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T he Estonian Electronic Health Record System

T he Estonian Electronic Health Record System. Madis Tiik CEO Estonian e-Health Foundation. Information Society. By 2013 All public services are digitaly available Public infrastruture is service oriented (x road)

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T he Estonian Electronic Health Record System

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  1. The Estonian Electronic Health Record System Madis Tiik CEO Estonian e-Health Foundation Baltic Congress in Laboratory Medicine 16 September 2010

  2. 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

  3. Analysis Follow-up Policy-making Treatment EHR Guidlines PublicServices Diagnostics Campaigns Tele-advice Appointment Workflow Notification Self-help Prescription Lifestyle

  4. Founders of the Estonian eHealth Foundation Ministry of Social Affars Society of Family Doctors Tartu University Clinic East Tallinn Central Hospital Union of Estonian Medical Emergency North Estonian Regional Hospital Estonian Hospital Association Estonian eHealth Foundation Board Management Board Strategy and Architecture Development Marketing and Channel Management EHR Operation Governance Family doctors Hospitals Nursing Care Patient Portal Health Authorities Endusers

  5. 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 (1.5mln € – 2010)

  6. Emergency Medical Service 2011 School nurses 2010 september Hospitals 2009 Family doctors 2009 SS SS SS SS SS SS Patient portal Monitoring portal HEALTH INSURANCE FUND Goverment’s e-service framework www.eesti.ee Prescription Centre 2010 january HEALTH INFORMATION SYSTEM ( EHR) 17.12.2008 KIT Citizen view EIT Enterprice view AIT Official’s view HEALTH CARE BOARD - Health care providers - Health professionals - Dispensing chemists Pharmacis 2010 january STATE AGENCY OF MEDICINES - Coding Centre - Handlers of medicines • Citizen Registry • Company Registry SS SS SS SS X-ROAD SS Healthcare Provider W-SS Doctor’s and pharmacies software solutions Estonian national eHealth infrastructure

  7. Document processing Infection notice Discharge letter Message Lab referal Swineflu notice Health record Demographics Üldandmed Üldandmed Üldandmed Health record agentEvent: Medication, Diagnosis, Procedure Mari-Liis Mari-Liis Mari-Liis Mari-Liis 47595064059 47595064059 47595064059 47595064059 Demographics Männi 1-2 Männi 1-2 Männi 1-2 Männi 1-2 Demographics agentAddress: Männi 1-2, Tallinn Tallinn Tallinn Tallinn Tallinn Diagnoos Diagnosis Diagnoos Diagnoos Statistics queryOutbreak report punetised chickenbox punetised punetised Allergia Allergy HPI Allergia Allergia Data integrationDemographics, health status HPIservices õietolm õietolm õietolm pollen Infection decease agentDiagnosis: chickenbox Timecritical reports Timecritical report agentAllergy: pollen

  8. Health Portal Devices Information Systems Public IT Infrastructure Standards and Services WSDLXSD Processes and Integration Health record Health status Booking Reports Ambulance Document archive Statistics Decision Support Demo-graphics Concent Metadata/ universal viewer Storage ( long time archive) EHR Central Functions

  9. Current Situation 15.09.2010 • There are 1858541documents in the Estonian EHR • Discharge letters (epicrises) 233338 • Out-patient consultation notes338922 • Dispensed medication information 770704  • DICOM images ( index) 264488 • Image reports 243797 • More than 400 000 citizens have digital medical records in EHR , it is 30% of the population

  10. Availability of Discharge LettersYear 2009 These 3 hospitals cover more than 60% of in-patient cases in Estonia

  11. ePrescriptions Prescription centre was launched 1st of January 2010 *estimation based on 2009 numbers - 700 000 prescriptions monthly ** 13.04 recomendation not to use e-prescription to the doctors

  12. eLab project • Translation of 10 000 LOINC terms • Implementation LOINC and RELMA program's in all labs • Mapping of Lab’s test’s with LOINC standard. • Influence to the other projects: • Enables dataexchange between labs and healthcare providers • Enables statistical analyzes and comparisons • Test results are seen to all users of EHR • Enables patient’s to see lab test • More info for decision support • Automatic exchange data with Infectious diseases register

  13. Workflow of lab test’s Doctors IT system 6. Report, alerts, lab test results 1.-2. Referal (patient ID, test specifikation, index number) Referal centre EHR Sample logistic 4. Sample + index number 3. Referal (test specifikation, index number) 5. Lab test result(index number) Lab

  14. Lab test standard http://pub.e-tervis.ee/standards2/Standards/3.0 <observation classCode="OBS" moodCode="EVN"> <!-- eristab mis liiki Observation kirjega on tegemist--> <code code="ANA" codeSystem="1.3.6.1.4.1.28284.6.2.2.5.1" codeSystemName="Observation liik" displayName="Analüüsi tulemused"/> <!-- staatus: lõplik--> <!-- <statusCode code="completed" codeSystem="2.16.840.1.113883.5.14" codeSystemName="ActStatus"/> --> <statusCode code="completed"/> <!-- analüüsi vastuse rea aeg--> <effectiveTime value="20060501134139"/> <!-- analüüsi tulemus --> <value xsi:type="ED"> 9.2 </value> <specimen typeCode="SPC"> <specimenRole classCode="SPEC"> <specimenPlayingEntity classCode="ENT" determinerCode="INSTANCE"> <!-- analüüsi parameeter--> <code code="tO2" codeSystem="OIDnr" codeSystemName="Analüüside parameetrid" displayName="tO2"/> <!-- ühik --> <!-- code="" codeSystem="2.16.840.1.113883.6.8" codeSystemName="UCUM", kui võimalik--> <desc>Vol %</desc> </specimenPlayingEntity> </specimenRole> </specimen> <referenceRange typeCode="REFV"> <observationRange classCode="OBS" moodCode="EVN.CRT"> <!-- referentsväärtus--> <text>10 Vol %</text> </observationRange> </referenceRange> </observation>

  15. Task Setup Ministry of Social Affairs, EeHF, Professional Society’s 6 months Life Cycle of Digitization of Medical Document Content Related Standardization The Estonian eHealth Foundation (EeHF) Technical Standardization – CDA document Developer (Outsourcing) • Installation Standard to the Test Environment (EeHF) 3 months • Development of Central System Services Development of Health Care Service Providers’ Developer (Outsourcing)Information Systems Health Care Service Provider’s ICT partner 3 months Testing and Acceptance Services Developer, EeHF, Health Care Service Provider’s ICT partner 12 months Standard published, installed to working environment, new service in portfolio of EeHF- EeHF • Ministerial degree naming the date for Health Care Providers when standard and new documentation is obligatory -Ministry of Social Affairs

  16. 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 Future of EHR

  17. EHR Portal Services for Citizen

  18. Decision Support Suggestions and Reminders Decision Support Service Health Records Service Knowledge Digitalization Digital Library Decision Scripts Health Records

  19. EBMeDS Evidence-Based Medicine electronic Decision Support Estonian NHIS EBMeDS Local Service EHR Document Service Global, National & Local Scripts Data Tables Patient Data ”Glue” component Conversion filters Evidence Links Decision Support Core Engine EHR DecisionSupport Web Server Application HCIworkspace • Drug Information • Best Practice • Contraindications • Interactions Log Files Forms & Calculators Response Messages JavaScript Interpreter Function Library Testing Applications Update Service HTTP FTP EBMeDS Central Service Testing Applications Administrator Tools • Web Resources • EBM Guidelines • Cochrane Library • Essential Evidence • EBMeDS Home Page EBMeDS Database EBMeDS Master File Package Script Editing Tools Compiling Tools Table Editing Tools

  20. Service Maintenanceof Estonian EHR System Continual Process Improvement Service Design Service Operation Service Strategy Service Transition ITIL Business Processes eHealth Partners Application Development Application Maintenance eHealth ApplicationOperations Monitoringhelp desk Database management Partners Server, Storage & Network Management Hardware and Data Center

  21. Operations Capacity Management Problem Management Demand Management Incident Management Configuracion Management Service Level Management Service Request Management Service Continuity Management Change and Release Management Maintenance of the EHR Business Processes W-SS Doctors portal Patient Portal EHR reguest servicis Patient summary Medication history 7 Business Processes Application Development 6 Application Maintenance and Support 5 Application Operations 4b Monitoring, Help Desk 4a DataBase Management 3 Server, Storage & Network Management 2 Hardware & Data Center 1

  22. Thank you for your attention!Questions?Madis.Tiik@etervis.eewww.etervis.ee http://eng.e-tervis.ee/

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