E-health croatia: National healthcare information...

E-health croatia: National healthcare information system

Andrea Budin, M.Sc.C.S. ([email protected]) Karlo Guštin, MBA ([email protected])

ICT for Industry & Society Ericsson Nikola Tesla, Croatia

April 2015

mailto:[email protected]

mailto:[email protected]

Ericsson e-Health Croatia | National e-Health Seminar LMF | 2015-04-16 | Page 2

What would you say about the industry where… Focus is on the process and the „seller” not the customer

Costs are fragmented, isolated, not easily manageable

Processes are fragmented and isolated

Decisions are often made upon individual knowledge and experience

Ordering process is manual and paper based

Experience is mostly individual and not truly shared

Information for any participant in the process is fragmented, isolated and not always available

Yes, this is can be a mess !

What about future costs?

What about quality in the

future ?


What if that industry was healthcare...?

What should we do?

What can we do?

How can we do it?

Focus is on the process and „seller” not the customer








What can/should we do? Patient centric

Centralized cost management

Managed processes, clinical pathways and guidelines Guidelines, evidence-based and personalized care

Automated

Best practices

Consolidated, centralized, comprehensive; available wherever and whenever needed

Focus is on the process and „seller” not the customer








How can we do it?

Through Using ict! Re-Organization, new processes, new & reused

knowledge and competences

Transformation

How to collect and distribute information?

How to trust that information?

How to measure success?

How, how, how?

Where to start?


Ehr (electronic healthcare

record)

Patient portal

Discharge summary from

PHC

Reporting infectious, malignant

diseases

E-prescription E-referral

Prevention programs

Retrieving administrative info

(insurance status, medical aids availability…)

E-health – main building blocks


› The begining was hard – legal, process, architectural, technical, motivation, resistance to change issues!!!

› You need to choose the right partner – experienced solution builder rather than a solution supplier

› Each new step is easier from previous › Each new step brings significantly more benefits than previous › After some point, momentum is there and you should only not ruin it

› Is it possible?

The real cases show that there is no single, ‘right’ strategy for implementing interoperable EHR and ePrescribing systems.

The most transferrable features from different projects are the experiences and capabilities gained, and requirements for success identified. European Commission, „The socio-economic impact of interoperable electronic health record (EHR) and ePrescribing systems in Europe and beyond“, October 2009


eHealth in croatia

Audit Messaging

Business registries(resources, patients coding lists…)

Auxilliary databases

Authentication & authorization

EHR

Specialized applications (e.g. national prevention programs, hospital information system, central

eBooking...)

BI & reporting

CEZIH

PatientsHospitals

Laboratory

Pharmacy

Healthcare insurance

Ministry of Health Public Health Specialist care

Outpatients care

School medicine

Dentist

Gynecologist

Pediatrics

General practitioner

Nurse app

Physician app

Patient portal

CEZIH is integration platform with selected business process mechanisms

Selected nationwide applications are part of CEZIH too


CROATIA 2007-

4 Million patients benefit from ehe

E-refeRral – 15,000 people do not need to drive each day

E-prescription (50m/YEAR)

Prevents errors & saves lives

EPSOS

E-referral in all hospitals (12m/YEAR)

e-booking in specialist care & hospitals

Presenter

Presentation Notes

This system is really about the patient. Any citizen can go to any pharmacy in country to pick up medication without any paper right after their doctor prescribed it. This service prevents avoidable errors. System is connected to epsos from this year. That means that every prescription can be available through NCP in other countries in EU that are also connected to epsos. Fifteen thousand people daily do not need to go and pick up their lab results because laboratory delivers it to their doctor electronically. That’s small town not commuting every day, unnecessarily. eBooking and eReferral go hand in hand together but they are not the same! Referral is patient's medical need while ebooking service ensures resources reserved in certain time for patient’s medical need. Every PHC in Croatia has that service in disposal when referring patient to any hospital.


CROATIA 2007-

Electronic healthcare record

Patient portal

DISCHARGE LETTERS

Primary health care providers

Administrative services

in daily use by 18,000+ healthcare professionals

Presenter

Presentation Notes

If we look a bit under the hood we will find services less visible to the patients but of great necessity for the healthcare ecosystem. Those are administrative services like patient’s insurance eligibility check, demographics queries, malignant and infectious disease reports and many others. One services of great importance is discharge letter from primary healthcare. It is a foundation of what we call „a crown jewel of system”: Electronic Healthcare Record.


Electronic healthcare record

Central electronic healthcare record is the

only system where authorized user can

access comprehensive lifelong patient medical

record

Source of the data is any application/system connected to cezih


› Comprehensive view on your own health

› Managing dashboard for different activities

› Administrative information

› Communication platform with different healthcare professionals

› Reminders, general info…

patient portal


our efforts have not gone unrecognized....

27001 13485

9001

Ericson Nikola Tesla

„The top 3 performers for ePrescription are Estonia (100%), Croatia (99%) and Sweden (97%)…” (EC, 2014)

Presenter

Presentation Notes

ETK eHealth solution has been selected as one of the 25 “the smartest” ICT solutions in the World when it comes to the social and environmental impact according to independent and non-profit “The Climate Group and the Global eSustainability Initiative”. ETK is one of the few ICT companies in the region with the ISO 13485 certificate for development, marketing and production of healthcare solutions. ISO 27001 for information security management system ISO 9001 for quality assurance EuroHealth Consumer Index 2009: Based on the informatization of the Primary Healthcare System (HNIS Platform), Croatia has been positioned on the 3rd place (among 33 countries) in the assesment of application of eHealth. Overall ranking 23rd out of 33 EuroHealth Consumer Index 2012: Overall ranking 16th out of 34. Ranked 4th (with Iceland) in category “Patient Rights and Information”


Croatia Pilot Execution

Carewell Multi-level integration for patients with complex needs

8 Countries Spain, UK, Denmark, Germany, Belgium, Poland, Croatia, Italy

36 months 18 months operational pilot period targeting multiple chronic diseases

Ericsson Nikola Tesla 1. Overall coordinator of Croatian pilot site

2. mHealth technology provider

- Ericsson Mobile Health

- System Integration

3. Pilot site deployment and maintenance

4. Service and organization design

COPD

Diabetes

cardiovascular

2016 2014 2015

Presenter

Presentation Notes

CareWell is EU funded project, as part of the competitiveness and innovation programe (cip). The goal of the project is to deliver integrated healthcare services to frail elderly patients trough coprehensive multidisciplinary programess with ICT playing major role in communication and coordination of healthcare staff and providing home care to chronic patients, with specific focus on education. Healthcare sevice will be delivered in pilot setting and targeting elderly chronic patients with multiple conditions (COPD as primary + diabetes and/or cardiovascular disease) and their informal care takers. Duration of the project is 36 months with 18 months of operational period. For the specific pilot in Croatia, consortium consists of three main partners and one healthcare delivery organization: Health Center – Zagreb center has the role of patient selection and onboarding as well as providing medical staff needed to deliver the integrated healthcare service Faculty of Electrical engineering and computing will drive the organizational change requirements as well as quality managment and technical interoperability assessment Croatian Society for Pharmacoeconomics and health economics will be responsible for pilot results analysis and pilot socioeconomic performance analysis And finally Ericsson Nikola Tesla that is taking the role of overall pilot coordinator, mHealth technology provider, implementation, maintenance and service design responsible


Faculty of Electrical Engineering

and Computing

Ericsson Nikola Tesla

Croatian Society for Pharmacoeconomics and Health Economics

Technology provider Organizational change managment Quality and security managment Technological Interoperability assessment

Overall coordinator of Croatian pilot site

mHealth technology provider

Healthcare service design and use-case creation

Pilot site deployment and maintenance

Patient recruitment Health professionals and decision makers involvement Data analysis and market research Pilot evaluation and socioeconomic performance analysis

Health Center ‘Zagreb Center’

(Healthcare Service Delivery)

Presenter

Presentation Notes

For the specific pilot in Croatia, consortium consists of three main partners and one healthcare delivery organization: Health Center – Zagreb center has the role of patient selection and onboarding as well as providing medical staff needed to deliver the integrated healthcare service Faculty of Electrical engineering and computing will drive the organizational change requirements as well as quality managment and technical interoperability assessment Croatian Society for Pharmacoeconomics and health economics will be responsible for pilot results analysis and pilot socioeconomic performance analysis And finally Ericsson Nikola Tesla that is taking the role of overall pilot coordinator, mHealth technology provider, implementation, maintenance and service design responsible


› Technology missing in filed nurse care:

– Communication tools between professionals on first line (GP and Field nurses)

– Communication support between patient and healthcare staff

– Digital educational materials for patient empowerment

Field nurse service in Croatia Technology status

- 64 hospitals - 46 health centers:

960 field nurses 5000 GP’s

› In place – EHR – ePrescription – eBooking – eRefferal


Presenter

Presentation Notes

The operational part of the Croatian pilot site is analyzing the processes improvement in primary care – with focus on field nurse service for chronic patients with complex needs. By implementing new ICTs and reengineering of healthcare processes, the CareWell pilot in Croatia will: Increase the availability of healthcare services for out-patients Speed up and simplify the communication and information exchange between medical professionals Increase patients QoL by providing disease information and education to targeted patient groups and their informal caregivers Decrease the cost of care for the targeted patient groups due to lesser number of hospitalizations and disease complications Ovdje je bitno naglasiti dio koji cemo mi adresirati i koje probleme ćemo riješiti: - Manje F2F komunikacije između healthcare staffa interno, healthcare staffa i pacijenta i dati bolji strukturirani oblik za integrated care i patient empowerment. �


home support

And patient empowerment

Integrated Care Coordination

Education materials on multiple devices:

- About disease

- Prevention

- Therapy adherence

- Regular Workouts

- Nutrition

Data Sharing

Communication Medical Measurements

Presenter

Presentation Notes

In Croatian pilot two use cases will be addressed: Integrated care coordination pathway (ICCP) -> Improoving communication, coordination and information sharing between health care and social care workers Patient Empowerment and home support pathway (PEHP) -> Improving the patients quality of life and quality of healthcare service delivered in home setting by providing To enable the service delivery, Ericsson Mobile Health (EMH) solution will be implemented and adopted for the purpose of CareWell project. Service delivery will be performed by filed nurses in both use cases: 1. ICCP - EMH will be used for the purpose of collecting and storing of various patient medical data (measurements, photos, questionnaires). Data will be stored in central database so that doctors can access it regardless of time and location via EMH doctors web application. Furthermore, EMH will provide medical staff with communication/messaging functionality, so that a nurse can send in-app massage to the doctor in case of the need to review patients status immediately. The Goal of this use case is to make patient data available to all healthcare staff which will enable them to make more informed decisions about the patients future treatments. 2. PHEP – adaptations will be done on EMH system with the goal of delivering ICT based educational tools that will be used by field nurses. The same educational content will be available to patients and their care takers even after the nurse has left their home – this will be achieved via smart-tv or tablet/smartphone applications that will be used by patients or care takers. The educational content will cover topics such as: medication related to patients disease, importance of therapy compliance, regular workouts and nutrition. The goal of PEHP use case it to empower patients to take an active role in treatment and to put emphasis on education and self care which will in the end decrease the number of chronic disease exacerbations and potential hospitalizations.


Added value for healthcare system › Increased amount of accessible information

› Increased speed of data flow on patient-doctor pathway

› Increased adherence to therapy and compliance with specialist examinations

› decrease in number of GP visits and unnecessary travel for patient

› decreased number of hospitalizations and excessive health resources usage

Medication

Therapy adherence

Regular Workouts

Nutrition

Data Sharing

Communication Medical Measurements

Integrated Care

Coordination

home support

And patient empowerment


The future depends upon the decisions made today

“Will we look into the eyes of our children and confess

that we had the opportunity, but lacked the courage?

that we had the technology, but lacked the vision?”*

* Energy Revolution Greenpeace, Pachauri foreword 2009

› www.ericsson.hr › www.cezih.hr

THANK YOU!

http://www.ericsson.hr/

http://www.cezih.hr/


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