Healthcare informatics in Czech Republic

1
Healthcare informatics in Czech Republic

• Petr Hanzlicek
• EuroMISE Center
• (European Center for Medical Informatics,
  Statistics and Epidemiology of Charles University
  and Academy of Sciences)
• Ministry of Health of Czech Republic

2
Introductory overview

• area of Czech Republic - 78867 km2
• 10.29 million inhabitants (1998)
• the GDP per capita was US 5050 (using the
  exchange rate) or US 13088 (purchasing power
  parity) (1997)
• unemployment rate 8.5 (1999)
• inflation around 10.

3
Introductory overview

• Infant mortality 5.2 per 1000 live births (1998)
• Life expectancy (1998)
• 71.1 years for men
• 78.1 years for women
• Diseases of the circulatory system are the most
  important causes of death in both men and women

4
Organizational structure and management of health
care
5
Proposal of a new healthcare system (1990)

• The new system of health care will form part of a
  global strategy for health regeneration and
  promotion
• The state will guarantee appropriate health care
  to all citizens
• Health services will be provided in a competitive
  environment
• Every community shall implement the principles of
  the national health policy in its territory

6
Proposal of a new healthcare system (1990)

• Every citizen will have the right to choose
  his/her physician and health care provider
• Health services will continue to be
  publicly-funded, but there will be a diversity of
  provision
• A basic element of public health care will be
  the provision of autonomous health care providers
  independent of the district institutes of
  national health

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Proposal of a new healthcare system (1990)

• Curative care will be focused particularly on
  primary health care and also on ambulatory care
  in general
• The health care system will derive its financial
  means from different sources (health insurance
  funds, state budget, local budgets, companies,
  citizens, etc.)
• A mandatory health insurance system will form an
  fundamental part of the health care system

8
Organization of normalization

• After 1989, new legislation (laws 142/1991 and
  632/1992)
• change of status of norms from obligatory to
  voluntary
• new term "harmonized Czech technical norm"
  introduced

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Organization of normalization

• The central governmental body for national
  normalization - the Ministry of Trade and
  Industry of CR
• Executive organ - the Office for Technical
  Normalization, Metrology and National Probation
  (UNMZ)
• National normalization organization - the Czech
  Normalization Institute (CSNI)

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Organizational schema of Czech Normalization
Institute
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Main activities of CSNI

• creation of Czech technical norms
• issue and distribution of Czech technical norms
• supply of information about technical norms
• cooperation with non governmental European and
  international organizations in the field of
  technical normalization

12
Technical work of CSNI

• The activity of CSNI is universal
• The work is based on expert advisory groups -
  Technical Normalization Committees (TNK)
• over 100 TNKs with about 1200 experts
• The information technology covered by TNK 20,
  founded in 1993
• Health informatics covered by subcommittee of TNK
  20 with about 10 members from universities,
  commerce and CSNI

13
Legislative framework

• National laws
• law 20/1966, care about people health
• law 160/1992, non governmental healthcare
  providers
• law 101/2000, personal data protection
• law 227/2000, electronic signature
• law 97/1974, archiving
• missing laws
• law defining the duty to keep health
  documentation
• technical notice to introduction of the
  electronic signature to public government

14
Hospital information systems

• 207 hospitals
• 23 large hospitals with more than 1000 beds
• 12 private ones
• 40 hospitals have full HIS
• about 60 hospitals have isolated modules of HIS
  without interaction
• about 20 companies developing HIS with about 115
  installations of HIS

15
Hospital information systems

• MEDEA 20 installations
• AMISH 17 installations
• AKORD 19 installations
• Progres-Lan 14 installations
• SAMED 7 installations

16
National standards

• Data standards for patient data transfer among
  information systems of health care providers
• National codes of laboratory items for sharing of
  the results of measurements between physicians
  and other users (based on ENV 1614)
• Unique person identifier (so called birth
  number)
• ICD 10 widely used in Czech translation (MKN 10)
• Obligatory interface for statistics
• Obligatory interface for health insurance
• Obligatory interface for Financial Offices
• Recommendation of the Ministry of Health on data
  protection
• Data standards for communication with
  governmental offices
• Methods and standards of the National Information
  System that is guaranteed by the Institute of
  Health Information and Statistics of the Czech
  Republic (data for health yearbooks, OECD and WHO)

17
Data standard

• Parts
• data structure
• external code lists
• registered codes of companies
• annotations to data file transfer
• other data blocks
• New version prepared, conversion of this standard
  into XML planned

18
Planned new standards, modifications

• New version of data standard (XML)
• Further support of existing national data
  standard by Ministry of Health
• Development of terminology norms during 2001

19
International and European Standards

• Ways of adoption to Czech normative structure
• translation
• adoption of original document
• adoption for direct use (endorsement)
• announcement of adoption for direct use

20
International and European Standards

• 31 CEN ENVs were adopted
• 13 ENVs are planned to be adopted by adoption of
  original document in 2001
• About 50 ISO/IEC normative documents planned to
  be adopted in 2001, about 10 documents
  translated, the others adopted by endorsement

21
Strategies of Ministry of Health

• Health informatics
• Informatics as a part of healthcare
• Change of technological approach of health
  informatics
• Development of communication technologies as a
  new impulse
• Movement from health informatics to telematics
• The role of informatics in healthcare providers
• Finding of optimal sources for further
  development

22
Concepts of Ministry of Health

• National information policy, the way to
  information society,
• The Action plan of realization of national
  information policy,
• The European initiative eEurope,
• Support of informatics development,
• Concepts of health informatics,
• Concepts of national information policy in
  education,
• Cooperation in introduction of European standards
  in Czech health informatics.

23
Projects of Ministry of Health

• Health registers
• Telemedicine
• Electronic form of messages and patient
  identification
• Intelligent card as a part of electronic
  documentation

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Health registers

• Formation of a system of national health
  registers
• Legislation, central evidence and registration in
  Ministry of Health
• Standardization of data structures, user rights
• Collection, processing and providing of data
• Technical support, coordination with governmental
  data networks
• Security and safety
• Medical, organizational and technical part of the
  system
• Realization 2000 - 2004
• 2000 Transnet, registers of hygiene service ARO,
  EpiDat

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Telemedicine

• Creating technical prerequisities
• Consultances, teleconferences, remote decisions
• Integrated care systems realization
• Support of health care standards, quality of care
• Information sharing and education
• Radiodiagnostics, nuclear medicine,
  hematology,...
• Realization 2000 - 2002
• 2000 support of project PACS in Brno

26
Electronic form of messages and patient
identification

• Legislation (paper and electronic documentation)
• Standardization of records, code lists,
  interfaces, protocols
• Decision support
• Security and safety of records, long term
  archiving
• On-line monitoring of life functions
• Electronic signature, linkage to electronic
  identifiers
• Realization 2000 - 2003
• 2000 support of project of electronic
  identifiers

27
Intelligent card as a part of electronic
documentation

• Cooperation of Ministry of Health and General
  Health Insurance Company
• Electronic card of insured, health card
• Card of healthcare professional
• Card as identifier
• Card and electronic signature
• Connection of a card and electronic documentation
• Card introduction and support of experts and
  public
• Advantages and development possibilities of a
  card

28
Prepared activities of ministry of health

• Data network of healthcare sector
• Healthcare information systems development
• Information system for evaluation of quality and
  efficiency of health care
• Web portal of healthcare information
• Unification of information systems

29
Legislative activities

• Modification of law 20/1966, defining
• the obligation to keep health documentation,
  conditions of electronic documentation,
  conditions of access to the documentation
• National health information system (NZIS)
• introduction of healthcare registers
• Draft of law about health care
• Draft of law about transplantations
• Methodic directions of Ministry of Health

30
Conferences and seminars

• Conference on electronic health documentation,
  Prague, 24.10.2000
• Seminar on Czech data standard and its future,
  Ministry of Health, 2.11.2000
• International conference Telematics in Czech
  healthcare, Military hospital Stresovice,
  8.-9.12.2000