

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Which tools can I use for management?

• Strategic Plan

• Strategic Map

• Balanced Score Cards

• …

Goals

Desired Outcomes

StrategiesMeasures & Targets

Results

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What about measuring the progress?

• Difficulties on having overall perspective

• Fragmented nature of most scientific studies on the field

• Statistical values cannot represent what is exactly going

on within the facilities

• Problem of "pretending do"!

• Culture vs. strategy!

• Vertical organizational structure vs. horizontal and

transient processes

• …

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Health Transformation Program of Turkey

• The story was started with

Health Transformation

Program in 2003

• …details are in the other

presentation of MoH


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Turkish Model in Using EMRAM for Digital HospitalTransformation

• In the Strategic Plan of MoH for 2013-17, oneof the aims was as follows:

– «Creating and expanding the digitalhospital concept in the facilities affiliated tothe Ministry and its affiliates»

• What happened then?


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HIMSS – MoH AgreementTurkish Model in Using EMRAM for Digital Hospital

Transformation

• The first public hospital got EMRAM Stage 6

certificate in May of 2013

• A workshop was organized with the attendance

of 10 public hospitals

• A collaboration protocol was signed by MoH

and HIMSS in December of 2013 for 5 years.

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Maturity modelsWhat does a maturity model do?

• Gives a patient centric overall perspective

• Requires interoperability rather than

stand alone perfect systems

• Focuses on results rather than steps.

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Maturity models of HIMSS

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STAGE

7 Personalized medicine & prescriptive analytics

6 Clinical risk intervention & predictive analytics

5 Enhancing quality of care, population health, and understanding the economics of care

4 Measuring & managing evidence based care, care variability, and waste reduction

3 Efficient, consistent internal and external report production and agility

2 Core data warehouse workout: centralized database with an analytics competency center

1 Foundation building: data aggregation and initial data governance

0 Fragmented point solutions

Adoption Model for Analytics Maturity Cumulative Capabilities


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Maturity Models Driving Digital TransformationTurkish Model in Using EMRAM for Digital HospitalTransformation

HIMSS Conferences hold in Turkey

Date Place Awards Event Name

4-5 June 2014 İstanbul 3 X Stage 6 HIMSS Turkey

20-21 March 2015 Antalya 6 X Stage 6 HIMSS Turkey

26-27 May 2016 İstanbul 1 X Stage 7,

7 X Stage 6

HIMSS Turkey

11-13 May 2017 İstanbul 2 x Stage 6 HIMSS Turkey

25-27 October 2018 İstanbul 154 x Stage 6 HIMSS Eurasia

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Date Place # of Attending Hospitals

1 September 2013 Ankara 10

2 4 March 2014 Ankara 200

3 17-18 December 2014 Ankara, İstanbul 257

4 10-11 June 2015 Ankara 100

1 20 April 2017 Ankara 29

2 18 May 2017 Ankara 50

3 25 May 2017 İzmir 74

4 1 June 2017 İstanbul 76

5 9 June 2017 Ankara 26 (HIS Vendors)

6 16 June 2017 Bursa 83

7 29 June 2017 Erzurum 71

8 6 July 2017 Tokat 83

9 13 July 2017 Kahramanmaraş 70

10 14 July 2017 Mersin 43

11 20 July 2017 Afyonkarahisar 66

12 27 July 2017 Siirt 64

13 31 July 2017 Ankara 82

Total 1.338 Hospitals and 26 HIS Vendors

567

771+26



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68



69

165

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9 6 3 2 2 2 1 1 1 1 1 1 1 1 10

20406080

100120140160180 # of EMRAM Stage 6 Hospitals

http://www.himss.eu/communities/himss-emram-stage-6-7-community as of May 2018

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USA:

Stage 6 - 985

Stage 7 - 141

Average scores:

Turkey 3,77

EU 3,2


http://www.himss.eu/communities/himss-emram-stage-6-7-community

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The keys of our success…1. Strong support at ministerial level

2. Different, but well coordinated stakeholders for HIMSSevents and analytics studies

3. Evidence based approach about the benefits of«meaningful usage of EMR» for improving healthcarequality and patient safety

4. Convincing the top level executives of the hospitals

5. Training the staff who will be in charge of digitaltransformation

6. Supplying rich and detailed gap analysis and trainingmaterial


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Thanks

[email protected]

Hope to see you in Istanbul, for 2019 HIMSS Eurasia event

http://himsseurasia.com/

http://himsseurasia.com/

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Turkish National Telemedicine Project: Achievements and Prospects

Session #: 78, February 12, 2019

Yaşar Alper ÖZKAYA, PhD

NTS Chief Architect, Turkish MoH

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Yasar Alper Ozkaya, PhD

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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• Technical outlines of National Telemedicine System (NTS)

• Use Cases

• Ongoing work

Agenda

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• Identify key strategies and approaches for establishing a national

medical image repository

• Evaluate several use case statistics of National Telemedicine

System (NTS)

• Gain insights into prospective use cases of NTS in Turkey

Learning Objectives

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• NTS is a central repository that is connected with

HIS, PACS, RIS systems throughout the country.

NTS is developed and maintained by Republic of

Turkey Ministry of Health.

• NTS allows

– Patients to access their medical images

and reports online anytime anywhere

– Radiologists to create radiological

reports, get/provide second opinion via

teleconsultation

– Specialists to make quality control of

medical images and reports

• Main objectives of NTS are to

– Avoid repetitive exams

– Allow physicians to access historical data of their patients thus to improve consistency of treatmens

– Improve quality of care given to patients

National Telemedicine System (NTS)

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NTS SSO

HIS

HL7

SERVE

R

XDA

SERVE

R

STM

SERVİSL

ERİ

WADO

PROX

Y

AUTHENTI

CATION

STM

WEBAP

P

Central

Image

Archive

VIEWER

SERVICE

S

MICRO

SERVICE

S

ORDER-

IMAGE

MATCHING

BIG

DATA

TCON

SERVE

R

E-

Pulse

MEDULA

NIS

APP

WADO

SERVER

PACS

Citizens

NIS Admins

Radiologists,

Physicians

ReportersMoH Admins

WADO

CHECKE

R

DB

WORKER

E-

govermentÇKYS

MoH

SSO

MoH

DSS

MoH

LDAP

NTS

ARCHITECTURE

POST

PROCESSIN

G SERVER

SOCKET

SERVER

VIEWER

WEBAP

P

HIS-PACS

Admins

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• Vendor neutral architecture of NTS allows seamless integration with local and global system vendors.

• NTS uses HL7, DICOM and XDS standards and implements following Integrating Healthcare Enterprise (IHE) profiles

– Consistent Presentation of Images

– Access to Radiology Information

– Audit Trail and Node Authentication

– Scheduled Workflow.b

– Cross-enterprise Document Sharing for Imaging (XDS-I.b)

Compliance

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Use Cases

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• Integrated with 1727 private and public hospitals, NTS currently holds 150m radiological exams and 73m radiological reports.

91.2

18.7

15.1

5.2

Exams (million)

CR CT MR Other

National Medical Image Repository

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• Over 3 million patients and 40 thousand physicians have accessed medical images via NTS.

• Conveyance and reproduction costs for radiological images have vastly been reduced in all hospitals.

Allowing Patients and Physicians Access Medical Images

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• Hospitals delivering radiological reports in more than 4 days utilize NTS to decrease turnover times. Over 80 radiologists currently provide reporting services for such hospitals in two major cities.

Radiological Reporting

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• HISs use NTS microservices to query existence of given exams for a visiting patient. This information is provided to the clinician with direct access to these reports and images.

Reducing Repetitive Exams

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• Radiological images can be assessed by reporting radiologists allowing them to report any inconvenience.

• Radiological reports can also be assessed by the requesting physicians.

Quality Assesment

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• Substantial variations exist in practice between some CT centers for similar types of examination and similar patient group

• These observations necessitate implementation of measures to keep all doses within acceptable ranges for the clinical purpose of each examination.

• Monitoring of CT examinations is achieved through recording examination-specific DRLs for various patient groups.

• National level DRLs can be used as a reference to compare different health centers and prevent abnormal dose usage by detecting somehow increased variations from mean national DRL.

Dose Monitoring

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• NTS validates all exams performed in the hospitals and provides National Insurance System (NIS) with this information enabling it to prevent billing of unperformed exams.

Billing Validation

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Teleconsultation

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• Paramedics performs ECG scans on patients with MI indication.

• These scans are instantly sent to cardiologists on duty for immediate ST elevation assessment.

• Emergency command center directs the ambulances to appropriate hospitals according to cardiologist assessments.

• Over 2000 scans have been assessed within 2 minutes on average.

• 8% of these scans indicated ST elevation.

Emergency ECG Assessment

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Ongoing Work

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• An AI based CAD system will be developed and integrated into NTS.

• The AI system will work as the second radiologist in mammography blind reading scenario.

• Estimated launch date: June 2020

Mammography CAD

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• This system will allow automatic

validation of exams (e.g. Brain CT

exam must contain Brain CT images

and not Thorax images)

• The system will also perform

automatic qaulity assessment based

on metadata and pixel data (such as

low FOV, high SNR, artifacts etc.)

• All MRI exams will be given a quality

score which can then be used for

performance evaluation and billing.

• Estimated launch date: January

2020

AI Based Image Validation and Quality Control

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• Based on ESR-ACR and Harvard

appropriateness criteria, microservices will

be developed that will allow assessment of

any radiological exam prior to ordering.

• Appropriatness of intended orders with the

patient condition and alternative orders will

be provided to the physicians.

• 110 Million TL of direct savings is

estimated as well as reduction of 500.000

personnel hours and 2 Million mSv patient

radiation dose.

• Estimated launch date: January 2020

EXAM APPROPRIATENESS SYSTEM

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• MISE is a repository of

anonimyzed radiological images,

reports and papers.

• MISE will allow radiologists to find

verified information about specific

cases in order to increase the

accuracy of their findings.

• MISE will also allow academicians

to share and collabarate in their

scientific studies.

• Estimated launch date: January

2020

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• ERC will provide instant reporting services for hospitals which do not have immediate access to radiologists on duty.

• Utilization of radiologists on duty will be increased while reducing shift hours per radiologist.

Emergency Reporting Center

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Second Opinion Center

• SOC will provide subspeciality (such as mammography and pediatric radiology) and supraspeciality (Oncoradiology, extremity, Cardiac CT and Cardiac MR) consultancy for local radiologists.

• Complicated exams will be diagnosed more accurately in shorter periods.

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• Yasar Alper Ozkaya, PhD

• [email protected]

Questions

mailto:[email protected]

ict projects of turkish moh...cdas was first implemented by turkish ministry of health in 2009. ......

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