Thinking of the bigger picture:How Estonia designed future
healthcare
Madis TiikMD, Scientific advisor
EU eHealth Task Force group [EST]
PRECONDITIONS FOR SUCCESFUL IMPLEMENTATION OF EHEALTH
e-Estonia
ICT and healthcare in Estonia
Local EMRsDigital Claims & Reimbursement
1992 2010 2015 2020
Time
Patient empowerment
• Software's for hospital and for GP in 1994• Digital claims since 1995• Equipping GP-s with PC-s 1998• Skipping paper claims 2002• Legally allowed to use only digital patient
record since 2002
Information Society Strategy 2001
By 2013 All public services are digitaly available
Ehealth services 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 those who
need it
Information society indicators100% of schools and government organisations have broadband
connection
71% of families have computer at home
68% of homes have broadband connection (2011)
EstWin project- 98% of households gets a broadband connection by 2015
99% of bank transfers are performed electronically
94% of income tax declarations made via the e-Tax Board
24% of votes were cast over the internet on 2011 (Parlament elections)
62%-E-census (jan2012) 815,467 persons have completed the questionnaire digitally
Estonian Information System
X-Road was launched in 2001
2000: Launch of e-Tax Board
2000: Launch of m-Parking
2002 : Introduction of national electronic ID-Card
2003: Launch of ID bus ticket
2005: i-Voting was introduced
2007: Introduction of m-ID
2007: Launch of e-Police system
2008: Launch of e-Health system
2010: Launch of e-Prescription
Some achievements
ICT and healthcare in Estonia
Central EHR 2005-2008Health Portal 2009Registries Integration ( non clinical) 2008Prescription centre 2010Standardization 2007-2012Integration of different user groups 2009-2012
Information Exchange
Local EMRs 1992-2005Digital Claims & Reimbursement
1992 2010 2015 2020
Time
Patient empowerment
ACTIVITY INDICATORS
Current situation
Mar
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May
June
July
Aug
ust
Sep
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ecem
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Janu
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Febr
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Mar
chA
pril
May
June
July
Aug
ust
Sep
tem
ber
Oct
ober
Nov
embe
rD
ecem
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Janu
ary
Febr
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Mar
chA
pril
May
June
July
Aug
ust
Sep
tem
ber
Oct
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Nov
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rD
ecem
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2009 2010 2011 2012
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
Retrieval of medical documents by health care professionals
Documents in EHR
There are 14 different types of standardized documents. Most popular documents are:
– Ambulatory consultation notes 1 286 203– Hospital discharge letters 694 974– Image address links 742 590– Image reports 938 594– Immunization notes 24 256
E-prescriptions
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aug.1
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sept.
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nov.1
0
dets.
10
jaan.1
1
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11
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nov.1
1
dec.1
1jan
.12feb
.12
mar.12
apr.1
2
may.12
-
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
ISSUED SOLD
Paper prescriptions
july august sept oct nov dec jan feb march april may0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
Services in portal• Medical files
• Time critical data (allergy, chronic diseases)• General practitioners and hospital visits• Summary of ambulatory and stationary case• Link to medical images
Expressions of will/Preferences• Closing medical records (opt out)• Name trusties• Donation of organs
Overview of logs
Electronic Health Record (EHR).Patient Portal
ICT and healthcare in Estonia
Central EHR 2005-2008Health Portal 2009Registries Integration (non clinical) 2008Standardization 2007-2012Integration of different user groups 2009-2012
Information Exchange
Local EMRsDigital Claims & Reimbursement
1992 2010 2015 2020
Time
Patient empowerment
Health certificate 2010-2012Integration with social care 2011-2012EbmDS decision support service 2011-2012Integrated statictics 2010-2012Clinical registries 2011-2013
Secondary use of data
Secondary use of data
Integration with social care
• Health status for disability pension
Inside healthcare• Health certificate for
driver licenses• Virtual registris
• Immunization registry
ICT and healthcare in Estonia
Central EHR 2005-2008Health Portal 2009Registries Integration ( non clinical) 2008Standardization 2007-2012Integration of different user groups2009-2012
Information Exchange
Local EMRsDigital Claims & Reimbursement
1992 2010 2015 2020
Time
Patient empowerment
Health certificate 2010-2012Integration with social care 2011-2012EbmDS decision support service 2011-2012Integrated statictics 2010-2012Clinical registries 2011-2013
Secondary use of data
Personal Simulation 2015Integration wth -Environment data 2015?-Behaviour data 2015?-Genetic data 2013?
Value Added services
Task Force raport: Levers of change
1. My data, my decisions
2. Liberate the data3. Connect up
everything4. Revolutionise health5. Include everyone
BenefitsPartnership, active roleUser focused, new servicesIntegration and useage of
PHR dataInformed and empowered
citizens to manage their own health
Greater involment, self care