1. dr. Carmen Ungurean National Institute of Public Health, Romania Health Information System in Romania

2. Strategic and regulatory framework Communication of the European Commission (EC) on “e Health – making healthcare better for European citizens: An action plan for a European e Health Area” EC Recommendation on cross-border interoperability of electronic health record systems Law no.95/2006 – on the Health System reform Health Strategy – 2014-2020 Government decision no. 900/2012 on methodological norms of national electronic health card and European health card Law on organization and functioning of the official statistics in Romania/2009

3. HIS = the main provider of information in support of decision-making in health policy at both central and local levels as well as for result evaluation. HIS = the main provider of information in support of decision-making in health policy at both central and local levels as well as for result evaluation. MoH is responsible to establish an integrated information system for public health management. Requirements are expressed for information on communicable diseases, emergency care, community assistance, hospital information, health insurance cards etc. MoH is responsible to establish an integrated information system for public health management. Requirements are expressed for information on communicable diseases, emergency care, community assistance, hospital information, health insurance cards etc. National Institute of Public Health, Romania

4. General principles of the HIS Responsibilities of the State institutions in the collection, storage and analysis of data on health determinants with the objective of creating the national database; Responsibilities of the State institutions in the collection, storage and analysis of data on health determinants with the objective of creating the national database; Definition of the information flow; Definition of the information flow; Guarantee and protection of the fundamental rights of individuals; Guarantee and protection of the fundamental rights of individuals; Necessity of data security assurance; Necessity of data security assurance; Definition of the areas and the conditions of data processing and data use; Definition of the areas and the conditions of data processing and data use; National Institute of Public Health, Romania

5. General principles of the HIS Accessibility of the decision-makers to existent data and information; Accessibility of the decision-makers to existent data and information; Patient confidentiality; Patient confidentiality; Data confidentiality; Data confidentiality; Right of the person, patient and population to both general and health-related information; Right of the person, patient and population to both general and health-related information; Regulations concerning specific diseases that represent a public health problem. Regulations concerning specific diseases that represent a public health problem. National Institute of Public Health, Romania

6. Organizational chart of health information flow National Institute of Public Health, Romania

7. The main information flow led by Ministry of Health National Institute of Public Health, Romania

8. Health data and information sources Type of data Primary data source Intermediary destinationFinal destination Routine data Health care providers from health system District Public Health Directorates District Statistical Directions District Health Insurance Houses Ministry of Health National Health Insurance House National Institute of Statistics Data and information for monitoring and evaluation of national health programmes and sub-programmes Health care providers from health system involved in the National Health Programmes District Public Health Directorates District Health Insurance Houses Ministry of Health National Health Insurance House Institutes of Public Health and Medical Health Care Institutes that are national programmes coordinators Surveys and special studies Various national and international organizations - Ministry of Health National Health Insurance House National Institute of Statistics National Institute of Public Health, Romania

9. Selected indicators – Romania, 2011 ECHI - Demography and socio- economic situation Romania21.4 EU 2725.9 Old age dependency ratio, 2010 Fertility rate, 2010

10. Selected indicators – Romania, 2011 ECHI - Health status Life expectancy, 2010 Infant mortality, 2010 Diseases specific mortality, 2010 (cancer)

11. Selected indicators – Romania, 2011 ECHI - Health status 10. Life expectancy (I)21(a). Diabetes: self-reported prevalence (I)31. Injuries: workplace (I) 11. Infant mortality (I)21(b). Diabetes: register-based prevalence (D)32. Suicide attempt (D) 12. Perinatal mortality (I22. Dementia (D) 13. Disease-specific mortality (I) 23(a). Depression: self-reported prevalence (I) 23(b). Depression: register-based prevalence (D) 33. Self-perceived health (I) 14. Drug-related deaths (I)24. Acute myocardial infarction (AMI) (D)34. Self-reported chronic morbidity (I) 15. Smoking-related deaths (D)25. Stroke (D)35. Long-term activity limitations (I) 16. Alcohol-related deaths (D) 26(a). Asthma: self-reported prevalence (I) 26(b). Asthma: register-based prevalence (D) 36. Physical and sensory functional limitations (D) 17. Excess mortality by heat waves (D) 27(a). Chronic obstructive pulmonary disease (COPD): self-reported prevalence (I) D) 27(b). Chronic obstructive pulmonary disease (COPD): register-based prevalence ( 37. General musculoskeletal pain (D) 18. Selected communicable diseases (I) 28. Low birth weight (I)38. Psychological distress (D) 19. HIV/AIDS (I) 29(a). Injuries: home, leisure, school: self-reported incidence (I) 29(b). Injuries: home, leisure, school: register- based incidence (D) 39. Psychological well-being (D) 20. Cancer incidence (D) 30(a). Injuries: road traffic: self-reported incidence (I) 30(b). Injuries: road traffic: register-based incidence (D) 40. Health expectancy: Healthy Life Years (HLY) (I)

12. Selected indicators – Romania, 2011 ECHI – determinants of Health Smoking prevalence, 2009 Alcohol consumption, 2005

13. Selected indicators – Romania, 2011 ECHI – health services Prevalence of PAP test, 2009 Prevalence of mammography testing, 2009

15. Strengths Established infrastructure by Ministry of Communications –e-governance; Established infrastructure by Ministry of Communications –e-governance; WG established for developing the strategy and inter-operability WG established for developing the strategy and inter-operability PC in all health care facilities PC in all health care facilities Tradition in collecting data Tradition in collecting data International coding in use: ICD 10; ICD – O3; International coding in use: ICD 10; ICD – O3; National Institute of Public Health, Romania

16. Weaknesses Passive data collection Passive data collection Lack of standard definitions (except the definitions of demographic events and case definitions for some communicable diseases); Lack of standard definitions (except the definitions of demographic events and case definitions for some communicable diseases); Lack of quality control and quality assurance mechanisms; Lack of quality control and quality assurance mechanisms; Reporting on paper and manual feed of various applications; Reporting on paper and manual feed of various applications; Absence of a national electronic network for data and information transmission; Absence of a national electronic network for data and information transmission; One-way circulation of data and information only: from source to the centre. Local centres do not have access to non- aggregated data from the system (lack of feed-back); One-way circulation of data and information only: from source to the centre. Local centres do not have access to non- aggregated data from the system (lack of feed-back); Low degree of data processing; Low degree of data processing;

17. Weaknesses Potential risk of generating and circulating discordant or unreliable data (lack of validity); Potential risk of generating and circulating discordant or unreliable data (lack of validity); Under-estimation of certain diseases. Under-estimation of certain diseases. Low level of inter-operability Low level of inter-operability Lack of cooperation and information sharing between various actors of the HS Lack of cooperation and information sharing between various actors of the HS Low sustainability of previous HIS projects Low sustainability of previous HIS projects Low level of automated processing at providers level and administartion level; Low level of automated processing at providers level and administartion level;

18. Opportunities Perceived need of reliable data at all levels: decidents, professionals Perceived need of reliable data at all levels: decidents, professionals Decreasing price of technologies Decreasing price of technologies Increasing quality and availability of technologies Increasing quality and availability of technologies Use of European financial mechanisms/projects Use of European financial mechanisms/projects International cooperation on the area of standardization and e-health initiatives International cooperation on the area of standardization and e-health initiatives National Institute of Public Health, Romania

19. Threats Current financial constrains Current financial constrains Personnel loss Personnel loss Posts cuts Posts cuts Pressure in producing results Pressure in producing results Frequent changes in legislation Frequent changes in legislation Frequent changes in strategic priorities Frequent changes in strategic priorities Competing interests between actors involved Competing interests between actors involved Personal barriers and frustration Personal barriers and frustration National Institute of Public Health, Romania

20. Hvala lepo Thank you Multumesc