Viete čo je E-Health? | Medicínske právo
              

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Viete čo je E-Health?


 | 16.6.2010 | komentárov: 444

Ministerstvo zdravotníctva SR na svojom webe uverejnilo zaujímavý materiál s témou E-Health. Ide o aktuálnu tému, s ktorou je dobré sa oboznámiť...

Obrazok Čo si má predstaviť občan pod pojmom eHealth?

eHealth alebo elektronické zdravotníctvo je podpora starostlivosti o Vaše zdravie prostredníctvom výpočtovej techniky a Internetu.        

Podpora spočíva napríklad v tom, že:

•    Národný zdravotný portál Vám aj Vašim lekárom poskytne informácie o chorobách, liekoch, nemocniciach, ambulanciách, metódach liečenia, varovania v prípade pandémie alebo ohrozenia a mnoho iných informácií. Na tieto informácie sa bude dať plne spoľahnúť.                            
•    Elektronická zdravotná knižka občana Vám a Vášmu lekárovi dáva k dispozícii v potrebnom čase a na potrebnom mieste všetky dôležité informácie o Vašom zdraví, ale aj o vykonaných zdravotných výkonoch.  Na základe týchto informácií sa skvalitní lekárovo aj Vaše rozhodovanie, zníži sa počet vyšetrení, aj riziko chyby alebo omylu.                             
•    Elektronická preskripcia a medikácia umožnia skvalitniť proces predpisovania aj zháňania potrebných liekov. Systém kontroly liekov Vás upozorní -  ak by Vám predpisovaný liek alebo rôzne lieky navzájom mohli škodiť. Dostanete informáciu, v ktorej lekárni sa potrebný liek nachádza. Zároveň systém zabráni zneužívaniu verejných zdrojov v oblasti liekov.
•    Elektronické objednávanie Vám umožní prostredníctvom Internetu sa objednať k Vášmu obvodnému lekárovi, aj niektorým špecialistom.  Pripomenie Vám pred dlhším časom objednané vyšetrenie, oznámi výsledky z laboratória.
•    Telemedicína umožní chronicky chorým znížiť počet návštev lekára. Ich zdravotný stav totiž môže byť monitorovaný na diaľku. Ak sa vyskytne zdravotný problém, je o tom upovedomený ošetrujúci lekár, prípadne záchranná služba, ktorá následne zasiahne.

Aké sú princípy a zásady budovania národného eHealth riešenia?

    Celospoločenský konsenzus.
    Služby pre všetkých.
    Transparentnosť.
    Koordinácia, súčinnosť a spolupráca.
    Interoperabilita a kompatibilita.
    Bezpečnosť je prioritou.
    Ochrana investícií.
    Programové riadenie.
    Implementácia v súlade s absorpčnou schopnosťou používateľov (nie „veľký tresk“).
    Kritické zhodnotenie realizovaných krokov a poučenie z chýb (lessons learned).

Aké sú strategické ciele eHealth?

Vytvorenie legislatívneho, normatívneho a architektonického rámca eHealth.
Vytvorenie bezpečnej infraštruktúry pre realizáciu vízie a poslania eHealth.
Informatizácia   procesov a  služieb v systéme zdravotníctva z verejných zdrojov.
Podpora nových procesov a foriem zdravotníckych služieb a zdravotnej starostlivosti prostredníctvom eHealth.


Môžete popísať  aký  je časový sled  implementácie eHealthu?

Národný program implementácie eHealth bude realizovaný v r. 2009 – 2013 v troch vlnách,  každá má  osobitné priority.

Prvá vlna :
1.    Národný zdravotný portál
2.    Elektronická zdravotná knižka občana – 1. etapa
3.    Elektronická medikácia a preskripcia – 1. etapa
4.    Elektronické objednávanie

Detailná špecifikácia priorít je  v štúdii uskutočniteľnosti  - schválená riadiacim výborom OPIS – „Štúdia uskutočniteľnosti projektov prioritnej osi č. 1 Elektronizácia verejnej správy a rozvoj elektronických služieb Operačného programu Informatizácia spoločnosti  - zameraná  na rozvoj služieb eGovernmentu na centrálnej úrovni - Elektronické služby zdravotníctva –  eHealth služby občanom  (Prvá prioritná oblasť)“. ( www.informatizacia.sk )

Prečo práve tieto 4 priority?  

Východiskom je materiál „Strategické ciele eHealth“ (schválila vláda SR 16.7.2008). Podrobnejšie informácie  na www.rokovania.sk.
 
Aké prínosy očakáva MZ SR od zavedenia elektronickej zdravotnej karty pre zdravie občanov?

Občan získa    
-    vyššiu kvalitu poskytnutej zdravotnej starostlivosti
-    možnosť komunikovať aj elektronickou cestou so systémom poskytovania zdravotnej starostlivosti z verejných zdrojov
-    prehľad o poskytnutých zdravotníckych službách, príslušných nákladoch a o možnostiach zdravotníckych služieb, ktoré sa ho týkajú
-    zdravotná dokumentácia: bude zabezpečená jej nepretržitá dostupnosť autorizovaným subjektom, dôvernosť a integrita, ochrana pred stratou
-    skrátenie času administratívnych prestojov
-    zníženie duplicít vo vyšetreniach
-    zvýšenú kvalitu prijímaných zdravotníckych služieb znížením chybovosti diagnostiky a terapie zvýšením kvality diagnostiky a monitoringom celého liečebného postupu
-    ľahko dostupné podklady pre rozhodovanie o svojom zdravotnom stave, výbere poskytovateľa zdravotnej starostlivosti, liekovej preferencii

-  zníženie úmrtnosti
-  zníženie chorobnosti
-  zníženie trvalých následkov
-  zníženie dočasných následkov
-  zvýšenie kvality a kvantity poskytovanej zdravotnej starostlivosti
-  zníženie nákladov na doplatky
-  zníženie nákladov na dopravu k lekárom
-  zníženie strát a výpadkov v príjmoch  znížením zdravotných dopadov
-  ušetrený čas
-  lepšia informovanosť občanov o zdravotníctve

Konkrétny príklad:

Lekár má po súhlase občana v krátkom čase k dispozícii dostupné  informácie z diagnostiky a liečby – predpísané lieky, výsledky laboratórnych testov.

•    Pacient  nemusí prácne vyhľadávať  staršie snímky, lekár čakať na papierové podklady od kolegov. Proces je rýchly, klesá riziko chyby lekára v dôsledku nedostatku informácií  - dôležité napr. pri onkologických pacientoch).

•    Ak lekár potrebuje napr. snímkovanie alebo laboratórne testy, najprv si v elektronickej zdravotnej knižke zistí, či nedávno podobné vyšetrenie nevykonal iný lekár. Ak áno, použije tieto výsledky. Prínosom bude  zníženie duplicity vyšetrení, nákladov, šetrenie času pacienta aj lekára.

•    Ak sa má občan zúčastniť na prehliadku alebo vyšetrenie, ktoré má vzdialenejší termín,  často naň zabudne. Lekár si tak  rezervuje čas na pacienta, ale ho vlastne nevyužije. Preto občan dostane deň pred vyšetrením automaticky SMS správu, ktorá mu  termín  u lekára pripomenie.

•    U starších ľudí je často problémom to, že užívajú  veľa liekov. Ak chce lekár predpísať nový liek, je dôležité, aby dal pozor na liekové interakcie. Lekár však nemá možnosť zistiť, či si v ambulancii pacient spomenul na všetky lieky, ktoré užíva . V Elektronickej zdravotnej knižky občana (EZKO) budú informácie o liekoch, ktoré pacient  užíva, rýchle ich bude mať k dipozícii, predpis bude jednoduchší, efektívny.  

•    Občan pri predpísaní lieku dostane aj  informáciu, v ktorých najbližších lekárňach liek  dostane.

Prínosy – zhrnutie:   

Zdravotníctvo bude efektívnejšie    
-    znížia sa náklady na administratívne činnosti
-    zvýši sa úroveň cielenej prevencie ochorení
-    znížia sa náklady odstránením duplicít vo vyšetreniach, vykazovaním fiktívnych výkonov, nesprávnou preskripciou
-    znížia sa sekundárne náklady na zdravotnú starostlivosť v dôsledku zníženia chybovosti diagnostiky, preskripcie a liečby
-    dôjde k zníženiu korupčného správania v zdravotníctve


Poskytovatelia zdravotnej starostlivosti získajú    
-    ich informačné systémy sa budú môcť  pripájať na základné registre a efektívne ich využívať
-    znížia sa náklady na administratívne činnosti
-    budú definované štandardy pre elektronický identifikátor, formáty pre tvorbu a ukladanie záznamov, komunikáciu s ďalšími subjektmi v zdravotníctve
-    jednotlivé IS (ambulantné, ekonomické, manažérske, nemocničné, lekárenské, špecializované) na úrovni ambulancie a nemocnice budú plne interoperabilné, schopné v definovaných formátoch navzájom komunikovať
-    komunikácia s ďalšími subjektmi bude prebiehať v elektronickej zabezpečenej forme
-    elektronická preskripcia  zjednoduší a sprehľadní celý proces

Zdravotné poisťovne získajú    
-    znížia sa náklady odstránením duplicít, znížením chybovosti a skrátením časov na realizáciu čiastkových činností
-    znížia sa náklady na administratívne činnosti
-    bude definovaný elektronický identifikátor pacienta a poskytovateľa
-    údaje pre near on-line  monitoring realizovaných zdravotných výkonov
-    komunikácia s poskytovateľmi pobeží v elektronickej zabezpečenej forme
-    dôjde k zefektívneniu komunikácie s poskytovateľmi zdravotnej starostlivosti

Zvýši sa kvalita dohľadu nad zdravotnou starostlivosťou    
-    dohľad nad zdravotnou starostlivosťou bude mať k dispozícii podklady na proaktívny monitoring
-    pri riešení jednotlivých podnetov získa ÚDZS z auditovacích záznamov dostatok podkladov k rýchlym a relevantným rozhodnutiam,
-    posilnení sa integračná a analytická funkcia ÚDZS vo vzťahu  k zdravotným poisťovniam s cieľom odhaľovania negatívnych dopadov na financovanie zdravotnej starostlivosti

Ako vlastne charakterizujete  elektronickú  zdravotnú  knižku?


Elektronickú zdravotnú knižku  definuje novela zákona 576/2004 Z.z.:

(1) Elektronická zdravotná knižka (v ďalšom EZKO) je zdravotnícky informačný systém zabezpečujúci spracovanie, uchovávanie, poskytovanie a prezentáciu údajov súvisiacich so zdravím fyzických osôb a poskytovaním zdravotnej starostlivosti z verejného zdravotného poistenia týmto osobám za účelom skvalitnenia starostlivosti o ich zdravie.
Údaje v Elektronickej zdravotnej knižke sú tvorené:
a)    z výpisov zo zdravotnej dokumentácie uvedenej osoby uložených v úložisku Zdravotne relevantných záznamov,
b)    zo záznamov Národných zdravotných registrov a Národných administratívnych registrov (§44 ods. 3 a 4.) týkajúcich sa uvedenej osoby,
c)    z údajov zdravotných poisťovní týkajúcich sa uvedenej osoby,
d)    z vlastných záznamov uvedenej osoby týkajúcich sa jej zdravotného stavu.

Vytvorenie EZKO znamená vytvorenie štruktúry (akoby prázdneho formulára), v ktorom budú demografické udaje z registra obyvateľov (REGOB) a registra prijímateľov zdravotnej starostlivosti. Do tejto knižky budú automaticky vložené  dáta občana o poskytnutej zdravotnej starostlivosti získané zo zdravotných poisťovní. Tieto dáta sa zbierajú aj dnes v elektronickej podobe a centrálne sa ukladajú  v informačnom systéme  zdravotných poisťovní.


Digitalizácia  zdravotnej dokumentácie v papierovej podobe – legislatívne znenie:

Už dnes je možné požiadať o výpis zo zdravotnej dokumentácie v papierovej podobe u  všeobecného lekára za poplatok. „Po novom“ bude vytvorený elektronický formulár pre pacientský sumár, údaje sa prenesú do Elektronickej zdravotnej knižky daného občana.  Poplatok bude rovnaký ako je dnes.
Je možné, ze zdravotné poisťovne chronicky chorým  pacientom uhradia  prenos  historických údajov dôležitých pri liečbe daného pacienta, ak  tento krok zvýši efektívnosť liečby a zníži náklady.
Ak bude mať niekto záujem o scanovanie alebo elektronický prepis časti zdravotnej dokumentácie, pôjde o štandardne platenú činnosť mimo všeobecných lekárov.

Historické zdravotné údaje do zdravotnej knižky zapíše vo forme elektronického výpisu zo zdravotnej dokumentácie  poskytovateľ všeobecnej  ambulantnej starostlivosti  na základe žiadosti osoby, s ktorou má uzatvorenú dohodu o poskytovaní všeobecnej ambulantnej starostlivosti.  Vytvorenie takéhoto  výpisu je službou súvisiacou s poskytovaním zdravotnej starostlivosti podľa § 13 písm. h) uhrádzanou na podľa osobitného predpisu58).

Aj v ďalších  krajinách EÚ, ktoré sú už v procese implementácie eHealth-u  (napr. Dánsko implementuje eHealth  15 rokov) sa  neuskutočnila plošná digitalizácia historických záznamov. Buď si tento prenos  občania hradili sami, alebo v prípade, že  zdravotné poisťovne  považovali za finančne efektívne mať digitalizované záznamy chronických pacientov s nákladnou liečbou, tak im to uhradili (tiež vo forme elektronických výpisov).  

Historické zdravotné údaje o občanovi budú okrem výpisov k dispozícii z týchto zdrojov:
-     údajov zdravotných poisťovní, ktoré vedú evidenciu vykázanej zdravotnej starostlivosti,
-     údajov, ktoré majú poskytovatelia zdravotnej starostlivosti v svojich informačných systémoch.  Tieto údaje budú odovzdávané medzi systémami, bez potreby  aktivity zdravotníckeho pracovníka.


Ako by mala EZKO vizuálne vyzerať? Má to byť nejaká čipová karta, ako napríklad kreditná karta?

EZKO je elektronický zdravotný záznam, ktorý bude prístupný cez Národný zdravotný portál.  Vizuálne stvárnenie týchto informácií bude podobné, ako už dnes existuje v nemocničných informačných systémoch. EZKO si môžeme predstaviť napr. ako bankový účet  občana. Ten tiež nemá fyzickú podobu, ale prístup je  elektronický.  Konkrétny vizuálny návrh EZKO je síce vecou víťaza súťaže na prvú vlnu eHealth, ale prvý návrh vizualizácie spracovali pracovníci NCZI.

 
Od januára  2013 sa bude EZKO dávať  všetkým novonarodeným občanom ?

Áno, všetkým občanom SR, vrátane  novonarodených, ale historické dáta sa budú  prenášať  do roku 2017.


Ako sa ku knižke  dostane lekár a pacient?

Prístup k EZKO bude podobne ako v Dánsku a u ďalších lídrov eHealthu v EÚ prostredníctvom Národného zdravotného portálu (NZP).  

Lekár sa prihlási na Národný zdravotný portál (NZP), identifikuje a autentizuje sa bezpečným spôsobom (prostredníctvom karty zdravotníckeho profesionála). V menu si vyberie oblasť služieb EZKO. Do ordinácie príde pacient, o ktorom je potrebné získať údaje z EZKO. Pacient dá  súhlas lekárovi na prístup k svojim zdravotným údajom prostredníctvom tokenu, ktorý má zo sebou (napr. eID alebo elektronická karta poistenca).  Lekár získa prístup  k údajom pacienta a môže s nimi pracovať. O prístupe k údajom sa  automaticky vytvorí  záznam.  Pre každú  špecializáciu lekára je určená skupina zdravotných záznamov, ktoré potrebuje k svojej práci.

Ak pacient bude chcieť,  môže lekárovi udeliť trvalý prístup k EZKO, ale aj ho obmedziť. Je potrebné si uvedomiť, že Váš ošetrujúci lekár pre poskytnutie kvalitnej zdravotnej starostlivosti potrebuje údaje o Vašom zdraví. Všetky kroky sa však uskutočnia iba na základe súhlasu pacienta priamo u lekára  alebo vopred (napr. údaje pre záchrannú službu – emergency data set).

Technické detaily riešenia a najmä vysoká úroveň bezpečnosti – to bude úloha pre budúceho riešiteľa (riešiteľov) eHealth v rámci OPIS.


Je možný aj prístup z domu?

Pacient / občan  sa k svojim zdravotným údajom dostane buď u lekára, alebo prístupom na Národný zdravotný portál (NZP)na zabezpečenom mieste (napr.  v rámci služieb eGovernmentu, v kancelárii svojej zdrav.poisťovne) a ak bude chcieť, aj z pohodlia domova. K tomu bude potrebovať bezpečnú identifikáciu a autentizáciu na NZP.  Mieru bezpečnosti si zvolí  sám, podobne ako pri Internetbankingu (napr. grid karta, token jednorazových hesiel a pod.).  

Údaje v EZKO si bude môcť prezerať, ale nie meniť zdravotné záznamy. Bude si môcť do vyhradenej oblasti dopísať svoje záznamy, meniť pravidlá prístupu k svojim údajom pre lekárov, alebo si svoje údaje aj stiahnuť napr. na USB pamäť.

Aj v tomto prípade technické detaily riešenia a najmä vysoká úroveň bezpečnosti – budú úlohou pre budúceho riešiteľa (riešiteľov) eHealth v rámci OPIS.


Aké  potrebuje ambulancia  technické vybavenie ?
 
Pripojenie k Internetu v postačujúcej kvalite pre ambulacniu je možné získať za 9, 9 eura (300 Sk) mesačne. Počítač používajú lekári aj dnes -  minimálne na  zasielanie výkazov pre zdravotné poisťovne. Väčšina lekárov už má v počítači informačný systém (IS) pre podporu ich práce (ambulantný IS, lekárenský IS, laboratórny IS, všetky nemocnice majú komplexné IS).
 
 
Prihliada sa aj na vekovo starších lekárov ( v preddôchodkovom, resp.dôchodkovom veku), ktorí by mohli mať problémy so zavádzaním  informatizácie?

Takéto názory  nie sú opodstatnené. Starší, skúsení lekári určite nebudú mať problém prispôsobiť sa novému systému,  medicína napreduje, preto sa každý lekár neustále vzdeláva, je to súčasť tohto povolania. Preto skôr treba  klásť otázku,  ako zabezpečiť, aby boli eHealth aplikácie rýchlo pochopiteľné a prijateľné pre lekárov a nezaťažovali ich.  Práve to je úlohou Národného centra zdravotníckych informácií,  ktoré je  Národným operátorom e Healtu.


Kedy vznikne Národný zdravotný informačný systém a Národný zdravotný portál?

Národný zdravotný portál bude k dispozícii od r. 2012, podobne aj prvé aplikácie v rámci Národného zdravotného informačného systému. Prototypy budú postupne prezentované v r. 2010, pilotné projekty sa rozbehnú v r. 2011.

Kedy sa bude možné  objednávať cez internet?

Od r. 2012.

Kedy začnú  fungovať  recepty na elektronický  predpis?

Od r. 2012  - ak bude schválená príslušná legislatíva. Rozbehnutie od pilotného projektu až po 90 %- tnú  využiteľnosť elektronických receptov odhadujeme na 5 rokov. V Dánsku, ktoré je v rámci EÚ lídrom tohto procesu,  trval vyše 10 rokov.


Ako bude pri eHealth-e zabezpečená bezpečnosť údajov o pacientovi, aby sa jeho zdravotné záznamy nedali zneužiť?

Osobitnú pozornosť venovať požiadavkám  na ochranu osobných údajov  - bezpečnosť bude realizovaná na základe schváleného bezpečnostného zámeru a projektu, detailne upravené postupy budú uvedené v bezpečnostných smerniciach.
Mimochodom, občan bude mať k dispozícii  informácie o všetkých transakciách, ktoré prebehli s jeho osobnými údajmi s tým, že nie je možné túto požiadavku obísť ani na úrovni správcu. Bezpečnostný mechanizmus zabezpečí, aby  databázy a dátové úložiská obsahujúce osobné údaje boli konfigurované tak, aby aj pri využití, zneužití či kompromitácii prístupových práv oprávnených osôb na úrovni správcov, nemohlo dôjsť k  masovému úniku osobných údajov.
Balík bezpečnostných opatrení je veľmi široký a najprísnejší v rámci  národných eHealth systémov v celej  EÚ.
Bezpečnosť a ochrana osobných údajov je najvyššou prioritou v eHealth. Ide o realizáciu množstva bezpečnostných opatrení nielen technického rázu, ale aj z oblasti administratívnej a personálnej bezpečnosti, ktoré nie je možné opísať niekoľkými vetami. Bezpečnostné opatrenia budú zamerané na dôvernosť osobných údajov, zabezpečenie dostupnosti a integrity systémov a služieb. Systém bude navrhnutý tak, aby sa ani administrátori nemohli dostať k zdravotným údajom, prístup lekárov k údajom bude na základe súhlasu pacienta a pacient bude mať informácie o všetkých prístupoch lekárov k svojim zdravotným záznamom. Celý systém bude monitorovaný z hľadiska činnosti vnútorných používateľov a možných pokusov o narušenie zvonku.

Kedy a ako sa ukážu prvé praktické výsledky eHealthu?

Očakávame ich  do 12 mesiacov od podpisu zmluvy s riešiteľom prvej vlny eHealth v oblasti autorizovaných informácií na Národnom zdravotnom portáli, v elektronickej medikácii. Vzniknú prvé stránky Elektronickej zdravotnej knižky občana – napr. elektronický očkovací preukaz.

Najprv sa budú všetky služby eHealth realizovať  formou  prototypu, neskôr ako malý pilotný projekt (napríklad v rámci jednej nemocnice, zdravotníckeho zariadenia), následne ako veľký pilotný projekt (realizovaný v rámci regiónu) a až potom sa projekt začne celoplošne.  Cieľom je, aby sa  včas identifikovali a odstránili všetky problémy, ktoré sa počas prevádzky môžu vyskytnúť, zároveň sa spracujú aj  praktické pripomienky používateľov.

Dokedy bude ukončený celý proces elektronizácie zdravotníctva?

Proces bude mať  niekoľko etáp  (viď  Strategické ciele eHealth)  tri  vlny budú  do konca r. 2013, druhá veľká etapa do r. 2018.  Ani po tomto termíne sa však eHealth nezastaví, budú sa  pridávať nové služby. Napr. v Dánsku pracujú na elektronizácii zdravotníctva od r. 1993 a ešte zďaleka nie sú na konci cesty.  


Čo prinesie eHealth v liekovej oblasti? Bude elektronický záznam pacienta prístupný aj v lekárňach?

Niektoré prínosy eHealth v liekovej oblasti sme už uviedli. Spočívajú  v tom, že lekár bude mať k dispozícii v čase preskripcie všetky potrebné informácie pre výber správneho lieku, systém zdravotníctva bude mať k dispozícii analytické podklady pre efektívny manažment liekovej spotreby, celý proces bude efektívnejší a transparentnejší.  

Časť elektronického záznamu pacienta v rozsahu potrebných preskripčných informácií bude dostupný aj v lekárňach. Vždy ale s podmienkou súhlasu pacienta na prístup k informáciám.

zdroj: health.gov.sk
pôvodné umiestnenie tu.
foto: api.ning.com





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