Read World Health Organisation text version

Turkey eHealth Strategy Towards the start of Implementation

by Salah Mandil, Ph.D. Senior Expert Consultant to the ITU, Geneva and Former Director Health Informatics & Informatics WHO, Geneva, Switzerland

Table of Contents

1. 2. INTRODUCTION--------------------------------------------------------------------------------------- 1 THE OCTOBER 2004 REPORT ------------------------------------------------------------------- 2 2.1 SUMMARY OF KEY RECOMMENDATIONS ------------------------------------------------------------2 2.2 RELATED DECISIONS BY TURKEY --------------------------------------------------------------------2 2.3 PREPARATORY STEPS FOR IMPLEMENTATION -----------------------------------------------------3 3. 4. 5. 6. 7. 8. 9. STANDARDS FOR NATION-WIDE COMPATIBILITY -------------------------------------- 3 NATIONAL HEALTH INFORMATION PLATFORM ----------------------------------------- 4 NATIONAL HEALTH CARE MIS------------------------------------------------------------------ 4 NATIONAL HEALTH DATA DICTIONARY ---------------------------------------------------- 6 NATIONAL ELECTRONIC MEDICAL RECORD --------------------------------------------- 7 DIGITAL SECURITY---------------------------------------------------------------------------------- 7 OTHER ISSUES --------------------------------------------------------------------------------------- 8 9.1 PATIENT NUMBERING ----------------------------------------------------------------------------------8 9.2 ORGANISATIONAL STRUCTURE -----------------------------------------------------------------------8 9.3 FUNDING--------------------------------------------------------------------------------------------------9 ANNEX I PEOPLE MET BY DR MANDIL DURING THIS ASSIGNMENT ------------------------------- 10 ANNEX II WORK PLAN (SHORT TERM)----------------------------------------------------------------- 11

November 2004

.

Turkey eHealth Strategy Towards the start of Implementation

by

Salah Mandil, Ph.D.

1.

INTRODUCTION

The Author concluded, in October 2004, a review of Turkey's strategy for the uses of Information & Communication Technologies (ICT) in the health sector, and made extensive recommendations for the improvement of the strategy itself and its costeffective implementation. His report entitled, "Turkey eHealth Strategy ­ review of and recommended improvements to", and hereafter referred to as the "October 2004 Report", had been speedily reviewed by the Turkey Ministry of Health (MoH) technical staff and decision-makers, and positively approved for implementation subject to some clarifications and further consultation on related logistics. These consultations and related additional reviews and recommendations, are the subjects of this brief, follow-up assignment, which was requested by the MoH again through the Bureau for the Development of Telecommunications, ITU/Geneva, and carried out in Ankara, Turkey, between 9 and 12 November 2004. The assignment comprised of numerous consultative meetings, extending over long and late hours, mainly with the IT Team of the MoH, the Deputy Under Secretary in charge of the Turkey Health Transformation Project and the Chairpersons of the various Working Groups charged with differing aspects of the Transformation Project. Annex I lists the individuals met this assignment. Where mere further technical clarification was requested and provided, this report merely gives the headings and sub-headings of the topics and issues covered with reference to the relevant parts of the first assignment's Report. Where further consultation was sought and provided, this report makes a brief summary of the relevant issues covered. Thus, section (2) of this report briefly recalls the Author's October 2004 Report, referred to above; the decisions of the MoH decision-makers thereon; and the immediate direct implications of such decisions on the necessary follow-up steps. This is then followed by several that which summarise the technical clarifications or tutorial explanations, and in some cases additional recommendations made, on these key issues: Standards for Nation-wide Compatibility (section 3); the National Health Information Platform, or Saglik-Net (section 4); the NHC/MIS (section 5); the National Health Data Dictionary (section 6); the National Electronic Medical Record (section 7); and Digital Security (section 8). Finally, section (9) covers the three additional issues of Patient Numbering, organisational structure and Funding.

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 1.

.

2.

2.1

THE OCTOBER 2004 REPORT

Summary of Key Recommendations

The October 2004 Report by the Author ascertained the feasibility and overall cost-effectiveness of a Nation-wide eHealth Support that was compatible in data, coding schemes, procedures, computerised applications and related tools. The Report went on to recommend these six inter-related areas: a) The enhancement of the existing MoH Wide Area Network into a National Health Information Platform (tentatively called Saglik-Net) hosting and enabling access to nationally required systems and services, by all Turkey health sector institutions; b) The strategic and technical importance of preceding the introduction of a "Family Physicians system" with the conception and core development of a National Health Care Management Information Systems, or NHC/MIS, based on individual MISs in each health care institution which should, as far as possible, be a "national solution" optionally offered to, and not imposed upon, any and all interested hospitals and health centres. c) The adoption of national standards for data items, entities and related procedures, and the development of the current and new content of health information in Turkey in accordance with such standards, and its storage in an National Health Data Dictionary that should be accessible over Saglik-Net; see (a) above. d) The development and operation of a National Electronic Medical Records system, that is functionally tied to the Electronic Patient Records components of the Health Care MISs referred to in (b) above. e) The expansion of the existing security measures of Redundancies, Firewalls, Anti-Virus, Passwords, etc... to cater for profound Digital Security of all health care transactions that ascertains the Identification and Authentication of all users; and the Integrity, confidentiality and Non-Repudiation of all health care messages and transactions.

2.2

Related Decisions by Turkey

After a thorough review of the Author's October 2004 Report, which included a number of meetings to clarify some points, the Deputy Under Secretary expressed, on behalf of the Minister of Health, the following views and decisions: a) their satisfaction with the emphasis, scope and level of detail of the Report; b) their acceptance of all the Report's recommendations and priorities; c) that the "2005 Action Plan" is to be amended to include the implementation of the Report's immediate recommendations, for which the Author was requested to

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 2.

.

prepare an Estimated Budget & Work Plan (for the short-term) for the installation of the recommended eHealth Support in a pilot 10-12 hospitals and 10-12 clinics; and, d) their need for further support in the preparation of the Requirements Statement and related Technical Specifications for the national platform, systems and services cited in points (a) to (e) of para 2.1 above. The Work Plan referred to in point c) above was drafted by the Author, its time scales discussed with the MoH IT Team where possible, amended as necessary and agreed to ­ as shown in Annex II of this report.

2.3

Preparatory Steps for Implementation

The Author was informed that the internal actions necessary for the implementation of the recommendations relating to the following have already been started: a) The recruitment of 4 additional professional staff to the MoH IT Team and the designation of specific areas to "Responsible Officers" within the Team ; b) The establishment of an eHealth Support "Users Group" to play the important advisory and promotional roles within the health sector; c) The conduct of the 1st Turkey National eHealth Conference, as a means of briefing and involving the whole sector in the development of the eHealth Support; d) The currently approved and earmarked funding by the World Bank to be reoriented to the implementation of the immediate recommendations cited above.

3.

STANDARDS FOR NATION-WIDE COMPATIBILITY

The standards cited, discussed and recommended in the October 2004 Report had since been approved for inclusion with the National eHealth Standards for the health sector. These are to be used and enforced until updated or alternative standards are justified and adopted. It is recommended that the time-consuming tasks of converting existing data to comply with the adopted standards, and of preparing written guidelines for applying such standards to new, subsequent data, should be started immediately by the responsible units such as Hospital Patients Registration, MoH health statistics and Admin-&Finance. Clearly, no standards are carved in stone and, in principle, any standard could be updated, challenged and changed, but that has to follow set procedures. In this regard, it is recommended that a Standing Committee on Health Information Standards be established, and:

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 3.

.

a) its membership should represent the various types of health care institutions (hospitals, clinics, academia, ...), types of information (statistics or epidemiology, management, admin-&-finance, literature and knowledge), ICT services and the Legal services; b) its Terms of Reference should enable it to receive and, as appropriate, to act on written proposals for changes/updating existing standards, or introduction of new standards, briefly citing the needs and rationale for the change/addition sought, and its implications on other existing standards and procedures; and c) it should channel its reports and its recommendations, through the relevant Deputy Under Secretaries, to the Under Secretary and the Minister, for final approval and fixing the date for the new/revised standard coming to force.

4.

NATIONAL HEALTH INFORMATION PLATFORM

The work on one of the October 2004 Report major recommendations for the enhancement of the MoH Wide Area Network to become the National Health Information Platform, has begun. The Author provided clarification and advice on a number of related issues, and on the procedure and the practical steps leading to: i. ii. The preparation of the Requirements Statement for the overall National Health Information Platform; The preparation of the corresponding Technical Specifications for the Platform for incorporation in an eventual Request for Proposals (RFP) for the supply, installation and operation of a "pilot platform" covering 10-12 hospitals and 1012 clinics, together with the necessary training and services. The criteria for a comparative, competitive evaluation (separately technical, then separately prices, then combined technical-with-prices) of the actual proposals received. The Acceptance Testing, and start of operations.

iii. iv.

It is stressed that, as per the explanations in the October 2004 Report, whilst the Platform should include important Nation-wide services such as access to the National Patient Data Base (and its component Electronic Patient/Medical Records) and the National Health Data Dictionary, these are in fact two major parts of the "national solution" and must be acquired and developed as an integral part of the proposed National Health Care MIS.

5.

NATIONAL HEALTH CARE MIS

The recent past experience of the MoH, that is until a couple of years ago, of attempting to centrally develop a Hospital MIS which was then to be forced onto hospitals

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 4.

.

throughout Turkey, was undoubtedly a most erroneous strategy - economically, technically and managerially. Why? First and foremost, the MoH is not in the business of information systems and software development, but is in the business of using these. Secondly, even the basic modules of such systems require 100's of person-years to conceive, develop, debug, document and learn to use effectively ­ and the person-years of the health care personnel are better devoted to health care and not software development. Thirdly, the world market including Turkey has numerous, competing systems which Turkey can cultivate through commercial competition to efficiently obtain a cost-effective solution. Fourth, whereas seeking to have compatible systems in a majority of Turkish hospitals is an important and readily justifiable objective, the notion of forcing such compatibility usually leads to opposite results. As the October 2004 Report recommended, it is re-stressed that a "national solution" can only be truly national and have a chance of being accepted by the majority of hospitals: a) if it is chosen based on requirements expressed by the actual representatives of the hospitals, clinics and other health care institutions; b) if it is chosen through open, competitive bidding based on a criteria agreed to by the actual representatives of these hospitals, clinics and other health care institutions; that is, if the choice provides the truly best costs and conditions; c) if its adoption by a hospital, clinic or other health care institution, is accompanied by well articulated advantages and incentives for the institution concerned; and d) if it is simply offered, and not forced on the hospitals. In compliance with the above, and after meeting with the Chairpersons of and learning more of the scope of the Working Groups on the different aspects of the Health Transformation Project, the Author confirmed that one of the existing working groups is working on the "hospital MIS" requirements, and it is therefore recommended that: o an additional working group be established and dedicated to the challenges cited in points (a) to (d) above, and be known as the Working Group on the National Health Care Management Information System (WG NHC/MIS); the WG NHC/MIS should comprise of representatives of a cross-section of the different types and regional distribution of Turkey's hospitals, clinics or other health care institutions; the WG NHC/MIS is chaired by a senior colleague from a hospital that have no computerised support at present, and who thus would be unbiased to any particular solution; the WG NHC/MIS should complete task (a) above within one-month of its estab-

o

o

o

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 5.

.

o

lishment; and for the fulfilment of (a) above, the WG NHC/MIS with the Draft Requirements Statement which was originally prepared by the present MoH IT Team and recently refined with comments by the Author.

In addition, the Author provided clarification and advice on a number of related issues, and on the procedure and the practical steps leading to: i. The preparation of the Requirements Statement for the overall NHC/MIS; this included several hours of explanation and discussion on how best to analyse the data already assembled through a recent Online Survey (1 to 30.9.2004) of all the MoH hospitals on their existing and anticipated "computerised data and information systems support"; The preparation of the corresponding Technical Specifications for the NHC/MIS for incorporation in an eventual Request for Proposals (RFP) for the supply, installation and operation of the "national solution" in a pilot 10-12 hospitals and 10-12 clinics, together with the necessary training and services. The criteria for a comparative, competitive evaluation (separately technical, then separately prices, then combined technical-with-prices) of the actual proposals received. The Acceptance Testing, and start of operations.

ii.

iii. iv.

6.

NATIONAL HEALTH DATA DICTIONARY

As stressed in the October 2004 Report, and recalled in section (4) above, initially the major content and uses of the National Health Data Dictionary (NHDD) are those related to the NHC/MIS. In other words, the NHDD would comprise initially of the data items and entities of the NHC/MIS, and would be gradually enriched with those of other needs and applications. It should be also recalled that the NHDD is essentially a computerised data base, that is a system/application and a data base. It is recommended, for both economy and operational efficiency, to adopt the Data Dictionary System (DDS) of the national solution selected for the NHC/MIS to also serve as the DDS for the National Health Data Dictionary. This has to be stipulated in the Technical Specifications for the national solution (point (ii) of section 5. above). In relation to the above, the Author provided clarification and advice on a number of related issues, and on the procedure and the practical steps leading to: i. ii. The preparation of the Requirements Statement for the overall NHDD; The preparation of the corresponding Technical Specifications for the NHDD as an integral part of the Request for Proposals (RFP) for the supply, installation and operation of the "national solution" in a pilot 10-12 hospitals and 10-

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 6.

.

iii. iv.

12 clinics, together with the necessary training and services. The criteria for a comparative, competitive evaluation (separately technical, then separately prices, then combined technical-with-prices) of the actual proposals received. The Acceptance Testing, and start of operations.

7.

NATIONAL ELECTRONIC MEDICAL RECORD

As stressed in the October 2004 Report, and recalled in section (4) above, one of the major services on the National Health Information Platform is to host and facilitate access to the National Patient Data Base which includes the Electronic Patient/Medical Records which are key components of any National Health Care MIS (i.e. the all important national solution cited in section 5. above). It is therefore recommended, that the national Electronic Medical Record system be selected as a fully integral part of the national solution. In relation to the above, the Author provided clarification and advice on a number of related issues, and on the procedure and the practical steps leading to: i. ii. The preparation of the Requirements Statement for the National EMR system; The preparation of the corresponding Technical Specifications for the National EMR system as an integral part of the Request for Proposals (RFP) for the supply, installation and operation of the "national solution" in a pilot 10-12 hospitals and 10-12 clinics, together with the necessary training and services. The criteria for a comparative, competitive evaluation (separately technical, then separately prices, then combined technical-with-prices) of the actual proposals received. The Acceptance Testing, and start of operations.

iii. iv.

8.

DIGITAL SECURITY

As stressed in the October 2004 Report, and recalled in point (e) of para 2.1 above, the level of Digital Security necessary for health care transactions is much higher than Firewalls, Anti-Virus and Passwords, and must ascertain the Identification and Authentication of all users; and the Integrity, confidentiality and Non-Repudiation of all health care messages and transactions. The Author was informed of a strategic decision regarding the Digital Security related to the Transformation Project which affects the recommendations on Digital Security made by the Author in his October 2004 Report. The Turkish authorities decided to

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 7.

.

designate the responsibility for the development and operation of a PKI-based Digital Certification Authority, to the Scientific & Technical Research Council of Turkey, an institution which reports direct to the Prime Minister's Office. This implies that the Scientific & Technical Research Council would be the Turkey National Certification Authority (CA), and that each Ministry would act as the Registration Authority (RA) for its sector. Thus, the Ministry of Health becomes the RA for the health sector, and may designate the actual Registration of the individual users, and the issuance of their Digital Certificates, to the individual institutions such as hospitals which would act as sub-RA's. The above approach is quite feasible and compares to many other countries that are successfully maintaining Digital Security with almost similar arrangements. However, the Author draws attention to three points to be re-ascertained: a) The above clearly covers the PKI Infra-structure, but it is not clear if the equally necessary Trust Infra-structure is to be covered in the same manner; b) The budgetary provision for Digital Security by the MoH is then for the installation and operation of RAs only, as it assumes that the CA costs will be totally covered separately and independently from any MoH budgetary provision; and c) The target dates for a fully operational National CA and related Sectoral RAs are such that it is well within the schedules of the MoH for the acquisition, installation and start of operation of the key developments summarised in para (2.1) above.

9.

9.1

OTHER ISSUES

Patient Numbering

No real practical progress seems to have achieved on the development of a Turkey Patient Numbering Scheme based on "MERNIS", the national security numbering scheme. The Author recalled the urgency with which this issue should be resolved. The Author suggested and discussed a few ideas, and stressed that for the sake of the fullest confidentiality, the final scheme should be conceived, documented and agreed upon within Turkey and with authorities such as the Ministry of Interior. If further consultancy support on this issue is required, the Author will be ready to provide that. 9.2 Organisational Structure

The importance, size and complexity of the eHealth Support development and sustenance, is such that it should be organisationally identified within the MoH structure and should be seen to belong to the entire Ministry. As such, it is recommended that

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 8.

.

serious consideration be given to the establishment of a Department or Directorate of eHealth Support attached and reporting to the Under Secretary or Minister's office. The Author provided advice on the scope of the Terms of Reference of such a Directorate. 9.3 Funding

The October 2004 Report stressed that the resources needed to implement the necessary eHealth Support, and to maintain and sustain that, over the next few years represent a significant budgetary provision. And, that the currently earmarked funding from the World Bank serves only as the seeding resource for the pilot. It was confirmed to the Author that the MoH authorities are well aware of that, and further confirmed that: a) the State Planning Organisation will fund the "2005 Action Plan" which will be modified, as stated in point c) of para 2.2 above, according to the requirements of implementing the recommendations of the October 2004 Report and this report; and b) the MoH has its own significant budgetary provisions explicitly earmarked for the "implementation" of the Health Transformation Project and that parts of these provisions would be used for the Nation-wide spread of the eHealth Support.

oooOooo

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 9.

.

Annex I People Met by Dr Mandil during this Assignment

NAME

Prof Dr Sabahattin Aydin Mr. Nihat Akpinar Dr. Nihat YURT Mr. lker Köse Mr. Ahmet Özçam Mr. Emin Aydoan Dr. Songül Doan Dr. Maher Dr. Betigül Güliter Prof Dr Mustafa Özmen Dr. Mustafa Körolu Mr. Hakan Yerlikaya Ms. Nihan Kircaliali Mr. Tolga Uu Mr. Türker Gülüm

AFFLATON

Ministry of Health Ministry of Health Ministry of Health Ministry of Health Ministry of Health Ministry of Health Ministry of Health Ministry of Health Ministry of Health Hacettepe University Turkish Military Forces State Planning Organization State Planning Organization Turkish Telecom Scientific &Technical Research Council

POSTON

Deputy Under Secretary Head, Department of Information Processing e-Health Project Coordinator Information Technology Consultant Information Technology Consultant Information Technology Consultant Department of Information Processing Department of Information Processing Department of Information Processing A Working Group Member Representative of Turkish Military Forces A Working Group Member A Working Group Member A Working Group Member A Working Group Member

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 10.

.

Annex II Work Plan (Priority Developments, Initial Budgetary Needs and some Schedules)

Component

Target Date

Reference in Initial October 2004 Budgetary Report Needs US$

1. NATIONAL STANDARDS 1.1 Scope ICD10 GMDN ATC BUT DRG Controlled Medical Terminology for Primary Health Care Unique Identifier for Doctors and Institutes 1.2 Steps Approve above standards Convert existing data to comply with above standard 2. NATIONAL HEALTH PLATFORM 2.1 Scope Increased capacity Access to Health sector Users Selected new 6 hospitals & 6 Clinics National Medical Data Dictionary (see 4. below) 2.2 Steps Prepare Requirement Statements Prepare Technical Specifications Issue RFP request for proposals Select best solutions Sign contract with successful bidders Start installation Acceptance testing Start operations 3. NATIONAL SOLUTION FOR HEALTHCARE MIS 3.1. Scope Hospital MIS Information System for Primary Physicians Information System for Clinics & Private Health Sector Electronic Patient Record (see 5. below) Information System for Laboratories Image Processing Systems Administrative & Financial Information Systems E-Prescription 3.2. Steps 04 Oct 04 Dec 04 July 04 Jan 06 Jun 05 Dec 05 Mar 04 Dec 05 Aug

Section 10

Section 15

Section 5 17 Dec

Section 15

Section 6

Section 15

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 11.

.

Component Prepare Requirement Statements Prepare Technical Specifications Issue RFP request for proposals Select best solutions Sign contract with successful bidders Start installation Acceptance testing Start operations 4. National Health Data Dictionary 4.1 Scope Formal Definition of all Data Items & Entities Procedures For Access and Updating Procedures For Access 4.2 Steps Prepare Requirement Statement Prepare & Include Technical Specifications In 3.2 above Sign contract with successful bidders Start installation Acceptance testing Start operations 5. Electronic Medical/Patient Record 5.1 Scope A Database of Medical Records of all Citizens in Turkey Procedures For Access and Updating Procedures For Access 5.2 Steps Prepare Requirement Statement Prepare & Include Technical Specifications in 3.2 above Sign contract with successful bidders Start installation Acceptance testing Start operations 6. Digital Security 6.1 Scope Digital certificate and signature for all users Trust structure 6.2 Steps Prepare Requirement Statements Prepare Technical Specifications Issue RFP request for proposals

Target Date 15 Feb

Reference in Initial October 2004 Budgetary Report Needs US$

Sections 5-7

15 Feb Section 15

Section 6

15 Feb Section 15

Section 9

Section 15 01 Jan

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 12.

.

Component Select best solutions Sign contract with successful bidders Start installation Acceptance testing Start operations

Target Date

Reference in Initial October 2004 Budgetary Report Needs US$

7. Approval of Required Resources

7.1. Approve 4 Additional Posts 7.2. Request World Bank for use of their US$ 8.231.900 7.3. Approve Funding As Pair (1) To (6) Above

Section 12

TOTAL AMOUNT

_________________________________________________________________________________________ "Turkey eHealth Strategy ­ Towards the start of Implementation" November 2004 by Salah Mandil, Senior Expert Consultant, ITU, Geneva; Page 13.

Information

World Health Organisation

14 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

1080808


You might also be interested in

BETA
Final Programme V04.pdf
10k of most popular keywords
Annual Report 2008
DocHdl1OnPN-PRINTRDY-01tmpTarget