The Way Forward in The Way Forward in E-Health: E-Health:

The National The National Health Insurance Health Insurance

Fund Fund BulgariaBulgaria

Presented byPresented byDr. Rachelle KayeDr. Rachelle Kaye

Maccabi Healthcare ServicesMaccabi Healthcare Services

National Health Insurance FuNational Health Insurance Fund nd Information SystemInformation System

The National Health Insurance Fund Information System

Project, in the final stages of completion, consists of 2 parts:

Kernel 1: The ERP system including Accounting, Inventory, Budget, Contracts

Kernel 2: Management of Medical Service Provider Relations including Claims Management and Audit and National Registries

National Health Insurance Fund National Health Insurance Fund Information SystemInformation SystemKernel 2 provides the Infrastructure for the futuredevelopment of the system. It contains: CHIP demographic information CHIP registry information( GP,infirmary, maternal, child) Outpatient primary and specialty care including

diagnoses and treatment Medical Diagnostic Services Outpatient Dental Care Inpatient hospital care information according to clinical

pathways Pharmacy Information – drugs prescribed and purchased

Central Computerized NHIF Data BaseCentral Computerized NHIF Data Base

Office visits

pathology

imaging

Laboratoryresults

medications

treatments

diagnostics

hospitals

ElectronicElectronic HealthHealth

RecordRecord

Central Computerized Electronic Health Central Computerized Electronic Health RecordRecord

Major Challenges: From a Data Base to a Major Challenges: From a Data Base to a Central Computerized Medical RecordCentral Computerized Medical Record Complete Electronic Reporting from ALL Medical

Service Providers according to required minimum data set

Electronic Reporting of Medical Diagnostic Activity RESULTS

Establishment of Communication Infrastructure and development of online interface with all MSPs

Ongoing transmission of data online in real time Modification of doctors’ EMR programs to enable

them to accept and integrate online input of information regarding patients – test results, medications purchased, visits to other doctors, etc.

Local NetBackBone

Local NetBackBone

Secu

reCo

mmu

nica

tions

Secu

reCo

mmu

nicat

ions

AS400AD/DNS/DHCP

WEB SERV

Appl. Serv

DB Serv Intranet

Exchange

Citrix

Storage

E1

VSAT

P-to-P RadioLinks

3G

PrivatePharmacies

Tele-MedicineClinics

Occupational Medicine

Home Visits

Branch

Branch

Intra-NetPortal

February 2006

Maccabi Health ServicesTelecommunications

System

Hospitals

Maccabi HMOMembers

ADSL

ADSL

ADSL

E1

SDH

Self-ServiceTerminalsSelf-Service

Terminals

Self-ServiceTerminals

Internet

ATM

Cellular

PDA

IPVPN ATM

Call Centers

IPVPN

Large Branches

ATM

Branches

Small Branches ATM

ADSL

PrivatePharmacies

PrivatePharmacies

Extranets

Tele-MedicineClinics

IT Services Suppliers

PrivateMedical Clinics

PrivatePharmacies

Maccabi’s Maccabi’s TelecommunicationsTelecommunications

IT at the physicians’ service

Doctor’s Electronic Medical Record

Physician lab orders are digital, generated by his EMR.

Lab test results are sent to the doctor in the shortest time possible.

Lab results are integrated into the CMR .

The patient has a full access to the information.

The information cycle , from start to finish, is fully automated

Electronic Medical Diagnostic Referrals Electronic Medical Diagnostic Referrals and Results: Laboratory Systemsand Results: Laboratory Systems

Review of Previous Lab Test Review of Previous Lab Test ResultsResults

Lab Referral Form in the Doctor’s Lab Referral Form in the Doctor’s ComputerComputer

Less frequent tests

Lab TestsLab TestsRequest for

lab test

Doctor Clinic

Consolidation of samples at regional collection hub

LAB

Distribution of resultsSelf Service Station Patient’s

Internet Site

Electronic PrescriptionElectronic Prescription

Index of drugs registered in Bulgaria

NHIF drugs index

Patient information including diagnoses, allergies

Preferred therapeutic alternatives

Drug Utilization Review Program – checks online for contraindications and provides immediate alerts

Access to additional information on drugs

Integrated Decision Support Systems for Integrated Decision Support Systems for PrescriptionsPrescriptions

Drug to Drug Interaction AlertDrug to Drug Interaction Alert

Alerts for AllergiesAlerts for Allergies

Preferred Drug AlertPreferred Drug Alert

E-prescribingE-prescribing

PatientDoctor Maccabi

Internet Services

patient asking forRenewal prescription

via InternetDoctor Receiving

the Request

Sending the Prescription to patient

Patient getting the prescription via internet

TelemedicineTelemedicine

In Maccabi’s ExperienceAn Integrated ICT system is

needed as a necessary Infrastructure

for mostTelemedicine Applications

““...the use of electronic ...the use of electronic information and information and communication technologies communication technologies to provide and support health to provide and support health care when distance separates care when distance separates the participants...the participants...””

from: Institute of Medicine: Telemedicine: A Guide to Assessing Telecommunications in Health Care

Telemedicine DefinitionTelemedicine Definition

The Beginning of Telemedicine

1876

Why Telemedicine?Why Telemedicine? Equal access all over the country. On-Line diagnosis . Extension of service hours. Reliable diagnosis due to digital tools. Quality control and assurance. Archiving capabilities for future comparison. Sharing information among physicians for treatment and

consultation. Sharing Information with the patient and patient empowerment Lower cost.

Tele-radiologyTele-radiology

Diagnostic Center : Tel Aviv

Diagnostic backup Center : Haifa

Ref. Phys.

Rpt

PACSPACS

Diagnostic Center

UNIX

Radiologist Clinic HQ (TA)

RISWIN2000

Tele-Radiology WorkflowTele-Radiology WorkflowInternet

Self Service

Rpt

Rpt

Referral for ECG at nursing station

ECG Performed in office

PoliclinicDoctor

Community Health Services

ECG

Analysis Center Doctor

Nurses’ Room

UNIX

APP. Service

Maccabi Central

Win2000

AS/400

SQL ServerEGK Archive

Referralדוח א.ק.ג

- ------ --- - ----- -- -- -- -- -- ---- - - - --- ------- - -- -- --- ------- -- :אבחנה

Referral

Website Self-Service Station

דוח א.ק.ג

-- -- --- ------- -- :אבחנה

דוח א.ק.ג

-- -- --- ------- -- :אבחנה

דוח א.ק.ג

-- -- --- ------- -- :אבחנה

Tele E.C.GTele E.C.G

Tele-Ophthalmology 2008

Maccabi Branch

Tele-monitoring Congestive Heart FailureTele-monitoring Congestive Heart Failure

Information Systems

RF

Patient houseMaccabi

Call center

PCP

Regional center

Devices:•BP•Pulse •Weight

HUB

Phone Lines

Tele-ConsultationTele-Consultation

Patient's web sitePatient's web site Medical Applications

Lab Results Radiology Results Personal Health Situation Cardiac Risk Factors Diet & Nutrition Personal List of Drugs

Administrative Application- Scheduling- Demographic Updates- Account Status- Visit List- Health Plans- Over seas Insurance

On Line Patient Secured Web Site On Line Patient Secured Web Site

On Line Patient Secured Web SiteOn Line Patient Secured Web Site

Patient's web site

Patient's web site

Patient's web site

Telemedicine Tomorrow – The Way ForwardTelemedicine Tomorrow – The Way Forward

Telemedicine is becoming a routine part of everyday medical care

Services will be provided to members, to the extent possible, at the most comfortable and convenient location for them (home, office) via use of the most advanced information and communication technology (web, e-mail, SMS)

Services that cannot be provided at home will be provided in the physician’s clinic which will be, to the extent possible, a “one stop shop” for most of the patient’s healthcare needs

Guiding PrinciplesGuiding Principles

Telemedicine will not take the place of the patient

physician relationship but will strengthen the relationship

Telemedicine will not replace the need for face-to-face

visits and physical examination when medically necessary

Telemedicine will add numerous tools and options that

will improve care, provide greater flexibility and comfort,

and improve the efficiency, timeliness and effectiveness

of health care

Personal Health Records - futurePersonal Health Records - future

Maccabi OnLine

The Way Forward – Technology is NOT the Issue

The People “behind” the Technology (doctors, nurses): Availability - Shortages Willingness to Participate Payment

Patient Preferences“Therapeutic” CommunicationPolicy Issues:

Investment in Infrastructure Reimbursement Privacy Malpractice

The Way Forward

Successful Telemedicine Requires:

Committed Policy makers

Committed Healthcare Professionals

Proactive Patients and Families

Significant Changes in cultural norms and

values

“We have to be prepared to do things differently”

Thank you for your attention