Estonian eHealth System

Raul Mill

Estonian eHealth Foundation

Hello!

GDP:

Agriculture 3.9%

Industry 29,7%

Services 66,4%

Estonia

Area - 45 000 km2

1.33 mlj. inhabitants

Healthcare expenditures in Estonia- 6.9% from GDP 2013 – 1.12 bln eur- 5.9% from GDP 2012 – 1.03 bln eur- 5.9% from GDP 2011 – 0.94 bln eur- 6.3% from GDP 2010 – 0.91 bln eur

E-STATE ARCHITECTURE

8 main softwares (totally 20)

752 associated juridical persons21 main hospitals73 stationary healthcare institutions (hospitals)479 family doctors (juridical persons)

2000 2002 2004 2006 2008

HIE platform history

Planning initiated

Project preparation (2003-2005)

Funding decision by Ministry

of Economic Affairs

Electronic Health Record

Digital Prescription

Digital Registration

Digital Images

eHealthFoundation established

(2005)

eHealthProjects

(2006-2008)

National HIE

Standardsmanagement

ITmanagement

Ministry of Social Affairs

East Tallinn Central Hospital

Tartu University

Clinic

Society of Family Doctors

North Estonian Regional Hospital

Management board

Estonian e-Health Foundation Board

ENHIS Operation

EstonianHospital

Assosiation

Union of Estonian Medical

Emergency

Organization

Servicesmanagement

Communication management

MedicalAdvisory

Board

PHARMACIES AND FAMILY DOCTORS2009

X-Road, ID-card, State IS Service Register

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NATION- WIDEHEALTH INFORMATION EXCHANGE PLATFORM2008 december

PRESCRIPTION CENTRE2010 january

PATIENT PORTAL2009

X-ROAD GATEWAY SERVICE2009

E-health architecture

The main security principles of Estonian eHealth system – Opt Out

1. A secure authentication of all users with ID-card or Mobile ID

2. Digital signing or stamping of all medical documents

3. A maximum accountability (transparency): all actions will leave an

unchangeable (and unremovable) secure trail

4. Encrypted database that allows to remove the confidentiality risk

5. Monitoring of all actions together with the corresponding counter-measures (both organizational and technical)

Central System– Databaseand related services

Data Exchange leveldifferent e-services

Institutional level–users cooperation model

• Healthcare processes• User needs• Training programs

• Partnership• Communication

The structure of Estonian Health Information System

• Set of data• Data Standards• Search criterias• Legal Framework• Software• Hardware

• User software• User interface• Data input• Data Visualisation• Searching information

• Data transmission standards (HL7)

EHR services for patient

Services for Social

Insurance Fund

Services fordental care

2015

Services for blood center

2016

Services forregisters

2015

Services fornurse

2016

M-and tele-health services

Health information services for

patient

E-learning services for

medical staffAnalyticsservices

Data and statistics services

A medical certificate services

Digital laboratory

services

2015

eAmbulanceservices

2014

Cross Border Data Exchange

services

2013 (EPSOS)

Digitalarchiving

(x-ray images)

eConsultation services

Digitalregistration

2016

EHR services for physician

Main services of the

eHealth in Estonia

Subservices

- Completed

- Development

- Planning

Infrastructure services External services

Supportingservices

Connecting Health

Acceptance

• All bigger hospitals use central system on a regular base

• The central system has over 10 300 medical users

• ePrescription covers 98% of issued prescriptions

• 98% of family doctors are sending documents to the central system

• Over 97% of stationary case summaries have sent to the central DB

• Ambulatory case summaries sending

– No certain rules for sending ambulatory case summaries!

• 1.35 mio persons have documents in central system (98% of the population)

• 0.74 mio persons information in the central DB have used by medical professionals

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Retrieval of medical documents by healthcare professionals 2009 - 2014

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2012 2013 2014

Sent documents by family doctors 2012 – 2014 – before and after realizing digital stamp

PATIENT PORTAL (UPGRADE) – 1.3 mio persons medical data

Standards

Standards

• HL7 and DICOM (Picture Archive)

• International classification: ICD-10, LOINC, NCSP, ATC

• Estonian eHealth’s OID registry

• Local eHealth classificators

– Published in publishing centre

– Classificators are regulated by government acthttps://www.riigiteataja.ee/akt/12910889

Standardization process

Create data set

Formalize and merge

Approve and publish

Data set document Classificators

Examples

Specialty assotiations

OID-s

XML schemas

Description documents

UML model

Healthcare providers

EeHF standardization

specialists

Social ministry

Stylesheets

UML+HL7 experts

Fixed version of artifacts in

publishing centre

Terminology experts

HIS developers

Health Insurance

Fund

Changes in NHIS documents

regulatory act

eHealth availability and use Indicator 2012: by country

LEARNING

POINTS

Healthcare is a reactive, rather than proactive industry.

Solve one specific problem in healthcare, not ten of them.

In healthcare you need to have a business model from the start.

Healthcare is very interdependent: you have the doctor, the pharmacy,the patient, the insurance provider, and a dozen other stakeholders that

any one service has to coordinate with.

EHR systems: more like plain than mobile phone …

FUTURE OUTLOOK

Data and services

integration

Apps for medical

specialties

UI standards

Single sign on

Hardware independent

Inter-operability

Graphical solutions

Collecting information

Location independent

Conclusion:

• Comperhensive planning – investments, processes and standards, legislation.

• Usability – fast and simple solutions, balance between security and usability

• Implementation – central training programs

• Service update – continuous feedback

Thank you!