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©2008 SIVECO Romania.
All Rights Reserved.
ICT Solutions for Management of Health sector resources
Chisinau – 19.05.2011
5/25/2011
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Alexandru Dan Donciulescu SIVECO Romania
Deputy Director of the e-Health Department of SIVECO Romania, the largest
software house of Romania. He is a Doctor Engineer in Applied Informatics at
the Politechnica University of Bucharest. He is specialised in Decision
Support Systems for Operational Control. He was for a long time with the
National Institute for Research & Development in Informatics and lectured as
a Professor at different Universities in Romania. In SIVECO Romania his
application fields are in e-Health, especially health insurances, and is a
Project Manager of the SIUI System, the Information System of the National
Health Insurance House in Romania.
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Summary:
1. Integrated Health Information System (IHIS)
2. IHIS Major Components
3. Conclusion
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1. IHIS - Integrated Health Information System
e-Health vision
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1. IHIS e-Health vision
Medical practice evolution:
From the treatment of acute illness, to the prevention of disease;
From considering each patient as an isolated entity, to perceiving the patient as a member of a population;
From a focus on the individual, to the broader perspective of public health
From paper documentation to an electronic, paperless environment
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In order to obtain optimal results, a National Health Information Strategy is required:
Interoperability
Security
Data confidentiality
Standardisation
Cost-effectiveness
1. IHIS e-Health vision
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The eHealth system should be designed in a manner that would offer the best possible results for its main beneficiaries: the patients
1. IHIS e-Health vision
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2. IHIS Major Components
Electronic Health Record
HIIS – Health Insurance Information Systems
e-Prescribing
Health Cards
Future expectations
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Health Insurance Information System
Management of the Health Insurance Fund(s)
Recommended integration between Health Insurance and Health Care systems
Any service has to be paid. Payment data are reported together with the service
Payments from insurance funds are restricted by rules
a HIIS covers all flows from the medical services contracts with the providers, to the reporting, validation and payment of the services
HIIS is the 1st step in building a medical complex system
2. IHIS Major Components
NHIH and 42 CHIH
SIUI main objectives
management of the National Health Insurance Fund
management of the Insurances Register
management of the medical services providers
contracts management
services validation and payment
access using qualified certificate
Business Intelligence analyses for managers
26 (SIUI) + 9 (ERP) modules
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Health Insurance Information System
SIUI of the NHIH
monthly
at each service
11
authentication
insurance category
service pre-validation
service claim
service validation
payment approval and
ordering
ERP System Bank
contracts other services
NHIH norms
SIUI Main Flow service
provider
SIUI
Health Insurance Information System
SIUI of the NHIH
Other functions:
management of prescriptions
management of the medical leaves
management of the insurance categories – links with partner organizations
management of independent contributors
ERP (9 modules: Financial Accounting, Payroll, Human Resources, Inventories, Procurement, Investments, Fixed Assets & Inventory Objects, Maintenance, BI)
Reporting to SIUI applications for 15 types of medical services providers
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Health Insurance Information System
SIUI of the NHIH
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Health Cards
Electronic Health Card – implementation in connection with other e-Health systems. Prerequisites: Interoperability and infrastructure availability.
2. IHIS Major Components
Stores administrative information regarding health insurance
The experience of other EU states regarding Health Cards – cards optimal use as identification devices, rather than data storage
Confirms the right of the patient to have access to medical treatment
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2. IHIS Major Components
Health Cards
Requirements:
new forms
new types of printers
reliable Internet connection
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Introduction
Recommended: integration with another e-Health system
e-Prescribing
2. IHIS Major Components
Advantages of an electronic prescribing system:
clear prescription text
minimization of human errors, through the implementation of a prescription validation expert system
limitation of fraud risks
facilitates efficient resource management
automatic reporting process
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2. IHIS Major Components
e-Prescribing
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Pre-requirements:
Standardized, complete and correct electronic medical data collection
Existence of IT tools for data analysis and statistical reports generation
Action: National EHR (Electronic Health Record) implementation
Objective: resource allocation and management according to national or even EU-level policies
Electronic Health Record
2. IHIS Major Components
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EHR is a complex system (comprising of hardware, software, people, policies and processes) which:
Gathers data from multiple sources
Is used by clinicians as a primary information source at the point of care
Offers decision support in evidence based healthcare.
The term describes the highest level of functionality in medical data computerized management
EHR – Electronic Health Record
2. IHIS Major Components
Electronic Health Record
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Electronic Patient File
Patient related medical data, gathered in a consistent and uniform manner, nationwide, constitutes the Electronic Patient File (EPF), sometimes referred to as Electronic Medical Record (EMR)
EPF is generated at birth, is updated throughout the patient’s life and is stored in the system for an undetermined period of time.
EPFs must be interoperable, secure, consistent, safe and must ensure data confidentiality.
2. IHIS Major Components
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All medical service providers must contribute in the EPF in a standardized format.
This does not mean all medical service providers must use the same Health Information System, but the Ministry of Health should enforce the use of a minimum set of standards, in order to ensure interoperability.
The medical data stored in the EPF can be accessed by the authorised clinicians at any time and from any location.
Connection with systems for health insurance management
2. IHIS Major Components
Electronic Patient File
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Electronic Prescriptions
Electronic Patient File
Medical service providers
Primary level
Decision level
Decision makers
Medical data Economic data
Electronic Health Record
eHealth system structure
Decisions
Health Insurance
2. IHIS Major Components
Electronic Card
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Timely access to patient electronic medical data whenever and wherever they are needed
Patient access to their own medical records and to relevant health information
Unified national healthcare and health insurance data collection, both in the public and private health system
Communication and information exchange between multi-disciplinary medical teams
e-Health objectives (1/2):
Future expectations
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Extensive use of international best practice guides and procedures
Improved quality, safety and efficiency of the clinical processes
High level of security, confidentiality and control in relation to information management
Continuous health system improvement by ensuring a transparent and optimized reporting process
Implementation of a better informed health strategy
e-Health objectives (2/2):
Future expectations
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Chronic diseases:
are long term conditions (over 6 months)
are not contagious
produce certain disfunctionalities or handicaps
in most cases, do not improve over time
are rarely healed completely
Chronic diseases are the main cause of death and morbidity (e.g. in Europe 87% of all deaths, in high income countries, according to WHO – World Health Organization)
Chronic Disease Management
Future expectations
CDM represents a systematic approach to improving the quality of the medical services provided for the chronic disease patients.
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Chronic Disease Management
Instrument: an efficient system for the remote monitoring of chronic disease patients and the prevention of related medical complications
Future expectations
Remote medical monitoring
enables medical professionals to monitor a patient remotely using various technological devices
Improves the quality of life for chronic disease patients, by reducing the number of hospital admissions
e.g. Electrocardiogram by phone
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Telemedicine
Interactive telemedicine services Tele-radiology and tele-consultations:
shorter waiting lists, optimized use of resources
Future expectations
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Homecare devices and applications
Glycemia measurement devices
Blood pressure measurement devices
Devices for the recording of vital signs and other clinical indicators
Telemedicine
Future expectations
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3. Conclusion
eHealth Strategy
Recommended approach:
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3. Conclusions
eHealth Strategy
a coherent and stable e-Health strategy
proper definition of the roadmap and milestones
appropriate funding for each of the steps
Benefits:
Deployment at a national level of an integrated eHealth
system, part of a national eHealth Vision
Reuse of solutions and experience from similar countries
Use of the state of the art technologies
Unique patient health record
Infrastructure and information to support the long term
health strategies
Improved health services and quality of life
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eHealth Strategy
3. Conclusions
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A Road Map
Initiative Year 1 Year 2 Year 3 Year 3 Year 5
I. Initiatives concerning legal matters
1 Creating the legislative framework
2 Determining the standardisation framework
3 Ensuring legislation coherence
II. Development and implementation of the IHIS
4 EMR – Electronic Medical Record
5 HIIS – Health Insurance Information System
6 eID – Health Cards for Citizens
7 ePrescription – Electronic Prescription System
8 National Health Portal
9 Hospital information Systems
III. Training
10 IT training for health professionals
3. Conclusions
Thank you for your attention!
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eHealth
