eHealth State Policy and Projects in Estonia

Oliver LillepruunEstonian eHealth Foundation

19.04.2007

Estonian eHealth Foundation I

• The Estonian eHealth Foundation is an organisation created by the Ministry of Social Affairs of Estonia and leading Estonian health care service providers

• The purpose of the Estonian eHealth Foundation is to develop and manage the information system of Estonian health care

• Founded in 2005

Estonian eHealth Foundation II

– Develops and administrates nation-wide health registries and infosystems;

– Plays an active role in development and publishing of standards and classifications in health care sector;

– Coordinates development of nation-wide medical guidelines;

– Cooperates with health care providers and with other institutions involved in health care provision.

E-projects of Estonian state

• Electronic Health Record– One of the most practical public administration services– One of the largest public IT development projects – The most important ID card application in Estonia in the

nearest future– The world’s first national eHealth system

• eHealth solutions supplement today’s public administration e-services:– Electronic school – Internet elections– Electronic Commercial Register, etc.

2007: four eHealth projects

• The three primary nation-wide services developed by Ministry of Social Affairs and Estonian eHealth Foundation are – Electronic Health Record– Digital Images– Digital registration of treatment queues, i.e. Digital

Registration• Digital Prescription – developed by

Estonian Health Insurance Fund

Background of eHealth projects I

• 2004 – Ministry of Social Affairs applies for aid from the European Union structural funds

• April 2005 – Ministry of Economic Affairs that coordinates allocation of structural funds made the funding decision for four eHealth projects:– Electronic Health Record (EEK 25 mln)– Digital Registration (EEK 3 mln)– Digital Images (EEK 3 mln)– Digital Prescription (EEK 3.7 mln)

• September 2005 – Ministry of Social Affairs announces tenders

Background of eHealth projects II

• Nov 2005 Estonian eHealth Foundation is founded:– Manages the projects of Electronic Health Record (EHR),

Digital Registration (DR) and Digital Images (DI)– Administers the information system of EHR

• July 2006 Winning consortium for the tender on EHR:– Estonian affiliate office of Hewlett-Packard OY– AS Microlink Eesti – AS Icefire

• Nov 2006 – Tender for the Digital Registration was won by AS

Medisoft and AS Cell Network – Tender for Digital Images was won by AS Microlink Eesti

Legal environment of eHealth

• The Health Information System Act is being prepared to – regulate the development and maintenance of the

health information system– Lay down the necessary requirements to the patient,

health service provider, etc

• The bill was drafted by Law Firm Raidla & Partnerid• Debate of the bill

– Government (spring 2007)– Parliament (autumn 2007)

ELECTRONIC HEALTH RECORD

What is Electronic Health Record?

• A national health information system

• A way for medical doctors to exchange health records

• Access for the patient to his or her health records through a designated patient’s portal

• Health care providers are able to enquire patients’ time-critical and general data

• The system stores the patient’s medical history and is a vital information source for physicians

Benefit to patients

• Patient Portal – access by one’s ID card to his or her medical data regardless of time and place

• Patient no longer needs to carry papers between different physicians– Physicians have an objective and accurate overview

of the patient’s health history– In collecting data to the EHR it is no longer necessary

to recall earlier diseases or drugs– Better overview of the health history improves the

medical quality

Benefit to physicians

• Improves and speeds up exchange of information – between physicians of different specialisation– between specialised and family physicians– for mutual counselling, considering second opinions

• The system provides and overview of time-critical data of the patient

• A more comprehensive and faster overview of the medical history– earlier visits and diagnoses– results of research and analyses– issued prescriptions

22/04/23

Medical Records

Treatment Decision

Queue

Referrals

Prescriptions

Images

Electronic Health Record

Doctors

eHealth IS

Health CareBoard

Social InsuranceBoard

Health InsuranceFund

Ministry of Education(Education Information

System)

Ministry of Interior(Population Register)

Ministry of Defence(Defence Force doctors,

Defence Force lists)

Ministry of Justice(prison medicine,

forensic medicine)

Agencyof

Medicines

Certification Centre

Interfaces with external

databases

X-Road

Medical registries:Birth Register

Cause of Death RegistryCancer Register

...Medical unitsof institutions

(kindergartens, schools,prisons)

Ambulatorymedical care ~450

Informationsystemsof family

physicians

Family physicians

~800

Statistics

Statisticsusers

Medicalresearches

Emergencymedical care

~30

Emergency physicians

Hospitals~50

Prescription centre(Health Insurance

Fund)

Pharmacies ~350

eHealth PortalDoctor Portal

Doctors

Citizen Portal

Citizens

Time-table

Project 2005 2006 2007 2008

Electronic Health Record                                

Digital Registration                                

Digital Images                                

At the moment we are in the developement

stage

The next stage: Pilot Project

• Pilot project: June 2007- May 2008• Solutions are tested in 6 establishments and 1 register:

– North Estonian Regional Hospital (NERH), Tartu University Hospital (TÜH), East Tallinn Central Hospital (ETCH)

– Centres of family physicians in Järveotsa and Koeru – Tartu Ambulance– Register of Causes of Death

• NERH, TUH and ETCH:– 45% of Estonian health care budget and 55% of all

specialised medical treatment

Security Layer

Pilot Solution

Patient’s Portal

X-Road

Internet

State Registers

Message Exchange Logic

Data

East Tallinn Central Hospital

North Estonia

Regional Hospital

Tartu University Hospital

Järveotsa centre of

family physicians

Koeru centre of

family physicians

Tartu Emergency

Aid

Registry of Causes of

Death

Digital documents - Epicrisis

Epicrisis – HL7 v3 XML

OTHER eHEALTH PROJECTS

Digital Images

• Electronic Health Records has separate links to analysis results

• No need to make repeat analysis because of loss of images

• Disease progress can be monitored over years since data is stored at least 110 years

• (Foreign) experts can be easily included in medical procedures

• More efficient use of analysis made with complex diagnostics equipment

Digital Registration

• Enables to remind the patient about the reception time

• Provides an objective and accurate survey of the length of treatment queues in health care establishments for health care management and national statistics

• Overview of vacant reception times of all medical specialists of the given area and a possibility to book/cancel the reception time through a web portal

• Registration systems of medical establishments continue to work in parallel

For further information please visit: www.digilugu.ee

Thank You

For further information please contact:

Oliver LillepruunProject manager

Estonian eHealth Foundationoliver@e-tervis.ee