1. Lithuania eHealth Overview Normantas Ducinskas Head of eHealth Coordination and Implementation Division Lithuania MoH

2. Aims  Transparent and Effective Health System with improved accessibility and quality of healthcare services and ensured the necessary information exchange using the information and communication technologies;

3. E-health System Priorities and Principles General access to e. health services for patient and health professional; Cooperation between the health care sector participants; General access to the health care sector information resources – Electronic Health Record (EHR), registers and classifications; General access to public administration information resources and e. government services; To create conditions for more efficient, more qualitative and accessable health services via continuous information gathering, data exchange, interoperability and information security.

4. Main Legislation Acts  E-Health system development programe for 2009 – 2015;  Amendment of Health Law in 2010;  Architecture of eHealth System in 2010;  Decision of Government to establish central system, defined ruler and main operator in 2011;  Requirements for HIS content 2011;  Requirements for integration to central system2011;  Specification of central system and subsystems 2013;  Bussines model in 2013;  Procuraments of implementor in 2013;  Legislation of State information systems 2014 – 2015;  Manual for usage of central system 2015;

5. Period 2009 – 2015 Projects  29 Total Program Projects  3 - Central system (EHR) with ePrescription and PACS;  20 Hospital Information Systems;  Register of Medications;  Register of Professional (Specialist) Licences;  Register of Health Institution Licences;  Telecardiology;  National Physician Support System;  Snomed CT;  eBooking for Ambulatory Consultation;

6. LITHUANIA E-HEALTH SYSTEM 2009 - 2015 EHR REGISTERS HOSPITALS INTERNET PORTAL PATIENT PHARMACIES ONLINE BOOKING EHR – Electronic Health Record Rx – Electronic Prescription Subsystem xRAY – Radiological Image Subsystem xRAY GP & SPECIALIST

7. Finances  Development 2009 – 2015: 27,9 mln. EUR  EU support 85 % Lithuania budget 15 %;  Maintenance: 6 mln. EUR per/year;

8. Lithuania eHealth electronic services Central System - EHR 1.Secure access for patient to their own electronic health records - EHR; 2.Secure access for health professionals to manage patient‘s EHR working in hospitals without information systems via eHealth Portal – www.esveikata.lt ;www.esveikata.lt 3.Secure access for health professionals to manage patient‘s EHR working in hospitals with information systems via integration to Central System; 4.Electronic Refferals for Consultation, Medical Examination and/or Treatment. ePrescription 1. Issuing ePrescription - electronic service for health professionals; 2. Medication Dispensation by e-prescription for pharmaceutical professionals; 3. E-prescription information to the patient. National PACS 1. National electronic archive of medical images;

9. What Hospitals will send to EHR NumberTitle of Medical Document 1Hospital Discharge Summary ( epikrisis ) 2Ambulatory Visit Summary 3Referrals for Consultation, Laboratory Tests, Treatment 4Answers to Referrals 5Radiological Image Report 6Vaccination Summary 7Request for Laboratory Test 8Laboratory Report 9Request for Pathology Test 10Pathology Test Report 11Electronic Prescription 12Medication Dispensation

10. Certificates Online NumberTitle of Certificate 1 Birth Certificate 2Students' Health Inspection Certificate 3Driver's Medical Examination Certificate 4Firearm Holder‘s Medical Examination Certificate 5Perinatal Death Certificate 6 Death Certificate

11. E-Health system usage dates  Since 2 nd of November 2015 production start;  Obligation for 170 of 500 state health care institutions, who took part in ehealth projects to start usage of Hospital information systems;  For those who did not took part in projects free of charge e-health portal is available;  Most of Pharmacies uses integration to Central system;  Since 2018 obligation for all Health care institution to use ehealth solutions;

12. Risks and Oportunities  Resistance  Institutional, Competetors, Negative History,  Hospital management of changes;  Standartisation  HL7 (V2, V3, FHIR), SNOMED CT;  Legislation  More structurised (standartized) bussiness documents and templates;  Wider involvement of stakeholders;  Support  Financing of support and development;  Political, State Aproach, European Aproach;  IT support;  eHealth Network  Common position with Neighbour countries, exchange of experiance;  Integration and exchange eprescription and patient summary among EU MS by 2020;