Estonian eHealth Foundation

1. Estonian eHealthFoundation 2012

2. Introduction The Estonian eHealth Foundation promotes and coordinates national e-solutions within the health care sector. The Estonian eHealth Foundation develops cooperation between different parties in both Estonia and Europe, is the initiator of new projects and promotes awareness of eHealth in society. The foundation’s aim is to use e-solutions to make health care service more accessible to the doctors and patients and thereby to increase treatment quality.

3. Contents Estonian eHealth Foundation Board of the Foundation Medical Advisory Committee Health information system eHealth services New development projects Cooperation projects Our people Publications Partners

4. 2012 was ... … a year of changes for eHealth. The principles that were defined in 2012 in cooperation with healthcare parties are the basis for the activities and development directions of the following years. This is the basic concept for systematically developing eHealth. Many objectives were reworded on the basis of the needs of users and the options for increasing system usability. The most important activities that need to be pointed out include carrying out mappings necessary for increasing the convenience and speed of use of the systems, as well as developing and improving work processes on the basis of the updated objectives. In conclusion, eHealth solutions should improve the efficiency of the treatment process for both the doctor and the patient, enabling the former to access more complete information and helping the latter to understand the treatment process better. Raul Mill, Member of the Board of the Estonian eHealth Foundation

5. 2012: 18 In 2012, there were 18 simultaneous developments taking place in the foundation. The more important of them were a service for the Social Insurance Board and a digital stamp solution for family doctors. Preparations were made to migrate the hosting of the central system. Developing eAmbulance, digital registration, doctor portal and patient portal continued. The largest of the external projects was epSOS, which focuses on exchanging patient’s electronic health records between EU countries.

6. I wish, that different e-solutions would “speak” to each other more than they have and that the data in the solutions could be used for mutual enrichment. I wish that different solutions could be used in one user environment – this would be the basis for the convenience of use of e-health solutions. I wish all the parties of the eHealth area strength, innovative and systematic approach and openness for cooperation. Taavi Rõivas Minister of Social Affairs

7. Mission. Vision. Core values The missionof the Estonian eHealth Foundation is to create value for the parties in the health care area. The basis for that is cooperation grounded on innovative IT solutions. The visionof the Estonian eHealth Foundation is to create a complete cooperation model for the health area and an information system that ensures secure availability of health information at the right time to the right person. The core valuesof the Estonian eHealth Foundation are professionalism, commitment and readiness for cooperation.

8. Strategic and development objectives until 2015 • To ensure the quality and availability of data in the health information system. • To support the quality of the health care system with high-level data exchange and to develop suitable IT solutions. • To increase awareness of the eHealthsolutions and possibilities among the providers and users of health care services. • To ensure a professional and well-functioning organisation required for meeting the objectives.

9. Principles for meeting the objectives Completeness– systematic solutions that consider all interests of the parties in the health care area. Quality: • data quality – can be standardised, processed, used; • solution quality – user-friendly, quick, secure, reliable; • work process quality – purposeful, planned, efficient, transparent, comprehensible. Innovativeness– implementing new technologies and concepts. Effectiveness– achieving interaction between solutions and parties. Optimal use of resources. Involvedness– wide involvement of interest groups and experts in developing the solutions. Awareness– increasing society’s awareness of health care services and their availability, of new solutions and usage options. Security– the most important principle and component of data exchange. Reliability– in cooperation with the parties in considering their interests, adhering to agreements and complying with good practices.

10. Board The Board of the Estonian eHealth Foundation has representatives from all founding members: East Tallinn Central Hospital, North Estonia Medical Centre, Tartu University Hospital Foundation, Estonian Hospitals Association, Estonian Society of Family Doctors, Union of Estonian Emergency Medical Services, Ministry of Social Affairs, also Estonian Health Insurance Fund and Ministry of Economic Affairs and Communications. The task of the Board consisting of different parties is to strategically manage the foundation.

11. Members of the Board IVI NORMET Deputy Secretary General on Health of the Ministry of Social Affairs IviNormet has worked as the Deputy Secretary General on Health of the Ministry of Social Affairs since 2005. She has graduated from the Faculty of Medicine of the University of Tartu as a paediatrician. IviNormet is also a Member of the Board of the Estonian Health Insurance Fund.

12. Members of the Board TANEL ROSS The Board Chairman of Estonian Insurance Fund Before joining the Insurance Fund Tanel Ross worked as a Deputy Secretary General for Development, European Union and External Relations at the Ministry of Finance. In addition, Ross has led the Department of International and Public Relations at the Bank of Estonia. KERSTI REINSALU Member of the Management Board of East Tallinn Central Hospital KerstiReinsalu has graduated from the Faculty of Economy of the Tallinn University of Technology. From 2008 to 2012, she was a Member of the Board of the Estonian Health Insurance Fund. Starting from November 2012, she is a Member of the Management Board of East Tallinn Central Hospital.

13. Members of the Board JAAN VINNAL The Head on budgets in the Finance and Property Management Department at the Ministry of Social Affairs JaanVinnal is a candidate of Science in Electronics Engineering. MARGUS PÜÜA in 2012, represented the Ministry of Economic Affairs and Communications as the Head of the Department of State Information Systems MargusPüüa is a system engineer. He has graduated from Tallinn Polytechnic Institute. He has practical work experience as a junior research fellow in the Institute of Cybernetics, Head of the Software Development Department in AS EestiTelefon, a Consultant at OÜ Goldratt Baltic and Head of the Development Department at the Estonian Information System's Authority.

14. Members of the Board MARGUS AUVÄÄRT The Head of Information- and Communication Technology Department at the Ministry of Social Affairs He has graduated from the Economic Data Processing specialty of the Tallinn University of Technology. TÕNIS ALLIK Chairman of the Management Board of North Estonia Medical Centre TõnisAllik has graduated from the Faculty of Economics of the University of Tartu. He is a Member of the Board of the Estonian Health Insurance Fund, a Member of the Board of Estonian Hospitals Association, a Member of the Board of the Estonian Competence Centre for Cancer Research, Chairman of the Board of Advisers of the Tallinn Health Care College, Member of the Board of the Technomedicum of Tallinn University of Technology. Since 2003, TõnisAllik is the Chairman of the Board of North Estonia Medical Centre.

15. Members of the Board KALEV KARU AS Representative of the Estonian Hospitals Association Chairman of the Board at Medicum Ltd. He has graduated from the Faculty of Medicine of the University of Tartu. In addition, he acquired a master's degree in the Healthcare Quality Management at the University of Helsinki. He has worked in Merimetsa Hospital and in the Board of Health of Tallinn City. MART EINASTO Member of the Management Board of Tartu University Hospital Foundation Mart Einasto has graduated from Tallinn University of Technology as an industrial planner and has a Master’s degree from the University of Tartu in sociology. He is also a social politics doctoral student at Turku University in Finland.

16. Members of the Board DIANA INGERAINEN The Chairwoman of the Board of Estonian Society of Family Doctors. Diana Ingerainen is the family physician and director of the Järveotsa Family Health Centre. She has graduated from the Faculty of Medicine of the University of Tartu, has worked in the Väike- ÕismäePolyclinic and been a Deputy Mayor of Tallinn. From 2011 she has been the Chairwoman of the Estonian Society of Family Doctors. AGO KÕRGVEE Chairman of the Management Board of the Union of Estonian Emergency Medical Services In addition to the Union of Estonian Emergency Medical Services, Ago Kõrgvee also manages the Emergency Medical Services Department of Tartu University Hospital and Tartu Emergency Medical Services and the Association of Doctors in Emergency Medical Services of Estonia. He also belongs to the Boards of Ida-Viru Central Hospital and Ida-Viru Emergency Medical Services.

17. Medical Advisory Committee Medical Advisory Committee is an advisory body created by the eHealth Foundation in 2012 and it includes 17 doctors-experts. The objective of the Advisory Committee is to advise the Foundation and to give evaluations from the medical aspect, mediating the proposals of treatment institutions for the development of the health information system. The Committee takes part in shaping the processes of data quality and developing new eHealth services.

18. Members of the Medical Advisory Committee Dr Agnes Aart, South Estonian Hospital· Dr Alice Lill, East Tallinn Central Hospital Dr Andres Tein, Tartu University Hospital Foundation·Dr Andrus Mäesalu, AS Medicum·Dr AnneliKaru, AS Medicum·Dr AnneliTalvik, Estonian Society of Family Doctors·Dr EnnoKase, Viljandi Hospital·Dr Katrin Gross-Paju, West Tallinn Central Hospital·Dr PeeterLaasik, Elva Hospital ·Dr ÜlleKadastik, Tartu University Hospital Foundation·Dr EneHalling, East Tallinn Central Hospital Dr KatrinLuts, Tallinn Children’s Hospital·Dr KülliKingo, Tartu University Hospital Foundation·Dr ToomasKariis, East Tallinn Central Hospital Dr VeikoVahula, Pärnu Hospital·Dr Peeter Ross, East Tallinn Central Hospital Dr KaireAadamsoo, North Estonia Medical Centre

19. Health information systemCooperation model of the health care sector The health information system is a cooperation model of the health care sector that involves different solutions and one of the most important parts of which is a central data collection belonging to the state information system. As at 31 December 2012, the health information system included the medical information of 1,009,824 people. In comparison to 2011, there was an increase of more than 20% (806,149).

21. eHealth services The eHealthservices meant for both doctors and patients are aimed at the better organisation and increased quality of the treatment process. The services are divided into direct services and indirect services. Direct services are directly available to users. Indirect services are necessary for ensuring the functioning of the system.

22. eAmbulancesolutioneHealth services eAmbulancesolution connects the alarm centre, health information system, ambulance, ambulance station and provider of the health care service (primarily the Emergency Medical Care Department) into a uniform information exchange system.

23. eAmbulanceeHealthservices The main developments of eAmbulance in 2012 were: the creation of a data exchange capability with the alarm centre; development of a mobile workstation for the ambulance; combining the ambulance software statistics option with the new system; creation of the eAmbulance administration system. In 2013 we plan to begin piloting eAmbulancesolutions.

24. eAmbulance eHealth services

25. Patient portaleHealth services The patient portal is an e-services environment, the aim of which is to enable the patient to examine his/her health information. Most important activities in the patient portal project in 2012: • updating the platform and services (including implementing mobile ID), designing the user interface; • creating new services for the patient portal, which is supported by the EU with two primary projects; • project SUSTAINS (Support USers To Access INformation and Services) within the ICT PSP programme, the objective is to make the patient an active user of health information; • epSOS project for developing an EU-level health state summary.

26. Patient portal eHealth services

27. Patient portal Health information system

28. Digital registrationeHealth services Digital registration makes it possible to reserve doctor’s appointments to different medical institutions from one place. A common environment enables the implementation of eAppointment, eConsultation and eReferral with digital registration. In the future, the digital registration solution will also include an overview of the length of the waiting list.

29. eCertificateeHealth services The eCertificate project will result in the introduction of three types of health certificates:health certificate A, B and C. Health certificates differ in the volume of data. Health certificate A contains the least and health certificate C the most data. Certificate C also covers the data of certificate A and B. An eCertificate is issued on the basis of a health check chart and health declaration and in the future the person can forward it via the patient portal to the recipient of the certificate.

30. eCertificate eHealth services

31. Doctor portaleHealth services The doctor portal is a web based user interface for using the health information system. As a result of the developments in 2012, it is possible to send documents to the health information system and make inquires about all documents in the system via the doctor portal. The doctor portal will be launched in the 3rd quarter of 2013 and is free for users.

32. Digital stampeHealth services The digital stamp solution enables family doctors to forward documents to the health information system without having to digitally sign all of them separately. The created solution helps doctors to save time when sending documents to the central system. In addition, the solution ensures a possibility of signing the documents prepared in the health information system.

33. Digital stampeHealth services Most important activities in 2012: In 2012, the 1st stage of the digital stamp project was completed and it enables the use of the solution in full functionality. In 2013, the development of the 2nd stage will continue in cooperation with the Estonian Information System's Authority and Cybernetica AS. As a result of the development of the 2nd stage, the evidential value of the documents sent will increase as the digital stamp solution will be taken from the central system to the user localisation.

34. eLabeHealth services The objective of the project is to create a possibility for forwarding and preserving the results of lab tests in the health information system using the LOINC standard and linking them with other services and solutions of the health information system. Between 2010 and 2012, the international health care laboratory observations terminology standard LOINC was Estonianizedand the RELMA program launched. Its objective was to unify the terminology of laboratory analyses conducted in Estonia and to make the analysis results of different laboratories comparable. The health information system solution for centrally gathering, preserving and viewing analysis results is planned to be completed in 2013.

35. e-Lab eHealth services

36. Services for the Social Insurance Board On the basis of the data in the health information system, the doctors and experts of the Social Insurance Board (SIB) can determine the degree of disability and/or permanent incapacity for work. Family doctors who have forwarded patient information to the health information system do not have to issue patient data separately on paper. The service launched in June 2012 can be used by the SIB doctors and experts initially via the portal.

37. Services related to statistics Statistical information based on the data in the health information system is forwarded to different target groups – main target groups are the Health Board, National Institute for Health Development, Ministry of Social Affairs, providers of health care services and patients. Upon launching the statistics module in 2013, it is possible to automatically prepare data for different statistical data processing processes. Thanks to the created solution, the volume of data currently forwarded via the A-web will be reduced and such data will be collected via the health information system. The statistics module also makes a significant contribution to increasing the data quality of the health information system by creating data control mechanisms.

38. Services related to statistics In 2012, the development process begun and the consolidated statistics notice was updated. In cooperation with the Ministry of Social Affairs and the National Institute for Health Development the first stage of the statistics vision was developed. The development will be completed in 2013 and then pilot usage will begin.

39. New development projects 1st stage of the digital archive development Developing the authentication and authorisation module Immunisation passport Cooperation projects with the Ministry of Social Affairs: Register of cancer research and screenings Registry of myocardial infarction Blood and tissues information system

40. Administration of the health information system The administration of the healthinformation system is an important component for ensuring the work of all existing and new developments. Administration includes the administration, helpdesk and updating of the main components of the system of both the central database and its user interfaces.

41. Cooperation within Estonia I Cooperation projects with the Software Technology and Applications Competence Centre, within which: a prototype for a text entry helping tool for the doctor’s desktop is created; data mining and data analysis is performed; the concept for the environment for disclosing classifications is developed; a solution for search algorithms necessary for processing data is developed.

42. Cooperation within Estonia IIDevelopment seminars Developers’ brainstorm Discussion seminar for hospital managers Estathon E-health information days Digital records– from idea to execution

43. International cooperation Project Regional Telemedicine Forum: the objective is to develop an international telemedicine cooperation network and to develop the best practices and policy recommendations for extensive implementation of telemedicine. Project epSOS: the objective is to exchange summary data about the digital prescription and patient’s health state between participating countries in the EU. Project EHR-QTN: the objective is to acknowledge the need for certifying e-services and to promote the certification of e-services in the health care area, primarily certification of electronic medical history, in partner countries. Project Momentum: the objective is to create a network of European telemedicine services experts and to develop instructions for the contract conditions and service levels for providin high-quality telemedicine services. The final objective is to ensure the existence of mechanisms for the sustainable implementation of telemedicine services. Project Antilope: the objective is to improve the implementation of standards that support the interoperability of eHealth, the creation of testing manuals and the development of the eHealthinteroperability framework in the European Union.

44. Idea group In order to systematise and better administer the needs of the partners’ eHealth area, the Estonian eHealth Foundation idea group was founded in 2011. In 2012, a system for managing ideas was created, including the process of handling and analysing new ideas. In 2012, the idea group received 16 proposals.

45. Our people

46. Most important publications in 2012 Final report of classification published in the eHealth Foundation publications centre. Author: Krista Hinno Summary overview SNOMED - What It Is and Whether It Meets the Expectations of eHealth and Estonian Medicine. Author: JaanPruulmann The concept of standards used in the health care system, mapping the terms related to the standardisation process and their definitions. Author: AnneliKaru Web-based access to personal health information: overview of patient portal usage. Author: PeeterRoss Regional telemedicine forum: analysis and examples of Europe’s best telemedicine services. Author: Peeter Ross

47. Media

48. Biggest cooperation partners Data Protection Inspectorate• Health Board• Ministry of Social Affairs• North Estonia Medical Centre• Tartu University Hospital Foundation• East Tallinn Central Hospital West Tallinn Central Hospital• Tallinn Children’s Hospital• Pärnu Hospital Ida-Viru Central Hospital• South-Estonian Hospital• Elva Hospital• Estonian Society of Family Doctors• Estonian Health Insurance Fund• Estonian Hospitals Association Estonian National Social Insurance Board• Ericsson

49. We thank all ourcooperation partners! Your Estonian eHealth Foundation 2012