Ministry of Health Slovenia Initiatives to Bring the

Ministry of Health, Slovenia Initiatives to Bring the Knowledge Society Closer to the Citizen e-Health Dušan Keber Ministry of Health, Slovenia Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 1

e-Health: possibilities Ministry of Health, Slovenia Recording of medical services Telemedicine Electronic prescription system Electronic health record Calculation of health providers’ costs Management Acceleration of claims Management of waiting lists Information for providers: web portal site Information for citizens: web portal site Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe Decision-making support 2

Healthcare Network LABORATORY Ministry of Health, Slovenia PHARMACY X-RAY INSURANCE HOSPITALS ADMINISTRATION NURSING GPs EMERGENCY HOME CARE

Healthcare Network Electronic Medical Record Systems (GPs, specialists, hospitals) Ministry of Health, Slovenia Electronic Libraries Knowledge Bases (Best Practice) Laboratories, Medical Imaging Expert Systems Computer Assisted Instruction Pharmacies NETWORK Telemedicine and Videoconferencing Patients at Home, Citizens Alliances Internet Services Directory Services $ Third Party Payers, Public Authority Pharmaceutical Industry Portal Sites Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 4

Electronic Health Records Compatible EVERYWHERE Communicable Ministry of Health, Slovenia ANY MOMENT Shareable Accessible Ljubljana, 3 -4 June 2002 INDEPENDENT OF THE ORIGIN European Ministerial Conference Information Society - Connecting Europe 5

Developmental stages of IT applications sys t imp emic act 6%– 5%– ICT / health budget 4%– 3%– 2%– 1%– 0%– Ljubljana, 3 -4 June 2002 Ministry of Health, Slovenia inte r-o r inte ganis gra atio ove tion na rlap l pro pin ces sesg com bet we mun en i appcatio lica n i tion appsolate s lica d tion s time Slovenia 1990 2000 European Ministerial Conference Information Society - Connecting Europe 2010 6

State of the Art in Slovenia Ministry of Health, Slovenia n Health care providers rather well equipped and IT supported. Communications to be improved. n An efficient nation-wide health insurance card system implemented n Electronic Data Interchange (health insurance, 80% of health care providers, . . . ) n n n Ljubljana, 3 -4 June 2002 invoicing, data on selected physicians, drugs social security Statistical Office of the RS. . . European Ministerial Conference Information Society - Connecting Europe 7

State of the Art in Slovenia (cont. ) Ministry of Health, Slovenia n Web portals, sites, services available. n An unique personnal identification number used on the nationwide scale - great advantage. A need for better common Information system foundations recognised. It is one of the targets of the Health Sector Management Project. Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 8

Web portals, sites, services Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe Ministry of Health, Slovenia 9

Health Insurance Card System Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe Ministry of Health, Slovenia 10

Health Insurance Card Infrastructure Ministry of Health, Slovenia Health Insurance Card 2. 000 (every insured person) Personal patient data, obligatory insurance, voluntary insurances, selected physician Technical aids Under consideration: electronic prescription, donorship of organs and tissues, alergies, vaccination • • Health Professional Card Identification card as a key for the professionals to access data on HIC Under consideration: e-certificates • • Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 11

Health Insurance Card Infrastructure (cont. ) Ministry of Health, Slovenia Self-service Terminals Prolongation of validity of obligatory and voluntary insurance Convention certificate before travelling abroad Data on health providers Advice on healthy lifestyle • • Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 12

Self Service Terminal Network Ministry of Health, Slovenia Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 13

Health Insurance Card System benefits Ministry of Health, Slovenia HIC system - a strategic step in the continuous development of HC and IT solutions to advance services to the service providers and to the citizen Demonstrated benefits • savings in time and labour, transparency of data and services, manageability, control over financial flows, data accuracy and security Infrastructure for future enhancement of functions • key elements of an integrated network services (combination of counter, information kiosk, call-center and Internet channels in public services to the citizens) Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 14

Trends Ministry of Health, Slovenia • Linking the existing sources of medical data, not building new, huge databases. • Centralised data management, standardisation. Organisationaly positioned high in the structures on the national level. Based on privacy, confidentiality and security! Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 15

Strateške usmeritve MZ Health Sector Management Project 3: Health Information System Implementation 1: Health Policy Support Component 1. 1 Reimbursement System in Health Sector 1. 2 Management of the Health Sector 2: Health Information Standards 1. 3 Clinical Guidelines Ljubljana, 3 -4 June 2002 Ministry of Health, Slovenia European Ministerial Conference Information Society - Connecting Europe 16

Health Sector Management Project (HSMP) Structure (1) Four components: Policy support n Information standards n Information systems implementation n Management and support n Ministry of Health, Slovenia

National Health Information System n Ministry of Health, Slovenia Definition of architecture, data model, processing and communication for the unified National Health Information System using applicable standards and best practices. Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 18

Health Sector Management Project (HSMP) Structure (2) n Ministry of Health, Slovenia Phase I n Define national standards Establish National Health Information Clearing House 3 pilot hospitals + MOH, IVZ (PHI), ZZZS (HIIS) n new payment system n management development n n n Phase II n national rollout

National Standards Ministry of Health, Slovenia n Define a Slovenian common health data model (and common middleware solutions), n to allow storing and retrieval of the common data through public services, n not depending on tehnological environments.

National Health Information Clearing House (1) Ministry of Health, Slovenia Ideas, wishes, final goals: Basic functions are clear : n n n Exchange of meaningful information (data) Based on agreed definitions, formats, (standards) Using an agreed architecture, and communication infrastructure Appropriate for clinical and business needs of all parties Suitable to support rapid delivery of best quality care to patients Widespread support of all parts of the health sector

National Health Information Clearing House (2) Ministry of Health, Slovenia Has the key role in: n co-ordination of data/information demands, collection, processing and distribution • Supports processes of decision making at all levels - operational, tactical and strategic • Connects all elements of the health sector • Strictly follows (and influences) the legislation

National Health Information Clearing House (3) Ministry of Health, Slovenia Core NHICH functionalities: • Monitoring and providing compliance with standards and codes. Non-personalised common data sets and clasifications publicly available • Operational and ad-hoc data management; financial data carefully merged with clinical (security&privacy, data pseudo/anonymised. . . ) • Data analysis and reporting; statistics, indicators, hosp. benchmarking • Additional functionalities: documents/data routing, web portals. . .

National Health Information System Health Insurance Institute General Practitioner Hospital General Practitioner Community Health Center Ljubljana, 3 -4 June 2002 Ministry of Health, Slovenia Ministry of Health Public Health Institute European Ministerial Conference Information Society - Connecting Europe Pharmacy 24

National Health Information System Ministry of Health, Slovenia Health Insurance Institute Ministry of Health General Practitioner Hospital General Practitioner Community Health Center Ljubljana, 3 -4 June 2002 National Health Information Clearinghouse Public Health Institute European Ministerial Conference Information Society - Connecting Europe Hospital Pharmacy 25

Evolution Ministry of Health, Slovenia Medicine n Healthcare n Health n E-Health n n Ljubljana, 3 -4 June 2002 HEALTH European Ministerial Conference Information Society - Connecting Europe 26

The vision: Citizen-centred care Ministry of Health, Slovenia “. . . a shift from healthcare institution-centred care to a citizen-centred care. . . The vision implies a decentralised health care where services with evidence based effectiveness are accessible to all and are provided in a way in which the organisational boundaries are invisible to the citizens. ” “. . . The Vision is comprised of two components: new innovative services to the citizens and networking services and care across organisational boundaries. . . The new health paradigm includes the informed citizen caring for his own health and stakeholders responsible for the continuity of health services within region. . . ” (European Commission, Telematics Application Programme) Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 27

Privacy, Confidentiality, Security • • Ministry of Health, Slovenia Privacy, confidentiality and security issues must be addressed in order for the public to trust having their patient medical records exchanged in electronic form. Dokaj dobre zakonske podlage. . . Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 29

Drivers, Key topics Ministry of Health, Slovenia Technology is not a major barrier to making this future a reality. Most of the barriers to an effective and benefitial national health information infrastructure are legal, societal, organizational and cultural in nature. The following topics are crucial: • • Privacy protection Information as both a private resource and public good Standards Quality standards for online information Costs Attitudes and practices Technology Equity - benefits shared equally by all Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 32

Availability of Products Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe Ministry of Health, Slovenia 33

Health Sector Management Project & Health Insurance Card n n Ministry of Health, Slovenia individually cost-beneficial & quality enhancing Together = an unparalleled opportunity Ultimately: unique patient identifiers; virtual electronic patient records; simultaneous database updating; real time expenditure information? “Everyone is a winner” (S. Blair, WB) Ljubljana, 3 -4 June 2002 European Ministerial Conference Information Society - Connecting Europe 34