e-heath compared: australia - finland

7/28/2019 E-heath compared: Australia - Finland

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Group 2:

• Adil Umer (504512)

• Anastasiya Koveshnikova (506447)

• Anna Yureva (506709)

• Asim Ali Imtiaz (506625)

• Muhammad Adnan Waheed (506502)

• Saikat Asaduzzaman (506681)

*



*

• 22.6 mln population • 81 years life expectancy • 1326 hospitals

Primary care

•GP

•Nurse

•Family doctors

•96%

Secondarycare

•Specialistdoctors

Acute care

•Advanceddiagnoses

•Complex treatment

•Acute conditions



*

National E-Health and Information Principal Committee. National E-Health Strategy. Deloitte, 2008



P.R. Croll, J. Croll, Investigating risk exposure in e-health systems, Int. J. Med. Inform. (2006)

Strengths Weaknesses

Defined planning horizons of 3, 6,

10 years

Lack of engagement of key stakeholders

• Lack of pressure for action from consumers

• Lack of efforts to engage care providers

Development of data standards

(PCEHR, UHI, NASH),

infrastructure and medical

accreditation programs

Shortage of IT health skills

• Complexity of the workplace

• Need for training and education programs

Awareness campaigns and

incentive programs

Security issues not resolved

• Harm to the system (availability; data corruption)

• Harm to the people (personal data; prescription

fraud)

Privacy risks

• System security (preventing unauthorized access)

• Patient confidentiality (levels of data access; notrevealing personal data used for research

purposes)

Quality not guaranteed. Risks of:

• Not meeting the requirements

• Poor engineering (full or partial use of functions)

*



National E-Health and Information Principal Committee. National E-Health Strategy. Deloitte, 2008

P.R. Croll, J. Croll, Investigating risk exposure in e-health systems, Int. J. Med. Inform. (2006)

Opportunities Threats

Stronger consumer push due to

increasing consumer technologies

sophistication

Fragmentation of healthcare system

• Disjointed service delivery processes

• Autonomous service providers

• Coordination difficulties

Improved quality, safety and

efficiency of medical practice,

especially in rural and remote

locations

Justifying spending

• 5-10 year ROI vs. 1-3 year for traditional

funding

• Funding E-Health vs. getting benefits

Ageing population Poor state of health IT systems and

infrastructure

• Historic underinvestment in IT

• Poor broadband coverage

• Small market for IT vendors• Limited on-demand availability of world

class health IT solutions

Niche, mobile and app-oriented

markets

Usability (low acceptance by users – clinicians,

patients, administrators)

*



• Governance

• Concerns over proposed governance structure: adequate

transparency and accountability mechanisms not provided• Safety concerns

• Unreliable performance of the National E-Health TransitionAuthority (NEHTA): “Accusations of ineffective oversight andfailure of administrators to acknowledge design flaws" and"warnings that the system will not succeed because itsimplementation has been ill-considered and rushed.“*

• Human error in registering data and reading data; loss of device.Irreparable consequences (effect on human health)

• Machine error in transmitting and processing data. Consequencesand effect on human health.

• Security concerns• PCEHR will be vulnerable to hacking via the endpoint computers

participants use to access the central system (Security responseteam AusCERT )

• Increasing reliance on system information (user number growth;more complex data; wider circle of health practitioners)

* “A call for national e-health clinical safety governance”, Medical Journal of Australia,August 2012



*



*

*Patient summary and electronic health record (EHR)



*

*ePrescription



* eView and citizens’ eHealth services

*Complement the eArchiving and ePrescription

* eView is a service for citizens wishing to view their own eHealth information

* An integral part of the national eHealth services, and is already functional for

the ePrescription data included in the ongoing pilot.

*The eView service is seen as a key tool for empowerment of citizens in the

maintenance of their own health and in their participation in their care plan.

*

*



*Strengths

• Compehensive basic IT infrastructure in

health care

• Widely adopted uniform set of procedures for data processing

• Strong political support for the

introduction of IT in the health care

• The social welfare sector has extensive

experience in the use of IT in insurance

Weaknesses

• Decentralized healthcare system

• The viewpoint of the individual citizen

has been of secondary importance indevelopment efforts

• Existing information systems do not

support quality management

• Project funding is available from several

sources which are not mutually

coordinated

Opportunities

• Structured information: easier to find and

easier to reuse data

• Centralized services make planning,

monitoring and management much

easier-> new opportunities for research• Uniformity ->IT infrastructure can be

more cost-effective and ensure a high

level of data security

• Possibilities in international cooperation

Threats

• Difficulty of anticipating the costs of the

system, the technical executability of the

design, the timetabling of implementation

and the acceptability of the system

among the various interest groups• Challenges of efficiently processing the

retrieval of information from the patient

registers of various organizations and

stored in a central archive

• The acceptability of the entire

architecture from the user’s point of view



• Epworth was established in 1920 by the Methodist Church as a communityhospital.

• Through development and acquisition Epworth has grown to encompass seven

hospitals in the Melbourne Metropolitan area and is now Victoria’s largest not-

for-profit private health care group.

• Renowned for excellence in diagnosis, treatment, care and rehabilitation.• It is the first healthcare organization to adopt surgical robotics and cardiac

surgery in Australia.

• To maintains its leadership position and to meet the increasing healthcare

requirements and treatment standards the Board has adopted a strategy of

expansion and redevelopment.

*

Using e-health strategy to facilitate the design & development of effective healthcare processes by Raphael

de francesco and Nilmini wickramasinghe



IndustryCompetitors

PotentialEntrants

Customers

Substitutes

Suppliers

*



*

SWOT

PPTS

Porter’sFive

Forces

TOWS



Maxi-Maxi

• Strengths andOpportunities

Mini-Maxi

• WeaknessesandOpportunities

Maxi-Mini

• Strengths andThreats

Mini-Mini

• Weaknessand Threats

Mapping withobjectives & criticalsuccess factors

*



• Use the already established ICT foundations and the hospital expansion and

redevelopment program as an opportunity to implement e-health solutions.

• Use the already established ICT infrastructure to facilitate the centralization of

information and the information sharing between hospitals to improve care

planning, coordination and decision making at the point of care.

• Use the existing intranet and internet infrastructure as delivery tools to providesecure access to hospital’s e-health services anytime anywhere.

Use the existing infrastructure, health information knowledge bases to build

knowledge sources for care providers and patients.

• Use the good change management practices to facilitate the implementation

and adoption of e-health solutions.

• Use the well established ICT foundation, the great technical IT skills, the project

delivery capabilities and the good governance practices to implement leading e-

health solutions aligned with the NEHTA PCEHR initiative.

*



• People:

• User resistance.

• Process:

• Optimized reorganization of business

processes.

• Technology:

• Compliance with existing ICT

infrastructure.

• Interoperability to external systems.

• Security:

• Secure information sharing.

• Compliance with security policies and

guidelines

•Management:

• Time

• Budget

• Resources

• Top Management support

• Change management

• Continuity of existing level of

service quality.

• Whole strategy based on

assumptions.



Source: empirica, Pilot on eHealth Indicators, 2007

*



*

*First drawn up in 1996 by the Ministry of Social Affairs and Health.

*Principle of citizen-centered, seamless service structures

*Horizontal integration of services (Social, Primary and Secondary care)

*Updated in 1998, Placing emphasis on Interoperability between legacy

systems, supported by a high level of security and privacy protection

*Personal Data Act (523/1999) and (811/2000)

Source: Electronic Patient Record in Finland.

Report 1/2009 National Institute of Health and Welfare



*

* In those hospital districts which had entered the clinical phase of regional

data exchange systems, five different types could be identified:

*The master patient index model, or "Fiale/Navitas system" used in 8 hospital

districts

*The Web distribution model or "Municipal ESKO" used in 4 hospital districts

*Regional sharing of electronic patient data or "Regional Effica system" used

in eight hospital districts

*Mixed model of patient data sharing or "Kainuu Model" was used in one

hospital districts

*Regional sharing of data from different patient record systems or "Keski-

Suomi Model" used in one districts

Source: Electronic Patient Record in Finland.Report 1/2009 National Institute of Health and Welfare



*

* 3 main services, ePrescription, eArchive and eAccess (for patients)

*ePrescription provides medication summary and enables a fully electronicprocess

* eArchive

– Centralised active and real-time datastore (+ legal archive)

– Allows sharing of data between healthcare providers securely and

with patient consent

*Focus on standards based solutions and interoperability (HL7 CDA R2)

*Original data in national services, trusted source of information

* eAccess, citizen can view their own prescriptions and electronic records

*National services are accessed through existing systems -> implementstandards in local systems

Source: Seen as, Jari Porrasmaa, Senior advisor,

Ministry of Social Affairs and Health, Finland 2010



*

Source: National Health Archive, Finland www.kanta.fi



*




*

*National guidelines for safeguarding of data

* Informed consent-secure archiving

* e-signature- identification of patients, documents

*Professionals and organizations by ISO/OID-standard

*PKI architecture-Legislation on the eArchive (Act 159/2007) and the

ePrescription system (Act 61/2007)


Management of informed consent

• e-signature

• Used in EpSOS

Electronic identification of health care professionals

• Smart Card (First the technology was used similar to Bank cards, later it was

changed)

• User name and password

*



*

* In terms of communication and security, Finland has chosen to adopt

international standards, such as:

*HL7: Base communication standard that uses XML as a basis for transfer of

patient information between health care organizations.

* and DICOM: For digital imaging standard

* In Information Security Management they have used ISO 17799 (based on

the BS7799)



*

*Professional education and training

*Computer skills of health care personnel

*Need for ICT training



*



Strengths Weaknesses

• Cost savings

• Independent from distances

• Seems not to be a tool for specializedhealth care because of the role in care

chain

• Doesn’t fit well for multi-problematic

patients

• More intensive and longer

therapies

• Equality of achieving services

• Shortage of resources for speech therapy

• Information can be lost because of lacking

tactile contact

Opportunities Threats

• Widening the service to outlyingsites

• Failure of technology

• Danger of hacking

• Quality of picture and voice transmission

• Risk that the service supplants f2f contacts

*



• Seamless healthcare services inEurope

Vision

• Separated national healthcareinfrastructures

• No information exchange betweencountries

Problem

• epSOS connects nationalinfrastructures

• epSOS enables informationexchange between nationalinformation systems

Solution

epSOS is the next step towards an integrated european

healthcare information system

*



*

Patient summary

* Access to important medical data for the further treatment of patients

ePrescription

*Cross-border use of electronic prescription services



NCP: the main component

• epSOS Services connect

NCPs with each other

The epSOS system relies on a service oriented architecture

• Individual national services connect

NCPs with national infrastructures

• Subcomponents of NCPs handle:

• Security

• Data transformation

• Data discovery

• Auditing



Achievements

• Data security using different OS and protocols

• Information exchange

• Patient Summaries

• ePrescriptions

• Semantic transformation

• Concept for the integration of heterogenous systems

epSOS succeded in laying the foundations for seamless european

healthcare services by enabling cross-border information exchange

Future Challenges

• Dissemination of epSOS

• Legal issues

• Lack of national infrastructures



*

*Better to take small steps instead of giant leaps

*Changing existing systems is slow, long term planning and together with

clear vision is necessary

*Enterprise Architecture and measuring must be used to guide development

*Security measures need to be taken along with the advancement of the

technology.

Techno log y and eHealth are only to ols, rea l changes can be obtained

by effc ient users .

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