Slovenia moving HIS applications to central eHealth platform (eZdravje)
Adrian Offerman
The Slovenian eZdravje (eHealth) project was started in 2005. It aims to integrate existing fragmented Health Information Systems into a complete solution that benefits all stakeholders.
The implementation of the eHealth project has been significantly hampered for a number of regulatory, financial, institutional and technological reasons. As a consequence, the current eHealth infrastructure is only partly functional.
The major problem eHealth is currently facing is a lack of appropriate strategic and implementation documents to comprehensively regulate its further development. Despite this lack of policy documents and substantial time delays, considerable progress has been made in the last two years. Basic infrastructure components such as the eHealth Network (zNET), the Interoperable Backbone (IH), and some other important IT solutions have been established and implemented on a national level. The roll-out of several eHealth applications is projected for 2016.
Considering the potential and the pivotal role of IT in modern healthcare systems, eHealth currently represents a very hot topic. It could define the future development trajectory of the Slovenian healthcare system.
According to Dalibor Stanimirović from the Slovenian National Institute of Public Health (NIJZ), the eHealth project was launched in 2005 with great expectations. It was supposed to integrate all of the country's existing fragmented Health Information Systems (HISes) and offer a complete solution benefitting all stakeholders.
eHealth entails the inclusion of stakeholders into the functional network, reconstruction of the healthcare system business model, as well as integration and harmonisation of many specialised HISs at different levels.
The main objectives of the eHealth project are to:
enable high-quality and professional working practices with patients; and
make available relevant and reliable economic, administrative and medical data, which facilitates better planning, control and management of individual healthcare organisations as well as the national healthcare system in general.
The strategic goals of the project are to:
increase the citizen's activity and responsibility in regard to their healthcare;
improve access to all necessary information, and allow citizens to participate in the development of high-quality healthcare services;
provide secure and reliable access to all key patient information for all healthcare providers, general practitioners, specialists and pharmacists through Electronic Health Records (EHRs) and other databases;
make planning and management within health organisations and the healthcare sector as a whole easier, based on high-quality and authenticated economic, administrative and clinical data; and
improve access to healthcare services for groups of people who are usually excluded because of reduced abilities, age or any other reason.
Description of the way to implement the initiative
The planning of the Slovenian eHealth project started in 2005 with the national eHealth Strategy 2010. Over the next two years, a conceptual model of the national HIS architecture was developed, followed by another two-year period to conduct a feasibility study. The actual implementation was planned for the period 2009-2015.
The implementation of the eHealth project started in September 2008, and was supposed to be completed in June 2015. It consisted of 18 subprojects and several pilots.
Technology solution
The structure of the eHealth project is as follows:
eHIS components:
zNET eHealth network:
secure exchange of healthcare data;
zVEM central eHealth portal:
searching, exchange and providing healthcare information and data;
secure and controlled use of national eHealth services;
Electronic Health Record (EHR):
electronic healthcare records, based on the open standard [1, 2] OpenEHR;
Centre of Health Care Information Technology:
the central hub of the star-like structure of eZIS, whose responsibilities include:
project management,
central support for national projects,
administration and distribution of best practices;
promotion, training and education to:
improve the healthcare process for all groups,
promote eHealth,
provide training for general areas of work and knowledge,
provide training and education in the use of specific eHealth services.
complementary projects:
redesign of the current Health Insurance Card (HIC),
transforming the card from a data carrier into an access key,
introduction of a Health Professional Card (HPC),
a digital certificate enabling electronic signatures and secure communication.
Technology choice: Standards-based technology
Main results, benefits and impacts
The implementation of the eHealth project has been significantly hampered for a number of regulatory, financial, institutional and technological reasons, says Stanimirović. As a consequence, the current eHealth infrastructure is only partly functional.
Apart from the operational difficulties of the existing HISs and deficiencies in project management, the major problem eHealth is currently facing is a lack of appropriate strategic and implementation documents to comprehensively regulate its further development. The existing strategic documents formally expired in 2010 and 2013, and the implementation of such a large and complex project as eHealth without proper strategic orientation is subject to various considerable risks.
Further development
The National Institute of Public Health (NIJZ) took over the management of the eHealth project at the end of 2015, Stanimirović continues. Until then, the project was governed by the Ministry of Health. According to their mandate, NIJZ is responsible for the preparation of strategic documents and action plans. The further adoption of the eHealth development platform will be kept in parallel with the national implementation and promotion of the existing eHealth solutions and services.
The original estimated total cost of the eHealth project was about 67 million Euro, funded through various public sources:
27 million Euro from the European Social Fund (ESF);
27 million Euro from the Slovenian Ministry of Health; and
10 million Euro from other public funds.
By 2023, the total investment was expected to grow to 133 million Euro.
According to Stanimirović, by the end of 2015, 22 million Euro has been invested in the eHealth project, of which 85 percent was contributed by the European Union and 15 percent by Slovenia. Since then, the eHealth project has been completely financed from the national budget.
Despite this lack of policy documents and substantial time delays, considerable progress has been made in the last two years, says Stanimirović. Basic infrastructure components such as the eHealth Network (zNET), the Interoperable Backbone (IH), and some other important IT solutions (TeleStroke, eTriage) have been established and implemented on a national level.
According to Stanimirović, the national roll-out of most of the following eHealth applications is projected for 2016:
ePrescription,
eReferral,
the National Health Portal,
a central registry of patient data and patient summaries,
a register of healthcare providers and healthcare workers,
a register of vaccinated persons, and
additional modification of legal regulations as a result of eHealth requirements.
Lessons learnt
The realisation of the infrastructure components and the planned implementation of other eHealth applications represent an important milestone in the public and professional perception of eHealth in Slovenia, says Stanimirović. Successful further implementation of eHealth solutions requires relative consensus between the various stakeholders in the healthcare system, as well as better coordination and cooperation throughout the development and implementation process.
Scope: National
Categorisation
General case study
www.ezdrav.si