National, regional and international interoperability of Croatian healthcare information system

National, regional and international interoperability of Croatian healthcare information system Paper Mladen Mauher, Dragan Schwarz, Ranko Stevanović, and Siniša Varga Abstract—Croatian national health ICT implementation strategy is determined by Croatian national health strategy and plan, Croatian ICT development strategy for 21st century, and requirements specifications for the health information system. National health ICT implementation strategy components are accented: purpose of the ICT implementation strategy, information principles, needs and ICT enablement in domains of patients, healthcare professionals, policymakers and managers and public. Telemedicine and telecare positions and implementation steps are described. Based on the determinants, three organizational levels have been established – government, ministerial and project levels. General architecture of Croatian healthcare information system and respective pilot projects and results of pilot implementations as well as national ICT environmental accelerators for health ICT implementations are presented. Keywords— health ICT implementation strategy, healthcare functional requirements, helthcare standards, electronic health record, integrated healthcare, agent based software technology, healthcare computer, communication network healthcare pilot implemetation. 1. Introduction Conceptual design of national healthcare information system has been based on: • national strategic documents: – Croatian strategy for health and health insurance reform [1], – Strategy of Information and Communication Technology Development – Croatia in 21st Century [2], – National Health ICT Implementation Strategy [3]; • international documents: – eEurope Action Plans: 2000, 2002, 2005, – EU eHealth Strategy, – The eEurope Smart Card (eESC) initiative, – National eHealth Strategies (GB and US); • health information system conferences and forums: – Conference on Health Information System and Telemedicine Developments (Zagreb, May 2001), – National Health Information System Implementation Conference (Zagreb, Nov. 2002), – Cooperation on Sustainable Healthcare Strategies, 1st Central East and South East Europe Symposium (Zagreb, Sept. 2003): Implementation and Interoperability of Health Information Systems in Central and South East Europe: Major Issue of the Reform; Sustainable Cardiovascular Healthcare and Technology Strategies for CE&SEEurope – Leading health and economy problem. Knowing the complexity of national healthcare information system and having experienced inefficiency and incompatibility of isolated legacy systems, competitive national pilot project approach has been implemented. 2. Project organization and management Three-level project organization and management has been established. Government level – Government Steering Committee for Internet Infrastructure Development (GSCIID) – responsible for national ICT policies and corresponding infrastructure developments. GSCIID established the health information system expert group as the advisory group of experts in the fields of medicine/health and ICT, with the responsibilities for advising and monitoring high level implementation policies. Ministerial level – advisory teams to minister of health were appointed with the representatives from hospitals, national institute for public health, national institute for health insurance, faculty of medicine, chambers of health, as well as the regulatory bodies for public procurement for the health related ICT projects. Pilot project level – central primary healthcare information system (PHIS) implementation team with 60 pilot implementation site teams, and hospital information system (HIS) implementation team with 4 corresponding pilot implementation site teams were appointed. 5 Mladen Mauher, Dragan Schwarz, Ranko Stevanović, and Siniša Varga 3. The requirements and functional specifications 3.1. National requirements The strategic national requirement for the national health information system (NHIS) is to enable implementation of national health system (NHS) reform. The strategic information requirements are: • to ensure patients can be confident that NHS professionals caring for them have reliable and rapid access, 24 hours a day, to the relevant personal, medical and health information necessary to support their care; • to eliminate unnecessary travel and delay for patients by providing remote on-line access to services, specialists and care, wherever practicable; • to provide access for NHS patients to accredited, independent, multimedia background information and advice about their condition and to provide every NHS professional with on-line access to the latest local guidance and national evidence on treatment, and the information they need to evaluate the effectiveness of their work and to support their professional development; • to ensure the availability of accurate information for managers and planners to support local health improvement programmes and the national framework for assessing performance; • to provide fast, convenient access for the public to accredited multimedia advice on lifestyle and health, and information to support public involvement in, and understanding of local and national health service policy development. The specific targets are: • reaching agreement with the professions on the security of electronic systems and networks carrying patient-identifiable clinical information; • developing and implementing a first generation of person-based electronic health records, providing the basis of lifelong core clinical information with electronic transfer of patient records between general practicioners (GPs) and medical specialists; • implementing comprehensive integrated clinical systems to support the joint needs of GPs and the extended primary care team, either in GP practices or in wider consortia (e.g., primary care groups); 6 • ensuring that all acute hospitals have the ability to undertake patient administration, including booking for planned admissions, with an integrated patient index linked to departmental systems, and capable of supporting clinical orders, results reporting, prescribing and multi-professional care pathways; • connecting all computerized GP practices to NHS virtual private network (NHS VPN); • providing 24 hour emergency care access to relevant information from patient records; • using NHS VPN for appointment booking, referrals, discharge information, radiology and laboratory requests and results in all parts of the country; • the development and implementation of a clear policy on standards in areas such as information management, data structures and contents, and telecommunications, with the backing and participation of all key stakeholders; • community prescribing with electronic links to GPs and the prescription pricing authority; • routinely considering telemedicine and telecare options in all health improvement programmes; • offering NHS direct services to the whole popu (...truncated)