1. Confidential RISK ADVISORY SERVICES Latvijas Republikas Veselības ministrija Healthcare Information System Policy in Latvia Rinalds Muciņš, Ministry of Health, Latvia Ivars Solovjovs, Ernst & Young Baltic, Latvia

2. Latvijas Republikas Veselības ministrija 2 e eHealth implementation roadmap in Latvia eHealth policy eHealth implementation plan EU ERDF IKT/eHealth activity planning IS architecture eHealth projects (EU) eHealth projects (other) eHealth program

3. Latvijas Republikas Veselības ministrija 3 Healthcare industry landscape

4. Latvijas Republikas Veselības ministrija 4 eHealth – both state program and initiative of health service providers State role –Vision and policy setting –IT support of public functions –Definition of framework and standards –Ensuring common infrastructure (EHR and other centralized systems) –Facilitation of IS development of service providers (including financial support of specific projects) Service providers –IS implementation project implementation –Application for funding (EU) –Cooperation, shared services Message for health service providers - be active, dont expect free lunch from government

5. Latvijas Republikas Veselības ministrija 5 Purpose of Health IS architecture Define industry application architecture – which system will support which functions –Architecture and functionality of EHR and other eHealth relates systems Set eHealth implementation framework –Technological: IS integration and data exchange –Organizational : State participation in informatization of health service providers Status –Draft for discussion (available on request) –To be accepted by IT Council of Ministry of Health

6. Latvijas Republikas Veselības ministrija 6 Current IS architecture

7. Latvijas Republikas Veselības ministrija 7 Current architecture – key findings Most of public functions has/will have adequate IT support –Health Management IS (WP financed project) provides public finance administration as well as basic health statistics and health record functionality –Emergency service needs new system Open questions regarding EHR and other eHealth specific systems Mostly paper based spaghetti type workflow and system integration Low level of IT usage of health service providers

8. Latvijas Republikas Veselības ministrija 8 Proposed Health IS architecture

9. Latvijas Republikas Veselības ministrija 9 Electronic Health Record IS overview

10. Latvijas Republikas Veselības ministrija 10 EHR IS key features EHR IS is separate, but tightly integrated with MIS (finance system) Hybrid architecture - centralized health episodes information, decentralized detailed health records (via links) Centralized health record –Patient identification and demography –Basic medical information – blood type, allergies, vaccination etc. –Access rights (granted by patient) –Healthcare episodes basic information –GP and other contacts –Links to detailed information Access authentication/ authorization by electronic health insurance ID card Industry registers and classificators (currently in MIS) Special decease registers (currently separate)

11. Latvijas Republikas Veselības ministrija 11 Standardization initiative (integration approach) Semantic integration –Unified data object identification and classificators International classification systems MIS registers and classificators –Messaging standards XML, HL7 – messaging syntax Messaging content standards has to be developed (based on CEN TC215, ENV 13306) Latvia e-government integration standards (IVIS) Application integration –Service Oriented Architecture (XML Web services) –Centralized hub based integration platform Technological interoperability

12. Latvijas Republikas Veselības ministrija 12 Integration platform – centralized hub model © Microsoft

13. Latvijas Republikas Veselības ministrija 13 Radiology IS/PACS - centralized images archive

14. Latvijas Republikas Veselības ministrija 14 Hospital IS implementation approach Support of hospital as small business Avoid big-bang HIS project approach –Limit implementation risks and costs Facilitation of open, modular HIS architecture, which uses defined data exchange standards (XML/HL7) Use existing best specialized systems and make them compatible through data exchange mechanisms Hospitals would select modules in accordance with their specialization Coordination and joint development among hospitals

15. Latvijas Republikas Veselības ministrija 15 Hospital IS architecture

16. Latvijas Republikas Veselības ministrija 16 Other new systems and initiatives Electronic prescription IS Centralized Clinical diagnostic IS Electronic health insurance ID card Coordinated (supported) GP, outpatient IS development Data warehouse based health statistics IS Electronic booking to GP Health workflow IS

17. Latvijas Republikas Veselības ministrija 17 Thank You! Questions? Healthcare IS architecture document draft (in Latvian) is available on request Any comments, suggestions are welcome For contacts – ivars.solovjovs@lv.ey.com