Nationwide e-Health platform Estonia

The Estonian Electronic Health Record System

Madis TiikCEOEstonian e-Health FoundationBaltic Congress in Laboratory Medicine 16 September 20101LifestyleSelf-helpTele-adviceAppointmentNotificationPrescription

CampaignsPublicServicesPolicy-makingAnalysisDiagnosticsTreatmentGuidlinesFollow-upEHRWorkflowFamily doctorsHospitalsFounders of the Estonian eHealth FoundationEnd usersStrategy and Architecture DevelopmentMarketing and Channel ManagementMinistry of Social AffarsEast Tallinn Central HospitalTartu University ClinicSociety of Family DoctorsNorth Estonian Regional HospitalManagement Board Estonian eHealth Foundation BoardEHR OperationEstonian Hospital AssociationUnion of Estonian Medical EmergencyNursing CarePatient PortalHealth AuthoritiesGovernanceOur tasksManagement of E-Health projectsStandardisation and development of medical digital documentsMaintenance of the Estonian EHR system International cooperation and scientific cooperation with universitiesDevelopment of new services for citizens and doctors

Financed from the State budget (1.5 mln 2010)

55X-ROADSSHEALTH CARE BOARD- Health care providers- Health professionals- Dispensing chemists

STATE AGENCY OF MEDICINES- Coding Centre- Handlers of medicinesSSSSHEALTH INSURANCEFUND

Prescription Centre2010 january

HEALTH INFORMATION SYSTEM ( EHR)17.12.2008SSSS Citizen RegistryCompany RegistrySSPharmacis2010 januaryDoctors and pharmacies software solutionsHospitals 2009Family doctors2009 Emergency Medical Service2011School nurses2010 septemberSSSSSSSS

Healthcare ProviderSSMonitoring portalPatient portalGoverments e-service frameworkwww.eesti.eeKIT Citizen viewEIT Enterprice viewAIT Officials view

W-SSEstonian national eHealth infrastructure6Lab referal

ldandmedMari-Liis47595064059Mnni 1-2TallinnDiagnoospunetisedAllergiaietolmSwineflu noticeldandmedMari-Liis47595064059Mnni 1-2TallinnDiagnoospunetisedAllergiaietolmMessage Timecritical reportsDemographicsHealth recordInfection noticeldandmedMari-Liis47595064059Mnni 1-2TallinnDiagnoospunetisedAllergiaietolmDischarge letterDemographicsMari-Liis47595064059Mnni 1-2TallinnDiagnosischickenboxAllergypollenDemographics agentAddress: Mnni 1-2, TallinnInfection decease agentDiagnosis: chickenboxTimecritical report agentAllergy: pollenHealth record agentEvent: Medication, Diagnosis, ProcedureHPIservicesDocument processingStatistics queryOutbreak reportData integrationDemographics, health statusHPIHealth PortalDevicesInformation SystemsStandards and ServicesProcesses and IntegrationWSDLXSDPublic IT InfrastructureConcentDocument archiveHealth recordStatisticsDecision SupportReportsHealth statusAmbulanceDemo-graphicsBooking

EHR Central FunctionsStorage ( long time archive)Metadata/ universal viewer Current Situation 15.09.2010There are 1 858 541 documents in the Estonian EHR Discharge letters (epicrises)233 338Out-patient consultation notes338 922Dispensed medication information 770 704DICOM images ( index) 264 488Image reports243 797

More than 400 000 citizens have digital medical records in EHR , it is 30% of the population

Availability of Discharge LettersYear 2009North Estonian Regional HospitalTartu University ClinicEast Tallinn Central Hospital27661319142403882%74%84%These 3 hospitals cover more than 60% of in-patient cases in EstoniaePrescriptionsPrescription centre was launched 1st of January 2010

January February March AprilMayJuneJulyAugustNumber of e-prescriptions issued278957 407609 520 000387 000381 836408 713386 493435431% from prescriptions issued*40%58%74%55%55%58%55%62%Purchasedprescriptions150 009221 800322 000288 000292 207318 968314 414333018% from purchased prescriptions*21%31%46%41%42%46%45%48%*estimation based on 2009 numbers - 700 000 prescriptions monthly** 13.04 recomendation not to use e-prescription to the doctors

eLab projectTranslation of 10 000 LOINC termsImplementation LOINC and RELMA program's in all labs Mapping of Labs tests with LOINC standard.Influence to the other projects:Enables data exchange between labs and healthcare providers Enables statistical analyzes and comparisonsTest results are seen to all users of EHREnables patients to see lab testMore info for decision support Automatic exchange data with Infectious diseases registerWorkflow of lab testsDoctors IT system

Sample logisticLabEHR1.-2. Referal (patient ID, test specifikation, index number)3. Referal (test specifikation, index number)

5. Lab test result(index number)6. Report, alerts, lab test resultsReferal centre4. Sample + index numberLab test standard

9.2 Vol % 10 Vol %

http://pub.e-tervis.ee/standards2/Standards/3.014Life Cycle of Digitization of Medical Document

12 months3 months3 months6 monthsTask Setup Ministry of Social Affairs, EeHF, Professional Societys

Content Related Standardization The Estonian eHealth Foundation (EeHF)

Technical Standardization CDA documentDeveloper (Outsourcing)

Development of Central System ServicesDevelopment of Health Care Service Providers Developer (Outsourcing)Information SystemsHealth Care Service Providers ICT partner

Installation Standard to the Test Environment (EeHF)

Testing and Acceptance ServicesDeveloper, EeHF, Health Care Service Providers ICT partner

Ministerial degree naming the date for Health Care Providers when standard and new documentation is obligatory - Ministry of Social AffairsStandard published, installed to working environment, new service in portfolio of EeHF-EeHFPatients Portal Personal Health Record (PHR) 2010-2011PHR one view for citizensIllness data from healthcare system (Patients Portal)Self-monitoring dataWellness data from third partiesData from social systemPatient forumsScreening remaindersDecision support Self-careVirtual health check

Future of EHR

EHR Portal Services for Citizen

Decision Support

Knowledge DigitalizationSuggestions and RemindersDecision Support ServiceDecision ScriptsHealth RecordsDigital LibraryHealth Records Service18

DecisionSupportCoreEngineEBMeDS Local ServiceEstonian NHISHCIworkspaceEHRDocument ServiceGlobal, National & Local ScriptsEvidence LinksFunction LibraryPatient DataForms & CalculatorsResponse MessagesDrug Information Best Practice Contraindications Interactions

Conversion filtersGlue componentEHR DecisionSupportWeb ServerApplicationEBMeDSEvidence-Based Medicine electronic Decision SupportHTTPWeb Resources EBM Guidelines Cochrane Library Essential Evidence EBMeDS Home Page

Script Editing Tools

EBMeDSDatabaseEBMeDSMaster FilePackageEBMeDS Central ServiceAdministrator ToolsTestingApplicationsTestingApplicationsTable Editing ToolsCompilingToolsJavaScriptInterpreterData TablesFTPLogFilesUpdateServiceApplication Maintenance Server, Storage & Network Management Database management Monitoring help desk Application Operations Hardware and Data Center Application Development Business Processes PartnerseHealtheHealthPartnersITILServiceContinual Process ImprovementService DesignService TransitionService OperationService StrategyMaintenanceof Estonian EHR SystemApplication DevelopmentServer, Storage & Network ManagementDataBase ManagementMonitoring, Help DeskApplication Operations

1234a4b567Hardware & Data CenterMaintenance of the EHRApplication Maintenance and Support

Business Processes

Business Processes Doctors portalPatient PortalW-SSEHR reguest servicisPatient summaryMedication history Incident ManagementService Request ManagementCapacity ManagementChange and Release ManagementProblem ManagementService Level ManagementService Continuity ManagementOperationsDemand ManagementConfiguracion ManagementPresentation Title22Iga kihi juures ressursid ja vimekusLbivad protsessid kihtidevaheline koostLessons learned 1Clear governance and decision makingAgreement of standards before the start of the implementationPreparation of proper legal environment including strict rules for patient delicate data handlingInvolvement of the main stakeholdersReuse already working IT solutions made by StateID cardXroad

Lessons learned 2Access rightsFinding suitable compromise between different stakeholders citizen, physician, stateControls beforeAccess is provided to all licensed medical professionals only (attending physician concept)Institutions are responsible for their internal controlsControls afterMonitoring based on risk analysis2424Thank you for your attention!

Questions?

Madis.Tiik@etervis.eewww.etervis.ee http://eng.e-tervis.ee/

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