The Status of National eHealth
Initiatives in Estonia
Madis Tiik
18.06.2010
CEO
Estonian e-Health Foundation
2
Facts about Estonia
• Population
1.32 million
• Area
45 000 km2
• Compulsory health insurance paid by employer
– Health insurance tax 13%
– Health care costs make up 5% of GDP
• Income tax
21% (flat tax)
• Healthcare providers are private, municipal or
governmental.
– Family doctors (private companies)
– Hospitals (shared companies or foundations)
3
e-Estonia
• Wide range of e-services
– e- election
(EU Parliament election june 2009 – 6,5%
electronically)
– e- tax board (2008 – 90,6% electronically)
– e- school
– e- commercial registri, etc
• High bandwith connectivity
– Internet
• 75% of population use regulary internet (2009)
• 67% households have PC and 91% of them are
connected to the
Information Society
• By 2013
– All public services are digitaly available
– Public infrastruture is service oriented (x road)
– Digital authorisation of users, based on the ID
card, is the best available in the world
– Data is stored were it is collected and exchange
of the data is available thous who need it
BANKS
DATABASES / INFORMATION SYSTEMS
Security
Server
Security
Server
Internet
Security
Server
-
Security
Server
Security
Server
::
…
::
Central server I
E-institution – Institution view
Monitoring
Helpdesk
Thematic view of the state
www.eesti.ee
Institutional view of the state
EIT
Enterpriser view
AIT
Public servant view
X-road certification centre
Tools centrally developed by the State
X-road Center
National Databases
register
Central server II
http://www.riik.ee/arr/
:: E-riik – State Portal ::
KIT
Citizen view
Security
Server
X-tee
:: E-county – county view ::
www.riik.ee
Tallinn Water IS
Estonian Energy IS
Security
Server
Vehicle Register
Security
Server
National Pension
Insurance Register
Health Insurance
Register
Population register
Security
Server
• SEBbank
• Swedbank
• Creditbank
• Sampo Bank
• Nordea Bank
ID – card
Certification Center
X-road
• Aggregates 360 different databases
• 2000 e-services
• 500 different organizations have integrated
their systems into X-road
• Services of X-road were used 420 000 000
times a year (2009)
• more information http://www.ria.ee/27525
Analysis
Follow-up
Policymaking
Public
Services
Campaigns
EHR
Tele-advice
Self-help
Treatment
Guidlines
Diagnostics
Appointment
Workflow
Notification
Prescription
Lifestyle
Founders of the Estonian eHealth
Foundation
Ministry
of Social
Affars
Society of
Family
Doctors
Tartu
University
Clinic
East Tallinn
Central
Hospital
Union of
Estonian
Medical
Emergency
North
Estonian
Regional
Hospital
Estonian
Hospital
Association
Estonian eHealth
Foundation
Board
Management
Board
Strategy and
Architecture
Development
Family
doctors
Governance
EHR Operation
Hospitals
Nursing
Care
End users
Patient
Portal
Marketing and
Channel
Management
Health
Authorities
Our tasks
• Management of E-Health projects
• Standardisation and development of medical digital
documents
• Maintenance of the Estonian EHR system
• International cooperation and scientific cooperation
with universities
• Development of new services for citizens and doctors
Financed from the State budget (1.2 mln € – 2008)
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HEALTH CARE BOARD
- Health care providers
- Health professionals
- Dispensing chemists
Pharmacis
2010 january
STATE AGENCY
OF MEDICINES
- Coding Centre
- Handlers of medicines
SS
Hospitals
2009
- Citizen Registry
-Company Registry
SS
SS
Emergency
Medical Service
2011
SS
SS
School nurses
2010 september
Family doctors
2009
SS
SS
SS
X-ROAD
SS
SS
Patient portal
Healthcare
Provider
Monitoring portal
HEALTH INSURANCE
FUND
Goverment’s e-service framework
www.eesti.ee
KIT
Citizen view
SS
EIT
AIT
Enterprice view Official’s view
Prescription Centre
2010 january
WSS
HEALTH INFORMATION
SYSTEM ( EHR)
17.12.2008
Doctor’s and
pharmacies
software solutions
Estonian national eHealth
Information
Systems
Devices
Public IT Infrastructure
Standards and Services
WSDL
XSD
Processes and Integration
Health
record
Health
status
Booking
Reports
Ambulance
Document
archive
Statistics
Decision
Support
Demographics
Concent
Metadata/ universal viewer
Storage ( long time archive)
EHR Central Functions
Health Portal
Current Situation 17.06.2010
• There are 1 557 704 documents in the Estonian EHR
•
•
•
•
•
Discharge letters (epicrises)
Out-patient consultation notes
Dispensed medication information
DICOM images ( index)
Image reports
186
244
743
213
164
460
609
944
397
069
• More than 370 000 citizens have digital medical
records in EHR , it is 25% of the population
Availability of Discharge Letters
Year 2009
North Estonian
Regional Hospital
Tartu University
Clinic
East Tallinn Central
Hospital
27661
31914
24038
82%
74%
84%
These 3 hospitals cover more than 60% of in-patient cases in Estonia
ePrescriptions
Prescription centre was launched 1st of January 2010
January February
March
April**
Number of eprescriptions
issued
278 957
407 609
520 000
387 000
% from
prescriptions
issued*
40%
58%
74%
55%
Purchased
prescriptions
150 009
221 800
322 000
288 000
% from
purchased
prescriptions*
21%
31%
46%
41%
*estimation based on 2009 numbers - 700 000 prescriptions monthly
** 13.04 recomendation not to use e-prescription to the doctors
May
381 836
55%
292 207
42%
Patient’s Portal → Personal Health
Record (PHR) 2010-2011
• PHR – one view for citizens
–
–
–
–
–
–
Illness data from healthcare system (Patient’s Portal)
Self-monitoring data
Wellness data from third parties
Data from social system
Patient forums
Screening remainders
• Decision support
– Self-care
– Virtual health check
EHR Portal Services for Citizen
Decision Support
Suggestions
and
Reminders
Decision
Support
Service
TIS
Health
Records
Service
TIS
Knowledge
Digitalization
TIS
Digital
Library
Decision
Scripts
Health Records
End user services,
hospital IT services
Patient: Oracle Portal
Hospital IS
Sending messages
between institutions
X-Road infrastructure
Message centre
Message validation,
authorisation, logging,
addressing
webMethods Integration
Server, custom Java
services
Message broker
Forwarding messages to
agents
webMethods Broker
Document processing
webMethods Integration
Server
Database operations,
database logging,
queries
webMethods Integration
Server, Oracle DBMS
Applications
X-Road
Message agents
Data services
EHR integration through X-Road
HL7
document
HL7
interaction
EHR
Hospital IS
X-Road message
Document processing
Lab notice
Üldandmed
Swineflu
notice
Mari-Liis
Üldandmed
47595064059
Infection
notice
Mari-Liis
Männi 1-2
Üldandmed
47595064059
Discharge
letter
Tallinn
Mari-Liis
Männi 1-2
Demographics
47595064059
Tallinn
Mari-Liis
Diagnoos
Männi
1-2
punetised
47595064059
Diagnoos
Tallinn
Männi
1-2
punetised
Allergia
õietolm
Diagnoos
Tallinn
Allergia
punetised
õietolm
Diagnosis
Allergia
chickenbox
õietolm
Allergy
pollen
Message
Health record agent
Event: Medication,
Diagnosis, Procedure
Health record
Demographics agent
Address: Männi 1-2, Tallinn
Demographics
Statistics query
Outbreak report
Infection decease agent
Diagnosis: chickenbox
Timecritical report agent
Allergy: pollen
HPI
services
HPI
Timecritical
reports
Maintenance
of Estonian EHR System
eHealth
Partners
Business Processes
Application
Development
Application
Maintenance
eHealth
Application
Operations
ITIL
Monitoring
help desk
Database
management
Partners
Server, Storage
& Network Management
Hardware
and Data Center
“Have an eExperience in Tallinn”
eHealth Conference in Tallinn 13-15 October 2010
www.ehealthtallinn2010.org
1. The Estonian eHealth Concept
2. Translating the Benefits & Cost of eHealth - Assessment of
Economic Impact of the Estonian Health Information System
(DIGIMPACT)
3. Opt-in or Opt-out? User Rights, eHealth Related Legal and
Privacy Issues in Estonia
4. Open Discussion: How Was the Estonian National Health
Information System Implemented? Overview of process,
problems we have encountered, different parties’ viewpoints on
implementation (e.g. physicians and patient representatives).
Thank you for your attention!
Questions?
Madis.Tiik@etervis.ee
www.e-tervis.ee
http://eng.e-tervis.ee/
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