E-health framework implementation

IS Architecture concepts and solutionsin context of Estonian experience and Latvia’s challenge

Presentation by Rudite SpringeCentre of Health Economics, Latvia

12.01.2011

Objectives of the workshop

• Exchange concepts and experience in e-health program implementation between Estonia and Latvia

• Compare models and structure of e-health program financing

• Compare program administration model• Identify best practice and lessons learned

from Estonia’s experience

Latvia’s challenge• Encourage balanced and financially proved e-health program

implementation and systems development (1st ERAF)– EHR– E-prescriptions– Booking and health portal– Integration platform for e-health data transport

• Strengthen e-health program administration and systems deployment– Resources management– Standardization– Legal framework

• Start to work on 2nd ERAF planning for e-health program an systems development involving sector’s administration and professionals, society, IT industry, incorporating best practices across EU

Current status of e-health program (LV)• Responsible organization for e-health implementation in

Latvia is Centre of Health Economics (VEC)– ERAF (2007-2013) budget for e-health system development 7

408 000 EUR– employees for e-health administration 5– Annual budget (administration) 82 500 EUR

• Outsourced e-health systems concepts and specification development (235 800 EUR from ERAF)– E-health information systems architecture and implementation

plan– Concepts and IS specifications for EHR, health integration

platform, e-prescriptions, booking, Health portal

Current status for e-health IS implementation (LV)

• Health integration platform pilot-project and 4 e-services (285 600 EUR)

• IS procurement procedures completed for:– EHR (1 668 000 EUR)– Health integration platform (941 000 EUR)

• IS procurement procedures in progress for:– E-prescriptions (338 700 EUR)– Booking & Referrals (2 126 100 EUR) – Health portal (128 000 EUR)!!! IS development is not started yet for none of the systems

Main impacts on e-health IS architecture (LV)

• No historical HIS• Poor coverage of IS in GP practices• Low level of digitalized data flows• Several separate registers

– Health billing system– Drugs register– Several disease registers

• State initiatives in e-governance introduction • Challenge to introduce transparent and efficient data-

flows and processes in healthcare system

E-health architecture (LV)

2nd ERAF priorities (LV)

• Next stage development for 1st ERAF IS– Extended functionality of EHR; booking; portal; e-prescriptions– Business intelligence solutions

• EU interoperability and data exchange– epSOS– EU statistics DB

• Service providers (HIS;GP) support– Hospital integration solution– Doctors’ workplace in Health portal

• Statistics IS (DWH)• National Digital images database

Architecture concepts LV & EST• E-health IS architecture concepts and functionality covers similar

scope in LV and EST• EST historically has better coverage of HIS and IS for GP, which

become corner-stone for e-health IS development in EST• LV has to develop e-health infrastructure “from scratch”, integrating

several “satellite IS”• Differences are in use of terms and boundaries of functionality

– EST EHR positions as national-wide framework , where EHR, booking, prescriptions, portal are integrated modules of the IS;

– LV each functionality is planed as separate IS (decision of Ministry of Health, 2006), developed under single e-health program management

• Significant difference in integration solution concept– EE X-Road refers to LV VISS (State information system integrator)– EE X-Roads modules developed for single IS, together compose analog

solution to LV sector’s integration platform– LV e-health integration platform refers to x-Road modules set

Electronic health record (LV)

EHR positioning & functionality (LV)Targer for EHR IS - implement cental solution for maintaining of pacients health record at national level, assure data access and availability in health care process, create platform for health and clinical information data processing, exchange and analytics

!!! All data in EHR IS will be stored and exchanged at standardized and structured format, reused for sector’s statistics and analytical purposes• 1 st stage

– Patient summary– Medical records– Links to PACS – Vaccination register– Disability statuss– Self services for citizens

• 2 nd stage– Additional medical information, patients registers, treatment outcomes data– EU data exchange (epSOS u.c.)– Business intelligence

EHR datasetEHR data set Structured/

unstructured data

Basic/main data Person’s and GP’s information S

EHIC data S

Essential health information S/N

Medical devices, implants, disabilyties S

Overview of prescribed medications S

Vaccination registry

Information about vaccinations S

Dynamic data Discharge letter/findings S/N

Epiciris summary S/N

Diagnoses, examinations, medications S/N

Other medical information S/N

E-prescriptions (LV)

E-prescription functionality (LV)

• Issuing of ordinary prescriptions• Issuing of special prescriptions• Release of prescription in pharmacy• Access of prescription information and

prescribed medication for individual in EHR and Emergency Medical services IS

• Support for vigillance messaging• Analytics and statistics

Booking & Referrals positioning & functionality (LV)

• Extend healthcare service availability and reduce time spent to book GP and specialist appointments for social active part of population;

• Rise doctors productivity by improving and digitalizing data-flows and availability of information, ensure referrals accountability and statistics

• Create central booking functionality and realted e-services for citizens• Digitalize sick-leave notes issuing process and data flows• Improve billing and refund administration proceses for state

compensated medical manipulations• Assure unifide approach for information security and personal data

protection policy for all e-health solutions introduced in health care organizations

• Introduce Health portal

Health portal (LV)Will be developed as part of Booking and referrals project

Main targets• Create unified user interface for different user groups for work with central e-health

systems– Booking and referrals;– E-prescriptions;– EHR

• Main user groups are:– Patients– Doctors– Pharmacists– Service providers and personell, who have not use own IT solutions

• Create central internet space for publishing health realated information at national level

• Develop several health related e-services for citizens, assure access to own health related information at personal level

E-health integration platform (LV)

E-health integration platform positioning & functionality (LV)

Administration (EST/LV)

Ministry of Health

VEC (5)

VEC (?)

VRAA

ICT partners

VEC (5) consultants

EST e-health program administration – 22 employees (Foundation) + 4 (Ministry); budget 500 000 EUR/yearLV e-health program administration – 5 employees (VEC); budget 82 500 EUR /yearLV – no agreed on role share, responsibilities and resources for infrastructure management LV- not established Standardization bodyLV – issue – involvement of end users (hospitals and GP) in definition stage of IS business case

Future functions split (LV)

E-health administration bodyCentre of Health Economics

Partners

E-health program governance Applications development

Standardization Systems concepts and specifications

Implementation strategy Governance advisory (business process)

Infrastructure strategy Infrastructure hosting

E-health business processes and stakeholders managementUsers management (helpdesk)

Public relations

International (EU) cooperation and representance of Latvia

Administration costs projection (LV) (based on EST experience figures)

E-health program financing EST / LV

Question-marks to EST experts

• Licenses and infrastructure costs for EHR system• Development costs for Health portal• EST E-prescription developed as SAP module on

existing infrastructure. If “Yes” – costs are not directly comparable between LV and EST– License & infrastructure costs

• Investments in x-road for e-health systems– Adaption of x-road, infrastructure costs– As Latvia does not implemented ID cards, costs are not

directly comparable for integration solution

Take-aways from EST • Use EST experience and best practice in fields of

e-health program administration • Legal framework for e-health• Standardization concept and approach• Involvement of different groups of stakeholders

in decision making process, IS designing and implementation

• Communication and work with citizens and society as whole

Thank You for attention!

For further information requests:Daiga Behmane, DirectorCentre of Health EconomicsE-mail info@vec.gov.lv

Rudīte Spriņģe, Leading consultant“AA Projekts” IT consulting and advisoryPhone:+371 29226670E-mail rudite.springe@aaprojekts.lv