Strategic Approach in Slovakia Vision of health care - approved Mission of ehealth - approved Vision of ehealth - approved Scope of ehealth - approved

Transcription

1 Interoperability and Telemedicine from needs to services M. Danilák Slovakia

2 Strategic Approach in Slovakia Vision of health care - approved Mission of ehealth - approved Vision of ehealth - approved Scope of ehealth - approved Strategic goals of ehealth - approved Requirements, modelling in progress National ehealth Program in progress Projects after feasibility stud ud. (y. 2009) Our real mission: decrease DALYs (Disability Adjustment Life Years by WHO)

3 Citizens oriented approach in ehealth Main steps Needs Demands / Wishes Requirements Candidate / used Solutions Candidate / used Services Barriers Challenges Problems Obstacles Risks Costs 3

4 Needs & Demands (examples) Main health related need of euro-citizens: To receive high h quality, safe, cost effective and just-in-time health care in every EU country. or explicitly (baseline for KPI): Decrease my possible DALYs (Disability Adjustment Life Years) to the level that I accept. Demands / wishes Please, understand what I really need. Give me freedom of choice (in all EU). Help me with my health related decisions (on every place in EU and all the time). Break the language barrier. 4

5 Functional requirements (examples) Requirements I want to get information dealing with local caregivers and healthcare e also in case that I don t understand local language. I want to consult health related issues with local caregiver (doctor, nurse) also in case that I don t understand local language. I want to show local caregiver my EDS / EHR data also in case that t he doesn t understand d my EHR native language and his IT system is different. 5

6 Solutions (examples) Candidate solutions (break the language barrier) Use own language and set of mandatory languages (English, German, French,?) Use always a own and one general language age together (English) Use own and one special language (Esperanto or Latin) Automatic translations - we need semantic interoperability General nomenclature / codes in EU (based on Snomed, MKCH10, EDS standard,...) Visual translations, based on Avatar model we need general nomenclature Use of human tele-translator translator (sitting in call center) 6

7 Solutions (examples) Levels of candidate solutions (break the IT barrier) 1. Use the same HW, SW, data format, data structure and data content (example: chain of private hospitals) 2. Use the same interface, data format, data structure and data content. 3. Use the same data format, data structure and data content (example: national EHR) 4. Use the same data structure, data content and SW for data format transformation. 5. Use the same level of granularity and SW adaptors for data and format transformation. 6. Use SW adaptors for partial data transformation between different data formats and data structure. 7. Use only SW for reading received data format, no data and format transformation (example: today EU) 7

8 Interoperability levels Top level Bottom level 8

9 Services (examples) Candidate services (for EU citizens) Worldwide accepted PHR in English (Google Health, MS Health Vault, ) National health portal with citizen s EHR and automatic translator to the EU languages EU caregivers maps (based on GPS, Google Maps and regional databases of health caregivers) Automatic EDS translator together with data on secure token (el. card, USB stick, mobile phone). Medical nomenclature translator (all EU languages) Avatar based visual translator Drugs name and prescription information translator 9

10 Tele-medicine why & how We need to understand: Health Disease burden disabilities & dysfunctions Healthcare Levels of healthcare Social trends Trends in healthcare Interactions between levels of healthcare ehealth Needs demands requirements solutions servicesservices Problems / obstacles / risks / challenges Costs & Benefits 10

11 Health determinants Genetic Fylogenetic genome aberations genome health influence Ontogenetic aberations somatic mutations Environment Factors: physical water chemical air biological traffic soil pathogens Social / Economics Influences: family income work social status community disparities society chudoba Life style smoking alcohol drugs physical (non) activity food stress,... Country Regional level National level Citizen s health National priorities - Diabetes mellitus - new infectious and parasitic diseases - environment - drugs Health related needs no problems health problems Preventtion / wellness / fitness Urgent healthcare (don t die) Standard healthcare (return health back) Chronical disease support (don t go worse) Paliative care (die in peace) Healthcare Levels of healthcare Individual level of healthcare Community level of healthcare Profesional level of healthcare Public health Health financing Privat sources personal resources gifts foundations Privat sources individual healh insurance co-payment ad hoc payments Public sources public health insurance Public sources Country / regional budgets 11

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13 egislation tion tandards nal standards re framework editation / HTA evel of HIN gement gement PKI infrast tructure Data regis ters EHR infras structure EDS infras structure National Health Portal Switch Poi int HPC HIC eprescripti ion infrastructure ereferrals infrastructure Middlewar e IS for GPs IS for Phar rmacies Laboratory IS PACS Hospital's IS IS for bloo d donors Integrated 112 IS for urge ent medicine erefferals eprescripti ion Public hea alth IS Monitoring health care Portal integ gration of appl. Call centre e for ehealth Telemedic cína IT support for EBM IT support for DRG EU patient t mobility elearning IT support for adv. medicine ehealth R& &D Token's re e-usability egovernen nt / ehealth integr Profesiona als/public accept. IS of State Health rel. Dpt.. Building blocks of National ehealth Program National legislation sd R mdr R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R EU legislation R R National standards sd D sd R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R International standards R sd Architecture framework D md sd D R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R D R Certification / acreditation / HTA sd md D md D R R R R R R R R R R R Network level of HIN md md D md sd R R R R R R R R R R R R R R R R R R R R R R R R R R R R R D R HIN management md md md D sd sd R R R R R R R R R R R R R R R R R R R R R R R R R R R HIN - data storage md md D md sd R sd md D R R R R R R R R R R R R R R R R R R R R R R D R PKI infrastructure sd md sd D D R md mdr R R R R R R R R R R R R R R R R R R R R sd sd Data registers (GP, patiens, drugs) sd md sd md md sd R R R R R R R R R R R R R R R R R R R D R D D R EHR infrastructure md md D D sd sd D D sd D D D D D md md R R R R R R R R R R R R R R R D D EDS infrastructure md md D D sd D D sd D D sd D D sd R R D D D R R R R R D D National Health Portal md md md md D D D D D md md md R R R D D D R R R R R R R R D D D D md md R R R R R R D D R Switch Point (EU - Slovakia) md sd md md md D md md D R R sd HPC D md D md sd sd D R R R R R R R sd sd HIC D D D D D sd D R R R R R R R sd sd R eprescription infrastructure md md md D sd D D sd D sd D sd sd D D R R R R R D R D D ereferrals infrastructure md md md sd D D md D D md sd sd md D R R R R D D D Middleware D md md D md md D D D D md D sd D D D sd sd sd D sd D mdmdmdsd md sd sd md md R R D md R md sd R IS for GPs D md md md R D md md md md D md R D D D md D md md md md md D D R R R R R R R R R md md R IS for Pharmacies / Drugstores D md md md R D md md md md D md R D D D md D md md md R R R R R R R R md md Laboratory IS D md md md R D md md md md D md R md md D md R R D R R R R R R R R R md PACS D md md D R D D sd md md D R D md md R R D R R R D R R md Hospital's IS D mdmdmdr D D D mdmdd D R D sd D D md D R R R R md R R R D R D R R D R R R md R IS for blood donors D md md md D md D sd md md md D D md R R sd R R R R D R Integrated 112 D D md D md md md D sd md md D md D R D R R D R R md D R IS for urgent medicine D mdmdmdmd md D sd D md sd D sd R R md md md erefferals D mdmdd D sd D D md sd md md D md sd sd sd sd R R md R R R md md R eprescription sd md D D D D sd md D D D md sd md sd md sd md sd sd sd sd R R R D R R R R R sd md R Public health IS md md md md D md md D md md D md md md D md md md D sd D md sd R Monitoring health care D md md md md sd D md mdmdd D mdmdd D D D sd D D D md D R D md D R R R md R R Portal integration of applications md md sd md D D D sd md D D md md D R R R R D D D md R D R md R R D D R Call centre for ehealth md md md D D md D md R md D D md D R D R md md md D md D R Telemedicine D md md D D D sd md D md D D D md D md md D D D D D R R md D R R R R R md D R IT support for EBM md md D md md D md D D sd R D R md D md IT support for DRG md md md md md D md D D D D D D D D D R R md R D D D md R EU patient t mobility md sd D sd md md D sd md md D md D md D D D D D D D md D R R D R R R R D md R elearning md md md D md md md md md md D D D R R R R R md IT support for advanced medicine D md md D D D D sd D D md D md md R R R R R R R R R R D md md D ehealth R&D D D D D D md md md md md md md md md md md R R R R R R R R R R R R R R R R R R R Token's re-usability sd md D md sd md sd sd sd D sd md D D D D md D D D D D R R egovernent / ehealth integration sd D md D D md R D D md md md D md md md md md md md md D md D D md md md D D Profesionals & Public acceptation sd D sd md D md D D D md sd D mdmd mdd D D mdsd sd md sd D md D md sd IS of State Health related Depart. md D md md md md md md md md D National le EU legislat National st Internation Architectur Cert. / acre Network le HIN manag HIN manag sd - strongly depends on D - depends on md - small dependance R - receives requirements from Example 1: National legislation strongly depends on EU legislation Example 2: National legislation receives requirements form PKI infrastructure (example: how to long-time archive revocations of certificates) GD Matrix of ehealth "Matrix" 13

14 Disabilities & Dysfunctions Classify, define impact profile and solve problems: Example list of dysfunctions / disabilities Mobility based Vision i based Ear based Memory based Mental (dis) order based Cognitive skills based Body movement control based Skeleton based Immunity based Heart based Organism homeostaze based Social skills based Social network based (loose of friends, family) Temporary, other diseases based, 14

15 Disabilities & Dysfunctions General needs and wishes: Understand d special needs of people with dysfunction. Don't increase social exclusion for citizens with dysfunction in case of new technologies. If possible, decrease social exclusion for citizens with dysfunction. More independence from others in everyday life (from nurses, family, friends). Decrease impacts of dysfunction in everyday y life. Reduction of physical movement caused by disease (regular monitoring of body parameters, visit doctor, take medicine from pharmacy). 15

16 Main issue of ehealth If we understand where we are ( (as is), and if we have vision of the future (to be), always there are lot of possible ways from as i is to to be, b and a lot of ways are blind only some ways are good and maybe one way is the best Which one?