HWISC

Health and Welfare Information Systems Center (HWISC)

HWISC is a ICT competence center founded on 1st of January 2017 which consolidates the roles and responsibilities of former ICT department of Ministry of Social Affairs and Estonian eHealth Foundation.

Mission

HWISC is the ICT competence centre under the governance of Ministry of Social Affaires which is providing ICT services to health, labour and social security areas.

Vision

ICT under the governance of Ministry of Social Affaires are consolidated to the HWISC with the goal to provide from the person point of view consolidated services via integration and synergy of areas as health, social security and labour.

Main responsibilities

Development of information systems, databases and e-services

Providing information

security

Maintenance of

services and infrastructure

Data analysis to support policy making, reporting, productivity monitoring and supervision

Clients

Other parties

Other parties

• Gender Equality and Equal Treatment Commissioner Agency
• Official Mediator Agency
• Estonian Health Insurance Fund
• Estonian Unemployment Insurance Fund
• Other ministries and agencies
• Estonian and EU habitants
• Estonian enterprises
• Local government
• Healthcare providers/hospitals

Electronical ID

• id and travel
• digital signing
• i-voting
• business, banking
• state and healthcare
• public transport
• loyalty card

• 99% of state services are online
• over 2000 services
• over 900 connected organizations, databases
• over 500 million transactions per year

5 Key Features of Estonian Healthcare

Earmarked social insurance tax

13% flat rate top-up to all salaries

State responsibility for insurance coverage

Single public purchaser of services (Health Insurance Fund)

Decentralized provider network

Private operators governed mostly by public entities

Strong primary care

Universal free Access >50% of outpatient contacts

One of the most cost-effective healthcare systems (perhaps)

3-time champion of “bang-for-the-buck” prize by Health Consumer Powerhouse (SWE)

Law and regulations

1. Health Care Services Organisation Act;

2. Statute of Health Information System

(governments Statute no 131 August 14th 2008);

3. The Statute no 53 September 17th 2008 of Ministry of Social Affairs on

The Composition of Data,

Conditions and Order of Maintaining of the Documents Forwarded to the Health

Information System;

4. Data protection law;

5. Public Information Act.

• All healthcare providers must send data to Health Information System

• Access only to licensed medical professionals

ID card or mID for authentication and digital signature

• Patient has the right to close his/her own data collected in the central database (opt out)

• Patient can access their own data (Patient’s Portal)

• Patient can declare their intentions and preferences

• Patient can monitor visits to their HIS.

Major architectural decisions of current Health Information System

• Integration through Central system
• Opt-out policy in form „patient can close data from doctors“
• XML based HL7 v3 (extended) messages
• Documents are kept in XML format (HL7 CDA R2)
• All identifiers have OID-s
• Only final versions of clinical documents are sent into central system after case is closed
• Reuse of national infrastructure
• ID card for authentication and digital signature
• X-road for secure communication

HL7 CDA Document characteristics

Persistence – the clinical document continues to exist in an unaltered state for a period of time defined by local and regulatory requirements.

Stewardship – the clinical document is maintained by a person or organization entrusted with its care.

Potential for authentication - the clinical document can be legally authenticated.

Wholeness – legal authentication applies to the entire clinical document; it does not apply to parts of the document taken out of context.

Human readability - the clinical document can be easily read and understood.

Health Information System

Health Information System (HIE)

HIE HISTORY

PATIENT PORTAL

LESSONS LEARNED

• Resources were planned only for central development
• Usability is important. Developing process has to include medical competence – users
• Data quality is important
• Complete and quality data give value
• Balance between security and usability
• PIN for every document