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“Health-e Europe” Experience in New Member

States

Dominic S. HaazenSr. Health Specialist, ECSHDWashington, DC

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Key Global Directions in e-Healthcapture of health information moves closer to the health eventhealth insurance/statistical data become by-products of the clinical encounterIncrease standardization in medical practice (clinical practice guidelines, care maps)Integrate hospital and ambulatory care (continuum of care)“close the loop” on diagnostic testing and drug administration (order entry/results reporting)Bring patients into process/decision-making

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Constraints – GlobalHigh cost of hardware/software, although hardware costs continue to declineHigh failure rate for implementationMultiple vendors, compatibility is not assured – can get locked into one vendorPhysician resistance to changing practice patterns and to technology generallyLack of staff available to devote to implementation – everyone is already busy!

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Constraints – New Member StatesExisting systems developed ad hoc, using a variety of platforms, software, and technical and medical definitionsLimited attention/experience with process re-designFew staff are trained to manage IT systems well (either development or operations)Privacy and data security is lowPoor communication between different parts of the health system

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Advantages – New Member StatesEstablished IT infrastructure is much smaller than other parts of Europe – more “green-field” opportunitiesGreat deal of interest in bringing existing systems and norms up to EU StandardsPotential ability to access EU structural funds to finance e-healthTechnical competence is generally good

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Latvia

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Latvia – Original HMIS Plan1. Collect data from and maintain

registers about Latvian healthcare providers and beneficiaries

2. Store information about contracts and payments between the health payment agency and medical institutions and pharmacies in SCHIA

3. Support health reform by providing decision-makers with needed medical, economic, and statistical information

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Latvia – Impact/Lessonsmanagement control structure is most interesting and innovative featurecontract construction and change management procedures were also important to project success external advisors used for both specification, and design/implementation phases, to monitor work of primary systems designers/contractors

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Hungary

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Hungary – Original HMIS Plan1. Provide 25 hospitals with ADT, radiology,

laboratory, financial management and e-mail software

2. Provide all hospitals in the country with a basic financial management module

3. Provide policymakers, managers and health care providers with a management support system to improve cost-effectiveness and efficiency

4. Develop health information standards

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Hungary – Achievements (1997-2000)

implementation of hospital information systems in 21 compared to a target of 60 hospitals

Note: ~160 hospitals in Hungary, population 10 million

hospitals represent approximately 13% of hospitals and 16% of all beds3 county-wide regional information systems with shared patient master index

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Hungary – Impact/Lessonshospital managers now have information on the cost of specific health care services, and this data is affecting resource allocation decisions HMIS was catalyst for administrative and operational consolidation of hospitalshospitals continued to use the information systems plans they developed as part of the competition

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Hungary – Impact/Lessons (2)

initiative led to essential growth in the health informatics profession in Hungarybenefits to hospital systems market: suppliers updated products to support the open, multi-vendor HISA model, fosters market growth

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Slovenia

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Slovenia – Original HMIS Plan1. develop health information

standards2. National Health Information Clearing

House -- “hub” for inter-agency exchange of information

3. Local clearing houses at 3 pilot hospitals

4. Information systems for Ministry of Health, Public Health Institute, and Health Insurance Institute

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Slovenia – Achievements (2000-2003)Health Information Standards

procedure classification, diagnosis grouping, inpatient minimum dataset and data dictionarydefinitions EU compliant (HISA)

Health Information Systems Developmentdelays due to the time required to reach a shared understanding of different parties’ relationship with the NHICHpolitical agreement not reached, NHICH not donedecided to develop Health Data Management Center but not completed

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Slovenia – Impact/LessonsEssential ground-work and consensus-building is needed for complex HMIS development to move aheadBusiness requirements (e.g., reimbursement systems) need to be defined firstParallel development of standards and new health management information systems are constrained by available human resourcesDevelopment time can be reduced by selectively using existing technology

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Lithuania

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Lithuania – Original HMIS Plan1. Develop “e-health” strategy

(consultants)2. Based on strategy, implement pilot

“EPR-Step One and Simple Communications”:

First phase of electronic patient recordCapability for various providers (hospitals, specialists, PHC) to communicate with each other and with the State Patient Fund

3. Develop health information standards

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Lithuania – Important FeaturesIncremental approach

Start with a selected number of institutions and providers, with limited capabilityExpand as systems are successful and benefits are demonstrated

Goal is “one patient-one record”, although record may be virtual – i.e., not “clearing house” approachProviding information to patients is key goalMonitoring and providing information for effective governance also key objectives

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Key Messages – Lithuania Strategy“If an e-Health approach is seen as something extra a doctor has to do, it won’t be adopted. It has to be seen as part of the workflow” To be effective, the strategy must be known, accepted and applied by all concerned actorschanging complex workflows and organizations is not easy …

must invest a lot of time and patience takes time for the profits/benefits to show

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Implications for New Member StatesCost of technology is coming down, especially hardware (PC, handheld, bar coding), so much more attention needs to be paid to softwareIncreasing use of web-enabled applications reduces communications/transaction costsAvailable expertise is limited/costly

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Implications for New Member StatesProjects need a multi-disciplinary approach: Projects need a multi-disciplinary approach: clinical science, public health, operations clinical science, public health, operations research, and information science – should research, and information science – should not be dominated by IT professionalsnot be dominated by IT professionalsCooperation between facilities and/or regions needed to justify/afford systems – use multiple copies of the same design?Ensure foundational work is done – HISA standards, data dictionary, coding standardsA phased approach is needed to ensure that development takes place in an orderly way

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Implications for New Member Statesallow adequate time for testing and training“total cycle cost”, maintenance and staffing needs must be carefully consideredtraining of staff in health informatics and standards issues is essentialexplicitly address the issues of patient confidentiality and privacyKeep an eye on benefits – what health and financial benefits can be accrued? How are these going to be captured?

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Conclusion

Despite the various issues which need to be addressed …

Substantial opportunities exist “to trigger a giant leap forward in quality, customer service and affordability of health care” (Leapfrog Group)