Professional Documents
Culture Documents
Estonia
Estonia
Artur Novek
Health and Welfare Information Systems Center/ IT architect
13.10.2017
Health and Welfare Information
Systems Center (HWISC)
COMPETENCE CENTER
of information and communication technology
in health, social protection and labour field
VISION
Director
Information
e-Services Information Supporting
System Data Analysis
Governance Security Services
Maintenance
AREA
SOCIAL
HEALTH LABOUR
SECURITY
NATIONAL INSTITUTE
FOR HEALTH
DEVELOPMENT
Estonian Healthcare
Professionals IS
Working Social Services and
Environment IS Benefits IS
Water and Health
Safety IS
where do
you come
from?
90-s. Local systems, focus on
insurance invoices
Restoration of
Estonian
independence
Mandatory
Central health electronic bills to
insurance fund insurance fund
AS Medisoft
program for
family doctors
2000 – 2010 health information
exchange, focus on health data
Planning of Project eHealth eHealth
ePrescription
health data preparation Foundation Projects
01.01.2010
exchange started (2003-2005) established (2006-2008)
Estonian eHealth
Foundation Board
Management
board
Services
development
IT
ENHIS Operation management
Standards
development
Administrators Programmers
Support
(Communication,
accounting, HR, lawyer, Helpdesk
security… )
Estonian eHealth,
where
are
you?
5 key features of
Estonian healthcare
Picturebank
Collecting health service
reimbursement invoices HWISC
Health status summary for ~1995
medical commission of Minstry Health insurance
of Defence information
2017 ~2000
Digital picture
Drug-drug interaction archiving services
detection (2016) 2005
• End-user software
End-user software • User Interface
development and • Data input
• Data Visualisation
data exchange services • Data filters
• Data transmission
HOSPITALS ROAD
~60 ADMINISTRATION
- Drivers licenses
NATION- WIDE
HEALTH PRESCRIPTION
INFORMATION CENTRE
SYSTEM 2010 january
2008 december
POPULATION BUSINESS
REGISTER REGISTER
Major architectural decisions of
current Health Information System
• Integration through Central system
• Opt-out policy in form „patient can close data from
doctors“
• XML based HL7 v3 (extended) messages
• Documents are kept in XML format (HL7 CDA R2)
• All identifiers have OID-s
• Only final versions of clinical documents are sent into
central system after case is closed
• Reuse of national infrastructure
• ID card for authentication and digital signature
• X-road for secure communication
STATE AGENCY OF MEDICINES
- Coding Centre
2013 v2
2009 v1
PORTAL
PATIENT
- Handlers of medicines
2013
- Health professionals
- Dispensing chemists
PORTAL
DOCTOR
POPULATION REGISTER
2012
SOCIAL
PORTAL
E BOARD
INSURANC
BUSINESS REGISTER
HEALTH INSURANCE
2009
FUND REGISTER
X-ROAD
SERVICE
GATEWAY
DOCTORS
AND FAMILY
PHARMACIES
PRESCRIPTION
CENTRE
2016
2010 january
database
Drug-drug
Interaction
2014
QUALITY REGISTERS.
MOBILE
Cancer. HIV. Myocardial infarction.
SERVICE
SERVICES
Tuberculosis. Etc.
AMBULANCE
APPLICATION
EMERGENCY
X-Road, ID-card, State IS Service Register
WORKSTATIONS
FAMILY DOCTORS
2009
SCHOOL NURSES
HEALTH
SYSTEM
2010 september
2008 december
INFORMATION
NATION- WIDE
HOSPITALS
2009
Estonian eHealth architecture
NATION-WIDE
PICTURE ARCHIVE
STATISTICS
VPN
PORTAL 2013
FOR STATISTICS
2013
eHealth copies e-state architecture
Message layers on X-Road
HL7 CDA
document
HL7
interaction
Digidoc
X-Road message
Document processing
Agents
Patient coding agent
Find or create patient Patient index
internal code
Lab notice
Medical documents receiver agent
Üldandmed
Swineflu notice
Mari-Liis Document: Lab notice,
Üldandmed Discharge letter Medical documents
Infection 47595064059
notice
Mari-Liis
Männi 1-2 Health record agent
Üldandmed
47595064059
Discharge letter
Tallinn
Mari-Liis Event: Medication, Diagnosis,
Männi 1-2
Demographics Procedure
47595064059
Tallinn
Mari-Liis
Diagnoos
Männi 1-2
punetised Medical events
47595064059 Infection disease agent
Diagnoos
Tallinn
Männi 1-2
punetised Diagnosis: chickenpox
Allergia
Tallinn õietolm
Diagnoos
Allergia
punetised
õietolm
Diagnosis
Demographics agent
chickenpox
Allergia Demographics
Address: Männi 1-2, Tallinn
õietolm
Allergy
pollen
Medical documents
Consultation Image
Epicrisis Referral Referral answer
note reference
Version 1 Version 1 Version 1
Version 2 Version 2
Medical events
Diagnosis Operation Visit Prescription Procedure
2011.06
2011.09
2011.12
2012.03
2012.06
2012.09
2012.12
2013.03
2013.06
2013.09
2013.12
2014.03
2014.06
Healthcare professional queries per month
2014.09
2014.12
2015.03
2015.06
2015.09
2015.12
HIS usage per month
2016.03
2016.06
Documents per month
2016.09
2016.12
2017.03
2017.06
2017.09
ePrescription
1.000.000
900.000
800.000
700.000
600.000
500.000
400.000
300.000
200.000
100.000
ISSUED SOLD
European Hospital Survey:
Benchmarking Deployment of е-Health Services 2012
Deployment Composite Indicator – comparison with 2010
index
European Hospital Survey:
Benchmarking Deployment of е-Health Services
2012
The Availability and Use Composite Indicator
Estonian eHealth,
where
do you
get the
money?
eHealth Foundation financing
Expenditure
Year (€) Taxes EU Funds
2005 6 853
2006 259 944
2007 462 193 Health Insurance Fund Ministry of Ministry of
2008 1 009 156 Social Affairs Economic Affairs and
2009 1 178 362 Communication
2010 1 433 602
2011 1 834 204 Healthcare Provider
2012 3 048 636 12% 64% 24% 2013
2013 3 293 680 eHealth Foundation
Without EU financing 1/3 from HCP-s and 2/3 from Social Ministry
EU funded projects
Estonian eHealth Foundation
• Electronic Health Record (1.6 mln €)
• Digital Registration (0.2 mln €)
• Digital Images (0.2 mln €)
• Activity surveillance module (0.4 mln €)
• Statistics module (0.4 mln €)
• Authentication and authorization module (0.2 mln €)
• eLaboratory (0.2 mln €)
what did
you
learn?
Lessons learned
• Resources were planned only for central
development.
• Usability is important. Developing process
has to include medical competence –
users
• Data quality is important
– Complete and quality data give value
• Balance between security and usability
– PIN for every document …
Digital stamp for family doctors
50000
40000
30000
20000
10000
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Estonian
eHealth,
where are
you going?
Estimated (qualitative) strength of
the fiscal impact by core projects
Reduced time
Less physical Reduced Reduced waste in Improved
waste during
contacts rehospitalisation IT development prevention
visit
1. Data quality
2. Data-driven and event-based ENHIS 2.0
3. Data capture
6. New patient portal
7. Clinical decision support
8. Personalized medicine
9. Patsient logistics
10. Healthcare process coordination
11. Integrated social and healtcare services
12. Monitoring of health services
13. Telehealth services
Next structure fund projects
• Funded
• Death certificate digitalisation
• State Agency of Medicines IS modernisation
• Digital registration (connecting hospitals)
• Digital referral and nursing summary
• Laboratory services management
• Applications planned 2018
• Data-driven and event-base ENHIS 2.0
• Health Board IS modernisation
• Health Board Laboratory IS phase II
• Health Board surveillance IS
Clinical decision support