2. Alexandru Dan Donciulescu
SIVECO Romania
Deputy Director of the e-Health Department of SIVECO Romania, the largest
software house of Romania. He is a Doctor Engineer in Applied Informatics at
the Politechnica University of Bucharest. He is specialised in Decision
Support Systems for Operational Control. He was for a long time with the
National Institute for Research & Development in Informatics and lectured as
a Professor at different Universities in Romania. In SIVECO Romania his
application fields are in e-Health, especially health insurances, and is a
2
Project Manager of the SIUI System, the Information System of the National
Health Insurance House in Romania.
5/25/2011
4. 1. IHIS - Integrated Health
Information System
e-Health vision
4
5/25/2011
5. 1. IHIS
e-Health vision
Medical practice evolution:
From the treatment of acute illness, to the prevention
of disease;
From considering each patient as an isolated entity, to
perceiving the patient as a member of a population;
From a focus on the individual, to the broader
perspective of public health
From paper documentation to an electronic, paperless 5
environment
5/25/2011
6. 1. IHIS
e-Health vision
In order to obtain optimal results, a National Health
Information Strategy is required:
Interoperability
Security
Data confidentiality
Standardisation
Cost-effectiveness
6
5/25/2011
7. 1. IHIS
e-Health vision
The eHealth system should be designed in a manner that
would offer the best possible results for its main
beneficiaries: the patients
7
5/25/2011
8. 2. IHIS Major Components
HIIS – Health Insurance Information Systems
Health Cards
e-Prescribing
Electronic Health Record
Future expectations
8
5/25/2011
9. 2. IHIS Major Components
Health Insurance Information System
Management of the Health Insurance Fund(s)
Recommended integration between Health Insurance and
Health Care systems
Any service has to be paid. Payment data are reported
together with the service
Payments from insurance funds are restricted by rules
a HIIS covers all flows from the medical services contracts
with the providers, to the reporting, validation and payment 9
of the services
HIIS is the 1st step in building a medical complex system
May 25, 2011
10. SIUI of the NHIH
Health Insurance Information System
NHIH and 42 CHIH
SIUI main objectives
management of the National Health Insurance Fund
management of the Insurances Register
management of the medical services providers
contracts management
services validation and payment
access using qualified certificate
Business Intelligence analyses for managers
26 (SIUI) + 9 (ERP) modules
10
11. SIUI of the NHIH
Health Insurance Information System
service
provider SIUI Main Flow
authentication SIUI
insurance service service
category pre-validation claim
at each service monthly
contracts
service
other services
validation
NHIH norms
payment ERP System Bank
approval and
ordering
11
12. SIUI of the NHIH
Health Insurance Information System
Other functions:
management of prescriptions
management of the medical leaves
management of the insurance categories – links with
partner organizations
management of independent contributors
ERP (9 modules: Financial Accounting, Payroll, Human
Resources, Inventories, Procurement, Investments, Fixed
Assets & Inventory Objects, Maintenance, BI)
Reporting to SIUI applications for 15 types of medical
services providers
12
13. 2. IHIS Major Components
Health Cards
Electronic Health Card –
implementation in connection with
other e-Health systems.
Prerequisites: Interoperability and
infrastructure availability.
13
May 25, 2011
14. 2. IHIS Major Components
Health Cards
Stores administrative
information regarding health
insurance
The experience of other EU
states regarding Health Cards
– cards optimal use as
identification devices, rather
than data storage
Confirms the right of the 14
patient to have access to
medical treatment
May 25, 2011
15. 2. IHIS Major Components
e-Prescribing
Introduction
Recommended: integration with another e-Health system
Requirements:
new forms
new types of printers
reliable Internet
connection 15
May 25, 2011
16. 2. IHIS Major Components
e-Prescribing
Advantages of an electronic prescribing system:
clear prescription text
minimization of human errors, through the
implementation of a prescription validation expert system
limitation of fraud risks
facilitates efficient resource management
16
automatic reporting process
May 25, 2011
17. 2. IHIS Major Components
Electronic Health Record
Pre-requirements:
Standardized, complete and correct electronic medical
data collection
Existence of IT tools for data analysis and statistical
reports generation
Action: National EHR (Electronic Health Record)
implementation
Objective: resource allocation and management according to 17
national or even EU-level policies
May 25, 2011
18. 2. IHIS Major Components
Electronic Health Record
EHR – Electronic Health Record
EHR is a complex system (comprising of hardware, software,
people, policies and processes) which:
Gathers data from multiple sources
Is used by clinicians as a primary information source at
the point of care
Offers decision support in evidence based healthcare.
The term describes the highest level of functionality in 18
medical data computerized management
May 25, 2011
19. 2. IHIS Major Components
Electronic Patient File
Patient related medical data, gathered in a consistent and
uniform manner, nationwide, constitutes the Electronic
Patient File (EPF), sometimes referred to as Electronic
Medical Record (EMR)
EPF is generated at birth, is updated throughout the patient’s
life and is stored in the system for an undetermined period of
time.
EPFs must be interoperable, secure, consistent, safe and
19
must ensure data confidentiality.
5/25/2011
20. 2. IHIS Major Components
Electronic Patient File
The medical data stored in the EPF can
be accessed by the authorised clinicians
at any time and from any location.
Connection with systems for health
insurance management
All medical service providers must contribute in the EPF in a
standardized format.
This does not mean all medical service providers must use
the same Health Information System, but the Ministry of 20
Health should enforce the use of a minimum set of
standards, in order to ensure interoperability.
May 25, 2011
21. 2. IHIS Major Components
eHealth system structure
Decision
level Health Decision Electronic
Insurance makers Health Record
Medical data
Decisions
Economic data
Primary 21
level Medical Electronic Electronic Electronic
service providers Prescriptions Card Patient File
May 25, 2011
22. Future expectations
e-Health objectives (1/2):
Timely access to patient electronic medical data whenever
and wherever they are needed
Patient access to their own medical records and to relevant
health information
Unified national healthcare and health insurance data
collection, both in the public and private health system
Communication and information exchange between multi- 22
disciplinary medical teams
May 25, 2011
23. Future expectations
e-Health objectives (2/2):
Extensive use of international best practice guides and
procedures
Improved quality, safety and efficiency of the clinical
processes
High level of security, confidentiality and control in relation
to information management
Continuous health system improvement by ensuring a 23
transparent and optimized reporting process
Implementation of a better informed health strategy
May 25, 2011
24. Future expectations
Chronic Disease Management
Chronic diseases:
are long term conditions (over 6 months)
are not contagious
produce certain disfunctionalities or handicaps
in most cases, do not improve over time
are rarely healed completely
Chronic diseases are the main cause of death and morbidity
24
(e.g. in Europe 87% of all deaths, in high income countries,
according to WHO – World Health Organization)
May 25, 2011
25. Future expectations
Chronic Disease Management
CDM represents a systematic approach to improving the
quality of the medical services provided for the chronic
disease patients.
Instrument: an efficient system for
the remote monitoring of chronic
disease patients and the
prevention of related medical
complications 25
May 25, 2011
26. Future expectations
Telemedicine
Remote medical monitoring
enables medical professionals to monitor a patient
remotely using various technological devices
Improves the quality of life for chronic disease patients,
by reducing the number of hospital admissions
e.g. Electrocardiogram by phone
Interactive telemedicine services
Tele-radiology and tele-consultations:
26
shorter waiting lists, optimized use of
resources
May 25, 2011
27. Future expectations
Telemedicine
Homecare devices and applications
Glycemia measurement devices
Blood pressure measurement devices
Devices for the recording of vital signs and other clinical
indicators
27
May 25, 2011
29. 3. Conclusions
eHealth Strategy
Recommended approach:
a coherent and stable e-Health
strategy
proper definition of the roadmap
and milestones
appropriate funding for each of the
29
steps
May 25, 2011
30. 3. Conclusions
eHealth Strategy
Benefits:
Deployment at a national level of an integrated eHealth
system, part of a national eHealth Vision
Reuse of solutions and experience from similar countries
Use of the state of the art technologies
Unique patient health record
Infrastructure and information to support the long term
health strategies 30
Improved health services and quality of life
May 25, 2011
31. 3. Conclusions
A Road Map
Initiative Year 1 Year 2 Year 3 Year 3 Year 5
I. Initiatives concerning legal matters
1 Creating the legislative framework
2 Determining the standardisation framework
3 Ensuring legislation coherence
II. Development and implementation of the IHIS
4 EMR – Electronic Medical Record
5 HIIS – Health Insurance Information System
6 eID – Health Cards for Citizens
7 ePrescription – Electronic Prescription System
8 National Health Portal
9 Hospital information Systems 31
III. Training
10 IT training for health professionals
May 25, 2011
