1. eHealth State Policy and Projects in Estonia Oliver Lillepruun Estonian eHealth Foundation 19.04.2007

2. Estonian eHealth Foundation I The Estonian eHealth Foundation is an organisation created by the Ministry of Social Affairs of Estonia and leading Estonian health care service providers The purpose of the Estonian eHealth Foundation is to develop and manage the information system of Estonian health care Founded in 2005

3. Estonian eHealth Foundation II –Develops and administrates nation-wide health registries and infosystems; –Plays an active role in development and publishing of standards and classifications in health care sector; –Coordinates development of nation-wide medical guidelines; –Cooperates with health care providers and with other institutions involved in health care provision.

4. E-projects of Estonian state Electronic Health Record –One of the most practical public administration services –One of the largest public IT development projects –The most important ID card application in Estonia in the nearest future –The world’s first national eHealth system eHealth solutions supplement today’s public administration e-services: –Electronic school –Internet elections –Electronic Commercial Register, etc.

5. 2007: four eHealth projects The three primary nation-wide services developed by Ministry of Social Affairs and Estonian eHealth Foundation are –Electronic Health Record –Digital Images –Digital registration of treatment queues, i.e. Digital Registration Digital Prescription – developed by Estonian Health Insurance Fund

6. Background of eHealth projects I 2004 – Ministry of Social Affairs applies for aid from the European Union structural funds April 2005 – Ministry of Economic Affairs that coordinates allocation of structural funds made the funding decision for four eHealth projects: –Electronic Health Record (EEK 25 mln) –Digital Registration (EEK 3 mln) –Digital Images (EEK 3 mln) –Digital Prescription (EEK 3.7 mln) September 2005 – Ministry of Social Affairs announces tenders

7. Background of eHealth projects II Nov 2005 Estonian eHealth Foundation is founded: –Manages the projects of Electronic Health Record (EHR), Digital Registration (DR) and Digital Images (DI) –Administers the information system of EHR July 2006 Winning consortium for the tender on EHR: –Estonian affiliate office of Hewlett-Packard OY –AS Microlink Eesti –AS Icefire Nov 2006 –Tender for the Digital Registration was won by AS Medisoft and AS Cell Network –Tender for Digital Images was won by AS Microlink Eesti

8. Legal environment of eHealth The Health Information System Act is being prepared to –regulate the development and maintenance of the health information system –Lay down the necessary requirements to the patient, health service provider, etc The bill was drafted by Law Firm Raidla & Partnerid Debate of the bill –Government (spring 2007) –Parliament (autumn 2007)

9. ELECTRONIC HEALTH RECORD

10. What is Electronic Health Record? A national health information system A way for medical doctors to exchange health records Access for the patient to his or her health records through a designated patient’s portal Health care providers are able to enquire patients’ time-critical and general data The system stores the patient’s medical history and is a vital information source for physicians

11. Benefit to patients Patient Portal – access by one’s ID card to his or her medical data regardless of time and place Patient no longer needs to carry papers between different physicians –Physicians have an objective and accurate overview of the patient’s health history –In collecting data to the EHR it is no longer necessary to recall earlier diseases or drugs –Better overview of the health history improves the medical quality

12. Benefit to physicians Improves and speeds up exchange of information –between physicians of different specialisation –between specialised and family physicians –for mutual counselling, considering second opinions The system provides and overview of time-critical data of the patient A more comprehensive and faster overview of the medical history –earlier visits and diagnoses –results of research and analyses –issued prescriptions

13. 17/08/2015 Medical Records Treatment Decision Queue Referrals Prescriptions Images

15. Time-table Project2005200620072008 Electronic Health Record Digital Registration Digital Images At the moment we are in the developement stage

16. The next stage: Pilot Project Pilot project: June 2007- May 2008 Solutions are tested in 6 establishments and 1 register: –North Estonian Regional Hospital (NERH), Tartu University Hospital (TÜH), East Tallinn Central Hospital (ETCH) –Centres of family physicians in Järveotsa and Koeru –Tartu Ambulance –Register of Causes of Death NERH, TUH and ETCH: –45% of Estonian health care budget and 55% of all specialised medical treatment

17. Security Layer Pilot Solution Patient’s Portal X-Road Internet State Registers Message Exchange Logic Data East Tallinn Central Hospital North Estonia Regional Hospital Tartu University Hospital Järveotsa centre of family physicians Koeru centre of family physicians Tartu Emergency Aid Registry of Causes of Death

18. Digital documents - Epicrisis

19. Epicrisis – HL7 v3 XML

20. OTHER eHEALTH PROJECTS

21. Digital Images Electronic Health Records has separate links to analysis results No need to make repeat analysis because of loss of images Disease progress can be monitored over years since data is stored at least 110 years (Foreign) experts can be easily included in medical procedures More efficient use of analysis made with complex diagnostics equipment

22. Digital Registration Enables to remind the patient about the reception time Provides an objective and accurate survey of the length of treatment queues in health care establishments for health care management and national statistics Overview of vacant reception times of all medical specialists of the given area and a possibility to book/cancel the reception time through a web portal Registration systems of medical establishments continue to work in parallel

23. For further information please visit: www.digilugu.ee

24. Thank You For further information please contact: Oliver Lillepruun Project manager Estonian eHealth Foundation oliver@e-tervis.ee