Preconditions for succesful implementation of eHealth

Thinking of the bigger picture:How Estonia designed future

healthcare

Madis TiikMD, Scientific advisor

EU eHealth Task Force group [EST]

PRECONDITIONS FOR SUCCESFUL IMPLEMENTATION OF EHEALTH

e-Estonia

ICT and healthcare in Estonia

Local EMRsDigital Claims & Reimbursement

1992 2010 2015 2020

Time

Patient empowerment

• Software's for hospital and for GP in 1994• Digital claims since 1995• Equipping GP-s with PC-s 1998• Skipping paper claims 2002• Legally allowed to use only digital patient

record since 2002

Information Society Strategy 2001

By 2013 All public services are digitaly available

Ehealth services 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 those who

need it

Information society indicators100% of schools and government organisations have broadband

connection

71% of families have computer at home

68% of homes have broadband connection (2011)

EstWin project- 98% of households gets a broadband connection by 2015

99% of bank transfers are performed electronically

94% of income tax declarations made via the e-Tax Board

24% of votes were cast over the internet on 2011 (Parlament elections)

62%-E-census (jan2012) 815,467 persons have completed the questionnaire digitally

Estonian Information System

X-Road was launched in 2001

2000: Launch of e-Tax Board

2000: Launch of m-Parking

2002 : Introduction of national electronic ID-Card

2003: Launch of ID bus ticket

2005: i-Voting was introduced

2007: Introduction of m-ID

2007: Launch of e-Police system

2008: Launch of e-Health system

2010: Launch of e-Prescription

Some achievements


Central EHR 2005-2008Health Portal 2009Registries Integration ( non clinical) 2008Prescription centre 2010Standardization 2007-2012Integration of different user groups 2009-2012

Information Exchange

Local EMRs 1992-2005Digital Claims & Reimbursement

1992 2010 2015 2020

Time

Patient empowerment

ACTIVITY INDICATORS

Current situation

Mar

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Aug

ust

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Janu

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Febr

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Mar

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pril

May

June

July

Aug

ust

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tem

ber

Oct

ober

Nov

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rD

ecem

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Janu

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Mar

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pril

May

June

July

Aug

ust

Sep

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Oct

ober

Nov

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rD

ecem

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2009 2010 2011 2012

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

Retrieval of medical documents by health care professionals

Documents in EHR

There are 14 different types of standardized documents. Most popular documents are:

– Ambulatory consultation notes 1 286 203– Hospital discharge letters 694 974– Image address links 742 590– Image reports 938 594– Immunization notes 24 256

E-prescriptions

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10

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aug.1

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10

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dec.1

1jan

.12feb

.12

mar.12

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2

may.12

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

ISSUED SOLD

Paper prescriptions

july august sept oct nov dec jan feb march april may0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

Services in portal• Medical files

• Time critical data (allergy, chronic diseases)• General practitioners and hospital visits• Summary of ambulatory and stationary case• Link to medical images

Expressions of will/Preferences• Closing medical records (opt out)• Name trusties• Donation of organs

Overview of logs

Electronic Health Record (EHR).Patient Portal


Central EHR 2005-2008Health Portal 2009Registries Integration (non clinical) 2008Standardization 2007-2012Integration of different user groups 2009-2012



1992 2010 2015 2020

Time

Patient empowerment

Health certificate 2010-2012Integration with social care 2011-2012EbmDS decision support service 2011-2012Integrated statictics 2010-2012Clinical registries 2011-2013

Secondary use of data


Integration with social care

• Health status for disability pension

Inside healthcare• Health certificate for

driver licenses• Virtual registris

• Immunization registry


Central EHR 2005-2008Health Portal 2009Registries Integration ( non clinical) 2008Standardization 2007-2012Integration of different user groups2009-2012



1992 2010 2015 2020

Time

Patient empowerment

Health certificate 2010-2012Integration with social care 2011-2012EbmDS decision support service 2011-2012Integrated statictics 2010-2012Clinical registries 2011-2013


Personal Simulation 2015Integration wth -Environment data 2015?-Behaviour data 2015?-Genetic data 2013?

Value Added services

Task Force raport: Levers of change

1. My data, my decisions

2. Liberate the data3. Connect up

everything4. Revolutionise health5. Include everyone

BenefitsPartnership, active roleUser focused, new servicesIntegration and useage of

PHR dataInformed and empowered

citizens to manage their own health

Greater involment, self care

Thinking of the bigger picture...

Madis Tiik

[email protected]

THANK YOU !

mailto:[email protected]