Geneva, Switzerland, 26-27 April 2012

State of Interoperability in the Czech Republic

Towards Personal Health Record

Miroslav Bursa,CTU in Prague, FEE, Dept. of Cybernetics, BioDat Research

Groupmiroslav.bursa@fel.cvut.cz

Joint ITU-WHO Workshop on e-Health Standards and Interoperability

(Geneva, Switzerland, 26-27 April 2012)

Geneva, Switzerland, 26-27 April 2012 2

Patient ID

Encoded birth date, sex and identifierconsistency check (mod 11)error-proneduplications might exist

Considered sensitive information (!)Some hospitals create their own ID

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Standards

Many local standards existInteroperable standards

DICOM/PACS

Mutually incompatible HIS are usedNo standard(s) for signal data, often proprietary closed format

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Health Record

Usually in paper formOften held in paper and el. form

Entered into HIS during night shiftFree text, duplicationsSignals, reports only in paper form

Statistics must be provided to state agency

tendency to fulfill the requirements only

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EHR

First attempt (IZIP) done via state-owned health-insurance company

Suspended fundingNot based on interoperable standardInconsistent with European efforts to interoperabilityNow called ‘health-book’

Smaller projects exist

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EP

In a pilot stage8 doctors, 8 pharmacies

Still have to printInsurance companies: no access

Runs since 2009, first EP on 04/2011

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Legislation

3rd party has right to look at the documentation

problem: doctor has internal notes

Question Owner of the data? Permission to use in research? Has the hospital right to obtain human-readable data for processing? Raw data?

Draft on health documentation under discussion. Does not cover EHR.

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Usual (mythic) reasons to reject EHR

MDs do not need computer to heal a patient40 % MDs do not have a computerMDs do not want to be restricted by computerMDs are afraid of easier liability claimsIT wants things that are not present in paper form

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Age Structure of MDs in Czech Rep.

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Age Structure of DDs in Czech Rep.

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Age Structure of PDs in Czech Rep.

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Conclusions and Recommendations

No fully interoperable EHREP running in pilot stageProblem of integration: no efforts‘Crisis problem’: Cheap appliancesLoosing data for long-term studiesIsolated solutions (reinventing wheel)No force to unify standards