1. Geneva, Switzerland, 26-27 April 2012 State of Interoperability in the Czech Republic Towards Personal Health Record Miroslav Bursa, CTU in Prague, FEE, Dept. of Cybernetics, BioDat Research Group miroslav.bursa@fel.cvut.cz Joint ITU-WHO Workshop on e-Health Standards and Interoperability (Geneva, Switzerland, 26-27 April 2012)

2. Geneva, Switzerland, 26-27 April 2012 2 Patient ID Encoded birth date, sex and identifier consistency check (mod 11) error-prone duplications might exist Considered sensitive information (!) Some hospitals create their own ID

3. Geneva, Switzerland, 26-27 April 2012 3 Standards Many local standards exist Interoperable standards DICOM/PACS Mutually incompatible HIS are used No standard(s) for signal data, often proprietary closed format

4. Geneva, Switzerland, 26-27 April 2012 4 Health Record Usually in paper form Often held in paper and el. form Entered into HIS during night shift Free text, duplications Signals, reports only in paper form Statistics must be provided to state agency tendency to fulfill the requirements only

5. Geneva, Switzerland, 26-27 April 2012 5 EHR First attempt (IZIP) done via state- owned health-insurance company Suspended funding Not based on interoperable standard Inconsistent with European efforts to interoperability Now called ‘health-book’ Smaller projects exist

6. Geneva, Switzerland, 26-27 April 2012 6 EP In a pilot stage 8 doctors, 8 pharmacies Still have to print Insurance companies: no access Runs since 2009, first EP on 04/2011

7. Geneva, Switzerland, 26-27 April 2012 7 Legislation 3 rd party has right to look at the documentation problem: doctor has internal notes Question Owner of the data? Permission to use in research? Has the hospital right to obtain human- readable data for processing? Raw data? Draft on health documentation under discussion. Does not cover EHR.

8. Geneva, Switzerland, 26-27 April 2012 8 Usual (mythic) reasons to reject EHR MDs do not need computer to heal a patient 40 % MDs do not have a computer MDs do not want to be restricted by computer MDs are afraid of easier liability claims IT wants things that are not present in paper form

9. Geneva, Switzerland, 26-27 April 2012 9 Age Structure of MDs in Czech Rep.

10. Geneva, Switzerland, 26-27 April 2012 10 Age Structure of DDs in Czech Rep.

11. Geneva, Switzerland, 26-27 April 2012 11 Age Structure of PDs in Czech Rep.

12. Geneva, Switzerland, 26-27 April 2012 12 Conclusions and Recommendations No fully interoperable EHR EP running in pilot stage Problem of integration: no efforts ‘Crisis problem’: Cheap appliances Loosing data for long-term studies Isolated solutions (reinventing wheel) No force to unify standards