1. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 1 Tanja Mate,M.D., Marjan Suselj On-line Access to Health Data in Slovenia - Experience and Perspectives

2. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 2 Contents 1. Slovene health care system 2. eHealth strategy in Slovenia – MoH perspective –Bases and objectives –Re-thinking health care –Priorities 3. Past development and infrastructure in place 4. Development towards integration and online access for health care workers and patients

3. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 3 Slovenia AREA: 20 000 sq km2 (0.5% of the total EU-25 area) POPULATION: 2 000 000 (88% Slovenes) (0.5% of the total EU-25 population) FORM OF GOVERNMENT: Parliamentary democratic republic; Unicameral national assembly (Državni zbor) HEAD OF STATE: President (elected directly) INDEPENDENCE: 1991 GDP PER CAPITA: €10 900 (47% of the EU-15 average) UNEMPLOYMENT RATE: 6% (EU-15 average: 9%)

4. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 4 Health Status Life expectancy at birth Total population 77 years (M 73, F 80.5, gender diff. 7,5 years) EU-15 average: 79 years (M 75,5, F 82, gender diff. 6,5 years) Infant mortality 3,8 Disease burden (%) Neuropsychiatric disorders 26 Cardiovascular diseases 17 Malignant neoplasms 16 Causes of death (%) Cardiovascular diseases 41 Malignant neoplasm's 26 Injuries 8

5. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 5 eHealth Players – HC Providers (1) Hospitals: 27 ( 16 general hospitals ) Physicians: 4500 Dentists: 1200 Nurses and other profs.: 14200 Total health expenditure as % of GDP: 8.68.6

6. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 6 eHealth Players (2) Health Insurance Institute of Slovenia (HIIS) Promotion and sponsoring of IT in HC Establishing infrastructural databases EDI National health insurance card system Public Health Institute – national (PHIS) and regional (PHI) Health statistic Prenatal information system Register of sick leaves Ministry of Health Health Sector Management Project

7. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 7 Starting Point Objectives and activities in field of e-health in Slovenia are deriving from * Action plan for a European e-Health Area and from experiences and current status of health informatics in Slovenia. * Communication on e-Health - making healthcare better for European citizens: An action plan for a European e-Health Area, COM(2004)356, (30 Apr. 2004) * Communication on e-Health - making healthcare better for European citizens: An action plan for a European e-Health Area, COM(2004)356, (30 Apr. 2004) http://europa.eu.int/information_society/doc/qualif/health/com 2004_356_ehealth.pdf

8. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 8 Bases EU action plan will enable progress in field of e-health, system solution and individual services. In the field of e- health there are 3 main fields of activities in EU members: –Defining of common basis and implementation of supporting environment for e-health –e Health pilot projects Information for all about education and prevention Connection of health information networks Promotion of electronic health cards –Exchange of experiences and progress measurements Dissemination of best practices in EU Benchmarking Active international cooperation

9. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 9 Slovenia’s Health Care System Strategy Equity and Access: ensuring that the same quality of care is provided to all, raising responsiveness of the system: providing timely services Quality, Performance and Effectiveness: improving health status and outcomes, improving safety or reducing errors, ensuring that clinical decisions are based on best current practice or best available evidence (avoiding over-use und under-use) Efficiency and Costs: improving efficiency and contain costs CITIZEN

10. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 10 Approach Harmonisation of the national policy with EU guidelines Health policy – reference framework for eHealth Affirmative experience of past projects (HSMP, HIC, …) shall be supplemented with implementation action elements Partnership and consensus -

11. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 11 Objectives Till 2005 every EU member has to prepare national and regional e- health plans, Use of standards, inclusion of open code initiative Introduce personal identifiers Connectivity of the patients’ electronic records Ensure mobility of patients and health care workers Advance infrastructure and technology Introduce testing and accreditation for eHealth Increase investment in eHealth Make regulations and legal bases.

12. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 12 eHealth = Re-thinking Health Care eHealth ≠ only/mainly information and communication technologies project in health sector eHealth => change management in health sector “We have nothing to loose but our chains …”

13. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 13 eHealth = Re-thinking Health Care

14. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 14 Key Words of our “Re-thinking Health Care” Key words: –Access –Equity –Efficiency –Quality The citizen/patient centred care is a result of a growing trend towards more effective management and collaborative work of health professionals i.e. we have to support “Shared Care”.

15. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 15 Future Development Electronic patient record Standardization of the elements of electronic records of medical data and of the interchange of data between different HC providers: Referral notes, dismissal notes, laboratory results, invoices Telemedicine Bedside PC National health portal Information support to standardisation through data dictionary Access to general and private HC related information. Direct communication between the citizens and HC providers -

16. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 16 Major Development Steps in the Past   Extensive proliferation of computer literacy of HC providers (acquisition of 2700 PC’s)   Infrastructural databases (insured persons, HC providers, drugs, obligors, …)   EDI   Introduction of the health insurance card system (HIC, HPC, SST network, unified API’s, upgraded application environment at HC providers)   Health Sector Management Project 1992/1993 1993/1996 1994/19961996/20002000/2004

17. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 17 Building the IT Base in HC   Full local IT support, limited integration   Continuous investment and development:   virtually all HC work posts computerized   EDI   HI databases   IT literacy HIC project - a step in the stream of continuous development efforts HIIS database Health insurance contributio n obligors Ministry of Health Institute of Public Health of RS Research Institutes Tax office of RS Police, Court Office of statistics of RS Institute of Pension and Invalidity Insurance Institute of Employme nt AJPES Ministry of internal affairs Health care service providers Report s, statisti cs Statistics, data on HC service providers Report s, statisti cs CHI data invoices Central population register Busines s register Data on regst. Into CHI Data on regist. into CHI Data on registering into CHI Applications for the registering into CHI

18. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 18 Slovene HIC System

19. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 19 Informatics Support for DRG (1) e-SPP project

20. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 20 Informatics Support for DRG (2) Communications: All hospitals connected to the governmental network Secure ID cards Digital certificates Sending data: in XML formatin XML format every 3 month (later monthly)every 3 month (later monthly) upload through web applicationupload through web application

21. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 21 Development in Progress e-SPP On-going adjustment of methodological instructions Establishing a data warehouse Support to coding, clinical paths and quality indicators National waiting lists Monitoring, efficient use of capacities, transparency, planning, priorities … e-Prescription and national drug database Improved procedure (issuing of prescription, issuing of drug, data processing in the pharmacy), Access to expert information on drugs Data on the portal accessible to patients as well. -

22. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 22 Objectives: Completion of the system  support to drug prescribing, issuing and accounting Safe medication Elimination of information flow bottlenecks in health care Advanced information tools for professional work Containment of expenditure on medication Two-phase approach: Phase 1: Z-KZZ Project  recording of drugs issued on prescription onto the health insurance card Phase 2: e-Prescription Project  Substitution of paper prescription forms for an electronic form, implementation of expert information systems Development in Progress (2) Medication Management

23. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 23 ePrescription EDI invoices and reports ePrescription HIC Expert IS SW PharmacyDoctor HIIS Upgraded SW SW Central database (users: doctors, Pharmacists) Paper prescription Support to prescribing Printing Generation of ePrescription Recording of issued drugs on HIC

24. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 24 On-line Access – Technical Perspective VS HIIS DATABASE TK S HC PROVIDERS VOLUNTARY INSURANCE PROVIDERS INTERNET SERVER E- Prescri ption

25. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 25 Next Steps - Challenges Integration of solutions (links between technologies and HC levels, application and upgrading of infrastructure in place and knowledge) Extension of IT services to the support of quality (support to professional medical work, knowledge databases, key role of medical experts in the development/selection of solutions) Limited development resources, need for joining efforts, need for amendment of regulations Active role of the patient (access to personal data, responsibilities, interactivity, involvement in decisions, access to knowledge databases) Promotion of international interoperability of solutions

26. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 26 The methods and tools that cause the problem cannot be used to solve the problem. The methods and tools that cause the problem cannot be used to solve the problem. (Albert Einstein)

27. MINISTRY OF HEALTH Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005 Tanja Mate and Marjan Sušelj 27 Thank you for your attention!