eHealth Strategy for Romania Dr. Andrei KOZMA Minister of Health’s Adviser Sep 2010

Integrated Health Information System (IHIS) Ministerul Sanatatii Integrated Health Information System (IHIS) eHealth vision Electronic Data Management Future expectations

Ministerul Sanatatii eHealth vision Medical practice evolution: From the treatment of acute illness, to the prevention of disease; From considering each patient as an isolated entity, to perceiving the patient as a member of a population; From a focus on the individual, to the broader perspective of public health From paper documentation to an electronic, paperless environment

Ministerul Sanatatii eHealth vision IHIS In order to obtain optimal results, a National Health Information Strategy is required: Interoperability Security Data confidentiality Cost-effectiveness Standardisation 4 4/6/2017

Ministerul Sanatatii eHealth vision IHIS The eHealth system should be designed in a manner that would offer the best possible results for its main beneficiaries: the patients 4/6/2017 5

Electronic Data Management Ministerul Sanatatii IHIS Electronic Data Management Patient related medical data, gathered in a consistent and uniform manner, nationwide, constitutes the Electronic Patient File (EPF), sometimes referred to as Electronic Medical Record (EMR) EPF is generated at birth, is updated throughout the patient’s life and is stored in the system for an undetermined period of time. EPFs must be interoperable, secure, consistent, safe and must ensure data confidentiality. 4/6/2017 6

Electronic Data Management Ministerul Sanatatii IHIS Electronic Data Management The medical data stored in the EPF can be accessed by the authorised clinicians at any time and from any location. All medical service providers must contribute in the EPF in a standardized format. This does not mean all medical service providers must use the same Health Information System, but the Ministry of Health should enforce the use of a minimum set of standards, in order to ensure interoperability. April 6, 2017 7 7

eHealth objectives (1/2): Ministerul Sanatatii IHIS Future expectations eHealth objectives (1/2): Improved quality, safety and efficiency of the clinical processes Timely access to patient electronic medical data whenever and wherever they are needed Patient access to their own medical records and to relevant health information Communication and information exchange between multi-disciplinary medical teams Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 8 8

eHealth objectives (2/2): Ministerul Sanatatii IHIS Future expectations eHealth objectives (2/2): Extensive use of international best practice guides and procedures Unified national healthcare and health insurance data collection, both in the public and private health system High level of security, confidentiality and control in relation to information management Continuous health system improvement by ensuring a transparent and optimized reporting process Implementation of a better informed health strategy Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 9 9

Chronic Disease Management IHIS Future expectations Chronic Disease Management Chronic diseases: are long term conditions (over 6 months) are not contagious produce certain disfunctionalities or handicaps in most cases, do not improve over time are rarely healed completely Chronic diseases are the main cause of death and morbidity, e.g. Europe (87% of all deaths, in high income countries, according to WHO – World Health Organisation) Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 10 10

Chronic Disease Management Ministerul Sanatatii IHIS Future expectations Chronic Disease Management CDM represents a systematic approach to improving the quality of the medical services provided for the chronic disease patients. Instrument: an efficient system for the remote monitoring of chronic disease patients and the prevention of related medical complications Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 11 11

Future expectations Ministerul Sanatatii IHIS Telemedicine Remote medical monitoring enables medical professionals to monitor a patient remotely using various technological devices Improves the quality of life for chronic disease patients, by reducing the number of hospital admissions e.g. Electrocardiogram by phone Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. Interactive telemedicine services Teleradiology and teleconsultations: shorter waiting lists, optimized use of resources April 6, 2017 12 12

Future expectations Ministerul Sanatatii IHIS Telemedicine Homecare devices and applications Glycaemia measurement devices Blood pressure measurement devices Devices for the recording of vital signs and other clinical indicators Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 13 13

IHIS Major Components Ministerul Sanatatii Health Cards e-Prescribing Electronic Health Record CDM – Chronic Disease Management 4/6/2017 14

Health Cards Ministerul Sanatatii IHIS Major Components Only after interoperability and infrastructure availability are ensured can we talk about a viable Electronic Health Card system implementation. Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 15 15

Health Cards Ministerul Sanatatii IHIS Major Components The experience of other EU states regarding Health Cards indicates that, whenever an implementation was successful, the cards were used as identification devices, rather than data storage. [ In Germany, the efforts made over the last 8 years to implement a National Health Card System have not materialized yet.] Even so, we consider that the introduction of a Romanian Health Card could have beneficial effects if proper approach and goals are adopted. Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 16 16

Health Cards Ministerul Sanatatii IHIS Major Components Health Card Functions Stores administrative information regarding health insurance. Confirms the right of the patient to have access to medical treatment. Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 17 17

e-Prescribing Ministerul Sanatatii IHIS Major Components Introduction The existance of a well structured EPF system offers the basis for the implementation of a national ePrescribing system Requirements: new forms new types of printers reliable Internet connection Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 18 18

e-Prescribing Ministerul Sanatatii IHIS Major Components Introduction Advantages of an electronic prescribing system: clear prescription text minimization of human errors, through the implementation of a prescription validation expert system limitation of fraud risks to the system facilitates efficient resource management automatic reporting process Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 19 19

e-Prescribing Ministerul Sanatatii IHIS Major Components Prescription example (standard form) Unique identifier Patient related data Medication details 2D Barcode – contains details about the medication and the patient 1D Barcode – contains form number and doctor’s ID number April 6, 2017 20 20

Electronic Health Record Ministerul Sanatatii IHIS Major Components Electronic Health Record Pre-requirements: Standardized, complete and correct electronic medical data collection Existence of IT tools for data analysis and statistical reports generation Action: National EHR (Electronic Health Record) implementation Objective: resource allocation and management according to national or even EU-level policies April 6, 2017 21 21

EHR – Electronic Health Record Ministerul Sanatatii IHIS Major Components Electronic Health Record EHR – Electronic Health Record EHR is a complex system (comprising of hardware, software, people, policies and processes) which: Gathers data from multiple sources Is used by clinicians as a primary information source at the point of care Offers decision support in evidence based healthcare. The term describes the highest level of functionality in medical data computerized management April 6, 2017 22 22

eHealth system structure Ministerul Sanatatii IHIS Major Components eHealth system structure Decision makers Electronic Health Record Decision level Medical data Economic data Decisions Medical service providers Information systems Electronic Patient File Primary level April 6, 2017 23 23

Ministerul Sanatatii Conclusion eHealth Strategy 4/6/2017 24

eHealth Strategy Ministerul Sanatatii Conclusions This presentation, too brief - considering the importance of the issues in hand, aims to mark the importance of: a coherent and stable (at least – for mid-term) eHealth strategy proper definition of the roadmap and milestones appropriate funding for each of the steps to be taken Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 25 25

eHealth Strategy Ministerul Sanatatii Conclusions Benefits: Deployment at a national level of an integrated eHealth system, part of a national eHealth Vision Reuse of solutions and experience from similar countries Use of the state of the art technologies Unique patient health record Infrastructure and information to support the long term health strategies Improved health services and quality of life Intrucat fiecare tip de populatie, natiune etc. prezinta anumite caracteristici din punctul de vedere medical, adesea se impune crearea de programe specializate pentru controlul si ameliorarea unor fenomene. Aceste programe de nivel regional, national sau chiar transfrontalier pot fi conduse gratie existentei informatiilor mentionate. April 6, 2017 26 26

Thank you for your attention! Ministerul Sanatatii eHealth Strategy for Romania Thank you for your attention! Dr. Andrei KOZMA 4/6/2017 27