Health services belong to the sectors working intensively with information. Nevertheless, the public health sector falls short in applying information technologies, which could facilitate sharing a patient’s real-time information, both within a country as well as abroad. At the same time, introduction of advanced information technologies in the public health area can rapidly increase work efficiency and help develop health care as such. In this context, the informatisation of health services should be perceived as an integral part of eGovernment services which the EU strives to make available without limitation for all citizens on the territory of any member country.
The main driver of the EU informatisation agenda of the public administration is the “Initiative i2010 – European Information Society for Growth and Employment“, stimulating the methodology of Information and Communication Technology as an extension to the eEurope agenda. The eEurope agenda is supported by the Lisbon Strategy and the eEurope 2005 Action Plan focused on the development of modern public services and dynamic eBusiness environment through extensive availability and open access to competitive prices and safe information infrastructure.
In the Slovak Republic, the eGovernment agenda is under the administration of the Ministry of Finance of the SR. Recently, the Ministry of Finance has launched the eGovernment strategic framework – the National Concept for Informatisation of Public Administration (NKIVS) – in the preparation of which Centire participated as a co-author. The NKIVS provides a comprehensive view on informatisation of public administration (state administration and self-government) through digitalisation of its individual sections.
By this, the public administration will become more effective as well as more transparent and by application of information and communication technologies (ICT) it will enable to eliminate “paper-work” partially by transition to the fully electronic form of processing documents and direct electronic communication with citizens and other subjects of the public administration.
eHealth constitutes only one part of informatisation of the public administration and is closely interlinked and complying with the concept of informatisation. For the public health area a “new model” for providing health-care services will be implemented based on prevention and individually oriented health care service systems. Electronic information in the course of health care provision could mark a milestone and a positive change in the current perception and attitude of patients and professional staff, with respect to the health services as such and the new strategic development of the health care sector in particular. New ICT technologies to be implemented enable to support the quality improvement, flexibility and effectiveness much more actively while reducing administrative burden and arranging for new forms of provision of health care services.
In simple words, eHealth can be defined as a client-oriented health care model where the institutions (i.e., all involved subjects) co-operate while using communication and information technologies for management, prediction, prevention, distribution and standardisation of health care quality at a regional, national and international level.
The objective of eHealth from the perspective of a health care provider and a patient is to provide services in real time and at a reduced cost. The “savings”, moreover, shall go back to the system in order to improve the overall quality of the services rendered.
eHealth in Slovakia
Citizens of the Slovak Republic expect continuous quality improvement of the health care services. This can be achieved via systemic eHealth implementation and interconnection with registers and databases of other governmental departments and other health care subjects.
Mr. Richard Raši, the Minister of Health, considers the informatisation of health care services to be an important landmark and a positive element of the whole system. "It will concern all people, and patients above all," said the Minister. He perceives eHealth to be an opportunity for providing the right data, at the right time and in the right place.
Slovakia’s strategy is aligned with the most recent European trends in the area of eHealth. The Ministry of Health of the SR, the main sponsor of eHealth, initiated the “New Health Service Programme”. This programme and its implementation should be seen as a particular step in the fulfilment of the strategic framework (i.e., the approved strategic documents, namely: the eHealth Mission and Vision; eHealth Strategic Objectives; and eHealth Components). At the end of September 2008, the Ministry of Finance of the SR received the Concept of Development of Information Systems (IS) from the Slovak Ministry of Health. Another document which is in the process of development is the Draft version of the Product & Services Catalogue (needs and services) for the area of eHealth which contains a more detailed specification of individual eHealth applications.
Preparation of feasibility studies which will provide a high-level process map, design technological architecture, and outline the changes potentially needed in legislation can be viewed as the following important steps. Subsequently, after delivering final feasibility studies, implementation of the top-priority Projects and Activities is planned for the second half of 2009. The second and the third waves of projects and activities are planned for the years 2010 and 2011 respectively.
At the end of March 2008, the government of the Slovak Republic acknowledged the Status Report on the Informatisation in the Health Service Sector and in mid-July the government approved a key document with the title “eHealth Strategic Objectives”. At present, the expected costs of informatisation in the health service sector for years 2009 to 2013 are estimated to exceed 7.6 billion Slovak Koruna (€ 252.4 million).
The initial benefits for citizens – provided that all potential projects risks are eliminated and well managed – could be available in the second half of 2010. At the end of 2012 and the beginning of 2013, citizens should be able to experience the benefits in a much larger extent.
The Expected eHealth Benefits
for the Slovak Health Sector
The benefits of eHealth implementation include market-oriented approach; transparency; strengthening of prevention; availability of flexible cross-border co-operation with related reduction of permanently growing quality demands on the provided health care. Therefore, eHealth focuses on the use of advanced information and communication technologies with the purpose of meeting expectations of citizens, patients, health-care providers, professional medical staff - short of all health-care subjects.
In spite of the fact that various comparative analyses and studies carried out within the EU (Empirica, ERA) show that Slovakia lags behind in introducing informatisation in the area of health services, the advantage is that Slovakia can learn lessons from the experience of other countries. For instance, Austria or Finland could be taken as examples since their existing systems of health care have to be extensively modified as the EU requires different standards.
According to the National Strategy, implementation of eHealth applications can improve effectiveness and add value to the provision of health care services.By supporting continuous care, eHealth can assist in avoiding unnecessary duplicity, diagnostics or therapy and treatments. Some pre-requisites for successful implementation and operation of eHealth include the adoption of effective legislation and consequently some necessary changes in the State executive and administration. Arranging for ICT inter-operability is probably the most important element of the eHealth idea. Health care providers, in general, use IS provided by different suppliers; based on different technological platforms; in different systems of health-care provision; and localised in national languages, which results in fragmentation of IS and data and in arising conflicts of standards.
An example of an inadequate inter-operability is a non-systemic exchange of information created by different health-care providers among hospitals, clinic physicians, pharmacies, health insurance companies and the Ministry (e.g., in Finland). In solving inter-operability issues the variant based on interconnection of the most used IS (switching costs) was proven as less expensive and faster, whereas the users of other systems had to adjust themselves accordingly (network costs). Estonia chose a different approach – they developed and distributed IS for the primary health-care providers (Tervisepank) – financed through a PPP project which is available as an operative leasing. Its advantages include the minimal charge compared with proprietary IS supplied by other contractors; integrated requirements on standards, safety, needs of the sector; and possibility of real-time updating. Tervisepank is a web-based solution, forcing its users to connect to internet, or to develop larger networks necessary for eHealth applications.
Nevertheless, what should be the tangible outcomes of the aforementioned strategies for a patient and/or physician? eHealth will include:
l. National Health Portal – should provide information support and help increase awareness of prevention, leading thus citizens to higher responsibility for their own health. In addition, it serves as an instrument for a timely evaluation of symptoms, diagnoses and thus preventing a patient from subsequent unnecessary visits of a physician. Electronic booking at the doctors belongs to one of the very important functionalities of the health portal worldwide, i.e., a patient has an opportunity to apply for any available date of a visit to the selected primary or specialised health-care provider. Notwithstanding, an inevitable precondition for launching this functionality is the existence of a searching facility within the database of health-care providers and services rendered by them. The benefit of implementation of such an electronic booking system will include reduced administrative costs in hospitals; time-saving; greater comfort; and easier access to health care also for people from distant regions which, as a consequence, should contribute to increased satisfaction of patients. This service can be later interconnected with an online access to the results of expert examinations or laboratory tests; with the ePrescription system and other applications.
2. Patient’s Electronic Record – includes a citizen’s medical history, e.g. documentation comprising a series of chronologically sorted medical records executed by health-care providers with different specialisations. The medical documentation also contains various documents resulting from analyses and tests; medical reports; findings; imagery; opinions; release reports; certificates; and other documents. At present, the patients' records or archives are fragmentised, causing thus significant time losses due to necessary collection and completion of records arising from various medical examinations, which is common due to missing automation of operations or processes. Electronic form of these records will enable greater mobility of a patient's documentation together with the patient both at national and international level. Other important benefits include ensuring continuous process of health care; faster access to a patient’s records; more transparent and better arranged reporting and invoicing environment of health processes; international inter-operability; and national localisation of a part of the records.
3. ePrescription and eMedication – enables electronic (no hardcopy) exchange of recipes and/or data in particular within the quadrangle of links among the health-care providers: physician – patient – pharmacy – health insurance company. Benefits of implementation of this service involve, in particular, better accessibility; simplicity; and time-savings on the side of a patient as well as a physician which, in addition, allows also save time of other patients queuing up in ambulances. It will improve the effectiveness and speed of communication between pharmacies and health-insurance companies, creating a correct database for reporting and development of statistical summaries – for the needs of all: the WHO, the EU, the Ministry of Health as well as individual health-care providers. Use of control mechanisms in the medication policy can be seen as another benefit in terms of a patient’s individual account with respect to his physician, health-insurance company and vice-versa. This can be illustrated by the experience gathered in other countries: for example, during the test phase of the ePrescription implementation project in Spain, a 40 per cent decrease in the number of patients’ visits to the doctor’s was recorded. This reduction was made possible through implementing an option of a remote prescription of a medicament. Another example from Denmark demonstrates clear benefits of improved patient’s safety due to the expert databases implemented directly in IS of providers or portals, such as medicinkombination.dk, for the public; counter-indications and unwanted effects of medicines prescribed in combination with others. Annually, in Denmark, there are more than 100-thousand cases when pharmacists brought attention of physicians to mistakes made by prescribing wrong medicine or generics.
Telehomecare – eliminates physical visit to the doctor’s via direct connection with the relevant physician through a portal (personal unique account). It is based on consultancies; visual connection with the physician; distance diagnostics; and laboratory tests, the results of which are integrated and immediately recorded in an electronic patient record.
Monitoring – is a continuous care of patients in a home care, people living alone or patients facing a temporary illness, the progress of which has to be monitored by interconnected on-line probes which allow monitoring of the actual patient’s status by physicians and/or specialised staff.
For eHealth applications to be functional, a close participation in the processes is required of all state institutions and decision-making authorities as well as business entities and other involved subjects. Such cooperation should contribute to standardising the system in order to assure that the investment targeted at increasing the required quality of electronic health care is spent effectively and adequately.
Subject to the fulfilment of these preconditions, we can more specifically recognise the costs of implementation of eHealth applications as the costs of migration and unification of the existing data based on standards; costs relating to the software updating; and costs of making the information systems to comply with the standards.
As the aforementioned facts indicate, it is necessary to define uniform business processes for particular categories of health-care providers and their relevant interfaces, workflows and related data, information or knowledge.
Centire (founded in 1994) has a long history of and can substantiate successful experience in implementation of projects in process management. Centire is a professional company specialised in management and enterprise consulting; the EU funds consulting; Financial outsourcing; and ICT services. We are holders of ISO certification for all services we provide to our clients.
Slovak and foreign experts of Centire have implemented sophisticated projects both for organisations of public administration and those from the private sector. Centire, as the first company in Slovakia, started to provide specialised advisory and consulting services for the government administration. The Centire consultants have been, for over five years, delivering solutions for informatisation of the public administration. In 2008, among others, we prepared the National Concept for Informatisation of Public Administration for the Ministry of Finance of the SR which draws on the conclusion of the Centire road map of Informatisation of Public Administration prepared for the Ministry of Transport, Posts and Telecommunications of the Slovak Republic.
Centire renders services and implements projects also for the public health entities which range from defining their strategy and strategic objectives to improvement of effectiveness, productivity and workflow by tailoring their business processes and organisational structure to the needs of individual subjects. An integral part of rendered services constitutes also crystallisation of hidden financial reserves; HR optimisation design; and actual deployment in individual processes/organisational units while, at the same time, assisting in implementation of the system of permanent management of quality improvement within the given organisation.
At present, the public health entities may apply for funds referring to the Operational Programme Health Care; Operational Programme Education (Priority Axis 2, Measure 2.2 – Education in Health); and other subsidy sources (e.g., the 7th Framework Programme or other Community programmes). In preparation of the projects, the Centire experience can provide you with the guarantee of a professional delivery, thus highly increasing your chances for a successful award of non-recurring financial grants dedicated to building, reconstruction and modernisation of general or specialised hospitals as well as implementation of innovative solutions and quality improvement in the system of post-graduate education.
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