Patient Empowerment through eHealth Portal in Bosnia and ...

Patient Empowerment through eHealth Portal in Bosnia and HerzegovinaPatient Empowerment through eHealthPortal in Bosnia and HerzegovinaZoran Gajic 1 , Sonja Sipka 1 , Jacob Bergsland 2 , Ozren Kordic 3 , Milan Mandic 3 , Danijel Pajic 3Exit IT Business Support Centre, Banja Luka, Bosnia and Herzegovina 1University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina 2University Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina 3SUMMARY: - - - Keywords and phrases: eHealthportal, eLearning, CME, patient empowerment Adopted in 2009 by the Ministryof Health and Welfare of Republicof Srpska (MoH RS), this documentcreates policy framework for all futureeHealth related projects in RSfor the next 8 years period of time.Correlated with EU strategic initiatives(iEurope 2010 and eHealthERA Coordination Action) and theWorld Health Organization recommendations,the Strategy, the documentenvisages establishment of a“patient centric” healthcare system,based on integration of health relatedinformation, which can be connectedto tomorrow’s EU integratedeHealth network (1,2,3,4,5,6,7,8).26 eHealth core project are groupedin 4 strategic pillars: Programme Management andImplementation – establishmentof eHealth steering committeeand executive body & educationof end users; Foundation eHealth projects –network infrastructure, electronicregisters of patients, professionals,institutions and services,terminology server; Implementation of Basic Systems– Electronic Health Record,Electronic Medical Record,Intelligent Cards, Hospital InformationSystem, PACS, Telemedicine,eLearning in CME,eLaboratory, Health ManagementInformation Tool,.. Information Integration andCommunication – NationaleHealth Data Centre, semanticand technical interoperabilitystandards, security and nationaleHealth portal on mothertongue.An incrementing approach in thestrategy implementation has beensuggested, based on gradual involvementof robust systems, though combinationof successful legacy systemswith new capacities, that steady buildrepository of consolidated and integrateddata needed for better healthcare.Phase 1 will provide credibleaccess to the priority health data,both for professionals at the pointsof care and for patients when needed,independently of geographic location.In practice, it means that foundationelectronic registries will be established.Phase 2 leads towards introductionof basic eHealth systems,providing access to clinical data andlater to integration of those data. Finally,Phase 3 means integration ofhealth information, based on internationaleHealth standards. Here itis where access to variety of eHealthapplications for citizens will be providedthrough eHealth portal. ELEARNING IN CME“eHealth” portal and eLearningin CME are two main componentsof eHIGICo BiH project which isdeveloped by EXIT Centre in cooperationwith Interventional CentreRikshospitalet in Oslo, Norwayand funded by Norwegian Ministryof Foreign Affairs (9,10,11,12,13). Itslocal implementing partners, as previouslymentioned, are both Ministriesof Health in BiH.“eHealth” portal is a commoncomponent of all eHealth systemsAIM 2009; 17(3): 151-154vol 17 no 3 SEPTEMBER 2009 151

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxPatient Empowerment through eHealth Portal in Bosnia and Herzegovinaxx xxx xxx xxx xxxxxacross the Europe. It is a startingpoint for searching for variety of informationaggregations and servicesavailable online. BiH “eHealth” portalis to serve as a platform to hostvarious online interactive services,used by citizens and healthcare professionalson everyday basis. This approachwill make them more mobile,independent of paper work andprovide them with timely and accurateinformation. Healthcare managementwill be enabled with basichealth management tools to contributeto improved accountability andtransparency in their work.Patient empowerment is one centralelement in the EU health strategy.The current EU “Programmeof Community action in the field ofpublic health (2003-2008)” includesactions on the quality of health informationat web sites and the launchingof the Health Portal to serve Europeancitizens (4). The proposal ofthe next “Programme for CommunityAction in the field of Health2007-2013” relays on three main objectives: Improve citizens’ health security; Promote health for prosperityand solidarity, and Generate and DisseminateHealth Knowledge AND HERZEGOVINAHealth care systems in Bosniaand Herzegovina are facing numerouschallenges created by variousexternal and internal factors. Burdenof low efficiency, high unemploymentrate, obsolete technology,with part of existing companies tobe considered as relicts of old system,low health care contributionscollection level, all represent challengesfor the development of sustainablehealthcare system in BosniaxxxxxxxxFigure 1. National eHealth Network of Republic of Srpskaxx xxx xx x xand Herzegovina. Weaknesses relatedto efficiency, equality and qualityof services require in-depth reforms(14,15,16,17,18).Main problems identified in thesector are: Inequality and injustice Inadequate health insurance coverageand control of healthcarecontributions collection. Imbalance between rights andavailable funds Inefficient organization of thesystem and services Low quality of service Health care corruptioneHealth portal goals and objectives: Provide reliable and up-to datehealthcare related information inmother tongue Improve inclusion of citizens inhealthcare delivery chain Better interaction between healthcare providers Healthcarequalitypressure–transparency Create quality informationchannels Lifelong learning / e-learningand CME Due to the systematic nature ofthe eHealth portal development, theportal is going to be introduced in 2phases. Phase 1 is primarily orientedtowards information delivery withlow level of interaction and Phase 2is oriented towards the integration ofVAAs (Value Added Applications)and introduction of interactive services.According the eHealth Strategy,in the future there is a potentialfor the eHealth portal to grow intothe complex online service whichwill be interconnected with variousother existing services.eHealth portal is a healthcare-focusedinformational and educationaltool oriented toward citizens andhealthcare providers of Republic ofSrpska and Federation of Bosnia andHerzegovina and through high userfocus and direct connection to relevanthealthcare bodies has potentialto establish synergetic relationshipwith healthcare providers, healthcareand educational institutions whoseemployees and academic staff shallbe a primary source of high valuecontent for the portal. People needto be educated on the hierarchy ofthe health organizational structure,health insurance, services available,fees, doctors in the area, referral procedures,etc.Services and products offered onthe eHealth portal are differentlyoriented towards different user (target)groups: The widest user group, and servicesand products offered to the same,are primarily in the form of informationprovision with the highergoal of patient empowerment. Patientempowerment is one of the centralelements in the EU health strategy.With National Health Authorities,EU Bodies, European Counciland WHO-Euro backing the patientempowering ideal. The Europeanexperience on eHealth patientempowerment has been in the mainoriented to: providing access to trustedinformation and advice, supportingpatient education for health literacy,implementing the process forthe patient to access and managetheir health data (e-PHR), increasingpatient security and convenience(e-Appointment and e-Prescribing),facilitating on-line health behavioralmodification (self-care) and supportingnew models for chronic care (e-Chronic Care).At the BiH eHealth portal patientswill have access to: Latest news related to health Information on health organizationsand events New and improved products offeredby the sponsors Opportunity to “Ask the Doctor”a specific question Advanced search engine (search152 vol 17 no 3 SEPTEMBER 2009AIM 2009; 17(3): 151-154

xxxxxxxx x xxxxxxxxxxxxxxxxxxxx x xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx x xxxxxxxxxxxxxxxxxxxxxxxPatient Empowerment through eHealth Portal in Bosnia and Herzegovinaxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx x xxxxxFigure 2. Initial CME Processxxx xxxxxxxxxx xxxxxxxxxxxxx x x xfor terms, illnesses, conditions,institutions etc.) Quick access to quality upto-dateinformation, servicecomparison Chronic diseases treatmentinformation Younger generations with theconvenience of the access to theinformation and ability to helptheir elderly without taking timeoff from work in order to do thesame In the future, the ability to makean appointment with the familydoctor or a specialist Information on available drugsand where can they get them Secured personal information Other This user group will be providingservices to the eHealth portal as wellusing the services offered by the portal.This section will concentrate onthe services that will be provided tothe healthcare professionals. Healthcareproviders will be provided withlatest technologies that support theirinteraction with patients, either ondirect or remote contacts (telemedicine),integrated health informationsystems that provide wide range ofinformation about the patient, collectedfrom different geographicallydistributed sources. Besides all ofxxxxxxxxxxxxxxxxxx x xxxxxxx x x xxx xxxxxxxxxxx xxxxxxx xxxxxxx xxxx x xxxxxthese benefits of the eHealth portal,the following services will be availableas well: Latest news in the form of videos,podcasts and articles; Information on professional societies,chambers, associations,agencies, etc. Job Vacancies; Professional Education (seminars,conferences, workshops,specialization, projects, grants,scholarships, etc.) Drugs and products (find a drug,law regulative, warnings and recalls,drug therapy, drug interactions,etc.) Library (resources, books,articles) Medical Law Regulations (ethics,strategies, policies, etc.) Better communication betweendifferent institutions Aggregation of relevant informationin one place Confidentiality of information Workload unloading (administrativereporting, electronic communication,etc.) Access to new information whichcan ease and better their work(staying up-to-date on patienttrends, new medications, treatments,etc.) Continuing Medical Educationonline Upcoming events and trainings Otherxxxxxxxx “eHEalth” Portal will be developedin mother tongue, which willhelp forming technological internationallyinteroperable communixxx xxxxxxxxxxx ELEARNING IN CMESkilled physicians, nurses, administrationand management in healthcare sectors are a key to successfulreform of health systems in Bosniaand Herzegovina. Being up-to-datewith information currently availablein mother tong is rather hard, sinceprocesses of adoption of new educationalmaterial and its distributionare a long term process. Supplyside seen in chambers of doctors ofmedicine cannot cope with demandsfrom healthcare providers’ side. Thatis where eLearning can be used as aboosting element, providing quickand wide access to up-to-date educationalcontent. Transfer of Norwegianexperience is of particular importancehere.CME will help physicians andother health professionals increasethe vitality and efficiency of theirpractices by providing educationalprogramming that is evidence-based,up-to-date, and learner-driven, designedto improve patient outcomes.CME portal’s mission is to contributeto better and more efficientcontinuing medical education forhealth care professionals. While havingaccess to important CME information,ability to register for CMEactivities and attend online course,thus, putting emphasis on userfriendly experience. This approachimproves the motivation of healthcare professionals to promptly managetheir own professional development.Based on conducted researchhealth care professionals find it difficultto dedicate time and/or travelto distant locations to participate inCME activities. As a solution CMEPortal will offer e-Learning courseswhere the health care professionalscan maintain their professionaldevelopment at own pace, time andlocation. At the same time the contentavailable on the CME Portalwill undergo accreditation process byhighly qualified personnel to ensurequality education.AIM 2009; 17(3): 151-154vol 17 no 3 SEPTEMBER 2009 153

Patient Empowerment through eHealth Portal in Bosnia and Herzegovinacation framework for implementationof the project goals. Citizens, aswell as the health care professionalsshould benefit through use of theseservices – citizens will be able to useinteractive services to broaden theirknowledge, while health care professionalswill be able to learn at theirown pace, in their own time. Thiswill motivate organizations and individualsto actively participate ineLearning in CME. The Portalshould be easily replicable on othercountries in the region, should receivepolitical support and providetransparent information (which willkeep users’ satisfaction on a high level),as well as raise awareness amongcitizens about benefits of eHealth. eHealth Portal developed andfilled in with the quality contenton mother tongue. eHealth Value Added Applicationdeveloped, tested and integratedinto portal framework Health Care Consumers andProviders use them eLearning System for CME establishedand tested 4 local online pilot courses producedand published Online users registered on thesystem and attending courses Raising number of requests towardparticipation in the eLC-ME Programme eLearning in CME Accreditationand Certification Authoritiesestablished Established legal framework foreLCME syllabus accreditationand certification of success onsuch programmes (“eLCME SyllabusAccreditation Authority”and “eLCME Certificate IssuingAuthority”) Content Providers for eHealthPortal identified and contracted Developed all business plan,technical specifications andguidelines documents Norwegian online educationalcontent for physicians and nursestranslated on local language andcustomized for local professionalpurposes, according rules of AccreditationBoard. Developed benchmarks for system’sstandards of performance Provided feedback mechanismsfor continuous improvement ofperformance Authorities of boards expandedtoward more medical and accompaniedsectors, providing moreparticipants that actively participatein the system functioning(e.g. more contributors to contentproviding, more eLearners,..) Raised number of users of thesystem in all target groups Created positive climate towardexpansion of the project on WesternBalkan region.1. “e-Health–making healthcare betterfor European citizens: An actionplan for a EU eHealth area”, EUcommission 2004.2. “eHealth priorities and strategies inEuropean countries”, eHealth ERA2007.3. “eHealth in 2010: Realizing aKnowledge-based Approach toHealthcare in the EU: Challengesfor the Ambient Care System”, EUcommission 2004.4. EU “Programme of Communityaction in the field of public health(2003-2008)” http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2002:271:0001:0011:EN:PDF5. “SINCERE Visionary eHealthroadmap” SINCERE SME, IntelligenceNetwork for Co-operationin E-health Road mapping Eventsand projects 2007.6. “Connected Health: Quality andSafety for European Citizens”, Reportof the Unit ICT for Health EUcommission 2006.7. “eHealth is Worth it The economicbenefits of implemented eHealthsolutions at ten European sites”, EUcommission.8. “Achieving Electronic ConnectivityIn Healthcare: A PreliminaryRoadmap from the Nation’s Publicand Private- Sector HealthcareLeaders Summary of RecommendationsTechnical Panel”, Connectingfor health & Markle Foundation2004.9. Croatia: “Integrated Healthcare InformationSystem- Croatian CaseStudy The Cornerstone for the NextGeneration Healthcare Sector inRepublic of Croatia”, Ericson.10. Slovenia: “e-Zdravje2010 InformationTechnology ImplementationStrategy in the Health Care Systemof Slovenia 2005-2010”, Republic ofSlovenia Ministry of Health 2005.11. Lithuania: “eHealth strategy andimplementation activities in Lithuania”,eHealth ERA project report2007.12. NHS Highland UK: “eHealthStrategy 2005- 2007 version 1 .4”,2005.13. NHS England: “The National Programfor IT in the NHS” ,Departmentof Health 2006.14. Scotland: “National eHealth/IM&T Strategy 2004 – 2008”,2004.15. Denmark: “eHealth fact sheet-Denmark, eHealth priorities andstrategies in European countries”,eHealth ERA project report 2007.16. Queensland: “eHealth strategy”,Deloitte 2006, “National IT Strategy2003-2007 for the DanishHealth Care Service”, Danish Ministryof Interior and Health 2003.17. Australia: “National Health InformationManagement Information& Communications TechnologyStrategy”, Boston ConsultingGroup 2004.18. British Columbia: “eHealth StrategicFramework”, British ColumbiaeHealth Steering Committee 2005.Corresponding author: Zoran Gajic, EXIT ITBusiness Support Centre, Banja Luka, Bosniaand Herzegovina. E-mail: zoran.gajic@exitcentre.org154 vol 17 no 3 SEPTEMBER 2009AIM 2009; 17(3): 151-154