Insider report Establishing public health eservices in Croatia

Insider report: Establishing public health eservices in Croatia Damir Kalpić Faculty of Electrical Engineering and Computing University of Zagreb Unska 3, 10000 Zagreb, Croatia http: //www. fer. hr/Damir. Kalpic/ damir. kalpic@fer. hr 1

History PRESENTATION BASED ON RELATED OCCASIONAL PERSONAL/INSTITUTIONAL ENGAGEMENT Topics: Sporadic computerisation efforts / Islands of computerisation Croatian Health Insurance – WB Loan in ’ 90 -ties WB Loan for health computerisation in a Croatian county Study of computerisation for the largest Croatian hospital complex in 2002 (KBC Zagreb - FER) Public tender for software in 2002: – – Primary health care (Cap Gemini, E&Y) Central Server of Primary health care (Cap Gemini, E&Y) Hospital information system Evaluation of the procurement status in 2004 (FER) Telemedicine 2

Sporadic computerisation efforts / Islands of computerisation Developments: – based on occasional donations – based on occasional injections of money – based on local enthusiasm & incentives – by own modest computing staff Partly functionally satisfactory Not integrated Not maintained 3

Croatian Health Insurance – WB Loan in ’ 90 -ties Alphanumeric application (Informix, Unix) Whole country covered Functionally adequate Never fully completed Improperly maintained – Due to (unnecessary? ) dispute with the developer New version currently under development 4

WB Loan for health computerisation in a Croatian county Bidding announced (only) in Financial Times of London International references required BIS Healthcare Group, UK had them: – Macedonia – Bosnia & Herzegovina – Did not have even a Web site Project in Croatia: Copy & Paste from Macedonia 5

WB Loan for health computerisation in a Croatian county (cont. ) Findings after a few million £: – Unfortunately, there is no computing expertise in Croatia – If patient’s data are stored in a database, they can be retrieved later – If patients visits are scheduled via Internet, they do not have to wait so much, etc. Results: – WB forbade to BIS Healthcare Group to apply for WB financed projects for a number of years – The responsible person in Croatia moved to a better paid position 6

Study for computerisation of the largest Croatian hospital complex (KBC Zagreb) in 2002 Large, complex, heterogeneous Different levels of computerisation Weak in-house IT Department Large savings possible, especially on medication Tendency to buy an ERP after a WB loan Advice: – Instead of paying back the loan, finance the gradual improvement by local contractors – If WB loan & ERP: Payment according to achieved and user-accepted functionality, not on consultant*hour base Licence prices according to per capita GDP What happened? 7

ERP Maturity test Campbell R. B. , “ERP: Show me the Money! Axilogic Consulting Inc. http: //www. axislogic. com/erpstory. htm (2002) You have a company strategy. Your employees (management at least) know the details of this strategy. The strategy includes an action plan so that it will be met. You see IT as an enabler and do what is required to keep it up. Your IT management is close to your business organization. Management is aggressive and is willing to take risks. Management is good at communicating goals and measuring progress. The organization is structured in a comprehensive fashion. Employees have a taste for change and innovation. Your organization has successfully completed 'large' projects in the last five years. 8

Primary health care (G 2) Public tender for software in 1998: q Bidding published in a local (Čakovec) newspaper q Oracle based application for nurse & doctor q CASE produced and unpolished q Developers ignored feedback from doctors & nurses q Failed! Public tender for software in 2003: q 5 solutions for general practitioners accepted and regionally assigned q Smart ID cards for medical staff temporarily introduced q Pilot project with connection to the central health server q Delayed deployment – allegedly until the end of 2005 9

Central Server of Primary health care (G 1) Cap Gemini Ernst & Young tender: – Central Server of Primary health care Developer Ericsson Nikola Tesla – Central Health Server 10

Role of G 1 as seen by developer 11

G 1 Architecture 12

National Information System on Health Infrastructure based on G 1 System architecture: – – Multi-tiered communications, Component based design, Asynchronous point-to-point communication, Usage of open systems norms and recommendations. Main components of NISHI are: – – – HCSI (Health. Care System Integrator), EPRS (Electronic Population Register System), HRRS (Health Resource Register System), EHCRS (Electronic Healthcare Record System), HCP (Health Care Portal). 13

Hospital information system About 3000 required functionalities in the tender (Dr. Dragan Schwarz’s tender) A year period to establish representative functionality All activities regarded as part of the bidding procedure No financial compensation for developers Tough conditions – only the strongest could afford it Very favourable for the purchaser In April 2003 4 suppliers were chosen and assigned to 4 hospitals In February 2004 Ministry of finance cancelled the bidding! 14

Hospital information system (cont. ) In July 2004: b 4 b – a Croatian SAP based developer – – After cancellation continued with developments High integration and functionality Working with historical data Ready for a (risky? ) Big Bang deployment Ericsson Nikola Tesla Consortium including smaller developers with relevant experience – After cancellation continued with developments – Partly integrated and modest functionality – Developed components in full use IBM Croatia – Allegedly the world’s best hospital SW – Did absolutely nothing! AME, Austria – After cancellation went home 15

Evaluation of the procurement status in 2004 Recommendations after evaluation: – G 1 Good concept as central health server, not primary health alone To continue with developments – G 2 Pay to developers and deploy their solutions – Hospitals Restore the legal status of the bidding Continue with both systems Acceptance test on real data Let them both survive if they deserve 16

Telemedicine In 2005 Kovač & Kalpić in the Procurement Committee for TM equipment – Meticulous considerations which bidder is better – No organisational efforts by the Ministry for TM deployment – Result TM equipment purchased for the Adriatic islands but mostly unpacked? 17

Further developments (1) Suggested Coordination Board for the Health IS: – – – – Ministry of Health Croatian Health Insurance Institute Representatives of hospitals Representatives of primary health care Public Health Institute Representatives of developers FER? Why? Coordination problems: – Health Insurance Institute does not accept reports on CD but rather on printed A 3 – Glue on recipes to be printed disables printers – Hiding of citizens’ unique identification number – Unilateral decisions, regardless on other stakeholders, etc. Supported by (most) stakeholders Never constituted! 18

Further developments (2) Report accepted but the Ministry did not do anything for a year Popular TV contact show (Otvoreno, Hloverka Srzić Novak) in 2005: – Primary health care software developers – Actual and former Minister of health – FER (Kalpić) Result: – (New) Minister obviously misinformed – The person in charge in the Ministry of health was selling his SW product instead – Fired after the TV show 19

Current status FER (Kovač & Kalpić) nominated to the Committee for procurement of the Integrated hospital information system – New tender for 7 hospitals announced for February 2006 Consider saving the existent solutions Too many at a time! Do not forget the role of G 1, the hospitals cannot communicate among themselves Primary health care allegedly deployed? Smart ID cards to be introduced in the future with resumed Unique Citizen’s Identifier 20

Speculation about conclusion Significant rationalisations possible through IT – Romania (Info World): 30% savings Insufficient care regarding computing expertise within the Ministry of health Not enough legal security for SW suppliers Same pattern of behaviour as 35 years ago! Public biddings time & place: – – – End of July Between Christmas and New Year A village newspaper XOR Financial Times MOTIVATION FOR SUCCESS? 21

Related published papers D. Kalpić, K. Fertalj, V. Mornar, M. Kos: A Proposal for Information System Development for Clinical and Hospital Centre Zagreb, 1 st Croatian Congress on Telemedicine with International Participation, Abstract, Ivica Klapan (ed. ), Makarska 16 -18. 05. 2002. D. Kalpić, V. Mornar, M. Kovač: Personal authentication and privacy protection on Internet, TELEMED 2004, 2 nd Croatian Congress on Telemedicine with International Participation, Zagreb, 19. 05. 2004. D. Kalpić, Damir; Mornar, Vedran; Kovač, Mario; Fertalj, Krešimir; Kos, Mladen: An insight into efforts to establish computerization and eservices for public health in Croatia // Proceedings of the 2005 Networking and Electronic Commerce Research Conference (NAEC 2005) / Gavish, Bezalel (ed. ). Dallas : Southern Methodist University, Dallas, USA, 2005. 75 -91 D. Kalpić, V. Mornar, M. Kovač, K. Fertalj, M. Kos: Establishment of computerization and e-services for public health in Croatia, Abstract, 3 rd Croatian & International Congress on Telemedicine and e-Health, Hvar, 2006 22