An eHealth suite for the support of Primary Health Care. Athena Triantafyllidi, IT Director at IDIKA explains the developments behind the eGov organisation for Social Security and what led them to be considered one of the leading European examples in implementing a digital reference for all those living in Greece. Twitter: @idikagr

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2.  HDIKA completed during 2015 a big national project that provides an eHealth
suite with a wide range of tools and services that upgraded the already
successful ePrescription system at a national level (National eAppointment,
Patient Summary, Patient Consent, Patient Access, EHR etc.).
 All these tools and services are accessed
◦ by Medical experts (physicians/pharmacists etc.) via a single secure account (the mature
user management of the ePrescription system). Single sign on (SSO)
◦ by citizens/patients via the Taxis Net credentials and the use of AMKA
 Integrated modules offer the user the ability to access all services under a
common framework
◦ easier to adopt and integrate a new procedure in his daily workflow.
 The types of indicators (KPIs) that could be generated is key to help a practice
actively manage patients, track operational indicators, and meet meaningful
use, and regulatory requirements.
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4. Verification
of executed
Prescription
by scanning
(off-line)
INTERNET
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3.
eP
DATABASE
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7.
8.
The National e-P system: Overall structure
Control / on-line payment / other
HC ORGS / EOPPY
Doctor
Pharmacy
/ Lab
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5. Ruled based prescription and referrals validation
Compatability between diagnosis and drug prescribed
Direct prescription execution and expenditure control
Reduction of medication errors
Patient Medication Summary
Monitoring of prescribing behavior
Electronic drug validation and control of the validity, legality of drug
movement to the supply chain
Accurate statistical data ensuring complete transparency and
important contribution to the decision making policy
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6.  For the patients:
◦ Provides easier prescription and medication pick-up procedures
◦ Reduces the risks associated with traditional prescription script writing
(error-free, accurate, and understandable prescriptions)
◦ Increases patient safety (rule based prescriptions, checked for harmful
interactions)
◦ patients can choose for the first time the drug they wish (list of equivalent,
including generics)
 For the physicians:
◦ Helps for better alignment with guidelines and prescription rules
◦ allows review of patient’s medical history
◦ on-line notification of drug interactions
◦ on-line review of the cost of prescription produced
 For the pharmacists:
◦ Reduces the number of mistakes by misreads
◦ Simplifies administrative and reporting procedures
◦ Simplifies and speeds up the claiming procedure
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8.  The eP system already helped identify several administrative problems and abuses,
that helped improve services and contain medication costs
 The overall savings achieved have been estimated by the supervising ministry
to several million Euros per month .
32.55
29.77
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9. Portal
- Secure – Authorized
Access
- Communication and
forums
Patient Data
- Demographic data
- Patient Summary
- EHR
- Social Security
Coverage
Health Professionals’
transactions
- Physicians
- Pharmacists
- Laboratories
Patient transactions
- Medical Visits
- Prescriptions
- Referrals or clinical
tests
- Patient consent
- Patient Access
Business Intelligence
- BI Reporting
- Data Analysis
- Risk Management
- Fraud Detection.
Good Practices
- Theraupeutic
Protocols
- Diagnostic Protocols
- SPC filters
Financials
- Clearance
- ePayments
- Access to financial
data
Interoperability
-
Interface with other
platforms
- Medicine’s National
Database
- National Social
security Registry
- Doctor’s,
pharmacist’s and
Laboratories’
software
- Hospital’s ERPs
- EPSOS Standards
 43.000 doctors
 11.900 pharmacies
 5.500.000 prescriptions /
month
 2.000.000 diagnostic referrals /
month
 2.900.000 patients served /
month
10 million unique patients
served since the start of ePre
System
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11. In the following slides we will briefly describe related to the concept of
supporting PHC subsystems:
 Patient’s medical appointments
 Therapeutic Prescription Protocols
 Patient Summary
 Electronic Health Record
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12. The system supports for the first time a single database which record all
medical appointments and in which all citizens have access free of charge
(Health Service Market Place)
Concerns all health providers:
 Health Centers
 Hospitals
 Doctors
Addressed to:
 Citizens
 Health providers
 5-digit support telephone numbers
 Disability Certification Centers
(KEPA)
 Citizen Service Center (KEP)
• Total appointments during 2016
4.357.000
• About 12.000 appointments per day
(Scheduled+ rescheduled).
• Since December 2016 citizens have access to
the electronic platform to arrange their medical
appointment via their Taxis Net credentials and
the use of their AMKA.
• Reduce costs per year
 1.5 million for the State
 1.8 million for the citizens
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13.  7 Health Care Regions
• Overall management/control of the health units
• User Management
• Data management of the units
 Health providers (Health Units, Health Centers, Hospitals)
• Data management of the units
• Appointment Schedule Setting
• Appointment Scheduling
 Doctors
• Users of e-prescription are logged in using SSO within e-prescription portal as individual
providers
• Management of their private appointments
• View appointments that are about to execute in health providers that they are employed
• Prints of all scheduled appointments
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14.  5-digit telephone numbers
• Detection and scheduling of appointments of health providers that are included in their
contract
• Determination of system administrator (IDIKA S.A) of the groups or particular health
providers for which each company can detect and schedule appointments
 Citizens
• Access to web application using TAXIS net credentials
• Detection/ scheduling/cancellation/rescheduling of appointments
• Print appointments
• View history of appointments
 KEPA (Disability Certification Centers)
• Pumping doctors to perform committees
• The system handles automatically exceptions for these doctors during the days of
committees
 KEP (Citizen Service Center)
• Universal detection and appointment scheduling to all health providers
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15. Services:
 The provider handles and publish the available appointments (non private)
 The individual plans an appointment for a specific provider
 The provider handles non publishing appointments (private)
 All types of appointments:
Regular, evening, unscheduled, ΕΟΠΥΥ, private
Search Criteria:
 Geographically (region, city, postal code)
 Date and Time
 Specialty
 Type of health provider
 Specific clinic/doctor
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16. • Prescription Guidelines have been integrated on the ePrescription
system:
Dyslipidaemia, Osteoporosis (5 protocols), Rheumatoid Diseases (rheumatoid arthritis,
osteoarthritis, gout, psoriatic arthritis, axoniki spondyloarthritis), hypertension, diabetes,
yperyrouchaimia, dementia, chronic obstructive pulmonary disease, exacerbation of chronic
obstructive pulmonary disease, bronchitis, early/installed Parkinson.
• Prescription Guidelines under construction on the ePrescription system:
Thromboembolic disease (6 protocols) epilepsy, early/installed psoriasis, cardiac arrhythmia.
• The development of the eTPP has the following objectives and benefits:
Common form and common coding and nomenclature for all protocols
Usable and easily accessible and searchable
Information-rich content combining ICD-10 codes for diagnoses and
standard EOF ATC4/ATC5 coding for Medicines
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17. • The eTPP for medicines developed by medical societies with the coordination of the
Athens Medical Society,
• Fully adapted guidelines and prescription protocols based on the up-to-day evidence.
• Have already been developed Prescription Protocols for thirteen therapeutic
categories (a total of 40 protocols).
• To make the use of Prescription Protocols mandatory, they are incorporated into the
e-prescription application. Appropriate “controls” can be activated at any stage to
limit the prescription according to various criteria, such as:
• proper medical practice
• cost
• negative & positive list of medicines
• use of generics
• etc.
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Textual Data Machine processable Information
The representation model of eTPP includes five upper levels
of information:
• General Information of Protocol
• Treatment steps
• Sub-conditions at each step
• Treatment at active substance level
• Treatment at medicine product level

19.  The implementation of patient summary supports the national
ePrescription based on the European Patient Summary guidelines
 Patient data from individual health data sources (Hospitals, ePrescription,
e.t.c) universally accessible.
Demographic data
•ΑΜΚΑ
•Full name
•Date of birth
•Sex
•Communication data
•Health insurance data
•Country
Administrative data
•Date of creation
•Date of last update
•Data of compliance history carrier
Clinical data
•Messages/alerts
Allergies and other important health labels
•History of diseases
Vaccinations
Surgeries and other major medical incidents
•Medical Issues
Current medical issues/ diagnoses
Surgeries, medical implants/devices the last 6 months
Therapeutical treatment
Autonomy / disability
•Medicinal history
Current/ past medication
•Diagnosis examinations
Basic diagnostic parameters / blood types
•Pregnancy history (women)
Codings:
•Diagnoses ICD10
•Symptoms ICPC-2
•Medical Procedures (ΕΟΠΥΥ code)
•Medication ATC5, (national organization of medicines code)
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22.  Internationally standards for the exchange of medical data were followed.
 Data exchange between the hospital sending discharge notes, and also
between Patient Summary and Electronic Prescribing Service, is
performed using the CDA (Clinical Document Architecture) format, which
is one of the most widely used standards of HL7. The CDAs exchanged is
formatted in XML format and the structure is modeled following epsos
standard (http://www.epsos.eu/home/about-epsos.html), so as to ensure
maximum interoperability with other European information health
systems.
 Coding Standards included are:
◦ ICD-10 (diagnosis)
◦ ICPC2 (diagnosis for primary care)
◦ ATC5 (Medicines-Drugs)
◦ Lab tests (National Codification – KEOKE)
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23.  The main objectives are:
◦ To improve patient safety
◦ To support effective and efficient health care delivery
◦ To facilitate management of chronic conditions
 Serves the needs of both the individual patient, the individual doctor and the national
health care statistics, enabling monitoring of health care parameters and facilitating
administration and management.
 Recognizes the needs of primary health care.
 Guarantees all privacy and confidentiality requirements.
 Improves effectiveness and efficiency of health care services but also public health services.
 Enables quality assessment and quality improvement (data analysis, etc.)
 Systematically developed in a coordinated manner to facilitate interconnectivity.
 Supports International and EU Standards for Information Exchange (ICD-10, ICPC2, ATC5,
epSOS etc.)
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24.  Demographic data
 History of medical visits (with medical factors per visit i.e. visit
diagnosis, referral info etc)
 Medical Issues (Patient's problem list)
◦ Allergies
◦ Hospitalization
◦ Medical procedures and test results
 Lifestyle
◦ Alcohol
◦ Smoke
 Medication list (Prescriptions )
 Family History
 Gynecological History
 Diagnoses
 Vaccinations program
 Medical factors/vital signs over time reporting/diagrams
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29.  eHealth suite could support personalized primary care to the
population within a framework, involving objectives of
accessibility, effectiveness, efficiency and quality.
 Is based on standards (HL7, CDA, etc) and common national
codings ( ATC5, ICPC2, ICD10, ΚΕΟΚΕΕ etc)
 Covers all the range of Primary Health Care services and
currently maintains all the necessary data (ePrescription,
Demographic, etc)
 With the mature ePrescription user management (with 50.000
doctors) and the transparent use of the various services ensures
adoption and easier integration on the daily work flow.
 Patient Consent and Patient Access subsystems based on
Taxisnet credential
 APIs for Doctors, Pharmacists and Laboratories
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30.  Ensuring continuity of care and integrated vaccination
programs in the EHR.
 Electronic Referral already implemented in the system
 Every interaction with the database is monitored.
 Ability to add additional health factors to be monitored
 Ability to generate KPIs and relate data from various
sources in order to assess doctors or monitor a desease, i.e.
◦ Performance indicators
◦ Exams expenditure per patient
◦ Disease prevalence vs resources utilizations
◦ Mean medical consultations per disease
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31. Thank you for your attention!
Triantafillidi Athina
IT DIRECTOR - IDIKA
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