E-health Croatia

Key Facts

• The Healthcare Networking Information System represents a comprehensive solution designed for the integration of healthcare processes, information management and business workflows for healthcare organizations, enterprises and delivery systems. It is developed as a modular, secure, and open communication platform that efficiently synergizes common enterprise integration services with healthcare specific application components.
  

• With care services supported by the system, care delivery organizations and enterprises can boost the efficiency of their financing, planning and the quality of care provision in a secure environment. To date some 2400 primary healthcare teams in all 20 counties and in the City of Zagreb have been networked. The first phase was initiated 2005, since then a number of phases were delivered.

  The solution allows e-prescription and e-referrals to be sent directly to pharmacies and labs / hospitals instead of carrying paper documents (printout). Retrieving and updating patient medical data (electronic healthcare record system). The solution also includes e-booking and e-reporting.
  

• The project took 6 months to implement

• Additional benefits that accrued include:

  • Organizational benefits, ie: allowing for a more efficient healthcare organization
  • Higher-quality business processes in administration, procurement, human resources management, patient data management, accounting, billing, continuous performance monitoring and reporting, etc.
• The primary sponsor for the project was The President of Ericsson Croatia

What was the impact?

• Did you use a specific methodology or third party to calculate CO2e or KWh savings?

  Life Cycle Assessment.

• Notes about Carbon savings/calculations

  • 10 percent of the system is allocated to the e-referral service, based on the fact that about 10 percent of the system’s PCs were installed in parallel to the overall solution.
  • The two services, e-referrals and e-prescriptions, together enable reductions of up to 15000 tons of CO2e/year.  
  • About 330 tons of CO2e/year of the emissions from operation and manufacturing activities are allocated to the services, which can give a reduction factor of up to 50. 
  • The results are based on assumptions that approximately 12 million patient visits per year can be reduced by 50 percent by the e-referral service. An average patient visit is assumed to require travel of 20 km, 25 percent by car and the rest by public transport.
    

  
  

• Comments on other resources saved

  By assuming that 50 percent of the prescriptions can be replaced by the e-prescription service, approximately 77 tons of paper per year can be saved.
  
• The project has independent verification for results

Making it Happen

• The following regulations or incentives allowed the business case to be more attractive

  The Croatian Institute for Health Insurance and the Ministry of Health and Social Welfare pay a monthly amount to all doctors who decide to join the e-health system (i.e. get networked). The amount is intended to cover their costs regarding the telecom link, license/ program maintenance, purchase of defined computer equipment. The amount is meant as an incentive.

• Barriers experienced during the initiation of the project

• Comments regarding barriers

  With no existing system to replace or upgrade, Ericsson was able to base the design on the latest technologies, equipment and methodologies.

  • To start from nothing implied a high degree of coordination between the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian National Institute of Public Health and Ericsson Nikola Tesla.
  • Solution deployment was delayed by legal and regulatory issues and obstacles regarding the electronic communication, commerce and invoicing.
  • E-signature Law had to be enforced
  • Current legislative issues include the "Rule Book" on prescribing and giving medications and the "Rule Book" defining the rights and entitlements in primary healthcare. Due to this, certain functionalities cannot be implemented yet.

• How were they overcome?

  Both Rule Books will be enacted soon.

• What were the key lessons learnt?

  To be the first in the field and to create something totally new requires a lot of effort, enthusiasm and expertise.