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Domain meetup: E-Healthcare #2

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Tatiana Lapteva

This document summarizes Ukraine's national eHealth system from its initial idea to ongoing implementation. It provides an overview of Ukraine's healthcare landscape, outlines the multi-phase MVP and EHR implementation projects, and describes some of the technical components including REST APIs, FHIR resources, and data volumes handled. While FHIR has been useful, integrating national clinical processes and releasing updates present challenges requiring coordination across a system of connected but decentralized components.

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National eHealth system in Ukraine from idea to implementation
Healthcare system in Ukraine 42.62 million - total population 25 000 - the number of GPs 6% GDP health expenditure (public + out-of-pocket) 16 million people visit GP at least once a year Government health expenditure: 55.6 billion UAH (2015) 54.0 billion UAH (2016) 75.1 billion UAH (2017) 86,9 billion UAH (2018)
eHealth landscape Fragmented and outdated: Various legacy eHealth systems (medstat, health professional registry) and outdated clinical registries (cancer registry) Lack of national infrastructure like population registry Up to 7% of facilities are covered with EHR solutions, mostly private ones Low level of computer literacy among GPs and poor ICT infrastructure eHealth Center of the MOH - a couple of TORs/strategy documents are produced, nothing is moved to implementation
Primary health care financing reform National health service of Ukraine Registration of HC facilities Registration of GPs IE GPs Employee GPs Registration of the patient-GP declarations Free reimbursed drugs Payments to pharmacies for the reimbursed drugs ePrescription TOOLS FOR ACCOUNTABILITY, EFFICIENCY AND PROCESS ANALYSIS ARE NEEDED Diagnostics eReferral Appointment NATIONAL eHEALTH SYSTEM CAN BE SUCH TOOL
MVP/Project office period (Oct 2016-Feb 2018 )
Approach for eHealth in the context of health care reform Final Goal: complete digitization of healthcare system First Steps: support of the PHC financing reform support of the affordable drugs program
Partners Business State NGOs
Approach for eHealth implementation eHealth Central component: collaboration of project office and business (D, registries, classifiers, reports, rules, regulation and policy, interoperability) Peripheral component: business (interface, end user support and training, additional functionality like appointments)
Domain meetup: E-Healthcare #2
Domain meetup: E-Healthcare #2
MVP ERD Not that simple, huh?
MVP Data Model Facilities, clinicians, declarations registries are inspired by national standards and common sense ePrescription is FHIR inspired, but not 100% FHIR Data model for additional services like uadresses is based on national standards (丐丕丕)
MVP REST API oAuth for authentication and authorization Synchronous+event manager 350+ endpoints
RESULTS
RESULTS
EHR phase 1 period (Aug 2018-Now ) Goals: PHC digitation and transition to ICPC2 Patient summary (national 025/o form)
FINALLY!
FHIR resources in scope of EHR phase 1 Encounter EpisodeOfCare Condition Observation AllergyIntolerance Immunization Device RiskAssessment MedicationStatement
Record volumes Object volume Patients 50.000.000 Visit up to 40.000.000.000 Episode up to 10.000.000.000 Encounter up to 40.000.000.000 Observation up to 500.000.000.000 Condition up to 500.000.000.000 Allergy intolerance 1.000.000.000 Immunization 1.000.000.000
Domain meetup: E-Healthcare #2
EHR phase 1 REST API oAuth for authentication and authorization Asynchronous 150+ endpoints
Domain meetup: E-Healthcare #2
FHIR fits perfectly out of box until You go deeper into national clinical processes and forms ..and and move from CRUDS to the document/composition level You realize that you're responsible for the distribution of classifiers You face FHIR releases and versioning
EHR phase 2 period (Nov 2018-Now ) Goals: Introduction of eReferral Support for the outpatient fee for service pilot
FHIR resources in scope of EHR phase 2 ServiceRequest DiagnosticReport
Security Sorry, not at the moment Nothing specific Penetration tests Pseudonymisation
Conclusions God bless FHIR, still BA>dev Classifiers and their localization is HUGE God bless microservices Overall approach with central component and connected systems is good, but requires a lot of coordination Still, cultures eat strategies for breakfast
Thanks! Eugene Yesakov, National officer on eHealth, World Health Organization CO Ukraine ypmacc@gmail.com

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Domain meetup: E-Healthcare #2

  • 1. National eHealth system in Ukraine from idea to implementation
  • 2. Healthcare system in Ukraine 42.62 million - total population 25 000 - the number of GPs 6% GDP health expenditure (public + out-of-pocket) 16 million people visit GP at least once a year Government health expenditure: 55.6 billion UAH (2015) 54.0 billion UAH (2016) 75.1 billion UAH (2017) 86,9 billion UAH (2018)
  • 3. eHealth landscape Fragmented and outdated: Various legacy eHealth systems (medstat, health professional registry) and outdated clinical registries (cancer registry) Lack of national infrastructure like population registry Up to 7% of facilities are covered with EHR solutions, mostly private ones Low level of computer literacy among GPs and poor ICT infrastructure eHealth Center of the MOH - a couple of TORs/strategy documents are produced, nothing is moved to implementation
  • 4. Primary health care financing reform National health service of Ukraine Registration of HC facilities Registration of GPs IE GPs Employee GPs Registration of the patient-GP declarations Free reimbursed drugs Payments to pharmacies for the reimbursed drugs ePrescription TOOLS FOR ACCOUNTABILITY, EFFICIENCY AND PROCESS ANALYSIS ARE NEEDED Diagnostics eReferral Appointment NATIONAL eHEALTH SYSTEM CAN BE SUCH TOOL
  • 5. MVP/Project office period (Oct 2016-Feb 2018 )
  • 6. Approach for eHealth in the context of health care reform Final Goal: complete digitization of healthcare system First Steps: support of the PHC financing reform support of the affordable drugs program
  • 8. Approach for eHealth implementation eHealth Central component: collaboration of project office and business (D, registries, classifiers, reports, rules, regulation and policy, interoperability) Peripheral component: business (interface, end user support and training, additional functionality like appointments)
  • 11. MVP ERD Not that simple, huh?
  • 12. MVP Data Model Facilities, clinicians, declarations registries are inspired by national standards and common sense ePrescription is FHIR inspired, but not 100% FHIR Data model for additional services like uadresses is based on national standards (丐丕丕)
  • 13. MVP REST API oAuth for authentication and authorization Synchronous+event manager 350+ endpoints
  • 16. EHR phase 1 period (Aug 2018-Now ) Goals: PHC digitation and transition to ICPC2 Patient summary (national 025/o form)
  • 18. FHIR resources in scope of EHR phase 1 Encounter EpisodeOfCare Condition Observation AllergyIntolerance Immunization Device RiskAssessment MedicationStatement
  • 19. Record volumes Object volume Patients 50.000.000 Visit up to 40.000.000.000 Episode up to 10.000.000.000 Encounter up to 40.000.000.000 Observation up to 500.000.000.000 Condition up to 500.000.000.000 Allergy intolerance 1.000.000.000 Immunization 1.000.000.000
  • 21. EHR phase 1 REST API oAuth for authentication and authorization Asynchronous 150+ endpoints
  • 23. FHIR fits perfectly out of box until You go deeper into national clinical processes and forms ..and and move from CRUDS to the document/composition level You realize that you're responsible for the distribution of classifiers You face FHIR releases and versioning
  • 24. EHR phase 2 period (Nov 2018-Now ) Goals: Introduction of eReferral Support for the outpatient fee for service pilot
  • 25. FHIR resources in scope of EHR phase 2 ServiceRequest DiagnosticReport
  • 26. Security Sorry, not at the moment Nothing specific Penetration tests Pseudonymisation
  • 27. Conclusions God bless FHIR, still BA>dev Classifiers and their localization is HUGE God bless microservices Overall approach with central component and connected systems is good, but requires a lot of coordination Still, cultures eat strategies for breakfast
  • 28. Thanks! Eugene Yesakov, National officer on eHealth, World Health Organization CO Ukraine ypmacc@gmail.com