Primary healthcare information system – development and deployment issues

Ranko Stevanovic a, Vinko Kojundzic b, Galibedin Galijasevic c
a Croatian National Institute of Public Health, Croatia
b Maticnjak Ltd, Croatia
c ABA informatika Ltd, Croatia

Abstract.

Croatian national primary healthcare ICT Implementation strategy is determined by Croatian national health strategy and plan, Croatian ICT development strategy for 21st century, and requirements specifications for the heath information system. National primary healthcare ICT implementation strategy components are accented: purpose of the ICT implementation strategy, information principles, need and ICT enablement in domains of patients, healthcare professionals, policy-makers and managers and public. Based on the determinants, three organizational levels have been established – government, ministerial and project levels. General architecture of Croatian primary healthcare information system and its implementation as well as national ICT environmental accelerations for national primary healthcare ICT environmental accelerators for health ICT implementations are presented.

Croatian Telehealth Strategy: Objectives, Technology, Customers, Benefits

I. Klapan*, A. Pavelin**, R. Stevanovic***
*Ministry of Health Republic of Croatia, Croatian Telemed Society, telMED@mef.hr
**T-Com, Service Department, Business Services and Solutions, Zagreb, Croatia
***Croatian National Institute of Public Health

Abstract:

ACTIVITIES:

1. installation of TeleMED equipment in small, as well as expert MCs (medical centers)
2. professional TeleMED Center has to be founded/inside VPN, based on the highest professional standards, rational, efficient, high ethical (such as i.e. Croatian Center for Telemedicine),
3. all “partners” are offered the possibility of contact with physicians from their settings, as needed, thus directly and significantly improving the Croatian TeleMED offer,
4. real time aplication/variuos TeleMED activities; information provided at once, better decisions.

MAIN GOAL AND OBJECTIVE:

1. promotes regional cooperation,
2. assists in pre-planning for present/future TelMED (telemedicine) coalitions; service to remote locations,
3. contribute to NATO, and operate with NATO forces,
4. become respectable partner with other partners,
5. “to improve dialogue with local partners in issues and scenarios related to military emergency medicine, developing of modern teleheath of the 21st century, emergency planning”

BENEFITS:

1. “telepresence” of the worldvide well known authorities in any MC of the Adriatic region/south-east Europe,
2. emergency planning,
3. intervention and momentary consultation / throughout 24 hrs in remote MCs,
4. protection, successful emergency response,
5. application of the latest technologies are closely followed and implemented in the health/telehealth care of both domicile population and foreign guests,
6. supervision of TeleMED activities will be performed nationally,
7. international agreements of the supervision should be developed and the possible need for international registration of doctors practicing TeleMED internationally shall be evaluated/developed.

TECHNICAL DETAILS:

1. Videoconference equipment: high-quality communication over ISDN and IP networks is enabled and facilitated with diverse implemented interfaces and supported audio-video standards, alongside the broad spectra of auxiliary equipment. The system can be easily upgraded in the future,
2. The system is an ITU-T H.320 and H.323 compliant for communication over ISDN and IP networks. The XGA (1024×768), SVGA (800×600) and VGA (640×480) video resolutions can be displayed on a system monitor. It is possible to attach additional displays, video cameras, a document camera, an additional PC, video recorder, microphone and speakers. The IP Ethernet 10/100 and 4 ISDN BRI network interfaces support efficient communication over any existing LAN and WAN technology,
3. Implemented IP protocol stack supports transparent integration of the installed videoconference equipment into the unique intranet environment of any MC. Relying on IP technology allows for integration with VoIP system and standard systems for centralized management, administration and billing. In the WAN segment, a transparent transition from ISDN to the next generation networks based on IP and MPLS technologies is inherent. Embeding the TeleMED system in an IP/MPLS VPN environment is estimated as the optimal intranet solution at the national level and is seen as an evolutionary step,
4. a connection to other telecommunication systems such as PSTN, the Internet or other intranets will be realized through the gateways. Appropriate safety mechanisms (firewall, AAA, NAT/PAT) will be used. The possibility of using the Internet as a system infrastructure should not be rejected. However, QoS and security issues remain restricting factors,
5. In addition to specific application servers a set of standard servers (WWW, mail, DNS) should be installed. Public WWW server is a priority task to be realized as early as phase A of the project. In subsequent phases, the cost-effectiveness of a dedicated video server should be considered in order to archive high quality medical images and video clips. This will form a sophisticated and efficient database of medical records that could prove highly useful. The possibility of using this video server for educative purposes of both medical students and professionals should be seriously considered.

Development and Deployment of Health Information System in Transitional Countries (Croatian Experience)

Ranko Stevanovic*, Ivan Pristas*, Ana Ivicevic Uhernik*, Arsen Stanic**
*Croatian Institute of Public Health, Croatia
**Orthopaedical Clinic in Lovran, Croatia

Abstract:

Croatian Primary Health Care Information System pilot project, conducted between 2001 and 2003, aimed to develop and deploy a health information system based on the latest technologies which would improve the quality of primary health care and rationalise the consumption. 60 primary health care teams (physician and nurse) were equipped with PCs and connected via central server to the main national health insurer, state treasury and public health institute. Developed information system enabled rapid retrieval of documents, replacement of manual data input and a real-time insight into needed information as well as prompt interventions within the system. The project also introduced electronic smart cards for physicians and nurses, so that at each medical check-up the information system verified both the ensuree’s and the physician’s or nurse’s status and rights. Based on the experiences from the pilot project, plan has been made for comprehensive health information system at national level which would connect primary health care teams, hospitals, laboratories, dentistries, health insurance companies, state treasury, public health institutes and electronic health records database. Its major goals are more rapid diagnostics, accuracy in prescribing therapy, standardisation of the good practice as well as better utilisation of capacities, shorter waiting times and shorter stays in hospitals, which would lead to improvement in overall health care quality and better control over the health care consumption. Estimated 5-year investment for installing such system would be 125 million EUR. However, information system could save substantially more and yield a return of investment in only two years. As information system for primary health care should be a strategic component of every health care reform and development plan, we can recommend our model, based on the results of the pilot project, to other transitional countries.