Good Practice Case of Romania: e‐Health and Interoperability ‐ Healthcare Provider Perspective

author: Cristian Taslitchi, InfoWorld Media Group
published: Feb. 19, 2010,   recorded: January 2010,   views: 3927


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The Romanian healthcare system is in the process of digitizing the health related documents and processes. This leads to many actors in the healthcare system creating their own data exchange models. The problem that has become evident lately is how to ensure the communication between these independent systems and how to expose the exchanged data to the end‐user, the patient. The traditional approach – the paper document exchange has become obsolete in the light of the volume of data that needs to be transferred.

The interoperability from the healthcare provider perspective needs to spit in separate directions according to the business specific: interoperability between healthcare providers, interoperability with payers, and interoperability with Ministry of Health (MoH) for Public Health Reporting.

Regarding interoperability between healthcare providers, a suitable solution should use a technology that would enable its users to interact with multiple heterogeneous systems while at the same time using a comprehensive data contract for communication. The server based communication with HL7 v3, CDA 2.0 documents as a data contract was the chosen solution for the data exchange between healthcare providers. The central actor to apply the solution is Medcenter, one of the most important private healthcare providers in Romania with many clinics and laboratories all over the country. Secondary actors of the solution are a number of hospitals from the national healthcare system that have outsourced their laboratory and radiology activity to Medcenter, National Health Insurance House(NHIH) and the patients for visualizing their medical data through a portal.

Medcenter needed a way to bring together the information about the patients, the results of the examinations performed in the clinics, the results of the tests performed in its laboratories as well as the results of radiology exams. Also, the requests of lab tests and radiology exams coming from hospitals belonging to the national healthcare system and the correspondent results had to be integrated within the same workflow.

The main beneficiaries of CDA based solution are:
‐ the patients as users of – the website where they can access their personal health record and visualize the results of their tests, the results of the medical examinations, radiology exams etc;
‐ the doctors (either specialists in the Medcenter clinics, the hospitals that have outsourced the labs activity to Medcenter or General Practitioners) – because of the possibility to manage the patient's longitudinal health record compiled from multiple healthcare information systems, allowing faster and more accurate diagnosis;
‐ the Medcenter’s nurses – because of the possibility to process multiple requests from different sources simultaneously with increased efficiency.

The HL7 CDA based solution that has been implemented is the common language of the heterogeneous information systems and offers at the same time a unique way of structuring the information. On a more pragmatic level, using the HL7 CDA solution empowers the patients by offering them possibility to visualize online the results of their examinations, tests and investigations and to ask for a second opinion on the diagnostic received. On the other hand, Medcenter as beneficiary of the CDA solution has been able to take advantage of the template based solution and operate changes on templates in use without disrupting its daily processes. This resulted in increased efficiency and reduced operating costs while at the same time maintaining the possibility of checking the semantic integrity of the exchanged documents.

Regarding interoperability with payers, we need to mention that core operational flows are related also to the electronic claiming. Currently, all the county offices of NHIH, the most important payer for healthcare services in Romania, are using a common system (SIUI), system in charge with insurance policy management, contracts between healthcare providers and insurance house, electronic claiming and reimbursement. The system implements extended electronic claiming capabilities for all healthcare specialties and currently Medcenter is able to claim in a batch mode all the performed healthcare services for the beneficiary patients.

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