The Status of National e-Health

Initiatives in Estonia

Madis Tiik18.06.2010

CEOEstonian e-Health Foundation

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Facts about Estonia

• Population 1.32 million• Area 45 000 km2• Compulsory health insurance paid by employer

– Health insurance tax 13%– Health care costs make up 5% of GDP

• Income tax 21% (flat tax)• Healthcare providers are private, municipal or

governmental. – Family doctors (private companies)– Hospitals (shared companies or foundations)

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e-Estonia

• Wide range of e-services – e- election (EU Parliament election june 2009 – 6,5%

electronically)

– e- tax board (2008 – 90,6% electronically)

– e- school– e- commercial registri, etc

• High bandwith connectivity– Internet

• 75% of population use regulary internet (2009)• 67% households have PC and 91% of them are

connected to the

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

KITCitizen view

EITEnterpriser view

AITPublic servant view

National D

atab

ases register

http://ww

w.riik.ee/arr/

Po

pu

latio

n re

giste

r

He

alth

Insu

ran

ce R

eg

ister

Na

tion

al P

en

sion

Insu

ran

ce R

eg

ister

Ve

hicle

Re

giste

r

Tallin

n W

ate

r IS

Esto

nia

n E

ne

rgy IS

Internet - X-tee

DATABASES / INFORMATION SYSTEMS BANKS

Central server I

Central server II

Monitoring

Helpdesk

X-road certification centre

X-road CenterTools centrally developed by the State Certification Center

ID – card

• SEBbank• Swedbank• Creditbank • Sampo Bank• Nordea Bank

Security Server

Security Server

Security Server

Security Server

Security Server

Security Server

Security Server

Security Server

:: … ::

E-institution – Institution view

:: E-county – county view ::

:: E-riik – State Portal ::

Institutional view of the state Thematic view of the statewww.riik.ee www.eesti.ee

Security Server

X-road

• Aggregates 360 different databases• 2000 e-services • 500 different organizations have integrated

their systems into X-road• Services of X-road were used 420 000 000

times a year (2009)• more information http://www.ria.ee/27525

Lifestyle

Self-help

Tele-advice AppointmentNotification

Prescription

Campaigns

PublicServices

Policy-making

Analysis

Diagnostics

Treatment

Guidlines

Follow-up

EHR

Workflow

Family doctors

Hospitals

Founders of the Estonian eHealth Foundation

End users

Strategy and Architecture Development

Marketing and Channel Management

Ministry of Social

Affars

East Tallinn Central Hospital

Tartu University

Clinic

Society of Family

Doctors

North Estonian Regional Hospital

Management Board

Estonian eHealth Foundation

Board

EHR Operation

Estonian Hospital

Association

Union of Estonian Medical

Emergency

Nursing Care

Patient Portal

Health Authorities

Governance

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 (1.2 mln € – 2008)

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X-ROAD

SS

HEALTH CARE BOARD- Health care providers- Health professionals- Dispensing chemists

STATE AGENCY OF MEDICINES- Coding Centre

- Handlers of medicines

SS

SS

HEALTH INSURANCEFUND

Prescription Centre2010 january

HEALTH INFORMATION SYSTEM ( EHR)

17.12.2008

SS

SS

- Citizen Registry- Company Registry

SS

Pharmacis2010 january

Doctor’s and pharmacies

software solutions

Hospitals 2009

Family doctors2009

Emergency Medical Service

2011School nurses

2010 september

SS SSSS SS

Healthcare Provider

SS

Monitoring portalPatient portal

Goverment’s e-service frameworkwww.eesti.ee

KIT Citizen view

EIT Enterprice view

AIT Official’s view

W-SS

Estonian national eHealth infrastructure

Health Portal DevicesInformation

Systems

Standards and Services

Processes and Integration

WSDLXSD

Public IT Infrastructure

ConcentDocument

archive

Health record

StatisticsDecision Support

ReportsHealth status

Ambulance

Demo-graphics

Booking

EH

R C

entra

l Functio

ns

Storage ( long time archive)Metadata/ universal viewer

Current Situation 17.06.2010

• There are 1 557 704 documents in the Estonian EHR • Discharge letters (epicrises) 186 460  • Out-patient consultation notes 244 609  • Dispensed medication information 743 944• DICOM images ( index) 213 397• Image reports 164 069

• More than 370 000 citizens have digital medical records in EHR , it is 25% of the population

Availability of Discharge LettersYear 2009

North Estonian Regional Hospital

Tartu University Clinic

East Tallinn Central Hospital

27661 31914 24038

82% 74% 84%

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

ePrescriptionsPrescription centre was launched 1st of January 2010

January February March April** May

Number of e-prescriptions issued

278 957 407 609 520 000 387 000 381 836

% from prescriptions issued*

40% 58% 74% 55% 55%

Purchasedprescriptions

150 009 221 800 322 000 288 000 292 207

% from purchased prescriptions*

21% 31% 46% 41% 42%

*estimation based on 2009 numbers - 700 000 prescriptions monthly** 13.04 recomendation not to use e-prescription to the doctors

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

Interactive Services

Viewing Prescriptions

Viewing Health Record

E-consultation

Immunization Passport

Virtual Health Check

Citizen Health Record

Collecting Personal Health Information

Self-help

Personal Data Management

Informational Services

Reminders

Invitation for Screening

Booking Service

Supporting Services

Rights Management

Authorizations

Expressions of Will

Access Rights

Log Archive

EHR Portal Services for Citizen

TIS

TIS

TIS

Decision Support

Knowledge Digitalization

Suggestions and

Reminders Decision Support Service

Decision Scripts

Health RecordsDigital Library

Health Records Service

ApplicationsEnd user services, hospital IT services

Patient: Oracle PortalHospital IS

X-Road

Sending messages between institutions

X-Road infrastructure

Message centreMessage validation, authorisation, logging, addressing

webMethods Integration Server, custom Java services

Message brokerForwarding messages to agents

webMethods Broker

Message agentsDocument processing webMethods Integration

Server

Data servicesDatabase operations, database logging, queries

webMethods Integration Server, Oracle DBMS

EHR integration through X-Road

HL7 interaction

HL7 document

X-Road message

Hospital IS EHR

Lab notice

ÜldandmedMari-Liis

47595064059

Männi 1-2

Tallinn

Diagnoospunetised

Allergiaõietolm

Swineflu notice

ÜldandmedMari-Liis

47595064059

Männi 1-2

Tallinn

Diagnoospunetised

Allergiaõietolm

Message

Timecritical reports

Demographics

Health recordInfection notice

ÜldandmedMari-Liis

47595064059

Männi 1-2

Tallinn

Diagnoospunetised

Allergiaõietolm

Discharge letterDemographics

Mari-Liis

47595064059

Männi 1-2

Tallinn

Diagnosischickenbox

Allergypollen

Demographics agentAddress: Männi 1-2, Tallinn

Infection decease agentDiagnosis: chickenbox

Timecritical report agentAllergy: pollen

Health record agentEvent: Medication,

Diagnosis, Procedure

HPIservices

Document processing

Statistics queryOutbreak report

Data integrationDemographics, health statusHPI

Application Maintenance

Server, Storage & Network Management

Database management

Monitoring help desk

Application Operations

Hardware and Data Center

Application Development

Business Processes

Partners

eHealth

eHealth

Partners

ITIL

Maintenanceof Estonian EHR System

“Have an eExperience in Tallinn”

eHealth Conference in Tallinn 13-15 October 2010www.ehealthtallinn2010.org1. The Estonian eHealth Concept 2. Translating the Benefits & Cost of eHealth - Assessment of

Economic Impact of the Estonian Health Information System (DIGIMPACT)

3. Opt-in or Opt-out? User Rights, eHealth Related Legal and Privacy Issues in Estonia

4. Open Discussion: How Was the Estonian National Health Information System Implemented? Overview of process, problems we have encountered, different parties’ viewpoints on implementation (e.g. physicians and patient representatives).

Thank you for your attention!

Questions?

Madis.Tiik@etervis.eewww.e-tervis.ee

http://eng.e-tervis.ee/

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