Raimo Laus Head of IT Department IT in EHIF Raimo Laus Head of IT Department

Video E-STATE ARCHITECTURE

E-Health architecture PHARMACIES AND FAMILY DOCTORS 2009 X-Road, ID-card, State IS Service Register HEALTH CARE BOARD - Health care providers - Health professionals - Dispensing chemists STATE AGENCY OF MEDICINES - Handlers of medicines - Coding Centre POPULATION REGISTER PHARMACIS 2010 january BUSINESS REGISTER HOSPITALS 2009 FAMILY DOCTORS SCHOOL NURSES 2010 september EMERGENCY MEDICAL SERVICE 2011 NATION- WIDE HEALTH INFORMATION EXCHANGE PLATFORM 2008 PRESCRIPTION CENTRE 2010 PATIENT PORTAL 2009 X-ROAD GATEWAY SERVICE 2009 HEALTH INSURANCE REGISTER 2005

X-Road OPERATOR FOR INFRASTRUCTURE PROBLEMS EHIF landscape STATE PORTAL PATIENT DRUG STORE SYSTEM EMPLOYER FAMILY PHYSICIAN SYSTEM CENTRAL SYSTEM MESSAGING SERVER PHYSICIAN WITHOUT AN INFORMATION SYSTEM UNIVERSAL PORTAL(s) X-Road BUSINESS WAREHOUSE HOSPITAL SYSTEM REGISTRIES (PHYSICIANS Tax and Customs Board etc)

Participants Governmental Iniformation systems Primary Care IS Perearst2 – 80% Watson- 15% Medicum - 4% Arstiportaal – 0,1 % Hospitals IS eHealth PerhIS Liisa Ester3 Dental Care Dentas Hammas Pharmacys Hansasoft Noom

How did it started 2003 – first e-service: insurance check - 80 % of hospitals had IS - poor cumputerization - uncontrolled data Exchange - data processing and correction in EHIF - reimbursment in 60 days. 2004 – new eInvoicing system („pipeline“): - Dataexchange over https - Hundreds of data quality checks - data processing in origin source - reimbursment in 60 days - explosion of computerization.

EHIF IS arcitecture - timeline … - 2006 „homemade“ IS components, not integrated, 2002- strategic decision: build up new IS Standard platform Standard data Exchange channel (x-road) webServices (SOAP, not HL7 etc) Governmental portal 2003- strategic decision: build up new IS Tender New strategic platform : SAP

EHIF IS arcitecture - with SAP 2003- SAP ERP for Finance 2004- SAP ERP for Invoicing 2005- SAP CRM for Insurance Register 2006-2008 SAP CRM for diferent benefiits in cash 2010 SAP ERP for digitaal prescription. 2002-2017: all data excange between SAP and x-road: trough SAP PO (Process Integrator) 2002-2017: all data are syncronized to data warehouse: comprehensive and with high quality data mining 2017- all SAP system migrated to SAP HANA (inmemory database)

IS arcitecture- web service-based data exchange Governmental service catalogue: https://riha.eesti.ee/riha/main Online fact sheet: https://www.ria.ee/x-tee/fact/#eng 2 governmental database: Health insurance register: 53 services Digital prescription database:38 services Mostly SOAP-XML messages Optimized querys HL7 only in some cases No document digital signing (all x-road messages are timestamped) Next - Insurance register service porfolio examples:

Primary care e-services: Functionality Service name Patient List Patient_list patient_list_changes adding_to_list patient_list_remove_patient insurance_check RiskPatient riskpatient_list riskpatient_add_data

Services for insured persons: Functionality Service name Master Data Patient_data change_bank_account Invoicing Invoicing_data Drug Benefits Additional_drug_benefit control Additional_drug_benefit_application

Benefit of incapacity of work: Functionality Service name Benefit of incapacity of work tvl_list_patient tvl_list_doctor tvl_list_employee tvl_sending tvl_validate tvl_add_data

Dental care e-services: Functionality Service name DentalCare dentalcare_invoice_info dental_compensation_limit dental_compensation_invoice_send dentude_invoice dentude_limit_control invoice_confirm aggregated_invoices_data

Development process: Analysis, Order to IT Service description for partners WSDL files pubishing Implementing in EHIF, in partner IT company Testing in EHIF Testing with IT partner Testing with hospitals GoLive

Perfomance statistics about e-prescription:

Future challenges: Clinical Decision Support system Integrated Planning in SAP New Invoicing system Referral letter, e-Consulting Quality Measurement System. ..

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