This document discusses transferring a clinical decision support system (CDSS-AC) for oral anticoagulation treatment from the Netherlands to Estonia. It finds that integrating the CDSS-AC with Estonian healthcare systems is technically feasible but financial resources may limit implementation. The CDSS-AC could help manage the growing number of patients on anticoagulation therapy through remote monitoring and optimized workflows. Standards for interoperability and security are important to enable successful integration of data between the Dutch and Estonian systems.

1. www.postersession.com
There has been an increasing number of patients with multiple
medical conditions in need of anti-coagulation treatment (ACT)1.
Two groups of Oral anti-coagulants (OAC) are Vitamin K
Antagonists (VKA) and New Oral Anti-Coagulant (NOAC).
Care models to monitor International Normalized Ratio (INR)
• Conventional process
• Near-Patient Testing (NPT)
• Self-Testing (ST) and Self-Management (SM)
Healthcare IT as evolving industry, came up with the idea of
computerized Clinical Decision Support System (CDSS).
Materials and Methods Conclusion
The usability and technical feasibility to transfer clinical decision support system
for oral anti-coagulation treatment from the Netherlands to run in Estonia
Hany Mina
Institute of Cardiovascular Medicine, Tallinn University of Technology, Estonia
hany.mina@ttu.ee
Bibliography
• Enterprise Architecture of the CDSS-AC current model, NL
• Focus unstructured interviews with clinicians & IT specialists
In anti-thrombosis clinic (Ede, NL) & ITK hospital (Tallinn, EE)
1. Heart Disease and Stroke Statistics—2011 Update A Report from the American Heart Association
Circulation, 123(4), e18–e209
2. Heneghan, C., Alonso-Coello, P., Garcia-Alamino, J. M., Perera, R., Meats, E., & Glasziou, P. (2006). Self-
monitoring of oral anticoagulation: a systematic review and meta-analysis. The Lancet, 367(9508) 404–411
3. F.Ryan, et al, (2009) Randomized controlled trial of supervised patient self-testing of warfarin therapy
using an internet-based expert system. Journal of Thrombosis and Hemostasis, 7:1284-1290
• CDSS-AC can support and validate the workflow efficiently at
the anti-thrombosis clinics and work as Tele-monitoring tool
• Technical possibility was found feasible to connect CDSS-AC
in Netherlands with the HIS of providers in Estonia
• CDSS-AC was seen to pave the road for better patient
engagement with those who follow ST and SM approaches
• The disparity of the access security standards can be overcome
but the finance availability might slow down the deployment
Introduction Results
Research Objective
Objective: Transferring a fully-functioning CDSS-AC
provided by eHealth vendor in the Netherlands into the
anti-thrombosis clinic in Estonia.
• To investigate the benefits of using CDSS-AC in anti-
thrombosis management as e-service from user’s perspective
• To assess the technical feasibility to integrate medical data
between eHeath vendor in Netherlands & healthcare provider
local HIS in Estonia
Integrated Care
System
Clinical Data
Data Extractor
CDA/FHIR repository
Clinical Data
Warehouse
BI & Reporting
User
Interface
SSO
Publishing Server
Patient
Centric
IHE
Subscription
Network
Patient Health
RecordsCDA/FHIR repository
Decision Support
(Classification
Algorithm-based)
Publish
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Data Flow
Trigger
HL7 (CDA, FHIR, ...
clinical messages
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Patient Access &
Consent
• CDSS-AC can be scaled up to work efficiently with such large
number of patients following different care models
• CDSS-AC Fits also as Tele-monitoring platform & workflow
optimizer
• CDSS-AC, in the Big Data era, can retrieve clinical and non-
clinical data for more precise decision support
• It is feasible to integrate data between CDSS-AC in the
Netherlands and Estonian local HIS
• Interoperability standards are of high importance for
successful integration and proficient usability
• Unifying the security standards to access both systems can be
overcome by very complex solutions but it’s possible
• Financial resources might be the limiting factor to implement
CDSS-AC at the current stage in Estonian healthcare provider
facilities