Discussion between Latvian and Estonian experts on e-Health program implementation in Latvia

1. E-health framework implementationIS Architecture concepts and solutionsin context of Estonian experience and Latvia’s challenge Presentation by Rudite Springe Centre of Health Economics, Latvia 12.01.2011

2. Objectives of the workshop Exchange concepts and experience in e-health program implementation between Estonia and Latvia Compare models and structure of e-health program financing Compare program administration model Identify best practice and lessons learned from Estonia’s experience

3. Latvia’s challenge Encourage balanced and financially proved e-health program implementation and systems development (1st ERAF) EHR E-prescriptions Booking and health portal Integration platform for e-health data transport Strengthen e-health program administration and systems deployment Resources management Standardization Legal framework Start to work on 2nd ERAF planning for e-health program an systems development involving sector’s administration and professionals, society, IT industry, incorporating best practices across EU

4. Current status of e-health program (LV) Responsible organization for e-health implementation in Latvia is Centre of Health Economics (VEC) ERAF (2007-2013) budget for e-health system development 7 408 000 EUR employees for e-health administration 5 Annual budget (administration) 82 500 EUR Outsourced e-health systems concepts and specification development (235 800 EUR from ERAF) E-health information systems architecture and implementation plan Concepts and IS specifications for EHR, health integration platform, e-prescriptions, booking, Health portal

5. Current status for e-health IS implementation (LV) Health integration platform pilot-project and 4 e-services (285 600 EUR) IS procurement procedures completed for: EHR (1 668 000 EUR) Health integration platform (941 000 EUR) IS procurement procedures in progress for: E-prescriptions (338 700 EUR) Booking & Referrals (2 126 100 EUR) Health portal (128 000 EUR) !!! IS development is not started yet for none of the systems

6. Main impacts on e-health IS architecture (LV) No historical HIS Poor coverage of IS in GP practices Low level of digitalized data flows Several separate registers Health billing system Drugs register Several disease registers State initiatives in e-governance introduction Challenge to introduce transparent and efficient data-flows and processes in healthcare system

7. E-health architecture (LV)

8. 2nd ERAF priorities (LV) Next stage development for 1st ERAF IS Extended functionality of EHR; booking; portal; e-prescriptions Business intelligence solutions EU interoperability and data exchange epSOS EU statistics DB Service providers (HIS;GP) support Hospital integration solution Doctors’ workplace in Health portal Statistics IS (DWH) National Digital images database

9. Architecture concepts LV & EST E-health IS architecture concepts and functionality covers similar scope in LV and EST EST historically has better coverage of HIS and IS for GP, which become corner-stone for e-health IS development in EST LV has to develop e-health infrastructure “from scratch”, integrating several “satellite IS” Differences are in use of terms and boundaries of functionality EST EHR positions as national-wide framework , where EHR, booking, prescriptions, portal are integrated modules of the IS; LV each functionality is planed as separate IS (decision of Ministry of Health, 2006), developed under single e-health program management Significant difference in integration solution concept EE X-Road refers to LV VISS (State information system integrator) EE X-Roads modules developed for single IS, together compose analog solution to LV sector’s integration platform LV e-health integration platform refers to x-Road modules set

10. Electronic health record (LV)

11. EHR positioning & functionality (LV) Targer for EHR IS - implement cental solution for maintaining of pacients health record at national level, assure data access and availability in health care process, create platform for health and clinical information data processing, exchange and analytics !!! All data in EHR IS will be stored and exchanged at standardized and structured format, reused for sector’s statistics and analytical purposes 1 st stage Patient summary Medical records Links to PACS Vaccination register Disability statuss Self services for citizens 2 nd stage Additional medical information, patientsregisters, treatment outcomes data EU data exchange (epSOS u.c.) Business intelligence

12. EHR dataset

13. E-prescriptions (LV)

14. E-prescription functionality (LV) Issuing of ordinary prescriptions Issuing of special prescriptions Release of prescription in pharmacy Access of prescription information and prescribed medication for individual in EHR and Emergency Medical services IS Support for vigillance messaging Analytics and statistics

15. Booking & Referrals positioning & functionality (LV) Extend healthcare service availability and reduce time spent to book GP and specialist appointments for social active part of population; Rise doctors productivity by improving and digitalizing data-flows and availability of information, ensure referrals accountability and statistics Create central booking functionality and realted e-services for citizens Digitalize sick-leave notes issuing process and data flows Improve billing and refund administration proceses for state compensated medical manipulations Assure unifide approach for information security and personal data protection policy for all e-health solutions introduced in health care organizations Introduce Health portal

16. Health portal (LV) Will be developed as part of Booking and referrals project Main targets Create unified user interface for different user groups for work with central e-health systems Booking and referrals; E-prescriptions; EHR Main user groups are: Patients Doctors Pharmacists Service providers and personell, who have not use own IT solutions Create central internet space for publishing health realated information at national level Develop several health related e-services for citizens, assure access to own health related information at personal level

17. E-health integration platform (LV)

18. E-health integration platform positioning & functionality (LV)

19. Administration (EST/LV) VEC (5) consultants ICT partners Ministry of Health VEC (5) VEC (?) VRAA EST e-health program administration – 22 employees (Foundation) + 4 (Ministry); budget 500 000 EUR/year LV e-health program administration – 5 employees (VEC); budget 82 500 EUR /year LV – no agreed on role share, responsibilities and resources for infrastructure management LV- not established Standardization body LV – issue – involvement of end users (hospitals and GP) in definition stage of IS business case

20. Future functions split (LV)

21. Administration costs projection (LV) (based on EST experience figures)

22. E-health program financing EST / LV

23. Question-marks to EST experts Licenses and infrastructure costs for EHR system Development costs for Health portal EST E-prescription developed as SAP module on existing infrastructure. If “Yes” – costs are not directly comparable between LV and EST License & infrastructure costs Investments in x-road for e-health systems Adaption of x-road, infrastructure costs As Latvia does not implemented ID cards, costs are not directly comparable for integration solution

24. Take-aways from EST Use EST experience and best practice in fields of e-health program administration Legal framework for e-health Standardization concept and approach Involvement of different groups of stakeholders in decision making process, IS designing and implementation Communication and work with citizens and society as whole

25. Thank You for attention! For further information requests: DaigaBehmane, Director Centre of Health Economics E-mail info@vec.gov.lv RudīteSpriņģe, Leading consultant “AA Projekts” IT consulting and advisory Phone:+371 29226670 E-mail rudite.springe@aaprojekts.lv