kristiina rebane ministry of social affairs of estonia ehealth in estonia
TRANSCRIPT
Kristiina Rebane Ministry of Social Affairs of Estonia
eHealth in Estonia
Main characteristics of eHealth in Estonia
Nation-wide integrated systemIntegration of different hospital information systems
into one health information system
Standardization > InteroperabilityHL7; SNOMED; LOINC; DICOM, ICD 10 etc
Use of existing IT infrastructureX-road (secure national data exchange layer)
ID-card (about 1 million owners)
X-Road
EHR (Epicrisis andLink Directory)
PopulationRegister
Estonian HealthInsurance Fund
E-CitizenPortal
Patient
Pharmacies (~350)
Emergencyservices
Medicalregistries
(~20)
Schools,kinder-
gardens,prisons
Hospitals(~50)
Generalpractitioners
(~800)
Specialists
Statistics
Statisticians Medicalresearch
Main characteristics of eHealth in Estonia
StatisticsCentralized health care organization and strategic
planning
Structural fundsProject based
Defined timeframe, project organization and finances
Political supportPoliticians
Doctors
Organization and management of eHealth in Estonia
EU structural funds
Ministry of Social Affairs
Health care providers
Political support
Estonian eHealth Foundation
National Health Insurance Fund
Estonian eHealth Foundation
Founded by the Ministry of Social Affairs, major hospitals and medical associationsThe general goal of the foundation is to coordinate the development of the nation-wide integrated health information systemMain goals of the foundation are:
Development and government of nation-wide ehealth projects;Coordinating the unification of Estonian health care providers information systems;
Estonian eHealth Foundation
Development and government of nation-wide health registries;
Plays an active role in development and publishing of standards and classifications in health care sector;
Coordinates development of nation-wide medical guide-lines;
Cooperates with health care providers and with other institutions involved in health care provision;
eHealth in Estonia – the Four Projects
The Core Project:Electronic Health Record
Defines eHealth architecture
The Side ProjectsDigital Prescription
Digital Images
Digital Registration
Timeframe
Project 2005 2006 2007 2008
Electronic Health Record
Digital Registration
Digital Prescription
Digital Images
Electronic Health Record Project
The Idea of Electronic Health Record
provide physicians access to necessary data for curing patients
provide patients with accurate overview of the use of their data (personalized data)
guarantee better quality and accuracy of the necessary data for organizing healthcare
to standardize the digital use and transmission of medical information
The General Composition of the Project
the project is rather complex, its compendious view consists of 6 components:
IT infrastructure
Data models, standards and classifications
Epicrisis
Informing (patients, specialists)
Ethics and legislation
Development of organization
Main features of EHR
The central database of EHR includes three types of data:Patient’s primary information (for example the contact information,
insurance information, allergies, important drug information etc)Link directory that points to other sources which include some medical
data about the patient (for example IT systems of hospitals and GPs)Centrally stored medical records
EHR connects current IT systems of hospitals, GP’s and other Health Service providers through interfaces, so there is no need to replace these IT systems.EHR gives to the doctors possibility to see patient’s entire health information when they need it.
EHR provides time critical information to ambulance (for example if patient has any allergies or if ther are any drugs that are dangerous to the patient).
EHR also acts as patient’s inoculation journal.
GP can send patient’s medical information through EHR system to the specialist who treats the patient. The patient doesn’t have to carry any papers himself. GP can also choose the most appropriate specialist for the patient through EHR.
EHR gives doctors possibility to receive consultation from colleagues as they can exhange patient’s medical information through EHR system.
Patient can receive medical certificates through EHR without having to deal with any papers. These certificates can also be sent to empoyers or state authorities through EHR system in electronic form.
Statistician
Patient’s employer,state authorities
Medical registries
EHR (Epicrisis andLink Directory)
Emergency services
Hospital
Report to registry
Link toLink Directory
Epicrisis, medical certificate
Statistics
Report to registry
Report to registry
Consulta
tion
Epicrisis
Epicrisis, medical certificate Time critical
data
Patien
t’s th
erap
eutic
infor
mat
ionDirection of patients
Co
nsu
ltatio
n
Epicrisis
Electronic medical
certificate
Epicris
is
Statis
tics
Epicrisis
Dire
ction
of p
atie
nts
Sp
ecia
list’s de
cision
Link toregistry based
on epicrisis
Doctor
Specialist
GP
Side-Projects
Digital Prescription
Digital Prescription: At the moment patients have to carry prescriptions on paper with them. This system has several weaknesses, for example it is easy to lose that paper or handwriting of the doctor may be unreadable. Electronic prescription solves these problems because all prescriptions are sent to a central database. When patient is in pharmacy the pharmacist receives the prescription from central database and there is no possibility that patient loses the prescription or it is unreadable.
Digital Images
Digital Images: nowadays most of the devices in medical diagnostics have the possibility to give the output in electronic form (for example as picture or video). At the same there are lot of databases to store these images. To make them available to other health service providers Digital Images project solves this problem by creating central databases that have information about medical images or videos stored in hospitals and to make them available to other health service providers through EHR system.
Digital ImagesEHR
Digital Registration
Link Directory
HIS/RIS
Hospital 1
PACS
Direction of patients
Anonymized images /Image buffer
HIS/RIS
Hospital 2
PACS
Direction of patients
ResultsLink to image
Results
Link to Image
DICOMquery engine
Link
s
Image
Image
Image
Image
HL7 or technical messages
DICOM queries
EHR web interface
Image viewer
ImageImage
Digital Registration
Digital Registration: At the moment several health service providers have their own electronic registration systems, which cannot communicate with each other, but large part of service providers have no electronic registration systems at all. Electronic Registration project creates common standards for all health service providers and connects their electronic registration systems to one central website. Therefore patients don’t have to use many different websites to book a time but can find all necessary information from one place.
Digital Registration
Web interfacefor the patient
Ministry ofSocial Affairs
Analysis ofwaiting times
EHR
Digital Registration
Lists of available times, specialties,
doctorsPatient registration
information
GP
GP IS
Inte
rfac
e to
an
exis
ting
ISHospital
Hospital IS
Inte
rfac
e to
an
exis
ting
IS
Lists of available times,
specialties, doctors
Patient registration
information
Registration to a suitable doctor
at a suitable time
Health Care Board
Database of health care providersDatabase of health care employees
List of providers and available specialties
Future developments of eHealth
eAmbulance
Automated generation of health registries
Datamaining for quality of health care service etc
Thank You
For further information please contact:
Ms Kristiina Rebane
Project Manager of EHR Project
Ministry of Social Affairs, Estonia