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MADIS TIIK MD, PHD

HOW DIGITALIZATION CHANGES HEALTHCARE

&

E-HEALTH IN ESTONIA

Tartu University, Medical Doctor, 1996

Tartu University, Family Doctor, 2000

Nordic School of Public Health (Sweden) -

Diploma in Public Health, 2003

Estonian Business School, ICT Management,

2001-2003

Tallinn University of Technology, PhD

(Healthcare Engineering) 2012

Scripps Translational Science Institute (San

Diego, USA), Digital Medicine intern, 2014-

2015

EDUCATION

Family doctor 1998-

Estonian Society of Family Doctors, Chairman 2001-2008.

Estonian eHealth Foundation (EEHF), Board member, 2005-2007

Terviseagentuur Ltd. CEO, Owner, 2006-…

Estonian eHealth Foundation, CEO, 2007-2011

Scientific adviser of the President of the Estonia. Preparing report for EU

Commission, how to improve ehealth after 2020. 2011-2012

Tallinn University of Technology (TUT), eHealth Lab, lecturer 2014-

Sitra (Finnish innovation fund), Senior Adviser, 2012-

CAREER

ESTONIA

HEALTH 1.0

EMR HIS

AI

1.0

PA

CSLIS

RIS

PIS

PHR

1.0

DEV

ICE

1

DIGITALIZATION

FACTORS INFLUENCING SUCCESSFUL IMPLEMENTATION

Common infrastructure

Standards

Access rights

National leadership

INFORMATION SOCIETY STRATEGY (2002)

By 2013

All public services are digitaly available

Public infrastruture is service oriented (x road)

Digital authorisation of users, based on the ID card,

is the best available in the world

Data is stored were it is collected and exchange of

the data is available thous who need it

CURRENT SITUATION IN ESTONIA

X-Road launched in Estonia in 2002

More than 170 databases are offering services via X-

Road (producer certificates)

More than 3000 services are available

More than 900 organisations are using X-Road daily

(consumer certificates)

More than 70% of citizens are using X-Road via

Citizen portal

Most of companies (~160 000) are used X-Road via

Entrepreneur portal

INFORMATION SOCIETY INDICATORS

100% of schools and government organisations have broadband

connection

75% of homes have broadband connection

99% of bank transfers are performed electronically

95% of income tax declarations made via the e-Tax Board

E-census (2012) 815,467 persons completed the questionnaire -62%

26% of votes were cast over the internet on 2015 (Parlament elections)

99% of prescriptions are digital

100% citizens has a digital medical record

ALL PUBLIC SERVICES ARE DIGITAL (2013)

HEALTH 2.0

EHR

HIE

AI

2.0

PHR

2.0

DEVI

CE 1DEV

ICE

2

INTEGRATION

HEALTH INFORMATION EXCHANGE PLATFORM

Operational since 01.01.2009

Implementation strategy (2009-2013)

step by step implementation

User groups in different timeframe

Documents in different timeframe

Only standardized medical documents accepted (HL7v3)

No previous history (before 2009)

Only agreed amount of medical information

Opt out approach for citizens and equal access for all

medical professionals

E-HEALTH SERVICES IN ESTONIA

Nation-wide health information system

Available documents

Time critical data (allergy, chronic diseases)

General practitioners and hospital visits

Summary of ambulatory and stationary case

Link to medical images

Referral letter

ePrescription

Digital images - available all over the county (for physicians only)

eReferral

eAmbulance

eSchool

eConsultation

Patient Portal

ACCESS RIGHTS FOR EHR

All healthcare providers must send data to EHR

Regulated by the law

Access only to licensed medical professionals

The attending doctor concept

ID card for authentication and digital signature

Patient has the right to close his/her own data collected to

the central database (opt out)

Citizen can access their own data

Citizen can declare their intentions and preferences

Citizen can monitor visits to their EHR

ORGANIZATION AND FINANCING OF E-HEALTH

Estonian eHealth Foundation

Standardization

Development of new services

Maintenance of the HIE system

Financed from the state budget

1/3 of the maintenance cost (HIE) is coming through

healthcare providers

Each price in the Estonian Health Insurance Fond

price list contains a ehealth components

Investment cost for ehealth

Maintenance cost

DISTRIBUTION OF COSTS AND BENEFITS OF ESTONIAN

E-HEALTH PLATFORM (DIGIIMPACT STUDY 2010)

Total cost of EHR system development (2005-2010) was

around 10M€ - it is 7.5€ per citizen

EU 2.8 M€EHR 1,599,705

IT SOLUTION 18%

STANDARDIZATION 34%

PUBLIC RELATIONS 15%

ETHICS AND LEGISLATION 12%

PROJECT MANAGEMENT 21%

DIGITAL PRESCRIPTION 218,822

DIGITAL REGISTRATION 188,223

DIGITAL IMAGES 186,479

EDUCATIONAL PROJECT (INCREASING MEDICAL

PROFESSIONALS SKILLS IN COMPUTING)624,254

HEALTHCARE SYSTEM TODAY

Specialist

329 will

meet a

medical

profession

al, e.g.

nurse

1000 citizens

During one

month

800 of

them have

some

medical

concerns

Green, LA. Fryer, GE Jr. Yawn, BP. Lanier, D. Dovey, SM (2001). ‘The ecology of medical

care revisited.’ New England Journal of Medicine, 344(26): 2021–2025

EHR

Laborator

y /other

tests

General

practicion

er

Laboratory

/other tests

DETERMINANTS OF WELLBEINGHealth Care

Environmental & social

factors

Genetics

Behaviour & lifestyle

IMPACT OF THE BEHAVIOURAL CHANGE

Cardiovascular disease: 73-83% (Nurses Health Study,

NEJM 2000;343:16-22, NEJM 2001;345:790-97)

Diabetes type II: 58-91% (Tuomilehto, 2001 NEJM 344(18):

1343-50 Nurses Health Study, NEJM 2000;343:16-22, NEJM

2001;345:790-97)

Cancer: 60-69% (De Lorgeril, Arch Int Med 1998;158:1181-87)

HALE Project. Knoops JAMA 2004;292:1433- 1439)

HEALTH 3.0

SOC

IAL

MED

IAENVI

RON

-

MEN

TAL

SOC

IAL

GEN

ETIC

OP

EN

DA

TAMY

DA

TA

BI

G

DA

TAHEALT

H

ACCOU

NT

AI

3.0

PHR

3.0

DE

VIC

E 1DE

VIC

E 2

HIE

PERSONALIZATION

25

WORKFLOW WITH VIRTUAL CLINIC

Nurse

Self-care

EH

R

PHR

Symptom checker

Data extraction

Data analytics

Decision making

Advice and

recommendation

Health account

1000 citizens

During one

month

800 of

them

have

some

medical

concerns

Genera

l

practitio

nerSpeciali

st

Laborat

ory640

160

AI

Services for

the person

Health

data

PHR

Health and

wellness

DEVICES

SERVICES

Genomic data

MY

HEALTH

Health

Account

IHAN My

Data

+ +

EHR

Sickness data

Disease episode

information

Medical

services

Open data

VISION OF HEALTH 3.0

ARCHITECTURE OF IHAN

Monitoring and

certification

Mobile App

For person

“Bank”Personal account

IHAN

consortium

UserB

Trust

Services

(CA/RA +

TSA)

Security ServerAdapter

INTERNET

UserC User

D

UserA

UserY

UserX

“Central bank”

Services

TRUST NETWORK

FI

VR

YR

VV

MR EE

RR

MTA

MR

AR

snet Xnet Ynet

Xcountr

NIS

NIS -Nordic Institute for

Interoperability Solutions

E-mail: [email protected]

CONTACT INFORMATION

GET IN CONTACT FOR FURTHER COOPERATION

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Round tables and discussion groups

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“Accelerating innovation saves

healthcare”

Madis Tiik

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