The eHealth Monitoring project addresses the challenges and problems of the population in cross-border regions, which is facing significant health problems, especially in remote areas, creating an opportunity for cooperation between the Greek and Bulgarian partners participating in the project. The implementation of a project with such a thematic focus is a contribution to the development of healthcare system in Bulgaria, in particular regarding the introduction of the eHealth concept.
Indicators for the health status of the population display low levels of provision of health services in border areas. We are witnessing the closure of health institutions due to a shortage of qualified staff and mismanagement of the allocation of financial resources. Indisputable factor for the worsened values of the indicators is the increase of the economic inequalities between the population in these border regions compared to the population living in the inner parts of the country, which affects the health systems and requires measures for improvement and higher efficiency.
The elaboration of an eHealth Management Strategy as part of the project is linked to the goal to improve the access to primary and emergency medical care in rural, isolated and economically disadvantaged areas.
The presented document considers in a general context the essence of the eHealth concept in Bulgaria and showcases the vision for its development according to the strategic documents adopted by the Bulgarian institutions.
The report was developed in accordance with the documents, adopted by the Government of Republic of Bulgaria on the development of healthcare, in particular the eHealth approach, and is also based on most recent scientific work and achievements in this sphere.
EUROPEAN PEOPLE AND NATIONAL CONTEXT
• One of the strategic objectives adopted at the European Council in March 2000 in Lisbon, is that the European countries shall develop most competitive and dynamic knowledge-based economy.
• The European Council reaffirmed this strategic objective and gave a mandate for an accelerated development of the information society and information and communication technologies.
• In the information society, eHealth is an extremely important and is seen as one of the main priorities in European development plans.
• The new initiatives of the European Commission are related to the introduction of electronic health cards and a single information system as an essential and integral part of modern healthcare.
SCOPE AND CONTENTS OF THE eHEALTH CONCEPT
The eHealth concept combines wide range of topics related to the health care:
– health prevention;
– medical and health care;
– health management;
-financial dimensions of healthcare / valuation of medical services;
– ideology and practice of health policy;
-all types of training in the field and change in qualification of the expert staff.
Systematic analysis of eHealth as a set of objects, entities, processes and phenomena has a systemic structure and includes:
• Technical means – IT and telecommunication infrastructures, mobile devices for communication between suppliers, authors and consumers; medical equipment; various kinds of software.
• Participants – medical and healthcare professionals – users; patients and health-insured persons; providers of technology that also take care of its maintenance and development; state, private and corporate financing institutions, regulating, licensing and controlling authorities and organizations.
• Methods and methodology for work with IT products and the regulation of this dialogue – these are the communication language (interface), the specific modes of operation of the apparatus and the setups for exchange of health data and information; medical qualification /knowledge, skills expertise/; standards and recommendations on the quality of service that allow other local health information systems to be integrated and developed.
WORKING WITH HEALTH INFORMATION. STAGES.
The creation and / or acquisition of electronic health information and its use goes through several stages, namely:
• Preliminary preparation. Selection of objects, processes, phenomena that become information sources, with clear indication of the reasons and peculiarities of this choice, as well as the reasons for the expected results.
• Collecting information. The gathering of information can be done by measuring devices and apparatus in a real or laboratory situation, by reporting and manually entering of descriptive data, by expert judgment on selected parameters, by comparative analysis with other archived information and some other methods.
• Controlling the quality of information applying selecting different mechanisms.
• Primary data processing, such as data compression, specialized layout as per pre-set scheme, etc.
• Actual data processing and possible analyses and conclusions. Creating new specialized programs or using known ones for diagnosis, prognosis treatment, etc.
• Documenting the results of the study. Tables, charts, patterns, conclusions, abstractions, etc. These results may be visible directly on a monitor, or may be a saved as a record on a physical medium – paper, plaque, or other external media that requires additional visualization or telemedicine transfer. Results can be accessed in real time or at a selected future time.
• Storage and archiving on external media. In the context of the use of the information gathered, it is necessary to have legally regulated rules on the storage of medical, hospital, and health information and allocation of access rights, as well as regarding the possible use of such information as evidence in forensic medical procedures.
• Update over time and access by priority. Updating over time and prioritizing access to information are tasks of paramount necessity. They are part of the design and programming of any computer or telecommunication system for processing medical information. The update may be partial or to run at a specific time. The complete software is also subject to regular update.
GENERAL PRINCIPLES OF eHEALTH CARE
In order not to alter the meaning, purpose and role of health information in human life, its electronic version should meet the following requirements:
• Efficiency. One of the main goals of eHealth is to increase the quality and volume of healthcare services provided while maintaining or reducing costs;
• Improved service quality. Increased efficiency involves not only cost reduction but also improved service quality.
• Evidence Based Medicine and Management. eHealth interventions must be based on arguments and evidence to become scientifically grounded. In this direction, long-term expert and financial efforts should be invested.
• Ethics. EHealth creates new forms of patient-doctor relationships and poses new challenges and ethical issues in relation to on-line practices, informed consent, access to information, privacy and confidentiality, language of communication and sought-after social support and empathy. Medical information is not just about informing, it is exchanged to triger action and attitude.
• Adequate qualification and training of health professionals.
• Supporting and developing a new form of relationship between a patient and a health expert through a real partnership where decisions are shared responsibility and true interaction and trust.
• Interoperability of information systems in healthcare.
• Expanding the healthcare beyond conventional borders. This includes both overcoming geographical constraints and concepts of medical work, which is no longer a subjective act, but a group expertise. eHealth allows you to offer local health care from global sources.
• Enhanced consumer rights – through access to personal health records and evidence-based practices, Healthcare is the guarantor of the best “informed choice” for the patient.
• Equality. Making healthcare more accessible is one of the major goals of eHealth.
• Authenticity and veracity. Any organization or expert who offers health information, products and / or services should be governed by this principle.
• Professional relationships are regulated through the application of standards.
• Informed consent and confidentiality. Policy to protect patients’ rights should be ensured, to ensure informed consent on the collection of their personal data; to limit the unauthorized access to personal health information, to ensure access to the personal information of the users themselves, and to have a mechanism for tracking the use of their personal information.
• Electronic dialogues between patient and doctor or a group of experts should have fixed parameters through: a clear and specific description of the nature of on-line relationships; outlined restrictions on on-line diagnosis; to put emphasis on the fact that on-line consultation does not displace personal contact with the physician; to clearly define the payment methods; that the patients understand every aspect of the necessary health care.
MEASURES FOR THE INTRODUCTION OF NATIONAL HEALTH-INFORMATION STANDARDS
The introduction of national health information standards includes:
• Development of mandatory standards for health information and statistics;
• Develop security policies and interoperability of information systems in healthcare;
• Establishment of a National Health Information System and provision of access to the system by electronic identifier;
ESTABLISHMENT OF A NATIONAL HEALTH-INFORMATION SYSTEM.
• The establishment of the National Health Information System (NHIS) enables on-line provision of many administrative and health services, provides access for patient to information about for their own health, improves the interconnections between the different levels of the system, improves the quality of medical services and ensures the efficiency of the spending of public funds for health care.
• The availability of NHIS is a prerequisite for the financial procedures to be transparent and easy to monitor, analyse and control, and to meet the requirements of all participants in the system.
• The concrete steps for the establishment of the National Health Information System (NHIS) will be implemented according to the Roadmap set out in the Program for eHealth Development.
• The Roadmap covers a six-year period (2014-2020) and includes three logical stages. The development of the eGovernment architecture of Republic of Bulgaria should be carried out step by step and each subsequent stage builds on and develops the achievements of the previous stage.
The first stage includes an analysis of the current state of the processes in the healthcare system in Bulgaria – participants, processes, responsibilities, used information systems, information flows, analysis of the expected interactions with European health IT systems and identification of the necessary regulatory regulation. The set of unified registers and nomenclatures needed for the work of the NHIS will be defined and uniform standards for the exchange of health information will be defined.
The second stage includes the extension of the NHIS – the development of additional administrative and specialized registers, the extension of the portal and the electronic services system, the development of risk analysis mechanisms, medical audit, electronic prescriptions, as well as analytical opportunities.
The third stage involves the creation of a backup data center, which includes image diagnostics possibilities, telemedicine, decision support elements, and elaboration of additional electronic services.
EXTENDING AND UPGRADING THE MODULES OF THE HEALTH INFORMATION SYSTEM.
• Exchange of real-time information between health professionals through the use of forms for electronic forwarding, electronic prescriptions, laboratory data and research;
• Creation of an electronic health record of the patient;
• Implementation of information communication technologies in the health infrastructure;
• Ensuring connectivity of all medical service providers through computer networks, communication devices, Internet access;
• Provision of hardware capacity for centralized electronic registers and electronic databases;
• introducing secure user identification,
• Ensuring security of information through encrypted forms of data exchange.
INFORMATION AND TRAINING THROUGH PROVISION OF WEB-BASED SERVICES IN REAL TIME:
• provision of information to the population (health prophylaxis, rights and obligations of health insured persons, etc.);
• provision of administrative services;
• provision of information to health care providers about rights and obligations, ways and level of reimbursement, etc.;
• health education;
• maintaining the qualification and continuing training of health professionals;
• provision of public registers for medical establishments, for persons providing medical services, health insurance funds, pharmacies, etc .;
This document is created under the project “Improving healthcare access through a personal monitoring system“/eHealth monitoring/, Subsidy contract B2.9a.11 with the financial support of Cooperation Programme “Interreg V-A Greece-Bulgaria” 2014-2020, Co-funded by the European Regional Development Fund and National funds of Greece and Bulgaria. The entire responsibility for the contents of the document rests on Euroradar Association and under no circumstances it can be assumed that the materials and information on the document reflects the official view of the European Union and the Managing Authority.