This document summarizes a presentation given by Rudite Springe comparing Estonia and Latvia's e-health framework implementation. Some key points: - Estonia has more developed e-health infrastructure and Latvia aims to learn from their experience in areas like administration, legal framework, and stakeholder involvement. - Latvia's e-health program has a budget of 7.4 million euros for 2007-2013 and is managed by the Centre of Health Economics with 5 employees and an annual budget of 82,500 euros. - Systems being developed include an electronic health record, e-prescriptions, booking and referrals, a health portal, and an integration platform. However, none have started development yet.

1. E-health framework implementationIS Architecture concepts and solutionsin context of Estonian experience and Latvia’s challengePresentation by Rudite SpringeCentre of Health Economics, Latvia12.01.2011

2. Objectives of the workshopExchange concepts and experience in e-health program implementation between Estonia and Latvia Compare models and structure of e-health program financingCompare program administration modelIdentify best practice and lessons learned from Estonia’s experience

3. Latvia’s challengeEncourage balanced and financially proved e-health program implementation and systems development (1st ERAF)EHRE-prescriptionsBooking and health portalIntegration platform for e-health data transportStrengthen e-health program administration and systems deploymentResources managementStandardizationLegal frameworkStart to work on 2nd ERAF planning for e-health program an systems development involving sector’s administration and professionals, society, IT industry, incorporating best practices across EU

4. Current status of e-health program (LV)Responsible organization for e-health implementation in Latvia is Centre of Health Economics (VEC)ERAF (2007-2013) budget for e-health system development 7 408 000 EURemployees for e-health administration 5Annual budget (administration) 82 500 EUROutsourced e-health systems concepts and specification development (235 800 EUR from ERAF)E-health information systems architecture and implementation planConcepts and IS specifications for EHR, health integration platform, e-prescriptions, booking, Health portal

5. Current status for e-health IS implementation (LV)Health integration platform pilot-project and 4 e-services (285 600 EUR)IS procurement procedures completed for:EHR (1 668 000 EUR)Health integration platform (941 000 EUR)IS procurement procedures in progress for:E-prescriptions (338 700 EUR)Booking & Referrals (2 126 100 EUR) Health portal (128 000 EUR)!!! IS development is not started yet for none of the systems

6. Main impacts on e-health IS architecture (LV)No historical HISPoor coverage of IS in GP practicesLow level of digitalized data flowsSeveral separate registersHealth billing systemDrugs registerSeveral disease registersState initiatives in e-governance introduction Challenge to introduce transparent and efficient data-flows and processes in healthcare system

7. E-health architecture (LV)

8. 2nd ERAF priorities (LV)Next stage development for 1st ERAF ISExtended functionality of EHR; booking; portal; e-prescriptionsBusiness intelligence solutions EU interoperability and data exchangeepSOSEU statistics DBService providers (HIS;GP) supportHospital integration solutionDoctors’ workplace in Health portalStatistics IS (DWH)National Digital images database

9. Architecture concepts LV & ESTE-health IS architecture concepts and functionality covers similar scope in LV and ESTEST historically has better coverage of HIS and IS for GP, which become corner-stone for e-health IS development in ESTLV has to develop e-health infrastructure “from scratch”, integrating several “satellite IS”Differences are in use of terms and boundaries of functionalityEST EHR positions as national-wide framework , where EHR, booking, prescriptions, portal are integrated modules of the IS;LV each functionality is planed as separate IS (decision of Ministry of Health, 2006), developed under single e-health program managementSignificant difference in integration solution conceptEE X-Road refers to LV VISS (State information system integrator)EE X-Roads modules developed for single IS, together compose analog solution to LV sector’s integration platformLV e-health integration platform refers to x-Road modules set

10. Electronic health record (LV)

11. EHR positioning & functionality (LV)Targer for EHR IS - implement cental solution for maintaining of pacients health record at national level, assure data access and availability in health care process, create platform for health and clinical information data processing, exchange and analytics !!! All data in EHR IS will be stored and exchanged at standardized and structured format, reused for sector’s statistics and analytical purposes1 st stagePatient summaryMedical recordsLinks to PACS Vaccination registerDisability statussSelf services for citizens2 nd stageAdditional medical information, patientsregisters, treatment outcomes dataEU data exchange (epSOS u.c.)Business intelligence

12. EHR dataset

13. E-prescriptions (LV)

14. E-prescription functionality (LV)Issuing of ordinary prescriptionsIssuing of special prescriptionsRelease of prescription in pharmacyAccess of prescription information and prescribed medication for individual in EHR and Emergency Medical services ISSupport for vigillance messagingAnalytics and statistics

15. Booking & Referrals positioning & functionality (LV)Extend healthcare service availability and reduce time spent to book GP and specialist appointments for social active part of population;Rise doctors productivity by improving and digitalizing data-flows and availability of information, ensure referrals accountability and statisticsCreate central booking functionality and realted e-services for citizensDigitalize sick-leave notes issuing process and data flowsImprove billing and refund administration proceses for state compensated medical manipulationsAssure unifide approach for information security and personal data protection policy for all e-health solutions introduced in health care organizationsIntroduce Health portal

16. Health portal (LV)Will be developed as part of Booking and referrals projectMain targetsCreate unified user interface for different user groups for work with central e-health systemsBooking and referrals;E-prescriptions;EHRMain user groups are:PatientsDoctorsPharmacistsService providers and personell, who have not use own IT solutionsCreate central internet space for publishing health realated information at national levelDevelop several health related e-services for citizens, assure access to own health related information at personal level

17. E-health integration platform (LV)

18. E-health integration platform positioning & functionality (LV)

19. Administration (EST/LV)VEC (5) consultantsICT partnersMinistry of HealthVEC (5)VEC (?)VRAAEST e-health program administration – 22 employees (Foundation) + 4 (Ministry); budget 500 000 EUR/yearLV e-health program administration – 5 employees (VEC); budget 82 500 EUR /yearLV – no agreed on role share, responsibilities and resources for infrastructure management LV- not established Standardization bodyLV – issue – involvement of end users (hospitals and GP) in definition stage of IS business case

20. Future functions split (LV)

21. Administration costs projection (LV) (based on EST experience figures)

22. E-health program financing EST / LV

23. Question-marks to EST experts Licenses and infrastructure costs for EHR systemDevelopment costs for Health portalEST E-prescription developed as SAP module on existing infrastructure. If “Yes” – costs are not directly comparable between LV and ESTLicense & infrastructure costsInvestments in x-road for e-health systemsAdaption of x-road, infrastructure costsAs Latvia does not implemented ID cards, costs are not directly comparable for integration solution

24. Take-aways from EST Use EST experience and best practice in fields of e-health program administration Legal framework for e-healthStandardization concept and approachInvolvement of different groups of stakeholders in decision making process, IS designing and implementationCommunication and work with citizens and society as whole

25. Thank You for attention!For further information requests:DaigaBehmane, DirectorCentre of Health EconomicsE-mail info@vec.gov.lvRudīteSpriņģe, Leading consultant“AA Projekts” IT consulting and advisoryPhone:+371 29226670E-mail rudite.springe@aaprojekts.lv