1. 1 “Health-e Europe” Experience in New Member States Dominic S. Haazen Sr. Health Specialist, ECSHD Washington, DC

2. 2 Key Global Directions in e-Health capture of health information moves closer to the health event health insurance/statistical data become by- products of the clinical encounter Increase standardization in medical practice (clinical practice guidelines, care maps) Integrate hospital and ambulatory care (continuum of care) “close the loop” on diagnostic testing and drug administration (order entry/results reporting) Bring patients into process/decision-making

3. 3 Constraints – Global High cost of hardware/software, although hardware costs continue to decline High failure rate for implementation Multiple vendors, compatibility is not assured – can get locked into one vendor Physician resistance to changing practice patterns and to technology generally Lack of staff available to devote to implementation – everyone is already busy!

4. 4 Constraints – New Member States Existing systems developed ad hoc, using a variety of platforms, software, and technical and medical definitions Limited attention/experience with process re-design Few staff are trained to manage IT systems well (either development or operations) Privacy and data security is low Poor communication between different parts of the health system

5. 5 Advantages – New Member States Established IT infrastructure is much smaller than other parts of Europe – more “green-field” opportunities Great deal of interest in bringing existing systems and norms up to EU Standards Potential ability to access EU structural funds to finance e-health Technical competence is generally good

6. 6 Latvia

7. 7 Latvia – Original HMIS Plan 1.Collect data from and maintain registers about Latvian healthcare providers and beneficiaries 2.Store information about contracts and payments between the health payment agency and medical institutions and pharmacies in SCHIA 3.Support health reform by providing decision-makers with needed medical, economic, and statistical information

8. 8 Latvia – Impact/Lessons management control structure is most interesting and innovative feature contract construction and change management procedures were also important to project success external advisors used for both specification, and design/implementation phases, to monitor work of primary systems designers/contractors

9. 9 Hungary

10. 10 Hungary – Original HMIS Plan 1.Provide 25 hospitals with ADT, radiology, laboratory, financial management and e-mail software 2.Provide all hospitals in the country with a basic financial management module 3.Provide policymakers, managers and health care providers with a management support system to improve cost-effectiveness and efficiency 4.Develop health information standards

11. 11 Hungary – Achievements ( 1997-2000 ) implementation of hospital information systems in 21 compared to a target of 60 hospitals Note: ~160 hospitals in Hungary, population 10 million hospitals represent approximately 13% of hospitals and 16% of all beds 3 county-wide regional information systems with shared patient master index

12. 12 Hungary – Impact/Lessons hospital managers now have information on the cost of specific health care services, and this data is affecting resource allocation decisions HMIS was catalyst for administrative and operational consolidation of hospitals hospitals continued to use the information systems plans they developed as part of the competition

13. 13 Hungary – Impact/Lessons (2) initiative led to essential growth in the health informatics profession in Hungary benefits to hospital systems market: suppliers updated products to support the open, multi-vendor HISA model, fosters market growth

14. 14 Slovenia

15. 15 Slovenia – Original HMIS Plan 1.develop health information standards 2.National Health Information Clearing House -- “hub” for inter-agency exchange of information 3.Local clearing houses at 3 pilot hospitals 4.Information systems for Ministry of Health, Public Health Institute, and Health Insurance Institute

16. 16 Slovenia – Achievements (2000-2003) Health Information Standards procedure classification, diagnosis grouping, inpatient minimum dataset and data dictionary definitions EU compliant (HISA) Health Information Systems Development delays due to the time required to reach a shared understanding of different parties’ relationship with the NHICH political agreement not reached, NHICH not done decided to develop Health Data Management Center but not completed

17. 17 Slovenia – Impact/Lessons Essential ground-work and consensus-building is needed for complex HMIS development to move ahead Business requirements (e.g., reimbursement systems) need to be defined first Parallel development of standards and new health management information systems are constrained by available human resources Development time can be reduced by selectively using existing technology

18. 18 Lithuania

19. 19 Lithuania – Original HMIS Plan 1.Develop “e-health” strategy (consultants) 2.Based on strategy, implement pilot “EPR-Step One and Simple Communications”: First phase of electronic patient record Capability for various providers (hospitals, specialists, PHC) to communicate with each other and with the State Patient Fund 3.Develop health information standards

20. 20 Lithuania – Important Features Incremental approach Start with a selected number of institutions and providers, with limited capability Expand as systems are successful and benefits are demonstrated Goal is “one patient-one record”, although record may be virtual – i.e., not “clearing house” approach Providing information to patients is key goal Monitoring and providing information for effective governance also key objectives

21. 21 Key Messages – Lithuania Strategy “If an e-Health approach is seen as something extra a doctor has to do, it won’t be adopted. It has to be seen as part of the workflow” To be effective, the strategy must be known, accepted and applied by all concerned actors changing complex workflows and organizations is not easy … must invest a lot of time and patience takes time for the profits/benefits to show

22. 22 Implications for New Member States Cost of technology is coming down, especially hardware (PC, handheld, bar coding), so much more attention needs to be paid to software Increasing use of web-enabled applications reduces communications/transaction costs Available expertise is limited/costly

23. 23 Implications for New Member States Projects need a multi-disciplinary approach: clinical science, public health, operations research, and information science – should not be dominated by IT professionals Cooperation between facilities and/or regions needed to justify/afford systems – use multiple copies of the same design? Ensure foundational work is done – HISA standards, data dictionary, coding standards A phased approach is needed to ensure that development takes place in an orderly way

24. 24 Implications for New Member States allow adequate time for testing and training “total cycle cost”, maintenance and staffing needs must be carefully considered training of staff in health informatics and standards issues is essential explicitly address the issues of patient confidentiality and privacy Keep an eye on benefits – what health and financial benefits can be accrued? How are these going to be captured?

25. 25 Conclusion Despite the various issues which need to be addressed … Substantial opportunities exist “to trigger a giant leap forward in quality, customer service and affordability of health care” (Leapfrog Group)