e Health in Estonia Kristiina Rebane Ministry of

e. Health in Estonia Kristiina Rebane Ministry of Social Affairs of Estonia

Main characteristics of e. Health in Estonia Nation-wide integrated system Integration of different hospital information systems into one health information system Standardization > Interoperability HL 7; SNOMED; LOINC; DICOM, ICD 10 etc Use of existing IT infrastructure X-road (secure national data exchange layer) ID-card (about 1 million owners)

Main characteristics of e. Health in Estonia Statistics Centralized health care organization and strategic planning Structural funds Project based Defined timeframe, project organization and finances Political support Politicians Doctors

Organization and management of e. Health in Estonia EU structural funds Ministry of Social Affairs Health care providers Political support Estonian e. Health Foundation National Health Insurance Fund

Estonian e. Health Foundation Founded by the Ministry of Social Affairs, major hospitals and medical associations The general goal of the foundation is to coordinate the development of the nation-wide integrated health information system Main goals of the foundation are: Development and government of nation-wide ehealth projects; Coordinating the unification of Estonian health care providers information systems;

Estonian e. Health 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;

e. Health in Estonia – the Four Projects The Core Project: Electronic Health Record Defines e. Health architecture The Side Projects Digital Prescription Digital Images Digital Registration

Timeframe Project Electronic Health Record Digital Registration Digital Prescription Digital Images 2005 2006 2007 2008

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 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.

Side-Projects

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: 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 Images

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

Future developments of e. Health e. Ambulance 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 kristiina. rebane@sm. ee