The Way Forward in The Way Forward in
E-Health: E-Health:
The National The National Health Insurance Health Insurance
Fund Fund
BulgariaBulgariaPresented byPresented by
Dr. Rachelle KayeDr. Rachelle Kaye
Maccabi Healthcare ServicesMaccabi Healthcare Services
National Health Insurance FuNational Health Insurance Fund nd Information SystemInformation System
The National Health Insurance Fund Information System
Project, in the final stages of completion, consists of 2
parts:
Kernel 1: The ERP system including Accounting, Inventory, Budget, Contracts
Kernel 2: Management of Medical Service Provider Relations including Claims Management and Audit and National Registries
National Health Insurance Fund National Health Insurance Fund Information SystemInformation SystemKernel 2 provides the Infrastructure for the futuredevelopment of the system. It contains: CHIP demographic information CHIP registry information( GP,infirmary, maternal, child) Outpatient primary and specialty care including
diagnoses and treatment Medical Diagnostic Services Outpatient Dental Care Inpatient hospital care information according to clinical
pathways Pharmacy Information – drugs prescribed and
purchased
Central Computerized NHIF Data BaseCentral Computerized NHIF Data Base
Office visits
pathology
imaging
Laboratoryresults
medications
treatments
diagnostics
hospitals
ElectronicElectronic HealthHealth
RecordRecord
Central Computerized Electronic Health Central Computerized Electronic Health RecordRecord
Major Challenges: From a Data Base to a Major Challenges: From a Data Base to a Central Computerized Medical RecordCentral Computerized Medical Record
Complete Electronic Reporting from ALL Medical Service Providers according to required minimum data set
Electronic Reporting of Medical Diagnostic Activity RESULTS
Establishment of Communication Infrastructure and development of online interface with all MSPs
Ongoing transmission of data online in real time Modification of doctors’ EMR programs to enable
them to accept and integrate online input of information regarding patients – test results, medications purchased, visits to other doctors, etc.
Local NetBackBone
Local NetBackBone
Secu
reC
omm
unic
atio
ns
Secu
reC
omm
unic
atio
ns
AS400AD/DNS/DHCP
WEB SERV
Appl. Serv
DB Serv Intranet
Exchange
Citrix
Storage
E1
VSAT
P-to-P RadioLinks
3G
PrivatePharmacies
Tele-MedicineClinics
Occupational Medicine
Home Visits
Branch
Branch
Intra-NetPortal
February 2006
Maccabi Health Services
Telecommunications System
Hospitals
Maccabi HMOMembers
ADSL
ADSL
ADSL
E1
SDH
Self-ServiceTerminalsSelf-Service
Terminals
Self-ServiceTerminals
Internet
ATM
Cellular
PDA
IPVPN ATM
Call Centers
IPVPN
Large Branches
ATM
Branches
Small Branches ATM
ADSL
PrivatePharmacies
PrivatePharmacies
Extranets
Tele-MedicineClinics
IT Services Suppliers
PrivateMedical Clinics
PrivatePharmacies
Maccabi’s Maccabi’s TelecommunicationsTelecommunications
IT at the physicians’ service
Doctor’s Electronic Medical Record
Physician lab orders are digital, generated by his EMR.
Lab test results are sent to the doctor in the shortest time possible.
Lab results are integrated into the CMR .
The patient has a full access to the information.
The information cycle , from start to finish, is fully automated
Electronic Medical Diagnostic Referrals Electronic Medical Diagnostic Referrals and Results: Laboratory Systemsand Results: Laboratory Systems
Review of Previous Lab Test Review of Previous Lab Test ResultsResults
Lab Referral Form in the Doctor’s Lab Referral Form in the Doctor’s ComputerComputer
Less frequent tests
Lab TestsLab Tests
Request for
lab test
Doctor Clinic
Consolidation of samples
at regional collection hub
LAB
Distribution of resultsSelf Service Station Patient’s
Internet Site
Electronic PrescriptionElectronic Prescription
Index of drugs registered in Bulgaria
NHIF drugs index
Patient information including diagnoses, allergies
Preferred therapeutic alternatives
Drug Utilization Review Program – checks online for contraindications and provides immediate alerts
Access to additional information on drugs
Integrated Decision Support Systems for Integrated Decision Support Systems for PrescriptionsPrescriptions
Drug to Drug Interaction AlertDrug to Drug Interaction Alert
Alerts for AllergiesAlerts for Allergies
Preferred Drug AlertPreferred Drug Alert
E-prescribingE-prescribing
Patient
Doctor Maccabi Internet Services
patient asking forRenewal prescription
via Internet
Doctor Receiving the Request
Sending the Prescription to patient
Patient getting the prescription via internet
TelemedicineTelemedicine
In Maccabi’s ExperienceAn Integrated ICT system is
needed as a necessary Infrastructure
for mostTelemedicine Applications
““...the use of electronic ...the use of electronic information and information and communication technologies communication technologies to provide and support health to provide and support health care when distance separates care when distance separates the participants...the participants...””
from: Institute of Medicine: Telemedicine: A Guide to Assessing Telecommunications in Health Care
Telemedicine DefinitionTelemedicine Definition
The Beginning of Telemedicine
1876
Why Telemedicine?Why Telemedicine?
Equal access all over the country.
On-Line diagnosis .
Extension of service hours.
Reliable diagnosis due to digital tools.
Quality control and assurance.
Archiving capabilities for future comparison.
Sharing information among physicians for treatment and consultation.
Sharing Information with the patient and patient empowerment
Lower cost.
Tele-radiologyTele-radiology
Diagnostic Center : Tel Aviv
Diagnostic backup Center : Haifa
Ref. Phys.
Rpt
PACSPACS
Diagnostic Center
UN
IX
Radiologist Clinic HQ (TA)
RISWIN2000
Tele-Radiology WorkflowTele-Radiology WorkflowInternet
Self Service
Rpt
Rpt
Referral for ECG at nursing station
ECG Performed in office
PoliclinicDoctor
Community Health Services
ECG
Analysis Center Doctor
Nurses’ Room
UNIX
APP. Service
Maccabi Central
Win2000
AS/400
SQL ServerEGK Archive
Referralדוח א.ק.ג
- ------ --- - ----- -- -- -- -- -- ---- - - - --- ------- - -- -- --- ------- -- :אבחנה
Referral
Website Self-Service Station
דוח א.ק.ג
-- -- --- ------- -- :אבחנה
דוח א.ק.ג
-- -- --- ------- -- :אבחנה
דוח א.ק.ג
-- -- --- ------- -- :אבחנה
Tele E.C.GTele E.C.G
Tele-Ophthalmology 2008
Maccabi Branch
Tele-monitoring Congestive Heart FailureTele-monitoring Congestive Heart Failure
Information Systems
RF
Patient houseMaccabi
Call center
PCP
Regional center
Devices:•BP•Pulse •Weight
HUB
Phone Lines
Tele-ConsultationTele-Consultation
Patient's web sitePatient's web site
Medical Applications Lab Results Radiology Results Personal Health Situation Cardiac Risk Factors Diet & Nutrition Personal List of Drugs
Administrative Application- Scheduling- Demographic Updates- Account Status- Visit List- Health Plans- Over seas Insurance
On Line Patient Secured Web Site On Line Patient Secured Web Site
On Line Patient Secured Web SiteOn Line Patient Secured Web Site
Patient's web site
Patient's web site
Patient's web site
Telemedicine Tomorrow – The Way ForwardTelemedicine Tomorrow – The Way Forward
Telemedicine is becoming a routine part of everyday medical care
Services will be provided to members, to the extent possible, at the most comfortable and convenient location for them (home, office) via use of the most advanced information and communication technology (web, e-mail, SMS)
Services that cannot be provided at home will be provided in the physician’s clinic which will be, to the extent possible, a “one stop shop” for most of the patient’s healthcare needs
Guiding PrinciplesGuiding Principles
Telemedicine will not take the place of the patient
physician relationship but will strengthen the relationship
Telemedicine will not replace the need for face-to-face
visits and physical examination when medically
necessary
Telemedicine will add numerous tools and options that
will improve care, provide greater flexibility and comfort,
and improve the efficiency, timeliness and effectiveness
of health care
Personal Health Records - futurePersonal Health Records - future
Maccabi OnLine
The Way Forward – Technology is NOT the Issue
The People “behind” the Technology (doctors, nurses): Availability - Shortages Willingness to Participate Payment
Patient Preferences“Therapeutic” CommunicationPolicy Issues:
Investment in Infrastructure Reimbursement Privacy Malpractice
The Way Forward
Successful Telemedicine Requires:
Committed Policy makers
Committed Healthcare Professionals
Proactive Patients and Families
Significant Changes in cultural norms and
values
“We have to be prepared to do things differently”
Thank you for your attention
