1. https://www.tervisepank.ee Tervisepank ® e-solution for primary care Madis Tiik, MD CEO, Estonian Society of Family Doctors 06.04.2006

2. Estonian primary care Key facts 787 patient lists 1.251.385 insured patients FDs: private entrepreneurs 100% funded by Estonian Health Insurance Fund Total annual budget: ca EUR 40M Monthly IT budget: ca EUR 75 per doctor

3. Computer literacy and use of internet in primary care In 2003 there were 2.369 workers in the primary care units (doctors and nurses) 1920 were using computers daily (81%), from those 1872 were using computers with internet connection (97%) all together 1207 computers, from those 1147 computers with internet connection 1350 doctors work in the primary care units 1242 use computers daily (92%), from those 1237 use computers with internet connection (99%)

4. Digitalization in Estonian primary care 1994 – 1998: First software solutions for FDs Purely structured, mainly text fails 1998: EHIF financial support for FDs Software oriented to the needs of EHIF First FD’s started using digital patient records only Since 2001: All claims’ data sent to EHIF digitally 3 – 4 local software companies Software architecture: only local installations Financial aspect: expensive license fees + monthly service fees

5. Flaws arising from existing architecture Data not available in time-critical situations; Most data exchanged and stored on paper; Medical decisions often based only on data received from patients; Patients tied to their FD: mobile patient loses health record history; Collected data not comparable and exchangeable; Software not corresponding to the requirements of processing delicate personal information; Expensive maintenance and updating of software FDs expected to be IT power-users

6. Key requirements to the new solution Functionality; Customer-friendly interfaces; Easily and independently learnable (ca 20 - 30 min); Central management, updating and archiving; Automatic claiming, reporting and statistics; Low requirements to the hardware; Easily scalable; Compliance with Data Protection Act.

7. Tervisepank – first PPP project in Estonian healthcare Customer: Estonian Society of Family Doctors Development of functionality and logic Financing: local private investors Design and technology: local IT companies Business model: operational lease of software No upfront fees; Everything (maintenance, archiving, updates, growth in functionality) included in fixed monthly price (ca EUR 40 per professional user). Further joint development: Ideas from FDs; Implementation by Tervisepank.

8. Time and costs Business process mapping – 2003; Design & programming, license from Data Protection Agency – 2004; Real-time launch – 29.12.2004; Real-time users – Q3 2005. Direct investments > 300.000 EUR

9. Tervisepank – centralized IT system Modern, web-based solution for primary care, but not limited to that; All users use the resources on same servers; Access through standard web browser and internet connection All encrypted patient data kept in one database; All updates are in force immediately to all system users;

10. Key functionality Fully functional daily work environment driven by doctors’ needs Key functionality: Practice administration and e- registry; Digital health record database; Patient management, disease curing and prevention; Medical decision making support; Documents, certificates etc; Claiming, reporting and statistics; Information exchange with third parties (laboratories, pharmacies etc).

11. Technical highlights Estonian ID card based encryption model Valid ID card Valid ID PIN code Technology: Microsoft.net 1.1. MS SQL Server 2000 Highly scalable

12. Key security features Unauthorized users are unable to connect personal data with medical records; FD can delegate his/her access rights to patients’ health records; System administrators do not have access to patients’ medical records; All activities are logged and saved; Approved by DPA

13. Win-win solution for doctors and patients Professional users: Full digital, real time and constantly updating health record database on every patient; Accessible from everywhere, 24/7; More information = better care; Medical decision making support; Extensive savings in time = better care; Automatic reporting; No initial investment required, usage results in significant savings; Only system licensed by DPA. Patients: All medical data in one secure place; Access to personal health records; Access to FD’s e-registry; Chance for alternative diagnosis; FD has more time for patient = better care; Report on persons viewing personal medical data.

14. Tervisepank – a virtual hospital of tomorrow E-consultation; Specialist doctors; Hospitals; Ambulance / emergency care; Laboratories; School healthcare; Drug / genetic research.

15. Thank you ! For further information, please contact: Mr. Loit Linnupõld partner Tervisepank Ph: +372 502 4152 loit.linnupold@tervisepank.ee https://www.tervisepank.ee Mr. Madis Tiik CEO Estonian Society of Family Doctors Ph: +372 510 9143 madis@pak.tt.ee