Geneva, Switzerland, April 2012 State of Interoperability in the Czech Republic Towards Personal Health Record Miroslav Bursa, CTU in Prague, FEE, Dept. of Cybernetics, BioDat Research Group Joint ITU-WHO Workshop on e-Health Standards and Interoperability (Geneva, Switzerland, April 2012)

Geneva, Switzerland, April Patient ID Encoded birth date, sex and identifier consistency check (mod 11) error-prone duplications might exist Considered sensitive information (!) Some hospitals create their own ID

Geneva, Switzerland, April Standards Many local standards exist Interoperable standards DICOM/PACS Mutually incompatible HIS are used No standard(s) for signal data, often proprietary closed format

Geneva, Switzerland, April Health Record Usually in paper form Often held in paper and el. form Entered into HIS during night shift Free text, duplications Signals, reports only in paper form Statistics must be provided to state agency tendency to fulfill the requirements only

Geneva, Switzerland, April EHR First attempt (IZIP) done via state- owned health-insurance company Suspended funding Not based on interoperable standard Inconsistent with European efforts to interoperability Now called ‘health-book’ Smaller projects exist

Geneva, Switzerland, April EP In a pilot stage 8 doctors, 8 pharmacies Still have to print Insurance companies: no access Runs since 2009, first EP on 04/2011

Geneva, Switzerland, April Legislation 3 rd party has right to look at the documentation problem: doctor has internal notes Question Owner of the data? Permission to use in research? Has the hospital right to obtain human- readable data for processing? Raw data? Draft on health documentation under discussion. Does not cover EHR.

Geneva, Switzerland, April Usual (mythic) reasons to reject EHR MDs do not need computer to heal a patient 40 % MDs do not have a computer MDs do not want to be restricted by computer MDs are afraid of easier liability claims IT wants things that are not present in paper form

Geneva, Switzerland, April Age Structure of MDs in Czech Rep.

Geneva, Switzerland, April Age Structure of DDs in Czech Rep.

Geneva, Switzerland, April Age Structure of PDs in Czech Rep.

Geneva, Switzerland, April Conclusions and Recommendations No fully interoperable EHR EP running in pilot stage Problem of integration: no efforts ‘Crisis problem’: Cheap appliances Loosing data for long-term studies Isolated solutions (reinventing wheel) No force to unify standards