Tanja Mate,M.D., Marjan Suselj

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Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj Tanja Mate and Marjan Sušelj 1 MINISTRY OF HEALTH Tanja Mate,M.D., Marjan Suselj On-line Access to Health Data in Slovenia - Experience and Perspectives

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On-line Access to Health Data in Slovenia - Experience and Perspectives. Tanja Mate,M.D., Marjan Suselj. Contents. Slovene health care system eHealth strategy in Slovenia – MoH perspective Bases and objectives Re-thinking health care Priorities - PowerPoint PPT Presentation

Transcript of Tanja Mate,M.D., Marjan Suselj

Page 1: Tanja Mate,M.D., Marjan Suselj

Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj

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MINISTRY OF HEALTH

Tanja Mate,M.D., Marjan Suselj

On-line Access to Health Datain Slovenia -

Experience and Perspectives

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ContentsContents1.1. Slovene health care systemSlovene health care system2.2. eHealth strategy in Slovenia – eHealth strategy in Slovenia –

MoH perspectiveMoH perspective– Bases and objectivesBases and objectives– Re-thinking health careRe-thinking health care– Priorities Priorities

3.3. Past development and Past development and infrastructure in placeinfrastructure in place

4.4. Development towards Development towards integration and online access integration and online access for health care workers and for health care workers and patientspatients

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SloveniaSlovenia

AREAAREA: 20 000 sq km: 20 000 sq km22 ((0.5% of the total EU-25 area0.5% of the total EU-25 area))

POPULATIONPOPULATION: 2 000 000 : 2 000 000 (88% Slovenes)(88% Slovenes)((0.5% of the total EU-25 population)0.5% of the total EU-25 population)

FORM OF GOVERNMENTFORM OF GOVERNMENT:: Parliamentary democratic republicParliamentary democratic republic; ; UUnicameral national assembly (Drnicameral national assembly (Držžavni avni zzbor)bor)

HHEAD OF STATE: EAD OF STATE: PPresidentresident ( (elected directlyelected directly))

INDEPENDENCEINDEPENDENCE: : 19911991

GDP PER CAPITAGDP PER CAPITA: : €10 900 €10 900 ((47% of the EU-47% of the EU-115 average5 average))

UNEMPLOYMENT RATEUNEMPLOYMENT RATE: : 6%6% (EU-(EU-15 average: 9%15 average: 9%))

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Health StatusHealth StatusLife expectancy at birthLife expectancy at birth

Total population Total population 77 years (M 73, F 80.5, gender diff. 7,5 years)77 years (M 73, F 80.5, gender diff. 7,5 years) EU-15 average: 79 years (M 75,5, F 82, gender diff. 6,5 years)EU-15 average: 79 years (M 75,5, F 82, gender diff. 6,5 years)

Infant mortalityInfant mortality 3,8 3,8

Disease burden (%)Neuropsychiatric disorders 26Cardiovascular diseases 17Malignant neoplasms 16

Causes of death (%)Cardiovascular diseases 41Malignant neoplasm's 26Injuries 8

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MINISTRY OF HEALTH eHealth Players – HC Providers (1)eHealth Players – HC Providers (1)

Hospitals: 27 (16 general hospitals)

Physicians: 4500

Dentists: 1200

Nurses and other profs.: 14200

Total health expenditure as % of GDP: 8.6

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eHealth eHealth PPlayers (2) layers (2)

Health Insurance Institute of Slovenia (HIIS)Health Insurance Institute of Slovenia (HIIS)• Promotion and sponsoring of IT in HC• Establishing infrastructural databases • EDI• National health insurance card system

Public Health Institute – national (PHIS) and regional (PHI)Public Health Institute – national (PHIS) and regional (PHI)• Health statistic• Prenatal information system• Register of sick leaves

Ministry of HealthMinistry of Health• Health Sector Management Project

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Starting PointStarting Point

Objectives and activities in field of e-health in Slovenia are deriving from * Action plan for a European e-Health Area and from experiences

and current status of health informatics in Slovenia.

**Communication on e-Health - making healthcare better for Communication on e-Health - making healthcare better for European citizens: An action plan for a European e-Health European citizens: An action plan for a European e-Health Area, COM(2004)356, (30 Apr. 2004) Area, COM(2004)356, (30 Apr. 2004) http://europa.eu.int/information_society/doc/qualif/health/com2004_356_ehealth.pdf

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Bases

EUEU action plan action plan will enable progress in field of e-health, will enable progress in field of e-health, system solution and individual services. In the field of e-system solution and individual services. In the field of e-health there are 3 main fields of activities in EU members:health there are 3 main fields of activities in EU members:

– Defining of common basis and implementation of Defining of common basis and implementation of supporting environment for e-healthsupporting environment for e-health

– e e Health pilot projectsHealth pilot projectsInformation for all about education and preventionInformation for all about education and preventionConnection of health information networksConnection of health information networksPromotion of electronic health cardsPromotion of electronic health cards

– Exchange of experiences and progress measurementsExchange of experiences and progress measurementsDissemination of best practices in EUDissemination of best practices in EUBenchmarkingBenchmarkingActive international cooperationActive international cooperation

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Slovenia’s Health Care SystemStrategy

Equity and Access:ensuring that the same quality of

care is provided to all,raising responsiveness of the

system: providing timely services

Quality, Performance and Effectiveness:improving health status and outcomes,

improving safety or reducing errors, ensuring that clinical decisions are based

on best current practice or best available evidence

(avoiding over-use und under-use)

Efficiency and Costs:improving efficiency

and contain costs

CITIZENCITIZEN

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Approach

Harmonisation of the national policy with EU guidelines

Health policy – reference framework for eHealth

Affirmative experience of past projects (HSMP, HIC, …)shall be supplemented with implementation action elements

Partnership and consensus

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Objectives

Till 2005 every EU member has to prepare national and regional e-health plans,Use of standards, inclusion of open code initiativeIntroduce personal identifiersConnectivity of the patients’ electronic recordsEnsure mobility of patients and health care workersAdvance infrastructure and technologyIntroduce testing and accreditation for eHealthIncrease investment in eHealthMake regulations and legal bases.

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MINISTRY OF HEALTH eHealth = Re-thinking Health eHealth = Re-thinking Health

CareCareeHealth ≠ only/mainly information and communication eHealth ≠ only/mainly information and communication technologies project in health sectortechnologies project in health sector

eHealth => change management in health sectoreHealth => change management in health sector

““We have nothing to loose but our chains …”We have nothing to loose but our chains …”

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MINISTRY OF HEALTH

eHealth = Re-thinking Health Care

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Key Words of our “Re-thinking Health Care”

Key wordsKey words::– AccessAccess– EquityEquity– EfficiencyEfficiency– QualityQuality

The citizen/patient centred care is a result of a The citizen/patient centred care is a result of a growinggrowing

trend towards more effective management andtrend towards more effective management andcollaborative work of health professionals i.e. collaborative work of health professionals i.e. we have to support we have to support “Shared Care“Shared Care”.”.

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Future Development

Electronic patient recordElectronic patient recordStandardization of thStandardization of thee elements of electronic records of medical data elements of electronic records of medical data and of the interchange of data between different HC providers:and of the interchange of data between different HC providers:

Referral notes, dismissal notes, laboratory results, invoicesReferral notes, dismissal notes, laboratory results, invoicesTelemedicineTelemedicineBedside PCBedside PC

National health portalNational health portalInformation support to standardisation through data dictionaryInformation support to standardisation through data dictionaryAccess to general and private HC related information.Access to general and private HC related information.Direct communication between the citizens and HC providersDirect communication between the citizens and HC providers

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Major Development Steps in the Past

Extensive proliferation of computer literacy of HC providers (acquisition of 2700 PC’s)

Infrastructural databases (insured persons, HC providers, drugs, obligors, …)

EDI Introduction of the health insurance card system (HIC,

HPC, SST network, unified API’s, upgraded application environment at HC providers)

Health Sector Management Project

1992/19931992/1993

1993/19961993/1996

1994/19961994/19961996/20001996/2000

2000/20042000/2004

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Building the IT Base in HC Full local IT support,

limited integration

Continuous investment and development:

virtually all HC work postscomputerized

EDI HI databases IT literacy

HIC project - a step in the stream of continuous development efforts

HIIS database

Health insuran

ce contribu

tion obligors

Ministry of

Health

Institute of

Public Health of RS

Research

Institutes

Tax office of

RS

Police,Court

Office of statistics of RS

Institute of

Pension and

Invalidity

Insurance

Institute of

Employment

AJPES

Ministry of

internal affairs

Health care

service provider

s

Reports,

statisticsStatistic

s, data on HC service provider

sRepor

ts, statist

ics

CHI data

CHI data

invoicesCentral population register

Business

register

Data on

regst. Into CHI

Data on

regist. into CHI

Data on registering into CHI Applications

for the registering

into CHI

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Slovene HIC System

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MINISTRY OF HEALTH Informatics Support for DRG (1)

e-SPP project

e-SPP project

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Informatics Support for DRG (2)

Communications:Communications:

Public network

router

Firewall

laptop

RSCSTRRDTD CDTALK / DATATAL K

laptop

LAN

LAN

LAN VPN

HKOMWorkstation

GPRS

ADSL, cable links

RemoteLocal networks

Firewall

Governmental

network

All hospitals connected to the governmental network

•Secure ID cards

•Digital certificates

Sending data:Sending data:•in XML formatin XML format•every 3 month (later every 3 month (later monthly)monthly)•upload through web upload through web applicationapplication

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Development in Progress

e-SPPe-SPPOn-going adjustment of methodological instructionsOn-going adjustment of methodological instructionsEstablishing a data warehouseEstablishing a data warehouseSupport to coding, clinical paths and quality indicatorsSupport to coding, clinical paths and quality indicators

National waiting listsNational waiting listsMonitoring, efficient use of capacities, transparency, planning, priorities … Monitoring, efficient use of capacities, transparency, planning, priorities …

e-Prescription and national drug databasee-Prescription and national drug databaseImproved procedure (issuing of prescription, issuing of drug, data processing Improved procedure (issuing of prescription, issuing of drug, data processing in the pharmacy),in the pharmacy),Access to expert information on drugsAccess to expert information on drugsData on the portal accessible to patients as well.Data on the portal accessible to patients as well.

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Objectives: Objectives: Completion of the system Completion of the system support to drug prescribing, support to drug prescribing, issuing and accountingissuing and accountingSafe medicationSafe medicationElimination of information flow bottlenecks in health careElimination of information flow bottlenecks in health careAdvanced information tools for professional workAdvanced information tools for professional workContainment of expenditure on medicationContainment of expenditure on medication

Two-phase approach:Two-phase approach:Phase 1: Z-KZZ Project Phase 1: Z-KZZ Project recording of drugs issued on recording of drugs issued on prescription onto the health insurance cardprescription onto the health insurance cardPhase 2: e-Prescription Project Phase 2: e-Prescription Project Substitution of paper Substitution of paper prescription forms for an electronic form, implementation prescription forms for an electronic form, implementation of expert information systemsof expert information systems

Development in Progress (2)Medication Management

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ePrescription

EDI invoices and reports

ePrescription

HIC

Expert IS

SW

PharmacyDoctor

HIIS

Upgraded SW

SW

Central database (users: doctors,

Pharmacists)

Paperprescription

Support to

prescribing

Printing

Generation of

ePrescription

Recording of

issued drugs

on HIC

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On-line Access – Technical Perspective

VS

HIIS DATABASE

TKS

HC HC PROVIDERSPROVIDERS

VOLUNTARY INSURANCE PROVIDERS

INTERNET SERVER

E-E-PrescriPrescriptionption

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Next Steps - Challenges

Integration of solutions (links between technologies and HC levels, application and upgrading of infrastructure in place and knowledge) Extension of IT services to the support of quality (support to professional medical work, knowledge databases, key role of medical experts in the development/selection of solutions)Limited development resources, need for joining efforts, need for amendment of regulationsActive role of the patient (access to personal data, responsibilities, interactivity, involvement in decisions, access to knowledge databases)Promotion of international interoperability of solutions

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The methods and tools that The methods and tools that cause the problem cannot be cause the problem cannot be

used to solve the problem.used to solve the problem. (Albert Einstein)

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Thank you for your attention!Thank you for your attention!