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T he Estonian Electronic Health Record System. Madis Tiik CEO Estonian e-Health Foundation. Information Society. By 2013 All public services are digitaly available Public infrastruture is service oriented (x road)

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t he estonian electronic health record system

The Estonian Electronic Health Record System

Madis Tiik

CEO

Estonian e-Health Foundation

Baltic Congress in Laboratory Medicine 16 September 2010

information society
Information Society
  • By 2013
    • All public services are digitaly available
    • 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 thous who need it
slide3

Analysis

Follow-up

Policy-making

Treatment

EHR

Guidlines

PublicServices

Diagnostics

Campaigns

Tele-advice

Appointment

Workflow

Notification

Self-help

Prescription

Lifestyle

slide4

Founders of the Estonian eHealth Foundation

Ministry of Social Affars

Society of Family Doctors

Tartu University Clinic

East Tallinn Central Hospital

Union of Estonian Medical Emergency

North Estonian Regional Hospital

Estonian Hospital Association

Estonian eHealth Foundation Board

Management Board

Strategy and Architecture Development

Marketing and Channel Management

EHR Operation

Governance

Family doctors

Hospitals

Nursing Care

Patient Portal

Health Authorities

Endusers

our tasks
Our tasks
  • Management of E-Health projects
  • Standardisation and development of medical digital documents
  • Maintenance of the Estonian EHR system
  • International cooperation and scientific cooperation with universities
  • Development of new services for citizens and doctors

Financed from the State budget (1.5mln € – 2010)

slide6

Emergency

Medical Service

2011

School nurses

2010 september

Hospitals

2009

Family doctors

2009

SS

SS

SS

SS

SS

SS

Patient portal

Monitoring portal

HEALTH INSURANCE

FUND

Goverment’s e-service framework

www.eesti.ee

Prescription Centre

2010 january

HEALTH INFORMATION SYSTEM ( EHR)

17.12.2008

KIT

Citizen view

EIT

Enterprice view

AIT

Official’s view

HEALTH CARE BOARD

- Health care providers

- Health professionals

- Dispensing chemists

Pharmacis

2010 january

STATE AGENCY

OF MEDICINES

- Coding Centre

- Handlers of medicines

  • Citizen Registry
  • Company Registry

SS

SS

SS

SS

X-ROAD

SS

Healthcare

Provider

W-SS

Doctor’s and

pharmacies

software solutions

Estonian national eHealth infrastructure

document processing
Document processing

Infection notice

Discharge letter

Message

Lab referal

Swineflu notice

Health record

Demographics

Üldandmed

Üldandmed

Üldandmed

Health record agentEvent: Medication, Diagnosis, Procedure

Mari-Liis

Mari-Liis

Mari-Liis

Mari-Liis

47595064059

47595064059

47595064059

47595064059

Demographics

Männi 1-2

Männi 1-2

Männi 1-2

Männi 1-2

Demographics agentAddress: Männi 1-2, Tallinn

Tallinn

Tallinn

Tallinn

Tallinn

Diagnoos

Diagnosis

Diagnoos

Diagnoos

Statistics queryOutbreak report

punetised

chickenbox

punetised

punetised

Allergia

Allergy

HPI

Allergia

Allergia

Data integrationDemographics, health status

HPIservices

õietolm

õietolm

õietolm

pollen

Infection decease agentDiagnosis: chickenbox

Timecritical reports

Timecritical report agentAllergy: pollen

slide8

Health Portal

Devices

Information Systems

Public IT Infrastructure

Standards and Services

WSDLXSD

Processes and Integration

Health record

Health status

Booking

Reports

Ambulance

Document archive

Statistics

Decision Support

Demo-graphics

Concent

Metadata/ universal viewer

Storage ( long time archive)

EHR Central Functions

current situation 15 09 2010
Current Situation 15.09.2010
  • There are 1858541documents in the Estonian EHR
      • Discharge letters (epicrises) 233338
      • Out-patient consultation notes338922
      • Dispensed medication information 770704 
      • DICOM images ( index) 264488
      • Image reports 243797
  • More than 400 000 citizens have digital medical records in EHR , it is 30% of the population
availability of discharge letters year 2009
Availability of Discharge LettersYear 2009

These 3 hospitals cover more than 60% of in-patient cases in Estonia

eprescriptions
ePrescriptions

Prescription centre was launched 1st of January 2010

*estimation based on 2009 numbers - 700 000 prescriptions monthly

** 13.04 recomendation not to use e-prescription to the doctors

elab project
eLab project
  • Translation of 10 000 LOINC terms
  • Implementation LOINC and RELMA program's in all labs
  • Mapping of Lab’s test’s with LOINC standard.
  • Influence to the other projects:
    • Enables dataexchange between labs and healthcare providers
    • Enables statistical analyzes and comparisons
    • Test results are seen to all users of EHR
    • Enables patient’s to see lab test
    • More info for decision support
    • Automatic exchange data with Infectious diseases register
workflow of lab test s
Workflow of lab test’s

Doctors IT system

6. Report, alerts, lab test results

1.-2. Referal (patient ID, test specifikation, index number)

Referal centre

EHR

Sample logistic

4. Sample + index number

3. Referal (test specifikation, index number)

5. Lab test result(index number)

Lab

lab test standard
Lab test standard

http://pub.e-tervis.ee/standards2/Standards/3.0

<observation classCode="OBS" moodCode="EVN">

<!-- eristab mis liiki Observation kirjega on tegemist-->

<code code="ANA" codeSystem="1.3.6.1.4.1.28284.6.2.2.5.1" codeSystemName="Observation liik" displayName="Analüüsi tulemused"/>

<!-- staatus: lõplik-->

<!-- <statusCode code="completed" codeSystem="2.16.840.1.113883.5.14" codeSystemName="ActStatus"/> -->

<statusCode code="completed"/>

<!-- analüüsi vastuse rea aeg-->

<effectiveTime value="20060501134139"/>

<!-- analüüsi tulemus -->

<value xsi:type="ED">

9.2

</value>

<specimen typeCode="SPC">

<specimenRole classCode="SPEC">

<specimenPlayingEntity classCode="ENT" determinerCode="INSTANCE">

<!-- analüüsi parameeter-->

<code code="tO2" codeSystem="OIDnr" codeSystemName="Analüüside parameetrid" displayName="tO2"/>

<!-- ühik -->

<!-- code="" codeSystem="2.16.840.1.113883.6.8" codeSystemName="UCUM", kui võimalik-->

<desc>Vol %</desc>

</specimenPlayingEntity>

</specimenRole>

</specimen>

<referenceRange typeCode="REFV">

<observationRange classCode="OBS" moodCode="EVN.CRT">

<!-- referentsväärtus-->

<text>10 Vol %</text>

</observationRange>

</referenceRange>

</observation>

life cycle of digitization of medical document

Task Setup

Ministry of Social Affairs, EeHF, Professional Society’s

6 months

Life Cycle of Digitization of Medical Document

Content Related Standardization

The Estonian eHealth Foundation (EeHF)

Technical Standardization – CDA document

Developer (Outsourcing)

  • Installation Standard to the Test Environment (EeHF)

3 months

  • Development of Central System Services Development of Health Care Service Providers’ Developer (Outsourcing)Information Systems

Health Care Service Provider’s ICT partner

3 months

Testing and Acceptance Services

Developer, EeHF, Health Care Service Provider’s ICT partner

12 months

Standard published, installed to working environment, new service in portfolio of EeHF-

EeHF

  • Ministerial degree naming the date for Health Care Providers when standard and new documentation is obligatory -Ministry of Social Affairs
patient s portal personal health record phr 2010 2011
Patient’s Portal → Personal Health Record (PHR) 2010-2011
  • PHR – one view for citizens
    • Illness data from healthcare system (Patient’s Portal)
    • Self-monitoring data
    • Wellness data from third parties
    • Data from social system
    • Patient forums
    • Screening remainders
  • Decision support
    • Self-care
    • Virtual health check

Future of EHR

slide18

Decision Support

Suggestions and Reminders

Decision Support Service

Health Records Service

Knowledge Digitalization

Digital Library

Decision Scripts

Health Records

slide20

EBMeDS

Evidence-Based Medicine electronic Decision Support

Estonian NHIS

EBMeDS Local Service

EHR

Document Service

Global, National & Local Scripts

Data Tables

Patient Data

”Glue” component

Conversion filters

Evidence Links

Decision

Support

Core

Engine

EHR DecisionSupport

Web Server

Application

HCIworkspace

  • Drug Information
  • Best Practice
  • Contraindications
  • Interactions

Log

Files

Forms & Calculators

Response Messages

JavaScript

Interpreter

Function

Library

Testing

Applications

Update

Service

HTTP

FTP

EBMeDS Central Service

Testing

Applications

Administrator Tools

  • Web Resources
  • EBM Guidelines
  • Cochrane Library
  • Essential Evidence
  • EBMeDS Home Page

EBMeDS

Database

EBMeDS

Master File

Package

Script Editing Tools

Compiling

Tools

Table Editing Tools

maintenance of estonian ehr system

Service

Maintenanceof Estonian EHR System

Continual Process Improvement

Service Design

Service Operation

Service Strategy

Service Transition

ITIL

Business Processes

eHealth

Partners

Application Development

Application Maintenance

eHealth

ApplicationOperations

Monitoringhelp desk

Database management

Partners

Server, Storage & Network Management

Hardware and Data Center

maintenance of the ehr

Operations

Capacity Management

Problem Management

Demand Management

Incident Management

Configuracion Management

Service Level Management

Service Request Management

Service Continuity Management

Change and Release Management

Maintenance of the EHR

Business Processes

W-SS

Doctors portal

Patient Portal

EHR reguest servicis

Patient summary

Medication history

7

Business Processes

Application Development

6

Application Maintenance and Support

5

Application Operations

4b

Monitoring, Help Desk

4a

DataBase Management

3

Server, Storage & Network Management

2

Hardware & Data Center

1

thank you for your attention questions madis tiik@etervis ee www etervis ee http eng e tervis ee
Thank you for your attention!Questions?Madis.Tiik@etervis.eewww.etervis.ee http://eng.e-tervis.ee/