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On-line Access to Health Data in Slovenia - Experience and Perspectives. Tanja Mate,M.D., Marjan Suselj. Contents. Slovene health care system eHealth strategy in Slovenia – MoH perspective Bases and objectives Re-thinking health care Priorities - PowerPoint PPT Presentation
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Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Tanja Mate,M.D., Marjan Suselj
On-line Access to Health Datain Slovenia -
Experience and Perspectives
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
ContentsContents1.1. Slovene health care systemSlovene health care system2.2. eHealth strategy in Slovenia – eHealth strategy in Slovenia –
MoH perspectiveMoH perspective– Bases and objectivesBases and objectives– Re-thinking health careRe-thinking health care– Priorities Priorities
3.3. Past development and Past development and infrastructure in placeinfrastructure in place
4.4. Development towards Development towards integration and online access integration and online access for health care workers and for health care workers and patientspatients
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
SloveniaSlovenia
AREAAREA: 20 000 sq km: 20 000 sq km22 ((0.5% of the total EU-25 area0.5% of the total EU-25 area))
POPULATIONPOPULATION: 2 000 000 : 2 000 000 (88% Slovenes)(88% Slovenes)((0.5% of the total EU-25 population)0.5% of the total EU-25 population)
FORM OF GOVERNMENTFORM OF GOVERNMENT:: Parliamentary democratic republicParliamentary democratic republic; ; UUnicameral national assembly (Drnicameral national assembly (Držžavni avni zzbor)bor)
HHEAD OF STATE: EAD OF STATE: PPresidentresident ( (elected directlyelected directly))
INDEPENDENCEINDEPENDENCE: : 19911991
GDP PER CAPITAGDP PER CAPITA: : €10 900 €10 900 ((47% of the EU-47% of the EU-115 average5 average))
UNEMPLOYMENT RATEUNEMPLOYMENT RATE: : 6%6% (EU-(EU-15 average: 9%15 average: 9%))
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Health StatusHealth StatusLife expectancy at birthLife expectancy at birth
Total population Total population 77 years (M 73, F 80.5, gender diff. 7,5 years)77 years (M 73, F 80.5, gender diff. 7,5 years) EU-15 average: 79 years (M 75,5, F 82, gender diff. 6,5 years)EU-15 average: 79 years (M 75,5, F 82, gender diff. 6,5 years)
Infant mortalityInfant mortality 3,8 3,8
Disease burden (%)Neuropsychiatric disorders 26Cardiovascular diseases 17Malignant neoplasms 16
Causes of death (%)Cardiovascular diseases 41Malignant neoplasm's 26Injuries 8
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH eHealth Players – HC Providers (1)eHealth Players – HC Providers (1)
Hospitals: 27 (16 general hospitals)
Physicians: 4500
Dentists: 1200
Nurses and other profs.: 14200
Total health expenditure as % of GDP: 8.6
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
eHealth eHealth PPlayers (2) layers (2)
Health Insurance Institute of Slovenia (HIIS)Health Insurance Institute of Slovenia (HIIS)• Promotion and sponsoring of IT in HC• Establishing infrastructural databases • EDI• National health insurance card system
Public Health Institute – national (PHIS) and regional (PHI)Public Health Institute – national (PHIS) and regional (PHI)• Health statistic• Prenatal information system• Register of sick leaves
Ministry of HealthMinistry of Health• Health Sector Management Project
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Starting PointStarting Point
Objectives and activities in field of e-health in Slovenia are deriving from * Action plan for a European e-Health Area and from experiences
and current status of health informatics in Slovenia.
**Communication on e-Health - making healthcare better for Communication on e-Health - making healthcare better for European citizens: An action plan for a European e-Health European citizens: An action plan for a European e-Health Area, COM(2004)356, (30 Apr. 2004) Area, COM(2004)356, (30 Apr. 2004) http://europa.eu.int/information_society/doc/qualif/health/com2004_356_ehealth.pdf
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Bases
EUEU action plan action plan will enable progress in field of e-health, will enable progress in field of e-health, system solution and individual services. In the field of e-system solution and individual services. In the field of e-health there are 3 main fields of activities in EU members:health there are 3 main fields of activities in EU members:
– Defining of common basis and implementation of Defining of common basis and implementation of supporting environment for e-healthsupporting environment for e-health
– e e Health pilot projectsHealth pilot projectsInformation for all about education and preventionInformation for all about education and preventionConnection of health information networksConnection of health information networksPromotion of electronic health cardsPromotion of electronic health cards
– Exchange of experiences and progress measurementsExchange of experiences and progress measurementsDissemination of best practices in EUDissemination of best practices in EUBenchmarkingBenchmarkingActive international cooperationActive international cooperation
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Slovenia’s Health Care SystemStrategy
Equity and Access:ensuring that the same quality of
care is provided to all,raising responsiveness of the
system: providing timely services
Quality, Performance and Effectiveness:improving health status and outcomes,
improving safety or reducing errors, ensuring that clinical decisions are based
on best current practice or best available evidence
(avoiding over-use und under-use)
Efficiency and Costs:improving efficiency
and contain costs
CITIZENCITIZEN
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Approach
Harmonisation of the national policy with EU guidelines
Health policy – reference framework for eHealth
Affirmative experience of past projects (HSMP, HIC, …)shall be supplemented with implementation action elements
Partnership and consensus
-
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Objectives
Till 2005 every EU member has to prepare national and regional e-health plans,Use of standards, inclusion of open code initiativeIntroduce personal identifiersConnectivity of the patients’ electronic recordsEnsure mobility of patients and health care workersAdvance infrastructure and technologyIntroduce testing and accreditation for eHealthIncrease investment in eHealthMake regulations and legal bases.
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH eHealth = Re-thinking Health eHealth = Re-thinking Health
CareCareeHealth ≠ only/mainly information and communication eHealth ≠ only/mainly information and communication technologies project in health sectortechnologies project in health sector
eHealth => change management in health sectoreHealth => change management in health sector
““We have nothing to loose but our chains …”We have nothing to loose but our chains …”
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
eHealth = Re-thinking Health Care
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Key Words of our “Re-thinking Health Care”
Key wordsKey words::– AccessAccess– EquityEquity– EfficiencyEfficiency– QualityQuality
The citizen/patient centred care is a result of a The citizen/patient centred care is a result of a growinggrowing
trend towards more effective management andtrend towards more effective management andcollaborative work of health professionals i.e. collaborative work of health professionals i.e. we have to support we have to support “Shared Care“Shared Care”.”.
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Future Development
Electronic patient recordElectronic patient recordStandardization of thStandardization of thee elements of electronic records of medical data elements of electronic records of medical data and of the interchange of data between different HC providers:and of the interchange of data between different HC providers:
Referral notes, dismissal notes, laboratory results, invoicesReferral notes, dismissal notes, laboratory results, invoicesTelemedicineTelemedicineBedside PCBedside PC
National health portalNational health portalInformation support to standardisation through data dictionaryInformation support to standardisation through data dictionaryAccess to general and private HC related information.Access to general and private HC related information.Direct communication between the citizens and HC providersDirect communication between the citizens and HC providers
-
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Major Development Steps in the Past
Extensive proliferation of computer literacy of HC providers (acquisition of 2700 PC’s)
Infrastructural databases (insured persons, HC providers, drugs, obligors, …)
EDI Introduction of the health insurance card system (HIC,
HPC, SST network, unified API’s, upgraded application environment at HC providers)
Health Sector Management Project
1992/19931992/1993
1993/19961993/1996
1994/19961994/19961996/20001996/2000
2000/20042000/2004
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Building the IT Base in HC Full local IT support,
limited integration
Continuous investment and development:
virtually all HC work postscomputerized
EDI HI databases IT literacy
HIC project - a step in the stream of continuous development efforts
HIIS database
Health insuran
ce contribu
tion obligors
Ministry of
Health
Institute of
Public Health of RS
Research
Institutes
Tax office of
RS
Police,Court
Office of statistics of RS
Institute of
Pension and
Invalidity
Insurance
Institute of
Employment
AJPES
Ministry of
internal affairs
Health care
service provider
s
Reports,
statisticsStatistic
s, data on HC service provider
sRepor
ts, statist
ics
CHI data
CHI data
invoicesCentral population register
Business
register
Data on
regst. Into CHI
Data on
regist. into CHI
Data on registering into CHI Applications
for the registering
into CHI
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Slovene HIC System
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH Informatics Support for DRG (1)
e-SPP project
e-SPP project
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Informatics Support for DRG (2)
Communications:Communications:
Public network
router
Firewall
laptop
RSCSTRRDTD CDTALK / DATATAL K
laptop
LAN
LAN
LAN VPN
HKOMWorkstation
GPRS
ADSL, cable links
RemoteLocal networks
Firewall
Governmental
network
All hospitals connected to the governmental network
•Secure ID cards
•Digital certificates
Sending data:Sending data:•in XML formatin XML format•every 3 month (later every 3 month (later monthly)monthly)•upload through web upload through web applicationapplication
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Development in Progress
e-SPPe-SPPOn-going adjustment of methodological instructionsOn-going adjustment of methodological instructionsEstablishing a data warehouseEstablishing a data warehouseSupport to coding, clinical paths and quality indicatorsSupport to coding, clinical paths and quality indicators
National waiting listsNational waiting listsMonitoring, efficient use of capacities, transparency, planning, priorities … Monitoring, efficient use of capacities, transparency, planning, priorities …
e-Prescription and national drug databasee-Prescription and national drug databaseImproved procedure (issuing of prescription, issuing of drug, data processing Improved procedure (issuing of prescription, issuing of drug, data processing in the pharmacy),in the pharmacy),Access to expert information on drugsAccess to expert information on drugsData on the portal accessible to patients as well.Data on the portal accessible to patients as well.
-
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Objectives: Objectives: Completion of the system Completion of the system support to drug prescribing, support to drug prescribing, issuing and accountingissuing and accountingSafe medicationSafe medicationElimination of information flow bottlenecks in health careElimination of information flow bottlenecks in health careAdvanced information tools for professional workAdvanced information tools for professional workContainment of expenditure on medicationContainment of expenditure on medication
Two-phase approach:Two-phase approach:Phase 1: Z-KZZ Project Phase 1: Z-KZZ Project recording of drugs issued on recording of drugs issued on prescription onto the health insurance cardprescription onto the health insurance cardPhase 2: e-Prescription Project Phase 2: e-Prescription Project Substitution of paper Substitution of paper prescription forms for an electronic form, implementation prescription forms for an electronic form, implementation of expert information systemsof expert information systems
Development in Progress (2)Medication Management
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
ePrescription
EDI invoices and reports
ePrescription
HIC
Expert IS
SW
PharmacyDoctor
HIIS
Upgraded SW
SW
Central database (users: doctors,
Pharmacists)
Paperprescription
Support to
prescribing
Printing
Generation of
ePrescription
Recording of
issued drugs
on HIC
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
On-line Access – Technical Perspective
VS
HIIS DATABASE
TKS
HC HC PROVIDERSPROVIDERS
VOLUNTARY INSURANCE PROVIDERS
INTERNET SERVER
E-E-PrescriPrescriptionption
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Next Steps - Challenges
Integration of solutions (links between technologies and HC levels, application and upgrading of infrastructure in place and knowledge) Extension of IT services to the support of quality (support to professional medical work, knowledge databases, key role of medical experts in the development/selection of solutions)Limited development resources, need for joining efforts, need for amendment of regulationsActive role of the patient (access to personal data, responsibilities, interactivity, involvement in decisions, access to knowledge databases)Promotion of international interoperability of solutions
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
The methods and tools that The methods and tools that cause the problem cannot be cause the problem cannot be
used to solve the problem.used to solve the problem. (Albert Einstein)
Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Ministerial European eHealth Conference, Tromso, Norway, 23-24May 2005Tanja Mate and Marjan SušeljTanja Mate and Marjan Sušelj
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MINISTRY OF HEALTH
Thank you for your attention!Thank you for your attention!