Income Tax Estonia 2010

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					The Status of National e-
          Health
  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
                                                   DATABASES / INFORMATION SYSTEMS                                                                                                                           BANKS


                                                                                                                                                                                                            • SEBbank


                               Register




                                                         Insurance Register




                                                                                  Vehicle Register




                                                                                                                                                      Tallinn Water IS
      Population register




                                Health Insurance




                                                          National Pension




                                                                                                                             Estonian Energy IS
                                                                                                                                                                                                            • Swedbank
                                                                                                                                                                                                            • Creditbank
                                                                                                                                                                                                            • Sampo Bank
                                                                                                                                                                                                            • Nordea Bank


Security                    Security                 Security                 Security                                   Security                 Security                                                  Security
Server                      Server                   Server                   Server                                     Server                   Server                                                    Server



                                                                              Internet                   -   X-tee

                                                                                                                                                                            Security
                                                                                                                                                                            Server
Security
                                                    ::   …            ::
Server                                                                                           Central server I                Monitoring
                                 E-institution – Institution view




                                                                                                                                                           http://www.riik.ee/arr/



                                                                                                                                                                                     National Databases
                             :: E-county – county view ::




                                                                                                                                                                                     register
:: E-riik – State Portal ::                                                                          Central server II     Helpdesk                                                                              ID – card
Institutional view of the state           Thematic view of the state
www.riik.ee                             www.eesti.ee

KIT                           EIT                           AIT
Citizen view                  Enterpriser view              Public servant view                  X-road certification centre



Tools centrally developed by the State                                                                       X-road Center                                                                                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


                             Policy-
                             making             Treatment


                                                     Guidlines
              Public              EHR
              Services                                        Diagnostics

Campaigns                Tele-advice   Appointment                       Workflow
             Self-help                                   Notification
                                                                        Prescription
 Lifestyle
                    Founders of the Estonian eHealth
                              Foundation
     Ministry    Society of     Tartu       East Tallinn    Union of    North           Estonian
     of Social    Family      University      Central       Estonian   Estonian         Hospital
                  Doctors       Clinic       Hospital       Medical    Regional        Association
      Affars                                               Emergency   Hospital




                                      Estonian eHealth
                                         Foundation
                                           Board


                                       Management
                                         Board

                 Strategy and                                          Marketing and
                 Architecture                                          Channel
                 Development          EHR Operation                    Management




                  Family                       Nursing       Patient        Health
                                Hospitals
                  doctors                       Care          Portal      Authorities

                                            End users
Governance
                    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)
                                                 11
             HEALTH CARE BOARD
                   - Health care providers
                   - Health professionals
                   - Dispensing chemists

                                                          Pharmacis                                        Emergency
                                                         2010 january                                     Medical Service
   STATE AGENCY
    OF MEDICINES                                                                                               2011
    - Coding Centre                   - Citizen Registry                   Hospitals     Family doctors                  School nurses
- Handlers of medicines              -Company Registry                       2009           2009                        2010 september


         SS                    SS              SS             SS                  SS           SS           SS                   SS

                                                                        X-ROAD
                           SS                                                                    SS                         SS

                      Healthcare
    Patient portal                    Monitoring portal
                       Provider
                                                                                                                  HEALTH INSURANCE
                                                                                                                       FUND
      Goverment’s e-service framework
              www.eesti.ee
                                                                                                                   Prescription Centre
                                                                                                                      2010 january

         KIT              EIT               AIT                         W-
    Citizen view     Enterprice view Of f icial’s view                         HEALTH INFORMATION
                                                                        SS        SYSTEM ( EHR)
                                                                                       17.12.2008

                                                            Doctor’s and
                                                             pharmacies
                                                          software solutions
                                                                                   Estonian national eHealth
                                                                 EHR Central Functions
                                                 Information
 Health Portal            Devices
                                                   Systems
                  Public IT Infrastructure

                  Standards and Services
                                                          WSDL
                                                          XSD




                 Processes and Integration

 Health      Health
                           Booking       Reports     Ambulance
 record      status

Document                  Decision       Demo-
            Statistics                                Concent
 archive                  Support       graphics

                  Metadata/ universal viewer
                  Storage ( long time archive)
         Current Situation 17.06.2010

• There are 1 557 704 documents in the Estonian EHR
     •   Discharge letters (epicrises)      186 460
     •   Out-patient consultation notes     244 609
     •   Dispensed medication information   743 944
     •   DICOM images ( index)              213 397
     •   Image reports                      164 069
• 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             Tartu University          East Tallinn Central
 Regional Hospital          Clinic                    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**          May

Number of e-     278 957    407 609      520 000      387 000          381 836
prescriptions
issued

% from           40%        58%          74%          55%              55%
prescriptions
issued*
Purchased        150 009    221 800      322 000      288 000          292 207
prescriptions

% from           21%        31%          46%          41%              42%
purchased
prescriptions*


   *estimation based on 2009 numbers - 700 000 prescriptions monthly
   ** 13.04 recomendation not to use e-prescription to the doctors
   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         Health
                                  Support         Records
                                  Service         Service




 Knowledge
                    Digital    Decision
Digitalization                               Health Records
                    Library    Scripts
                 End user services,        Patient: Oracle Portal
Applications     hospital IT services      Hospital IS

                 Sending messages          X-Road infrastructure
                 between institutions
X-Road

                 Message validation,       webMethods Integration
Message centre   authorisation, logging,   Server, custom Java
                 addressing                services
                 Forwarding messages to    webMethods Broker
Message broker   agents

                 Document processing       webMethods Integration
Message agents                             Server

                 Database operations,      webMethods Integration
Data services    database logging,         Server, Oracle DBMS
                 queries
      EHR integration through X-Road

                 HL7
               document            HL7
                               interaction




Hospital IS                                  EHR




                          X-Road message
                         Document processing
     Lab notice              Message
      Üldandmed                    Health record agent
    Swineflu notice
        Mari-Liis                  Event: Medication,
                                                                         Health record
      Üldandmed
           47595064059
  Infection notice                Diagnosis, Procedure
         Mari-Liis
           Männi 1-2
    Üldandmed
         47595064059
Discharge letter
           Tallinn
      Mari-Liis1-2                 Demographics agent
         Männi
 Demographics                  Address: Männi 1-2, Tallinn               Demographics
      47595064059
         Tallinn
   Mari-Liis
         Diagnoos
      Männi 1-2
           punetised
   47595064059
      Diagnoos
      Tallinn                              Statistics query
   Männi 1-2
         punetised                        Outbreak report
         Allergia
   Tallinn õietolm
    Diagnoos
      Allergia
      punetised
         õietolm
                                                                HPI           HPI
 Diagnosis                                                    services
    Allergia
   chickenbox                    Infection decease agent
      õietolm                    Diagnosis: chickenbox
 Allergy
   pollen
                                 Timecritical report agent                Timecritical
                                    Allergy: pollen                         reports
         Maintenance
   of Estonian EHR System
eHealth               Business Processes

                     Application
Partners           Development

                Application
              Maintenance

              Application
eHealth       Operations

               Monitoring                       ITIL
                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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