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Estonian Electronic Health Record System _EHR_

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					Estonian Electronic Health Record
          System (EHR)

          MD.Madis Tiik
               CEO
   Estonian E-Health Foundation
                                                                                         STATE AGENCY OF MEDICINES
                                                                                                - Coding Centre
                                                                                            - Handlers of medicines




          2011
                          2009

       HCP PORTAL
                     PATIENT PORTAL
                                                                                            HEALTH CARE BOARD
                                                                                             - Health care providers
                                                                                              - Health professionals
                                                                                              - Dispensing chemists



                                                                                            POPULATION REGISTER




     2009
                               2009
                              SERVICE




PHARMACIS AND
FAMILY DOCTORS
                          XROADS GATEWAY
                                                                                              BUSINESS REGISTER




                                                                                          HOSPITAL ( HIS) integration
                                                                                                      2009
                                                                                                                              healthcare IT




                  EHR

                  2009
                                                                                               FAMILY DOCTORS


                SYSTEM
           eHealth Foundation                                                                         2009



                                                                                                  PHARMACIS
                                                                                                                        Architecture of Estonian




                                                                                                  2010 january
                                           X-Roads, ID-card, State IS Service Register




                                                                                               SCHOOL NURSES
                                                                                                2011 september
              CENTRE
            2010 january
           PRESCRIPTION
          Health Insurance




                                                                                         EMERGENCY MEDICAL SERVICE
        INSURANCE REGISTER
      CLAIMS & REIMBURSMENT




                                                                                                      2012
        Situation in 01.05.2011
• Availability of digital documents on the EHR
            – Discharge letters (epicrises)      90%
            – Out-patient consultation notes     around 15%
• Other documents in the EHR
            –   Images raports
            –   immunization note
            –   Day surgery note
            –   Referrals
            –   Birth epicrises
• There are 4 886 891 ePrescriptions issued during 2010, it is more than
  80% all prescriptions in 2010

• 100% of Radiological images (excl. dental) are digital and stored to the
  PACS

• More than 602 379 citizens have digital medical records in EHR – it is
  47% of the population

• 29 105 citizens have viewed his/her data in EHR (Patient Portal)
Retrieval of medical documents by healthcare professionals
60,000




50,000


                         More than 95% of Estonian doctors
                         have used the EHR services
40,000




30,000




20,000




10,000




    0
                               June




                                                                  October




                                                                                                                                             June




                                                                                                                                                                                October
                         May




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         March




                                      July




                                                                            November



                                                                                                  January



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                                                                                                                                                    July




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                                                                                                                                                                                                                                      March
                                             August

                                                      September




                                                                                                                                                           August

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                                                                                                                                                                                                                           February
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                                                                                                                                                                                                     December
                 April




                                                                                                                               April




                                        2009                                                                                                   2010                                                                       2011                4
  Distribution of costs and benefits of Estonian e-
  Health platform (Digimpact study 2010)
  :




Total cost of EHR system development (2005-2010) has been
around 10M€ - it is 7.5€ per citizen

                           http://eng.e-tervis.ee/digimpact-final.html
Estonian roadmap for eHealth

              Impact
                                                                   Simulation
                                                 Shared            Environment Tracking
                                                 care              Behaviour Tracking
                                                                   Online Intervention
                                                                   Lifestyle Value Added

                                                 Personal Guidelines
                              Decision           Care Paths
                                                 Service Brokering
                              Support            Integrated Statistics
                                                 Social Networking

                                  Central EHR
              Information         Health Portal
                                  Registries Integration
              Exchange            Standardization

             Local EMRs
             Digital Claims & Reimbursement                                            Time

           1992                      2010                    2015                  2020
                    Healthcare transformation
• Patient data available to any clinician who needs to see it
       • Legal reforms
       • Access protocols
       • Clinician engagement
• Payment for value and for care coordination
       • Relationship between providers and payers
       • Metrics of value
       • Processes of coordination
• Preventive health maintenance centred on the patient
         • Allocation of funding and staff
         • Patient engagement
         • Clinician engagement
E-Health is one thing that makes these transformations in healthcare possible,
   but it is not a substitute for the transformations!
      Thank you!

e-Health=healthcare management

e-Health ≠ICT project



                        madis@etervis.ee
                        wwww.etervis.ee

				
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