The Status of National e-Health Initiatives in Estonia Madis Tiik 18.06.2010 CEO Estonian e-Health Foundation
Dec 20, 2015
The Status of National e-Health
Initiatives in Estonia
Madis Tiik18.06.2010
CEOEstonian e-Health Foundation
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Facts about Estonia
• Population 1.32 million• Area 45 000 km2• Compulsory health insurance paid by employer
– Health insurance tax 13%– Health care costs make up 5% of GDP
• Income tax 21% (flat tax)• Healthcare providers are private, municipal or
governmental. – Family doctors (private companies)– Hospitals (shared companies or foundations)
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e-Estonia
• Wide range of e-services – e- election (EU Parliament election june 2009 – 6,5%
electronically)
– e- tax board (2008 – 90,6% electronically)
– e- school– e- commercial registri, etc
• High bandwith connectivity– Internet
• 75% of population use regulary internet (2009)• 67% households have PC and 91% of them are
connected to the
Information Society
• 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
KITCitizen view
EITEnterpriser view
AITPublic servant view
National D
atab
ases register
http://ww
w.riik.ee/arr/
Po
pu
latio
n re
giste
r
He
alth
Insu
ran
ce R
eg
ister
Na
tion
al P
en
sion
Insu
ran
ce R
eg
ister
Ve
hicle
Re
giste
r
Tallin
n W
ate
r IS
Esto
nia
n E
ne
rgy IS
Internet - X-tee
DATABASES / INFORMATION SYSTEMS BANKS
Central server I
Central server II
Monitoring
Helpdesk
X-road certification centre
X-road CenterTools centrally developed by the State Certification Center
ID – card
• SEBbank• Swedbank• Creditbank • Sampo Bank• Nordea Bank
Security Server
Security Server
Security Server
Security Server
Security Server
Security Server
Security Server
Security Server
:: … ::
E-institution – Institution view
:: E-county – county view ::
:: E-riik – State Portal ::
Institutional view of the state Thematic view of the statewww.riik.ee www.eesti.ee
Security Server
X-road
• Aggregates 360 different databases• 2000 e-services • 500 different organizations have integrated
their systems into X-road• Services of X-road were used 420 000 000
times a year (2009)• more information http://www.ria.ee/27525
Lifestyle
Self-help
Tele-advice AppointmentNotification
Prescription
Campaigns
PublicServices
Policy-making
Analysis
Diagnostics
Treatment
Guidlines
Follow-up
EHR
Workflow
Family doctors
Hospitals
Founders of the Estonian eHealth Foundation
End users
Strategy and Architecture Development
Marketing and Channel Management
Ministry of Social
Affars
East Tallinn Central Hospital
Tartu University
Clinic
Society of Family
Doctors
North Estonian Regional Hospital
Management Board
Estonian eHealth Foundation
Board
EHR Operation
Estonian Hospital
Association
Union of Estonian Medical
Emergency
Nursing Care
Patient Portal
Health Authorities
Governance
Our tasks
• Management of E-Health projects• Standardisation and development of medical digital
documents• Maintenance of the Estonian EHR system • International cooperation and scientific cooperation
with universities• Development of new services for citizens and doctors
Financed from the State budget (1.2 mln € – 2008)
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X-ROAD
SS
HEALTH CARE BOARD- Health care providers- Health professionals- Dispensing chemists
STATE AGENCY OF MEDICINES- Coding Centre
- Handlers of medicines
SS
SS
HEALTH INSURANCEFUND
Prescription Centre2010 january
HEALTH INFORMATION SYSTEM ( EHR)
17.12.2008
SS
SS
- Citizen Registry- Company Registry
SS
Pharmacis2010 january
Doctor’s and pharmacies
software solutions
Hospitals 2009
Family doctors2009
Emergency Medical Service
2011School nurses
2010 september
SS SSSS SS
Healthcare Provider
SS
Monitoring portalPatient portal
Goverment’s e-service frameworkwww.eesti.ee
KIT Citizen view
EIT Enterprice view
AIT Official’s view
W-SS
Estonian national eHealth infrastructure
Health Portal DevicesInformation
Systems
Standards and Services
Processes and Integration
WSDLXSD
Public IT Infrastructure
ConcentDocument
archive
Health record
StatisticsDecision Support
ReportsHealth status
Ambulance
Demo-graphics
Booking
EH
R C
entra
l Functio
ns
Storage ( long time archive)Metadata/ universal viewer
Current Situation 17.06.2010
• There are 1 557 704 documents in the Estonian EHR • Discharge letters (epicrises) 186 460 • Out-patient consultation notes 244 609 • Dispensed medication information 743 944• DICOM images ( index) 213 397• Image reports 164 069
• More than 370 000 citizens have digital medical records in EHR , it is 25% of the population
Availability of Discharge LettersYear 2009
North Estonian Regional Hospital
Tartu University Clinic
East Tallinn Central Hospital
27661 31914 24038
82% 74% 84%
These 3 hospitals cover more than 60% of in-patient cases in Estonia
ePrescriptionsPrescription centre was launched 1st of January 2010
January February March April** May
Number of e-prescriptions issued
278 957 407 609 520 000 387 000 381 836
% from prescriptions issued*
40% 58% 74% 55% 55%
Purchasedprescriptions
150 009 221 800 322 000 288 000 292 207
% from purchased prescriptions*
21% 31% 46% 41% 42%
*estimation based on 2009 numbers - 700 000 prescriptions monthly** 13.04 recomendation not to use e-prescription to the doctors
Patient’s Portal → Personal Health Record (PHR) 2010-2011
• PHR – one view for citizens– Illness data from healthcare system (Patient’s Portal)– Self-monitoring data– Wellness data from third parties– Data from social system– Patient forums– Screening remainders
• Decision support – Self-care– Virtual health check
Interactive Services
Viewing Prescriptions
Viewing Health Record
E-consultation
Immunization Passport
Virtual Health Check
Citizen Health Record
Collecting Personal Health Information
Self-help
Personal Data Management
Informational Services
Reminders
Invitation for Screening
Booking Service
Supporting Services
Rights Management
Authorizations
Expressions of Will
Access Rights
Log Archive
EHR Portal Services for Citizen
TIS
TIS
TIS
Decision Support
Knowledge Digitalization
Suggestions and
Reminders Decision Support Service
Decision Scripts
Health RecordsDigital Library
Health Records Service
ApplicationsEnd user services, hospital IT services
Patient: Oracle PortalHospital IS
X-Road
Sending messages between institutions
X-Road infrastructure
Message centreMessage validation, authorisation, logging, addressing
webMethods Integration Server, custom Java services
Message brokerForwarding messages to agents
webMethods Broker
Message agentsDocument processing webMethods Integration
Server
Data servicesDatabase operations, database logging, queries
webMethods Integration Server, Oracle DBMS
EHR integration through X-Road
HL7 interaction
HL7 document
X-Road message
Hospital IS EHR
Lab notice
ÜldandmedMari-Liis
47595064059
Männi 1-2
Tallinn
Diagnoospunetised
Allergiaõietolm
Swineflu notice
ÜldandmedMari-Liis
47595064059
Männi 1-2
Tallinn
Diagnoospunetised
Allergiaõietolm
Message
Timecritical reports
Demographics
Health recordInfection notice
ÜldandmedMari-Liis
47595064059
Männi 1-2
Tallinn
Diagnoospunetised
Allergiaõietolm
Discharge letterDemographics
Mari-Liis
47595064059
Männi 1-2
Tallinn
Diagnosischickenbox
Allergypollen
Demographics agentAddress: Männi 1-2, Tallinn
Infection decease agentDiagnosis: chickenbox
Timecritical report agentAllergy: pollen
Health record agentEvent: Medication,
Diagnosis, Procedure
HPIservices
Document processing
Statistics queryOutbreak report
Data integrationDemographics, health statusHPI
Application Maintenance
Server, Storage & Network Management
Database management
Monitoring help desk
Application Operations
Hardware and Data Center
Application Development
Business Processes
Partners
eHealth
eHealth
Partners
ITIL
Maintenanceof Estonian EHR System
“Have an eExperience in Tallinn”
eHealth Conference in Tallinn 13-15 October 2010www.ehealthtallinn2010.org1. The Estonian eHealth Concept 2. Translating the Benefits & Cost of eHealth - Assessment of
Economic Impact of the Estonian Health Information System (DIGIMPACT)
3. Opt-in or Opt-out? User Rights, eHealth Related Legal and Privacy Issues in Estonia
4. Open Discussion: How Was the Estonian National Health Information System Implemented? Overview of process, problems we have encountered, different parties’ viewpoints on implementation (e.g. physicians and patient representatives).
Thank you for your attention!
Questions?
http://eng.e-tervis.ee/
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