EHR S ystems U se and Q uality in Bulgaria

1. Latchezara Maneva, Head of Application software department, NHIF Tzvetan Georgiev, expert NHIF EHR Systems Useand Qualityin Bulgaria EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

2. NHIF carries out the obligatory health insurance in Bulgaria. • It was founded as an independent public institution; • Separated from the structure of the social healthcare system; • It has its own bodies of management. National Health Insured fund(NHIF) EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

3. Obligatory participation in the contributions recruitment; • Participation of the state, the insured persons , and the employers in the NHIF management; • Solidarity of the insured persons in using the funds; • Equality in the use of medical care; • Equality of the medical care providers on signing contracts with NHIF; • Self government of NHIF; • Publicity in the NHIF activities. The obligatory health insurance in Bulgaria is implemented on the basis of the following Major principles: EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

4. NHIF contract partners - 2011 • GP practices 4030, doctors 4700; • Specialists practices 3050; doctors 11400; • Dental practices 5432; dentists 5775; • Laboratories – 650; • Hospitals – 330; • Pharmacies – 2040. NHIF pays out each month of its contractual partners for the carried out health care (for Bulgarian citizens or EU citizens). EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

5. Since 2009 NHIF designed, developed, and brought into operational level its own integrated information system.The system is about to input, process, and store the complete medical information of performed medical care from the NHIF contractual partners.The information in the system is entered and processed on a monthly basis. Integrated information system (IIS) EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

6. As a health insurance authority, NHIF obtained medical and personal information about patients as a prerequisite for payment of the activities performed by hospitals, partners of the NHIF. • This information is stored centrally in the National Health Insurance Fund and it is used to build a unified single patient's file for health insured persons in Bulgaria. • Patient's file integrates and store historical information for the patient’s registration with GP, its diseases, allergies and immunizations, and all medical services which were provided by various medical institutions (hospitals, laboratories, pharmacies, primary outpatient care, specialized outpatient care, etc.). • The Personalized Information System is build up on the basis of information contained in the integrated system of the NHIF. • Personalized Information System was developed as a system of Data Warehouse type. Personalized information system (PIS) EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

7. Electronic Health Record Categories of data stored on individual EHR are: • Personal data of the patient (identification, names, addresses, contacts); • Medical data of the patient (allergies, immunizations, blood type, Rh blood group system); • Registration with GPs; • Dispensary; • Risk groups; • Prescribed and dispensed drugs, medical food and supplies; • History of the medical, diagnosis, outpatient sheets issued; • Laboratory tests; • Made of highly specialized procedures, physiotherapy activities, and other medical manipulations; • Dental care; • Hospitalization. EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

8. Contract partners Insured persons • Government • and state Institutions • Ministry of health; • National revenue agency; • National social security • Institute; Integrated Information System Personalized Information System Portal of the NHIF Portal of the NHIF EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

9. Single patient's file for health insured persons EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

10. EESSI (Electronic Exchange of Social Security Information) Regulation no. 883/2004 (EC) from 29th April 2004 on the coordination of social security systems Regulation 987/2009 of the European Parliament and Council (EC) from 16th September 2009 • According to the regulations 883/2004, and 987/2009, the obligation of all EU member states is to secure international electronic data exchange in the area of social security within the framework of the entire European network. • The electronic data exchange should gradually completely replace paper communication between the institutions of the member states. Every member state accesses the EESSI system via a so-called Access Point which consists of a national and an international part. • An Access Point is understood as being any electronic contact point designated by the appropriate organ for one or more of the areas of social security. • Bulgaria will have 4 Access Points to cover the areas of social security of Regulation 883/2004. The APs are: • the National Health Insurance Fund, • the Agency for Social Assistance, • the National Revenue Agency,and • the National Social Insurance Institute. EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

11. Branches of social security which EESSI applies: • Sickness benefits - NHIF; • Benefits for maternity and equivalent paternity - NHIF; • Disability benefits; • Security in old age; • Survivors' benefits; • Benefits for occupational accidents and diseases - NHIF; • Death grants; • Unemployment benefits; • Pre-retirement benefits; • Family benefits. NHIF and EESSI EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

12. List and present the public initiatives / projects, if any • To promote / enforce the use of EHR systems • To assure quality of the systems • To improve interoperability • To recognise quality labelling and certification EESSI EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

13. Day to day reporting of contractual partners; • Get information by email/or SMS, that a change has occurred in the patient's file; • Notification by e-mail/or SMS of upcoming immunizations on immunization calendar of the Republic of Bulgaria in a specified format and frequency of communication; • Notification by e-mail/or SMS of upcoming screening in a certain format and frequency of communication; • Notification by e-mail/or SMS of upcoming screenings according to the programs or expiration of programs (dispensary observation, maternal, child health care) in a specified format and frequency of communication. Future plans: What should be done in the next year? EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade

14. National Health Insurance Fund • Address: 1 "Krichim" str., 1407 Sofia, Bulgaria • Phone/+359 2 9659 217; +359 2 9659 218 • Portal: www.nhif.bg Thank you Closing slide EHR Systems Quality Labelling and Certification 21 - 22 November 2011, Belgrade