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PETR NOVOTNY

European Commission, DG Information Society, eHealth Unit

E-HEALTH IN CENTRAL AND EAST EUROPEAN COUNTRIES


with focus on Czech Republic, Hungary, Poland and Slovenia

Brussels 29.2.2004

PREFACE AND THANKS ...............................................................................................................................................................................................4


EXECUTIVE SUMMARY ...............................................................................................................................................................................................5
1. TELEMEDICINE IN EUROPE ...................................................................................................................................................................................12
1.1 Situation in EU 15........................................................................................................................................................................................12
1.1.1 Longer-term trends........................................................................................................................................................................12
1.1.2 The European healthcare ICT market...........................................................................................................................................12
1.2 Situation in Central and Eastern Europe ....................................................................................................................................................13
1.2.1 Introduction to Central and Eastern Europe (CEE) ......................................................................................................................13
1.2.2 Demographic Data ........................................................................................................................................................................13
1.2.3 Health Indicators ...........................................................................................................................................................................14
1.2.4 Telemedicine Implementation ......................................................................................................................................................14
1.2.5 Economic and Information Technologies (IT) indicators ............................................................................................................15
1.2.5.1 GDP Gross Domestic Product ................................................................................................................................................15
1.2.5.2 IT penetration.............................................................................................................................................................................15
1.2.6 IT Spending...................................................................................................................................................................................17
1.2.6.1 Investment in IT (excluding telecommunications) compared to GDP......................................................................................17
1.2.6.2 ICT market shares in 2002 (Relative IT market size) ...............................................................................................................18
1.3 Online Search for health information Europe .............................................................................................................................................18
2. COUNTRY PROFILES..............................................................................................................................................................................................19
2.1 Czech Republic.............................................................................................................................................................................................19
2.1.1 Government Action Plans (AP) ....................................................................................................................................................19
2.1.2. List of National Information Society Related Websites..............................................................................................................19
2.1.3 Ministry of Health.........................................................................................................................................................................20
2.1.4 The use of the Internet in Czech Health Institutions in 2002.......................................................................................................20
2.1.5 Survey of the Information Systems (IS) in the Czech Hospitals 2003.........................................................................................20
2.1.6 Telemedicina.CZ - Telemedicine Projects in Czech Republic.....................................................................................................21
2.1.7 ROSCH Foundation ......................................................................................................................................................................22
2.1.8 IZIP Internet Medical Database.................................................................................................................................................22
2.1.9 MEDTEL & NetC@rd..................................................................................................................................................................23
2.1.11 Czech Society of Nuclear Medicine ...........................................................................................................................................23
2.1.12 PET center in Nemocnice Na Homolce hospital ........................................................................................................................24
2.1.13 IKEM CZ Institute for clinical and experimental medicine....................................................................................................24
2.1.14 Euromise .....................................................................................................................................................................................24
2.1.15 Branch Contact Organization - Healthcare (BCO).....................................................................................................................25
2.1.16 Coordination Center for Departmental Medical Information Systems ......................................................................................26
2.1.17 National Health Registers ...........................................................................................................................................................26
2.1.18 Central registry of R&D projects................................................................................................................................................27
2.2 Hungary........................................................................................................................................................................................................28
2.2.1 Ministry of Health.........................................................................................................................................................................28
2.2.2 Ministry of Informatics and Communication ...............................................................................................................................28
2.2.3 List of National Information Society Related Websites...............................................................................................................28
2.2.5 National Institute and Library for Health Information .................................................................................................................29
2.2.6 GYOGYINFOK Center for Healthcare Information.................................................................................................................29
2.2.7 Hungarian Office for Research and development ........................................................................................................................29
2.2.8 Institute of Experimental Medicine ..............................................................................................................................................29
2.2.9 OTKA National Research Institute............................................................................................................................................30
2.2.10 Computer and Automation Research Institute, Hungarian Academy of Sciences ....................................................................30
2.2.11 PROREC.HU & WIDENET.......................................................................................................................................................30
2.2.12 PRIMACOM...............................................................................................................................................................................30
2.2.13 RETRANSPLAT ........................................................................................................................................................................30
2.2.14 MiM Medical Info Media ........................................................................................................................................................31
2.2.15 VARIMED ..................................................................................................................................................................................31
2.2.16 List of Contacts ...........................................................................................................................................................................31
2.3 Poland ..........................................................................................................................................................................................................32
2.3.1 Ministry of Health.........................................................................................................................................................................32
2.3.2 List of National Information Society Related Websites...............................................................................................................32
2.3.3 ePolska (ePoland)..........................................................................................................................................................................32
2.3.4 National Health Care Programme.................................................................................................................................................33
2.3.5 Registry of Medical Services........................................................................................................................................................33
2.3.6 National Pharmaceutical Portal ....................................................................................................................................................34
2.3.7 Informatization of hospitals in the Malopolskie province, 2002 .................................................................................................34
2.3.8 Telemedicine at University Hospital in Krakow ..........................................................................................................................34
2.3.9 Telemedicine in Poland.................................................................................................................................................................34
2.3.10 Research and Development Units...............................................................................................................................................35
2.3.11 The Role and Advantages of Using the Tele-ECG System in Daily Medical Practice - Telemedicine Project .......................35
2.3.12 Tele-ekg - CARDIAC MONITORING SYSTEM .....................................................................................................................36
2.3.13 Telewelfare.com..........................................................................................................................................................................36
2.3.14 PIONIER .....................................................................................................................................................................................37
2.3.15 Krakow Center of Telemedicine.................................................................................................................................................38
2.3.16 PRO-ACCESS ............................................................................................................................................................................40
2.3.17 The University Hospital in Krakow............................................................................................................................................42

2.3.18 Telemed.......................................................................................................................................................................................43
2.3.19 E-rejestracja ................................................................................................................................................................................43
2.3.20 List of Contacts ...........................................................................................................................................................................44
2.4 Slovenia ........................................................................................................................................................................................................45
2.4.1 Governments Action Plans ..........................................................................................................................................................45
2.4.2 Ministry of Information ................................................................................................................................................................45
2.4.3 Ministry of Health.........................................................................................................................................................................46
2.4.5 List of Other National Information Society Related Websites.....................................................................................................46
2.4.6 Institute of Public Health ..............................................................................................................................................................46
2.4.7 Institute of Biomedical Informatics ..............................................................................................................................................46
2.4.8 Slovene Medical Informatics Association ....................................................................................................................................47
2.4.9 SIZN - Nursing Informatics Interest Group .................................................................................................................................47
2.4.10 Telemedicine in Slovenia report .................................................................................................................................................47
2.4.11 Telemedicine Projects.................................................................................................................................................................48
2.4.11.1 Transtelephonic transmission of ECG.....................................................................................................................................48
2.4.12 InfoNet Healthcare Information Systems Company ...............................................................................................................50
2.4.13 Nova Vizia (New Vision) ...........................................................................................................................................................53
2.4.14 List of Contacts ...........................................................................................................................................................................53
Annex I................................................................................................................................................................................................................54
Telemedicine Implementation in CEE region Brief Overview ..........................................................................................................54
Plans and organisations for Telemedicine implementation in CEE ......................................................................................................57
SIBIS report (abstract) .................................................................................................................................................................................59
Annex III .............................................................................................................................................................................................................62
The use of the Internet in the Czech health institutions in 2002 .................................................................................................................62
Annex IV .............................................................................................................................................................................................................65
Survey of the Information Systems (IS) in the Czech hospitals 2003.........................................................................................................65
Annex V...............................................................................................................................................................................................................73
Telemedicina.CZ - Telemedicine Projects in Czech Republic..............................................................................................................73
Annex VI .............................................................................................................................................................................................................77
IZIP Internet Medical Database, Czech Republic ....................................................................................................................................77
Annex VII............................................................................................................................................................................................................80
MEDTEL & NetC@rd, Czech Republic .....................................................................................................................................................80
Annex VIII...........................................................................................................................................................................................................82
National Health Registers, Czech Republic.................................................................................................................................................82
Annex IX .............................................................................................................................................................................................................87
E-HEALTH CARE IN HUNGARY, REPORT NO. 1..........................................................................................................................................................87
Annex X...............................................................................................................................................................................................................89
EHEALTH CARE IN HUNGARY, REPORT NO. 2 ...........................................................................................................................................................89
Annex XI ...........................................................................................................................................................................................................131
Department Of Informatics, National Institute And Library For Health Information, Hungary ..............................................................131
Annex XII..........................................................................................................................................................................................................134
Regional and International Integrated Telemedicine Network for Organ Transplant, Hungary ..............................................................134
Annex XIII.........................................................................................................................................................................................................135
Health care on-line abstract from ePolska Action Plan, Poland.............................................................................................................135
Annex XIV.........................................................................................................................................................................................................138
Informatization of hospitals in the Malopolskie province, Poland ...........................................................................................................138
Annex XV ..........................................................................................................................................................................................................148
Telemedicine at University of Krakow hospital, Poland...........................................................................................................................148
Annex XVI.........................................................................................................................................................................................................150
Telemedicine in Poland..............................................................................................................................................................................150
Annex XVII .......................................................................................................................................................................................................156
Research and Development Units, Poland.................................................................................................................................................156
Annex XVIII ......................................................................................................................................................................................................159
Tele-ekg - CARDIAC MONITORING SYSTEM, Poland .......................................................................................................................159
Annex XIX.........................................................................................................................................................................................................163
Telemedicine in Slovenia MESS report..................................................................................................................................................163
Annex XX ..........................................................................................................................................................................................................167
Telemedicine in Slovenia...........................................................................................................................................................................167
Annex XXI.........................................................................................................................................................................................................180
Health Insurance Card Project Health Insurance Institute, Slovenia .....................................................................................................180
Annex XXII .......................................................................................................................................................................................................182
InfoNet healthcare information systems company, Slovenia .................................................................................................................182

Preface and Thanks


This report was done during my stage with eHealth Unit of Directorate General (DG) Information Society at
European Commission from October 2003 to February 2004. It was done in order to compliment my previous
experience in the telecommunication sector and to broaden my views in one of the leading industries of the near
future that will be very dependent on information and communication technologies.
The aim of this report is to give an overview about countries basic indicators, governments action plans for
eHealth, and provides a collection of different telemedicine projects and studies that have been conducted in Central
and Eastern Europe. The focus is on the following 4 countries: Czech Republic, Hungary, Poland and Slovenia.
Telemedicine work in these four countries is presented in separate chapters.
The overview is divided into short introduction on EU 15 eHealth market situation, general information about
Central and Eastern Europe (CEE) and more detailed description of above mentioned four countries. The latter
consists of presentation of official policy of each country, and eHealth and telemedicine projects/ pilots in the
various medical fields where telemedicine is already of increasing importance.
The projects and studies presented here do by no means cover the whole area of what is currently going on in the
field of telemedicine. They represent a selection made by the author based mainly on the availability of the
information on the Internet and response to the queries done by the author. Many more articles would also have been
suitable for presentation, but due to the limited amount of space and time for collection as well as due to the lack of
information in English on Internet, this was not possible. The sources from which the articles were obtained were the
Internet and the contributions from public and private institutions.
I would like to thank the following people for helping me during creation of this report:
Within the European Commission, eHealth unit:
- Ilias Iakovidis (advisor)
- Jean-Claude Healy
- Silas Olsson
- Andreas Lymberis
- Octavian Purcarea
- Sigurd von Ingersleben
- Benedicte Vasseur-Tries
- Jacqueline Teller
Within the accessing countries
- Jiri Valek
the Czech Republic
- Jana Zvarova
the Czech Republic
- Sandor G. Vari
Hungary
- Tamas Gergely
Hungary
- Pal Simon
Hungary
- Mariusz Duplaga
Poland
- Witold Poniklo
Poland
- Bostjan Bercic
Slovenia
- Livia Tusar
Slovenia

Petr Novotny

Executive Summary
Objective: The main focus of the report is to describe current situation on eHealth and telemedicine (these two (2)
terms will be used interchangeably) in Central and Eastern European Countries, namely Cyprus, the Czech Rep.,
Hungary, Poland, Romania, Slovakia and Slovenia.
Methods: Information was collected primarily from available internet websites as well as by contacting relevant
experts by e-mail and phone. Information was translated, analysed and classified in several categories and tables.
The main report (53 pages) includes European Information Technologies market overview, Central and East
European (CEE) countries basic indicators and separate chapters on eHealth situation and more detailed collection of
pilots in 4 countries: Czech Republic, Hungary, Poland and Slovenia. The supporting materials such as complete
surveys reports, detailed articles mentioned in the report, contributions from the other authors and other material are
contained in the Annexes (130 pages).
Findings: There are many pilots, especially in Central European Countries, that are mostly local in nature and often
without any government or Health Authority commitment. All of the countries studied have eHealth action plans that
often stems in different ministries than Ministry of Health. In some cases, such as the Czech Republic, Poland, and
Slovenia, the competency and sometimes co-funding lies within Ministry of Health. Majority of the development
and set up of pilots have been financed from private sources, but without follow up. The pilots are predominantly
telemedicine services such as teleconsultation. Slovenia has made significant progress in deployment of electronic
health record and health cards and has the only viable eHealth service that the author found in his research. Several
countries are following that example of insurance based health data system. Also, the region of Krakow
(Malopolskie) has made significant progress in planning and deploying eHealth systems and services. The findings
of author lead to one major conclusion: creation of favourable environment for all the players (ministries, users,
industries and social insurance players) to have common understanding and objectives through open dialog and
optimising of resources. The national and regional plans should draw from the experiences and best practices that
were developed elsewhere and that were supported by the EU research and development programmes in eHealth.
More extended summary of the report follows:
Telemedicine
Todays worldwide aging of the population is a direct consequence of the ongoing global fertility transition (decline)
and of mortality decline at older ages, population aging is expected to be among the most prominent global
demographic trends of the 21st century. Population aging is progressing rapidly in many industrialized countries, but
those developing countries whose fertility declines began relatively early also are experiencing rapid increases in
their proportion of elderly people. This pattern is expected to continue over the next few decades, eventually
affecting the entire world. Population aging has many important socio-economic and health consequences, including
the increase in the old-age dependency ratio. It presents challenges for public health (concerns over possible
bankruptcy of Medicare and related programs) as well as for economic development (shrinking and aging of labour
force, possible bankruptcy of social security systems). [1]
The challenge for the health sector is to improve the standard of living through increased technology utilization
reducing the costs of healthcare.
It is clear that such technologies are changing the face of healthcare. For example, the Internet already offers society
the opportunity to become better informed on health issues. This could eventually result in major changes in the
relationship between doctor and patient. The UK Foresight Programme provides one vision of this future:
By 2020 [] the first point of contact with health care will be through a virtual cyber-physician (CP). Accessed
through a TV screen, the CP system will replace other forms of triage such as the telephone and give access to
information about professionals, hospitals and other aspects of health care. (OST, 2001, p. 18)

Changing patterns of information sharing and patient/doctor relationships will bring some fundamental changes to
health organizations and the working relationships of health personnel. For instance, ICT systems are set to
revolutionize information sharing between health professionals, e.g. through the development of seamless electronic
patient records.
It is widely anticipated that clinicians will have access to information and decision support at the point of care. This
could occur by using a computer screen in offices and surgeries, or through a personal digital assistant (PDA) or
mobile phone on wards and in other circumstances, including emergencies. Of course, changes in informationsharing patterns will bring different security concerns onto the health agenda. The security of health information is
likely to be provided by a range of procedures and technologies, such as smart cards or biological identifiers.
Telematics is the use of ICT to solve any type of problem remotely. Telemedicine is the application of telematics to
facilitate healthcare delivery, and is defined by the EU Telemedicine Project as the investigation, monitoring and
management of patients, using systems which allow ready access to expert advice and to patient information, no
matter where the patient or relevant information is located. The major benefits of telemedicine applications are the
improvements in the speed and cost of health services as well as an expected increase in the quality of patient care.
Despite the high initial costs of investing in hardware and software, this should ensure considerable savings in the
long term. [2]
Central and East European Countries
This report is primarily dealing with Central and East European countries and the telemedicine situation including
Governments Action Plans for eHealth, telemedicine pilots and projects that are planned for the near future or that
has already taken place on national or regional level. It also contains surveys concerning IT state and plans in the
hospitals of the respective countries.
The countries covered in the report are Cyprus, Czech Republic, Hungary, Poland, Romania, Slovakia and Slovenia
with special focus on Czech Republic, Hungary, Poland and Slovenia.
The total population of these countries is 89.5 M people with Poland being the most (38.5 M) and Cyprus the least
(745 K) populated. The projected population in 2030 is 86.5 M people. The number of the people with the age
structure 65 years and older is on average 13% of the population at the moment. This number is expected to increase.
Life expectancy is 74 years on average with Cyprus (77.27 years) having the longest and Romania (70.62 years)
having the shortest life expectancy.
The average health expenditure in region is around 6% of GDP with Slovenia having the highest (8.2 %) and
Romania the lowest (3.9%) expenditure. The Czech Republic claims to have 0.4% investments into health
informatics as part of the total health expenditures (7.24% of GDP).
The total GDP of the selected countries is almost 937 billion USD. This figure can be compared to the GDP
produced by Spain in 2002 (850.7 billion USD). The leading GDP in the region has Poland (368.1 billion USD). The
purchasing power per capita is on average 13800 USD but there are big differences in the region. The highest figure
is showed by Slovenia (18000 USD) and the lowest by Romania (7400 USD).
Regarding IT penetration although, on average, 77% of households in the candidate countries now have a fixed
telephone service as compared to 86% in the EU-15, the penetration rates for fixed telephone services in some
countries hide large differences in penetration between urban and rural areas. From the observation that mobile
penetration is starting to overtake fixed penetration in some Candidate Countries (CCs) and considering that
technological innovations in mobile transmission (2.5 G and onwards) allow mobile networks to become Internet
delivery platforms, it follows that these mobile networks have the potential to become the main Internet and voice
delivery platform in the CCs, at least in those areas with poor fixed terrestrial infrastructure. (IPTS, No.77 JRC
Seville, September 2003)
At the end of 2001, 11% of the population in the Central and Eastern Europe (CEE) accessed the Internet an average
of once a month, compared with 39% for West Europe as a whole (EITO, 2002). The low PC and Internet

penetration in general, particularly at home, limited by the access charges and high cost of PCs, the low level of
fixed-line penetration, and low penetration of alternative access technologies, may represent a potential bottleneck
for short to medium term Internet development in the region. (IPTS, No.77 JRC Seville, September 2003)
As far as IT spending number of the countries still invest about 2% of GDP annually into IT, which suggests that it
still will take couple of years for the region to reach IT penetration and spending levels of current EU15 states. The
highest IT spending is reported in the Czech Republic (4%) and the lowest in Romania (1.5%). Per capita spending
is reported highest in Slovenia (257 EUR) and lowest in Romania (30 EUR).
Across the CEE region there are key differences in terms of current ICT market development, demand for specific
technologies and the growth potential of individual country markets. The largest ICT spending has been reported in
Poland (15.049 M EUR) and the Polish market represents 37.6 % of all region. The average ICT spending for the
region is 4 M EUR.
A survey carried out in 2002 shows that nearly 30% of Internet users in CEE reported online search for healthrelated information during 12 months period. Compare to EU15 (36,4%) its quite a satisfactory number but still low
compare to U.S. (58.3%). Unfortunately the survey doesnt contain success rate of searching for CEE countries. The
success ration in the other countries was about 80 %.
Czech Republic
In the Czech Republic Ministry of Informatics (www.uvis.cz) is in charge of development of national action plan for
information society. The projects dealing with health (Zdravotnictvi online) are in the competency of Ministry of
Health (www.mzcr.cz) and are set for 2001 2005 with the total budget around 9700 EUR.
The use of the Internet in the health institutions survey that was conducted in 2002 by the Institute of health
information and statistics showed the following results:
51.5% of the institutions responded to the survey
86.3% of the institutions that have responded and have access to the Internet use it for gaining of the
information mostly legislative and then pharmaceutical information respectively.
74% use it for communication with insurance companies and then other administration respectively.
99% have access only from health institution, 38% only from home, 23% from the institution and home
The survey hasnt given any result about how many institutions are connected to the Internet, it only shows the
purpose of using of the Internet.
Another survey conducted by Ministry of Health shows the state of hospital information systems (HIS) in the Czech
hospitals in 2003. The return rate of the sent questionnaires was 24% and it revealed the following results:
70% of the institutions that have responded have complete or at least half-way to complete HIS.
Only 3% of the institutions with complete HIS consider change of the system.
17% of the institutions with incomplete HIS are satisfied, 40% look for change.
61% of the institutions with incomplete HIS consider lack of finances as main barrier for completion.
Czech doctors show preference for future implementation of PACS-type solutions but very low interest in
management support systems and public solutions.
The IT personnel in Czech hospitals are without any influence on management decisions.
There are few telemedicine projects already working in Czech hospitals. A good start for the overview is a portal
www.telemedicina.cz with list of project and pilots already running or planned in Czech hospitals. Some of the
projects done are Interventional teleradilogy, Acute neurotraumatology, Telepathology, etc. The platform was until
recently supported by Czech Telecom.
Another two big projects that are done in cooperation with VZP the biggest health insurance company in the Czech
Republic are IZIP medical record online and NetC@rd - EHR.
Most of the telemedicina.cz projects where possible due to the sponsorships and donations of private organizations
such as Czech Telecom that unfortunately stopped recently its support and at present most of the planned projects are
on hold. In the case of VZP the project results are available only to the patience covered by this insurance company.

In the future is will be necessary that these projects are done with support of entity such as Ministry of Health is we
want to avoid failures of the projects due to the withdrawal of private sponsors that currently they are dependant on.
Or that they are only available to the patience covered by sponsoring insurance company.
There are also many institutes dealing with telemedicine. They are for example:
- Czech Society of Nuclear Medicine
- IKEM CZ Institute for Clinical and Experimental Medicine
- Euromise Education and Research in Medical Informatics
- Branch Contact Organization in Healthcare
- or Coordination Center for Departmental Medical Information Systems
Hungary
In Hungary Ministry of Informatics and Communication (www.ihm.hu) is in charge of eHungary, an action plan for
information society for the years 2004 2006. eHealth is one of the sectoral responsibilities for the AP.
A survey made in 2001 by GKI Economic Research Inc. (http://www.gki.hu) has revealed that while all of the
Hungarian outpatient centres possess and operate computer systems, only three-quarter of them is able to
systematically lead the medical history of the patients by a suitable software system.
A survey conducted in 2001 by GKI Economic Research Inc., Westel Mobile Communication Inc. and Sun
Microsystems Hungary Ltd. on hospitals, outpatient stations, general practitioners and other health care institutions
has revealed the following facts:

9/10 of hospitals and 1/3 of outpatient stations had an Internet access.


Electronic communication between different institutions is rather an exception
Internet is used mainly for searching for professional information, developing contact with Hungarian or foreign
clinics and scientific centers and libraries.
of GPs are able to access the Internet from work
4% of GPs have their own website to spread medical information and consultancy

According to the survey the development of Internet access and webpage creation among general practitioners has a
very positive tendency. It was expected to double in 2003.
Local outpatient centres with Internet access are searching for the following information:

social security rules

laws, decrees and other regulations

professional articles

description of drugs
Moreover, local outpatient centres with Internet access regularly make electronic contacts with the Ministry for
Health, the Social Security Fund, other hospitals and laboratories. There are no local outpatient centres, which
operate a service empowering patients to check in via Internet for a medical examination.
Another survey shows that 64% of the IT assets owned by the healthcare institutions (incl. software/hardware) are
more than 3 years old. This ratio is 66% for PCs and terminals, 67% for software, and 52% for mainframes, network
and accessories.
There is a wide selection of Government sponsored tenders in order to disseminate digitally based devices, methods
and activities in the field of e-Health care.
For example there are regularly repeated Government tenders with the aim of providing direct support for doctors,
nurses, social care workers and others in the form of granting for them PCs, Internet access or ISDN connection
cheaply or for free. In some case the co-financing of the tenders by private companies is available.

A way for overview about telemedicine projects in Hungary is a health care portal Varimed (www.varimed.hu). It
lists the projects especially from international cooperation such as PROREC.HU & Widenet, Primacom or
Retransplant.
E-health care is also promoted by various professional organizations such as:
- Hungarian Foundation for Medical Informatics
- Hungarian Society for Medical Informatics
- GYOGYINFOK Center for Healthcare information of MoH
- National Institute and library for Health Information
- Institute of Experimental Medicine
Poland
In Poland Ministry of Scientific Research and Informatization technology (www.kbn.gov.pl) is in charge of
development of national action plan for information society. The document ePoland for 2001 - 2006 follows the
approach of eEurope+ and contains specific tasks for Health care on-line projects such as Creation of a uniform
electronic data base on medical establishments and facilities available via the Internet, Creation of database on
patients covered by health insurance, etc. The positive message is that MoH (www.mz.gov.pl) is usually the source
of financing for these projects.
The survey about Informatization of hospitals in Malopolskie province in 2002 with 98% questionnaire return
showed the following results:
All hospitals have IT personnel. 47% are permanent employees, the rest are contractors, external firms or mix of
the two
18% have complete network, 56% have at least half-way to completion network, 8% have absence of network!
18% states full or near the integration of the software. The rest are long way from software integration.
61% is declaring 3 years to be horizon for planned informatization.
45% of hospitals plan to spend max. 65.000 EUR on IS building. Another 45% plans to spend funds beginning
from 100.000 EUR, which is more realistic.
There is a range of telemedicine projects already implemented in Poland as they can be seen for example in
Telewelfare.com (telezdrowie.pl), portal offering interactive service for diagnosis and rehabilitation of senses
responsible for communication. Krakow Center for Telemedicine is also a center for telemedicine projects mainly
focused on teleconsultation, telemonitoring and tele-education. Other examples can be also tele-ecg project that has
been running in Poland from mid. 90s or project called Improvement of Care Delivery for Severe Asthma Patients
co-financed by MoH and Ministry of Scientific Research and Informatiozation Technology www.astma.web.pl.
Slovenia
In Slovenia Ministry of Information (http://www2.gov.si/mid/mideng.nsf) is in charge of development of national
plan for information society. Health is 1 of 12 e-services for citizens and 1 of 15 areas of Action Plan up to 2004.
Responsibility for health area projects is in domain of Ministry of Health (http://www2.gov.si/mz/mz-splet.nsf).
Ministry of Information runs Slovenian eGovernment portal since 2001. It provides range of e-services &
government information for citizens, businesses and civil servants.
Ministry of Health is responsible for National Health Sector Management Project and others like e-Waiting lists and
E- SPP projects which the Health Sector Management Project initiated.
Report of Ministry of education, science and sport (http://www.mszs.si/eng/) includes some interesting data
regarding budgets allocated for research in Slovenia.
Slovenia has investments in healthcare 8.6% of GDP = 1.877.3 M EUR. The proposed Slovenian direct investment
in healthcare informatics (MoH) for 2004 is 4.3 M EUR.
As far as telemedicine Slovenia is very successful with the implementation of EHR when all Slovenian residents
have this card for at least one year. HIC includes basic information on the health of the particular person. The project
was done in cooperation with ZZZS Institute of Health Insurance in Slovenia. Other telemedicine projects

implemented in Slovenia are - just to name few for example transtelephonic transmission of ECG used regularly by
health institutions, PRIMACOM as international project, RETRANSPLANT or WIDENET.
There are also many institutes dealing with telemedicine. They are for example:
- Health Informatics Standards Board
- Health Informatics Council
- Centre for Health Informatics
- Institute of Biomedical Informatics
- Slovene Medical Informatics Association
- or Nursing Informatics Interest Group SIZN
Conclusion
eHealth Activity

There is need for eHealth, mostly personal endeavours, lot of interest

Lack of Health Authority commitment and leadership

Most of the contries have some sort of eHealth action plan but it often stems from other ministries than Ministry
of Health (MoH). Although it is sometimes co-funded by MoH and/or the responsibility rests with MoH.
There is certainly telemedicine activity in the CEE region. Most of the projects are introduced by doctors or
businesses but they are rarely supported by official government sources. The result is that they are rather
individualistic not systematic projects.
Doctors in the countries of focus were not aware of any national eHealth plans. This means that Ministries of
Health in the surveyed countries should improve their communication to the medical staff.

National versus Regional Pilots and Implementation

In the large countries regional differences in the level of telemedicine can be expected (Poland) while in the
small countries the activities can be easier implemented nationally (Slovenia).
Without a favourable environment of cooperation between state and private sector the projects will be rather
standalone than national.

Funding and sustainability

Majority of the projects has been financed from private sources, which carries the danger of sudden termination
of partner from the projects (Czech Telecom) and causing the projects to be on hold before another strategic
partner is found. MoH should play more active role in the promotion granting and implementation of
telemedicine projects to avoid this danger in the future.

Challenges

To find a solution by defining common goals and cooperation between state and private sectors. This is
important for the systematic approach to eHealth and it will be important especially in the larger countries.
To help to improve the communication to the doctors and to increase the number of professionals involved and
interested in the matter through these partnerships.

Trends for the near future


Governments will be forced to adopt certain eHealth strategies accompanied by concrete actions if they want to
keep up with the future demands on health care and reduce increasing costs in the long run.
State sector will need to cooperate with private sector for implementation of successful nationwide projects.
The growth of the nationwide initiatives will enable use of electronic health record (EHR).
In case there is a 1 health insurance institute in the country than the projects as Electronic Health Card (EHR) is
done to cover the whole population (Slovenia). In case there are more than 1 health insurance providers then it is
done to cover primarily the insured persons of the sponsoring insurance company (Czech Republic).

10

Hospitals are going to be more interconnected for running the telemedicine solutions using ISDN connection in
short/medium timeframe and broadband connection, as it becomes available and financially feasible.
All hospitals are going to have access to the Internet using dial-up or fixed connection.
Medical professionals will continue to use Internet for searching for information concerning their field of
specification. They will use the Internet as a main instrument for correspondence.
As the number of the households connected to the Internet grows, the number of the websites/portals dedicated
to patients with certain decease (for ex. diabetes) will grow as well. It will also increase online communication
between doctors and patients - email exchange, on-line booking systems.

Solutions
Addressing common challenges

Health authorities leadership


Creation of favourable environment for all players to have common understanding and objectives
Interoperability of health information systems
Constant enhancing of the information and communication technologies infrastructure
Leveraging investments

Accelerating beneficial implementation

Information to citizens and authorities for health education and disease prevention
Integrated health information networks

Facilitating synergies and monitoring

Source:

Disseminating best practices


Benchmarking
International cooperation
[1] http://longevity-science.org/Population_Aging.htm;
[2] http://www.emcc.eurofound.eu.int/publications/2003/sf_hss_1.pdf

11

1. Telemedicine in Europe
1.1 Situation in EU 15
1.1.1 Longer-term trends
Population ageing is consistent across the globe. At the start of the twenty-first century, the world population
included about 600 million people aged 65 and older (10% of the world population), triple the number recorded 50
years earlier (or 8% of the world population in 1950). By mid-century, there will be some 2 billion older persons
(21%), once again a tripling of this age group in a span of 50 years.
An ageing population has considerable implications and expected impacts on a wide variety of socio-economic
factors and processes, such as economic growth, capital markets, pension systems, but also on technical progress and
innovations, education and human capital, family and household structures - and last, but not least, on the health and
social care system. It implies that the prevalence of chronic diseases will grow and the numbers of disabled persons
rise. Evidence of age-related rationing of health interventions has been documented in some countries in the
European Region. [1] For example Liz Lloyd discusses the nature of health and social care interventions in the care
of older people dying in Britain. [2]
The health sector is today already one of the leading sectors of all industrialized societies. It is to be expected that
health in a wider, holistic sense - by encompassing wellness, personal development, environmental protection,
biotechnology and the like - will further develop into the new leading industry of the 21st century.
Source:
2003

[1] ICT&e-Business in the Health and Social Services Sector, the European e-Business Market Watch, sector report No.7 II/January
[2] LLOYD, L. (2000). Dying in old age: promoting well-being at the end of life. Mortality, 5, 171 188.

1.1.2 The European healthcare ICT market


It was estimated that the European Healthcare Information Society Technology (HIST) market
amounted to approximately 11 billion Euro in 2001, which would account for less than 2% of the total western
European ICT market of about 643 billion Euro p.a. Considering the economic relevance of the health sector for the
EU with total expenditure of more than 8% of GDP, this HIST market value is very low and amounts to about 1.6%
of the overall EU healthcare market estimated at 700 billion Euro for 2001. In the hospital sector, for example, the
level of total annual IT investment is estimated at only 1.2% of all expenditures as compared to 2.5% in the USA and
up to 10% (for ICT) and more in other information-intensive sectors such as financial services. Also for the USA, it
is estimated that with a 50% penetration, Healthcare has the lowest penetration of Internet business solutions, but
at the same time it is assessed that this sector may have the greatest upside with regards to cost savings in the future.
Considering the relevance of the health sector for economic activity and employment, this state of
affairs may be surprising. But when reflecting on the earlier discussions, a variety of factors come to mind which
help to explain this situation: the wide variety and complexity of national healthcare systems, the varying and
shifting public/private mix of delivery and financing, the size structure of the establishments, the complexity of
communications relationships, the wide variety of business partners and the particular type of customers. All of these
and additional factors render an analysis of the sector particularly challenging, and the dearth of detailed information
and hard facts on ICT and e-business applications in this sector confirms this.
Source: ICT&e-Business in the Health and Social Services Sector, the European e-Business Market Watch, sector report No.7 II/January 2003

12

1.2 Situation in Central and Eastern Europe


1.2.1 Introduction to Central and Eastern Europe (CEE)
From early nineties, Central and Eastern Europe countries (CEEC) have undertaken considerable efforts to include
themselves in the main activities related to research and development in health telematics in Europe. Countries of
this region demonstrate diversified environment of economy transformation and healthcare system status. The
process of market economy development brings essential risks to the healthcare system performance. What is also
important, healthcare is particularly sensitive domain of social expectations. It seems that efforts of developing ehealth environment in CEEC may be substantially accelerated by the co-operation with partners in current member
states of European Union. [1]
The use of e-health solutions may bring increased benefits for candidate countries with transforming economies. The
reforms in healthcare systems are usually considerably delayed when compared to mainstream of changes taking
place in these countries. The funds spent for healthcare are limited and the expectations of the society in this area are
still growing. The implementation of telemedical applications may result in augmented effects in terms of quality of
care and access of the patients to advanced diagnostic and therapeutic procedures.
Source:

[1] Mariusz Duplaga, Technologies to Central and Eastern European Countries, E-He@lth in Common Europe, Pro Access 2003
[2] Mariusz Duplaga, MD, PhD; II Chair of Medicine, Jagiellonian University, Krakow, Poland, The Promotion of E-Health Initiatives
in Central and Eastern Europe Countries

1.2.2 Demographic Data


Country
Name

Total
Populatio
n 1995 [1]
745,000

Projected
Populatio
n
2030 [1]
970,000

Media
n Age
1995
[1]
31.8

Total
Population
(latest figure)
[2]
771,657

10,230,060

9,412,000

35.8

10,249,216

10,106,000

8,448,000

37.4

10,045,407

38,557,000

39,939,000

33.7

38,622,660

22,728,000

20,732,000

33.8

22,271,839

5,338,000

5,441,000

32.4

5,430,033

Cyprus

Czech
Republic
Hungary

Poland

Romania

Slovakia

Age
Structure
(65 y.) [2]

Life Expectancy[2]

11.1% (male
37,345; female
48,284)

total population:
77.27 years
male: 74.94 years
female: 79.71 years
total population:
75.18 years
male: 71.69 years
female: 78.87 years
total population:
72.17 years
male: 67.84 years
female: 76.81 years
total population:
73.91 years
male: 69.77 years
female: 78.28 years
total population:
70.62 years
male: 66.88 years
female: 74.59 years
total population:
74.43 years
male: 70.44 years
female: 78.64 years

14% (male
554,922;
female
884,576)
14.9% (male
544,099;
female
952,775)
12.7% (male
1,879,445;
female
3,044,636)
14% (male
1,290,343;
female
1,837,339)
11.7% (male
238,912;
female
396,582)

13

1,925,000

1,687,000

36.4

1,935,677

Slovenia

Source:

14.7% (male
105,837;
female
179,177)

total population:
75.51 years
male: 71.65 years
female: 79.58 years

[1] Demographic Year Book, 1995 edition, UN


[2] CIA fact book, July 2003

1.2.3 Health Indicators


Country
Name

Health
Expenditu
re as % of
GDP [1]

General
Practicioners per
100.000 in
primary
healthcare
-

No. of physicians /
Physicians
working in
hospitals in % per
100.000 [2]
-

No. of hospitals
/ No. of
hospitals per
100.000 [2]
-

68.2

307,8 / 25.9

364 / 3.54

892,3 / 68.0

5.7 %
(2001)

67.0

361.4 / 32.5

172 / 1.71

385,1 / 85.0

6.2 %

233.0 / -

746 / 1.93

527 / -

3.9 %

81.3

191.4 / 50.7

425 / 1.89

404 / 58.3

5.7 %
(2001)

44.4

322.2 / 60.1

134 / 2.48

723,3 / 68.7

8.2 %
(2001)

45.0

215.2 / 52.8

26 / 1.32

693,1 / 53.9

5.7%
(2000)
EUR 200,2
million

Cyprus

Czech
Republic

Hungary

7.24 %
(2000)

No of nurses/
Number of
Nurses working
in hospitals per
100.000 [2]

Investment
in health
informatics
0.4% of
total health
expenditure

Poland
Romania
Slovakia
Slovenia
Source:

[1] Telemedicine Glossary September 2003: Luciano Bolchi (editor);


[2] http://www.reformazdravotnictva.sk/pril/RZ_Data.pdf

Relevant data can be also obtained from WHOs HIT profiles at http://www.observatory.dk.

1.2.4 Telemedicine Implementation


The following information was extracted from Telemedicine Glossary September 2003 edited by Luciano Beolchi
and can be found in Annex I of the report.
It contains information about:
Brief overview about telemedicine implementation
Plans and organization for the telemedicine implementation

14

in Cyprus, Czech Republic, Hungary, Poland, Romania, Slovakia and Slovenia.

1.2.5 Economic and Information Technologies (IT) indicators


1.2.5.1 GDP Gross Domestic Product
Country
Name
Cyprus

Czech
Republic

GDP purchasing power


parity (PPP)
Greek Cypriot area: $9.4 billion (2001 est.);
Turkish Cypriot area: $787 million (2002 est.)
- $155.9 billion (2002
est.)

GDP per capita PPP

GDP real growth

Greek Cypriot area: $15,000 (2001 est.);


Turkish Cypriot area: $6,000 (2002 est.)
- $15,300 (2002 est.)

Greek Cypriot area: 1.7%


(2001 est.); Turkish
Cypriot area: 2.6% (2002
est.)
1.5% (2002 est.)

$134.7 billion (2002 est.)

$13,300 (2002 est.)

3.2% (2002 est.)

$368.1 billion (2002 est.)

$9,500 (2002 est.)

1.3% (2002 est.)

$166 billion (2002 est.)

$7,400 (2002 est.)

4.5% (2002 est.)

$66 billion (2002 est.)

$12,200 (2002 est.)

4% (2002 est.)

$36 billion (2002 est.)

$18,000 (2002 est.)

3% (2002 est.)

Hungary
Poland
Romania
Slovakia
Slovenia
Source: CIA fact book, July 2003

1.2.5.2 IT penetration
Country
Name

Cyprus

Telephones main lines in


use
427,427 lines,
61.69lines/100
inhabitants
(2002) [1]

Telephones
mobile :
417,933
60% penetration
(2002) [1]

Telephone system:
general assessment: excellent in both the
Greek Cypriot and Turkish Cypriot areas
domestic: open-wire, fiber-optic cable, and
microwave radio relay
international: tropospheric scatter; 3 coaxial
and 5 fiber-optic submarine cables; satellite
earth stations

Internet
users:
150,000
(2002)

15

Czech
Republic

Hungary

Poland

Romania

3,869,000
(2000)

9,342,200
(2003) [2]

37 lines/100
inhabitants [5]

91 mobiles/ 100
inhabitants
[6]

3,095,000
(1997)

7,211,000
(2003) [3]

31 lines/100
inhabitants[5]

71 mobiles/ 100
inhabitants [6]

8,070,000
(1998)

13,000,000
(2002)

21 lines/ 100
ihhabitants [5]

34 mobiles/ 100
inhabitants [6]

4,174,000
(2002) [4]

4,496,800
(2002) [4]

18 lines/100
inhabitants [5]

20 mobiles/ 100
inhabitants [6]

general assessment: privatization and


modernization of the Czech
telecommunication system got a late start but
is advancing steadily; growth in the use of
mobile cellular telephones is particularly
vigorous
domestic: 86% of exchanges now digital;
existing copper subscriber systems now being
enhanced with Asymmetric Digital Subscriber
Line (ADSL) equipment to accommodate
Internet and other digital signals; trunk
systems include fiber-optic cable and
microwave radio relay
international: satellite earth stations
general assessment: the telephone system has
been modernized and is capable of satisfying
all requests for telecommunication service
domestic: the system is digitalized and highly
automated; trunk services are carried by fiberoptic cable and digital microwave radio relay;
a program for fiber-optic subscriber
connections was initiated in 1996; heavy use
is made of mobile cellular telephones
international: Hungary has fiber-optic cable
connections with all neighboring countries;
the international switch is in Budapest;
satellite earth stations
general assessment: underdeveloped and
outmoded system in the process of being
overhauled; partial privatization of the stateowned telephone monopoly is underway; the
long waiting list for main line telephone
service has resulted in a boom in mobile
cellular telephone use
domestic: cable, open-wire, and microwave
radio relay; 3 cellular networks; local
exchanges 56.6% digital
international: satellite earth stations
general assessment: poor domestic service,
but improving
domestic: 90% of telephone network is
automatic; trunk network is mostly microwave
radio relay, with some fiber-optic cable; about
one-third of exchange capacity is digital;
roughly 3,300 villages have no service
international: satellite earth station - 1
Intelsat; new digital, international, direct-dial
exchanges operate in Bucharest;

2,690,000
(2001)

1,200,000
(2001)

6,400,000
(2001)

800,000
(2002)

16

Slovakia

Slovenia

Source:

1,934,558
(1998)

3,100,000
(2003)

36 lines/ 100
inhabitants [5]

58 mobiles/ 100
inhabitants [6]

722,000
(1997)

1,650,000
(2002)

38 lines/ 100
inhabitants [5]

86 mobiles/ 100
inhabitants [6]

general assessment: a modernization and


privatization program is increasing
accessibility to telephone service, reducing the
waiting time for new subscribers, and
generally improving service quality
domestic: predominantly an analog system
that is now receiving digital equipment and is
being enlarged with fiber-optic cable,
especially in the larger cities; mobile cellular
capability has been added
international: three international exchanges
(one in Bratislava and two in Banska Bystrica)
are available
domestic: 100% digital (2000)

700,000
(2000)

600,000
(2001)

CIA fact book, July 2003,


[1] Cyta Annual Report 2002, www.cyta.com.cy,
[2] www.eurotel.cz, www.t-mobile.cz, www.ceskymobil.cz,
[3] http://www.templetonthorp.com/en/news349,
[4] http://www.alcatel.com/newslink/0302/pdf/latitude.pdf
[5] Formula: IT penetration.Telephones-main lines in use/Demographic Data.Total population
[6] Formula: IT penetration.Telephones-mobile/Demographic Data.Telephones-mobile

1.2.6 IT Spending
1.2.6.1 Investment in IT (excluding telecommunications) compared to GDP
Country
Name

IT Spending
EUR million
NA

Share in %
NA

Ration IT/GDP
in %
NA

Per capita IT
spending in EUR
NA

2602

22.5

252

1910

16.5

3.2

187

4093

35.4

2.1

106

680

5.9

1.5

30

729

6.3

3.4

136

510

4.4

2.4

257

11574

100

2.6

110

Cyprus
Czech
Republic
Hungary
Poland
Romania
Slovakia
Slovenia
Total
CEE *

* Includes Bulgaria, Estonia, Latvia, Lithuania


Source: European Information Technology Observatory - EITO 2003

17

1.2.6.2 ICT market shares in 2002 (Relative IT market size)


Country
Name

IT Spending EUR
million
NA

Share in %
NA

6422

16

6111

15.3

15049

37.6

3916

9.8

2296

5.7

1688

4.2

40023

100

Cyprus
Czech
Republic
Hungary
Poland
Romania
Slovakia
Slovenia
Total CEE *

* Includes Bulgaria, Estonia, Latvia, Lithuania


Source: European Information Technology Observatory - EITO 2003

1.3 Online Search for health information Europe


The following data were acquired from SIBIS 2003 report. The full abstract can be found at Annex II.
This report focuses primarily on presenting some statistics and indicator results from the SIBIS benchmarking
surveys. The survey fieldwork was carried out in April May 2002 and January 2003. A representative General
Population Survey (GPS) was conducted in 2002 in all 15 EU Member States, as well as Switzerland and the US,
involving a total achieved sample size of 11,832 and in the above 10 Newly Associated States in 2003, involving a
total sample size of 10,407. A representative survey of establishments the Decision Maker Survey (DMS) covered 7 EU Member States, including the five largest Member States (Germany, Spain, France, Italy and the UK)
as well as Finland, expected to be an information society frontrunner, and Greece, expected to be less well advanced.
This involved a total achieved sample size of 3,139 establishments.
It contains results of:
Online search for health-related information (% of all Internet users)
Online search for health-related information (% of population)
Success in finding suitable health-related information on the Internet

(% of Internet users who have searched online for health-related info in the last 12 months)
Sibis website can be found at http://www.empirica.biz/sibis/.

18

2. Country Profiles
2.1 Czech Republic
2.1.1 Government Action Plans (AP)
Ministry of Informatics (http://www.uvis.cz) has developed their action plan for state information policy
implementation for the years 2002 and 2003.
The AP contains National AP eEurope+ CR that can be found in the Information democracy section of the AP. The
part of point 3 The support of Internet use contains subsection Zdravotnictvi on-line (Health on-line).
Zdravotnictvi on-line can be found in both APS for 2002 and 2003. Zdravotnictvi on-line can be found among 2003
AP projects. Following is the relevant abstract:
Project Name
Zdravotnictvi
on-line

Target
(Outputs)
Registers,
telemedicine,
medical
documentation

Competency

Associate Partner

Deadline

Health
Ministry CR

ZIS R, KS RZIS,
VIS (coherent with
KI ISVS)

20012005

Financial
Costs CZK
119.830
(2001)
71.000
(2002)
51.000
(2003)
35.000
(2004)
35.000
(2005)

Financial costs are in Czech korunas. At the time of the report 1 EUR = 32 CZK.
The coherent steps with eEurope+
To build up telematic infrastructure in the health domain including regional networks for primary and secondary
health care providers.
To implement on national and regional level the basic qualitative criteria for web pages with the relation to health
created in the EU member states.
To interconnect the networks and databases of EU public health care.
The coherent indicators of eEurope+
The percentage of the health professionals connected to the Internet.
The use of various categories of information as web content by health professionals.

2.1.2. List of National Information Society Related Websites


The Office of the CR Government (http://www.vlada.cz/): Comprehensive information on Members of the Cabinet
and their program, links to the respective Ministries, search function (in government decisions), records from press
conferences, etc. It also includes information of the CR Government Council for State Information Policy
(http://www.vlada.cz/1250/eng/vrk/rady/rady.htm). Available in English.

19

The Office for Public Information Systems (http://www.uvis.cz/): New website, currently under preparation. Access
to basic documents related to State Information Policy, standards, and information from abroad, links to information
resources. Available in English.
Czech Forum for Information Society (http://www.info-forum.cz/indexe.html): The Forum is intended as a public
dialogue on information society issues. Available in English.
Czech Telecommunication Office (http://www.ctu.cz/index_a.htm): Site presents the origins of the Czech
Telecommunication Office, its mission and activities. List of legal acts and implementing provisions. International
activities. Available in English.
Central website address (http://www.centralni-adresa.cz/cadr/index.htm): The official information system on public
procurement and auctions. Link to the Public Administration portal (Prototype version) which is to become an
integrated site to get information and/or use the services of public administration bodies. Available only in Czech.
Source: eEurope+ 2003, Action Plan, June 2001 http://www.kbn.gov.pl/cele/eeurope/eeurope.pdf

2.1.3 Ministry of Health


The official Ministrys web site can be found at www.mzcr.cz. The specialized section for Health informatics can be
found at http://www.mzcr.cz/kat/8 (Czech version only).

2.1.4 The use of the Internet in Czech Health Institutions in 2002


The following data were acquired from the information bulletin no. 13 from 3.4.2003 of UZIS CR (Institute of health
information and statistics CR). For the complete information see Annex III of the report.
The report consists of the data concerning:
The purpose of communication over the Internet.
The purpose of acquiring information over the Internet.
The use of the Internet in pharmacies and at GP office in 2002
The use of the Internet for gaining the Information

2.1.5 Survey of the Information Systems (IS) in the Czech Hospitals 2003
The survey was conducted by Ministry of Health CR and IPVZ (Institute of postgraduate education in health),
Prague. For the complete report please go to Annex IV of the report.
The following data come from Anketa informatiku ceskych nemocnic, vysledky jaro 2003 (Survey of IT personnel
in Czech hospitals, results spring 2003), edited June August 2003, MuDr. Miroslav Seiner, IPVZ Prague.
Note: HIS = Hospital information system
The report consists of the data concerning:
Return of the sent our questionnaires
Types and size of the health institutions
State and perspective of building IS
Current state of building of integrated HIS in the health institution
Satisfaction with complete HIS
Satisfaction with unfinished HIS
The reasons for not implementing HIS
The opinions about the perspective of the various types of applications
Interest in further IS

20

HIS personnel
Position of head of IT dept.
Status of the position
Education level of heads of IT dept.
Information and their relation to the institutions
The requests to Ministry

2.1.6 Telemedicina.CZ - Telemedicine Projects in Czech Republic


There has been an interesting project of Information platform organized by Prof. Rosch Foundation with the support
of Czech Telecom. The aim of this project was a support of new technologies through the pilot project that were
mainly focused on the clinical applications (teleconsultations of the doctors during the surgery or the transmission of
these surgeries for the purposes of distant education and training of the doctors). The site is available at
http://www.telemedicina.cz.
You can see the list of individual projects that were executed or are planned in the Annex V of this report.
Below is the map of the Czech Republic with the regional location of the projects.
The picture shows that most of the telemedicine activity of the planned or executed projects within Telemedicina.CZ
is located in:
Prague region
Southern Moravia, mainly in Brno
Northern Moravia and Silesia, mainly in Olomouc and Ostrava
There is also bigger activity in Eastern Bohemia, mainly in Hradec Kralove. Lower activity can be seen in all the
regions of the Czech Republic.
The biggest activity is in the regions neighbouring with Poland and Slovakia, centrally the biggest activity is in the
Prague region.

10)
12)

4) 7) 9) 12) 15) 17)


2) 3) 4) 7) 8) 12) 16)

13)

4) 12)
4)

12)

1) 5) 7) 8) 12) 15) 17)

4)
Zlin

8) 11) 12) 14)

1) 4) 6) 7) 10) 12) 13) 15) 16) 17) 18)


12)

1) 7) 8) 11) 12) 14) 15) 17)


11) 14)

Name of project/pilot
Interventional teleradiology
Acute neurotraumatology
Home (tele-)working for neurosurgeons
Telepathology

11)

Number
1
2
3
4

21

Interconnection of the Olomouc country hospitals


Telecardiology
Telehematology
Teleortography
Teleconsultations and treatment of acute
myocardial infarction
Teleconsultation of laparoscopic executions
Interconnection of Brno region hospitals
Teletraumatology
Teleconsultation in the area of pediatric
auxomology and syndromology
Interconnection of Injury hospital Brno with
cooperating hospitals
Teleendoscopy
Teledermatology
Telearthroscopy
Telebronchoscopy

5
6
7
8
9
10
11
12
13
14
15
16
17
18

2.1.7 ROSCH Foundation


Recent Activities
Since established in 1998, the Foundation and its partners have participated
in the following activities:
Five point-to-point tele-video medical specialty conferences between Prague and Portland, Oregon.
Two multi-point televideo medical conferences between Prague, Graz and Portland, Oregon, USA.
Regular multi-point televideo conferencing and teleconsutation services between a constellation of five
Czech hospitals in Prague, Hradec Kralove, Olomouc and Brno.
Technical planning and performance of more than 20 hours of transmission of live cases and multi-point
panel discussion to the 6th and 7th International Workshop in interventional radiology.
Live case transmission with demonstration of new minimal invasive procedures to five international
meetings in Europe and Asia.
Performance of a three-hour tele-meeting on advances in minimal invasive treatment with physicians in
Japan.
Teleconsultation in neurosurgery between 10 hospitals in Northern Moravia for facilitating diagnosis of
head and spine trauma injury management.
Home working via PCs and ISDN services for neurosurgeons at the Ostrava Hospital in the Czech
Republic.
Telepathology consultation at 6 Czech hospitals.
Telecardiology at several Czech hospitals with successful transmission of echocardiographic studies and
teleconsultations.

2.1.8 IZIP Internet Medical Database


For the full text please go to Annex VI of this document. You can find complete info about the project at the project
website: http://www.izip.cz.
The abbreviation IZIP in Czech language means Internet Access to Patient's Medical Information.
The objective and substance of the IZIP project is to place the medical database of the insured patient into the public
information network - the Internet.

22

The database consists of selected parts of medical documentation written into IZIP by the attending physicians. Both
the doctor and the patient may at any time use a computer with internet access to view the results of clinical
examinations, laboratory tests and X-ray pictures as well as a list of prescribed and used medicaments.
The IZIP project is executed by a private company IZIP Ltd., Prague, with the support of General Health Insurance
Fund of the Czech Republic (VZP CR) and other partners such as IBM, Czech Telecom, Eurotel, Komercni banka
and others. The application solution, software and implementation are supplied by IBM, and the Czech Telecom and
Eurotel look after the data transfer.
Initiators
Initiators of the projects were Pavel Hronek otorhinolaryngologist, Milan Cabrnoch pediatrician and Miroslav Ouzky
rehab doctor.
Demo version
Available at http://www.izip.cz/demo/

2.1.9 MEDTEL & NetC@rd


For the full text concerning MEDTEL and NetC@rd project, please go to Annex VII of this document. You can find
complete info about the project at the project website: http://www.medtel.cz/index_e.php.
MEDTEL, o.p.s. is a non-profit organization. MEDTEL is a member of EHTEL.
NetC@rd project
Czech Republic prepares countrywide introduction of new health insurance cards for the ensured persons of VZP
(70% of population) at the middle of 2004. The card reverse will have European health insurance card (EHIC)
format and CR will be one of the first countries where EHIC will be implemented.
Goal of the pilot project
The goal is to securely identify the insured person and to create the pre-requisite for the automated authorization of
the transactions.
Costs related to the Czech part: 310,000,- EUR

2.1.10 MeDiMed Regional Centre for Archiving and Interhospital Exchange of


Medical Multimedia Data
The website can be found at http://www.mou.cz and http://www.muni.cz.
The goal of the project is to create shared outsourced medical multimedia data archiving and communication center
which can serve as a Trustworthy Neutral Exchange Point for all participants of this project. More can be found at
http://www.ten.cz/doc/2003/zprava/medimed.html (Czech only).

2.1.11 Czech Society of Nuclear Medicine


The website of the Society can be found at http://www.csnm.cz/.
PACS = Picture Archive and Communication System

23

PET = Position Emission Tomography


The website describes telemedicine, PACS and PET systems in particular with the links to the PET center in Prague
at Nemocnice Na Homolce hospital: http://www.homolka.cz/nm/. However in the time of writing this document
there has been a second PET center opened in Brno at Masaryk Oncology Institute hospital: http://www.moi.cz/.
The web site also contains various statistics for Czech Republic nuclear medicine data.

2.1.12 PET center in Nemocnice Na Homolce hospital


For the information about position emission tomography (PET) center, go to the official website:
http://www.homolka.cz/nm/index-e.html.
PET Center Prague is located in a separate building within the complex of Na Homolce Hospital.
The Department of Nuclear Medicine is located on the first floor of PET Center Prague. It is equipped with
dedicated PET camera CTI/Siemens ECAT EXACT and with Siemens SPECT camera (E.CAM).

2.1.13 IKEM CZ Institute for clinical and experimental medicine


You can find out more about IKEM at http://www.ikem.cz
IKEM hosts CZI MEDICON, Healthcare Informatics Center for the development and operation of application and
communication environment of the healthcare data network in the Czech Republic. It is a valuable resource for
public, health outcome researchers, and academicians both in and outside of the Czech Republic.
OVID
System Ovid Web Gateway is an instrument for searching and working with bibliographical and full text information
from the area of biomedicine. It is accessible to all employees of the member institutions of the consortium on the
address: http://gateway.ovid.com/autologin.html
Data Network of Health Department (dSRZ) medicon.cz
DSRZ is multifunctional network of selected health institutions that are the base for future infrastructure of National
Health Informational System (NZIS) and serve for informational and communicational needs of health department
with country coverage, especially in the area of selected Informational System of NZIS framework
DSRZ is realized on the base of TCP/IP protocol using the public network infrastructure of TCP/IP EUnet on top of
which is built non-public network infrastructure of VPNs with the use of encrypted IP/IP tunnels. The traffic is
separate from public Internet, at the same time there is a possibility to access Internet from the individual virtual
private network (VPN).
DSRZ is defined as a framework of mutually separated but interconnected independent VPNs of health sector with
variable but controlled level of required level of security. This network infrastructure will enable other controlled,
reliable and secure interconnection on other non-public and public networks, including the relationship on
informational system of chip cards.

2.1.14 Euromise
Euromise represents Education and Research in Medical Informatics and it can be found at http://www.euromise.cz
and http://www.euromise2004.org.
The European Center for Medical Informatics, Statistics and Epidemiology of Charles University and Academy of
Sciences (EuroMISE Center) was set up in 1994.

24

Development of interdisciplinary postgraduate and lifelong education, mostly of university teachers, has been the
main goal of the European project Teaching Methodology for Heath Care under the TEMPUS program and
development of interdisciplinary research has started with the cooperation on the project Managing Uncertainty in
Medicine - MUM under the program COPERNICUS.
The main targets of EuroMISE Center are:
To create an European teaching network for higher education in medical informatics, statistics and
epidemiology;
To organize and initiate graduate and postgraduate education on international level.
To start international research and development programs in the interdisciplinary field of medical informatics,
statistics and epidemiology; to cooperate closely with the healthcare resort.
Further development of the EuroMISE Center of Charles University and Academy of Sciences is based on close
cooperation with European universities, research and health organizations and on recommendations of the
international committee.
Research
Research activities of theEuroMISE Center are focused on the development of interdisciplinary research. It
concentrates on methods of statistical data analyses, methods for extracting relevant information for decision making
and managing uncertainty, methods for decision support, study of risk factors of diseases, mathematical methods in
genetics and epidemiology. The research cooperation of the EuroMISE Center with other academic and health
institutions is stimulated by Czech grant agencies (Grant Agency of the Czech Republic, Grant Agency of Charles
University, Grant Agency of Ministry of Health of the Czech Republic) and by European projects MUM
(COPERNICUS) and I4C - TRIPLEC (4th Framework Programme). Some research results are applied by
programme prototypes, for example E. T. (quick processing of data from epidemiological studies), CORE (reduction
and constitution of data) and HYPERTENZE (optimization of decision support in therapy of arterial hypertension).
The results are published in both Czech and international journals. The EuroMISE Centre is also involved in
editorial boards of journals (International Journal of Medical Informatics,
Physician and Technology) and in scientific societies (IMIA, EFMI, Czech Medical Society of J. E. Purkyne,
Society for cybernetics and Informatics of the Academy of Sciences of the Czech Republic).

2.1.15 Branch Contact Organization - Healthcare (BCO)


Oborov kontaktn organizace - zdravotnictv (OKO) - Branch Contact Organization Healthcare (BCO) in
English. The web site can be found at http://www.oko-zdravotnictvi.cz.

Helps to involve Czech health care research subjects into the network of European institutions using shared
activities and programmes, especially with focus on the 5th Framework Programme of Research and
Technological Development of EU (and prospectively on the 6th of Framework Programme),
Is a small organization based on the common project of the Czech Medical Association J. E. Purkyne and the
consulting of the Econsult and the financing with the grant support of the programme EUPRO by the Czech
Ministry of Education,
Reports the information about the programmes from the sphere of the international cooperation in the research
and development at the health services of the Czech Ministry of Education,
Is situated close to the secretariat of the Czech Medical Association in the Medical House in Prague (addr. Praha
2, Sokolsk 31),
Supports communication, coordination a cooperation among interested parties in the Czech Republic, especially
healthcare researchers, small and medium-sized enterprises aimed on the health services and related partners in
European Union,
Organizes special informative events, looks for suitable partners for international projects of healthcare research
and development,
Assists and consults relevant project proposals,
Creates thematic database for healthcare research and innovation on Internet,
Opens up the Czech medical research and development on the Internet.

25

Branch Contact Organization for healthcare closely collaborates with Technological Center of Academy of
Science the National Contact Organization for the 5th Framework Programme of EU, with related National
Contact Point as well as with other regional and branch contact organizations.

2.1.16 Coordination Center for Departmental Medical Information Systems


Koordinacni stredisko pro resortni zdravotnicke informacni systemy (KSRZIS) was established by the Ministry of
Health as of December 1, 2000 as a contributive organization. The web site can be found at http://www.ksrzis.cz/.
The main task of the Coordination Center is to perform managing, developing, coordination and publishing activity
in medical informatics in connection with setup and operation of selected information systems with departmental
force in the following areas:
national health registers
other information systems of medical department.
Other tasks of the Center are in particular the following:

1. organization of direct operation and delegated administration of appointed departmental medical


information systems,

2. organization and unification of information and communication technologies for operation of appointed

medical information systems, particularly departmental data networks, system and application software,
data interface, standards of medical informatics, and systems of electronic identification etc.,

3. Performance of data analysis according to health department requests.


The subject of activity of the Center is development, operation, and administration of data networks of the health
department. The Center also fulfils tasks at development, operation and data processing in the following areas:

National register of cardiovascular interventions,


National register of patients after organ transplants,
National list of candidates for organ transplants including databases,
National register of deceased donors of organs including databases,
Other national medical registers appointed by the Health Ministry,

Other information systems in the health department.

2.1.17 National Health Registers


Following is the list of the national health registers. You can find complete details about the registers at
http://www.ksrzis.cz/ (Czech version only) or in Annex VIII of this report.

IS TRANICON
National cardiosurgery registry (NKCHR)
National oncology registry (NOR)
National registry of vascular surgery
National registry of arthal replacements
Ophthalmology registry (OFR)
Nosocomial Infection registry (RNI)

26

2.1.18 Central registry of R&D projects


The search in Central registry of R&D projects shows only 1 telemedicine project funded by Ministry of Health. The
CEP web site is at http://www.vlada.cz/1250/rvv/cep/index_cep.html.
Name: High-speed transmissions and archivation of digital medical images.
Description: The project is of interdisciplinary character and deals with introducing the functional system of
transmission and archiving image medicinal data into clinical practice and teaching the students and its effects on
rationalization and economization of working. Another of the principal tasks is securing immediate availability of
the data about patients for an attending physician and the possibility of immediate remote consultations of cases with
colleagues.

2.1.19 List of Contacts


Organization
Department of Informatics of
Ministry of Health
Department of Informatics of
Ministry of Health
Telemedicina.cz

Name
Mr. Pribik director

Contact Details
Tel.: +420224972397

Mr. Cizek deputy

Tel.: +420224972774

Ing. Jiri Valek

tel./fax: 222318305, e-mail: valekjiri@quick.cz


e-mail:
radek.svarz@roschfoundation.org,
info@roschfoundation.org
Phone: +420 2 4143 1122
Javor@ics.muni.cz
e-mail: info@izip.cz
tel.: 00420 224 212 200
tf: 233 376 194
e-mail: medtel@medtel.cz
Tel.: +(420) 25727 2165

ROSCH foundation

Radek Svarz, Project


Development Manager

MeDiMed
IZIP

Michal Javornik

MEDTEL, o.p.s.
PET centre Na Homolce
hospital
IKEM
Euromise
Coordination Center for
Departmental Medical IS

Otakar Belohlavek
Head of Information and
communication department
Ing. Vladimr ROUS
Jana Zvrov
head of the department

tel: 261 364 201


email: vladimir.rous@medicon.cz
+420 266 053 097
zvarova@euromise.cz
tel.: +420 2 6136 4045
e-mail: ksrzis@ksrzis.cz

27

2.2 Hungary
2.2.1 Ministry of Health
The official website of the Ministry is at http://www.eszcsm.hu/eszcsm/eszcsm_angol.main.page.

Health Portal
Ministry of Health also hosts a health portal at: http://www.eszcsm.hu/eszcsm/agazati_angol.main.page.
At the moment the information is available only in Hungarian.

2.2.2 Ministry of Informatics and Communication


The official website of the Ministry is at http://www.ihm.hu.

eHungary
eHungary is an action plan (AP) for information society for the years 2004 2006. eHealth is one of the sectoral
responsibilities for the AP. Unfortunately it doesnt contain any concrete projects mentioned in the text.
More info can be found at http://www.ihm.hu/English/_20030211_5.html.

2.2.3 List of National Information Society Related Websites


The Government of the Hungarian Republic (http://www.meh.hu/).
Ministry of Informatics and Communication (http://www.ihm.hu/).

2.2.4 eHealth in Hungary


There are 2 reports describing telemedicine situation in Hungary.
The 1st report was written by Peter Futo and its part of SIBIS+Project WP4, Policy Issues document published 29.
January 2003 in Budapest. This report gives overview about eHealth situation.
The 2nd report was written by Sandor G. Vari, Tamas Gergely and Pal Simon and contains several articles giving
more detailed information about the topic. This report is quite large in volume and it contains 30 pages.
It contains articles about:
- Historical review
- Major milestones of Information Society Technologies (IST) development and implementation
- The current situation of health informatics in Hungary
- Implementation and use of the IST by hospitals/doctors today
- Review of the National and EU RTD activities and implementations
- IST strategies and action plan for eHealth in Hungary
- and General comments regarding eHealth in Hungary
You can find the 1st report in Annex IX and 2nd report in Annex X of this report.

28

2.2.5 National Institute and Library for Health Information


Founded with the purpose to provide the Hungarian medical community with the latest achievement of foreign
medical sciences. Its function is to provide information and literature to healthcare institutes, the community at large,
and experts working in the healthcare profession.
The official website of the Institute can be found at: http://www.medinfo.hu/index_en.html.
The large abstract about the Institute can be found at Annex XI at the end of this report.
The abstract contains info about:
Health communication
Healthline
National Library of Health Sciences
Proprietary databases
Other services
Other tasks

2.2.6 GYOGYINFOK Center for Healthcare Information


Gyogyinfok is the Center for Healthcare Information of the Ministry of Health, Social and Family Affairs. The
Centers website can be found at http://www.gyogyinfok.hu/angol.htm.
Scope of activities: An organizational-methodological and research institution of the Ministry of Health, Social and
Family Affairs in the field of health informatics with national responsibilities.
Projects
Programs (only in Hungarian)
DRGs Version 4.3;
DRGs Version 4.1; DRGs Version 4.0
DRGs Version 3.0; DRGs Version 3.1; DRGs Version 3.2
Outpatient unit's activity (TETELES Version 7.3)
Dental program for data gathering
at patient encounter level (TETFOG Version 2.82)

2.2.7 Hungarian Office for Research and development


HunOR was established in 1999 by a national consortium of organizations responsible for science, research and
development in Hungary in order to facilitate successful participation of Hungary in the Framework Programmes.
The official website with information can be found at http://www.hunoriroda.hu/english.htm.

2.2.8 Institute of Experimental Medicine


The Institute of Experimental Medicine of the Hungarian Academy of Sciences in Budapest is the only research
institute in Hungary dedicated exclusively to medical research.
The Institutes website can be found at http://www.koki.hu/.

29

2.2.9 OTKA National Research Institute


Provides independent and extensive support to scientific research and to the research infrastructure and gives
assistance for young researchers and to promote the achievement of scientific achievements of international
standards.
The website can be found at http://www.otka.hu.

2.2.10 Computer and Automation Research Institute, Hungarian Academy of


Sciences
The website of the Institute can be found at http://www.sztaki.hu.
The list of the projects can be found at http://www.sztaki.hu/sztaki/projects/.

2.2.11 PROREC.HU & WIDENET


The Hungarian PROREC Center is a separate project of the Computer and Automation Research Institute of the
Hungarian Academy of Sciences.
The main goal of PROREC is to promote and co-ordinate the European wide convergence towards comprehensive,
communicable and secure Electronic Healthcare Records (EHCR). The full information can be found at
http://www.sztaki.hu/projects/prorec-hu/Htmleng/prorec-hu.html.

2.2.12 PRIMACOM
The official website can be found at http://www.primacom.dk.
The INCO-COPERNICUS project PRIMACOM (PRIMAry Care Physicians COMmunication Network)
demonstrates how such communication can be established in regions in Hungary and Slovenia. PRIMACOM is
building on European messaging standards for EDI (Electronic Data Interchange) with practical experience from the
Danish MedCom project.
PRIMACOM is building on European messaging standards for EDI (Electronic Data Interchange) with practical
experience from the Danish MedCom project and already commercialised in Slovenia and Hungary.
The pilot site in Hungary includes a hospital and primary care center. A Hungarian software provider and a
consultant are involved.

2.2.13 RETRANSPLAT
The website can be found at: http://retransplant.vitamib.com/.
The full abstract can be found in Annex XII of the report.
Regional and International Integrated Telemedicine Network for Organ Transplant

30

The RETRANSPLANT project aims to facilitate the development of Telematics tools for dialysis and organ
transplant centers, organizations coordinating recipient-donor selection, and other health care facilities for transplant
services in the Central Eastern European Countries (CEE).

2.2.14 MiM Medical Info Media


Health communication and information system provides information resources to the medical community by the one
hand, and the consumers who search recovery, and rehabilitation by the other hand. The system enlists healthcare
professionals, provides contact details and presentation of businesses, organizations and institutions related to health
care in general.
The website can be found at http://www.mimnet.hu/0200_eng/.

2.2.15 VARIMED
Health Portal with the links to Hungarian telemedicine projects.
The website can be found at http://www.varimed.hu/.

2.2.16 List of Contacts


Organization
Prorec.HU & Widenet
Primacom
Primacom
Primacom
Varimed

Name
Gyrgy Sznt
Attila Simay
Family Doctors Association of
Miskolc
Geza Nagy
Semmelwis Hospital
Dept. of Anesth. & CCU
Lszl Szernyi
Praxis Medical System
Dr. Sandor G. Vari

Contact details

szanto@sztaki.hu
Tel: (+36 1) 209 5270
e-mail: asimai@mail.datanet.hu
Phone: +36 46 320 335
e-mail: medaninf@alpha.bzlogi.hu
Phone: +36 30 584 612
e-mail: praxis@mail.datanet.hu
Phone:(818) 904-1954 (USA)
Mobile: (818) 398-2642 (USA)
Phone:36-1 487-0430 (Hungary)
e-mail : varimed@axelero.hu

31

2.3 Poland
2.3.1 Ministry of Health
The official Ministrys web site can be found at http://www.mz.gov.pl.
The contact list of the Ministry can be found at
http://www.mz.gov.pl/wwwmz/index?mr=m01411&ms=&ml=en&mi=141&mx=0&ma=656.

2.3.2 List of National Information Society Related Websites


The website of the Polish Forum for Information Society (http://www.kbn.gov.pl/cele/index.html), the advisory body
to the Council of Ministers, presents the basic Polish documents related to the Information Society development in
Poland as well as the activities of the Forum.
The Information Society website maintained by the State Committee for Scientific Research (KBN)
(http://www.kbn.gov.pl/gsi/index_eng.html) presents the strategy "Aims and Directions of the Information Society
Development in Poland" adopted by the Council of Ministers in 2000, other documents related to the Information
Society development in Poland, links to the websites of European Information Society (documents, programmes,
etc.) and provides information on the IST programme. Some essays and interviews could also be found.
The website of the Ministry of Posts and Telecommunications (http://www.ml.gov.pl/english/documents/index.html)
presents the list of ministerial licenses, regulations and documents; among them the latest "ePoland - The Strategy of
an Information Society Development in Poland for 2001-2006".
The Polish Information Processing Society website (http://www.pti.org.pl/english/index.html) provides information
on the Society activities. It also presents some useful links to the Polish, foreign and international organizations
active in IT related issues and provides information on the European Computer Driving License.
The Interkl@sa programme website (http://www.interklasa.pl/portal/index/strony) presents the wide range of
initiatives related to the education aspects of Information Society. It gives an overview of the actions undertaken,
links to some educational web sites and many institutions active in this field.
Source: eEurope+ 2003, Action Plan, June 2001 http://www.kbn.gov.pl/cele/eeurope/eeurope.pdf

2.3.3 ePolska (ePoland)


On 11 September, 2001 the Council of Ministers adopted the document "ePoland Action Plan on the Information
Society Development in Poland for the years 2001 2006", which follows the approach of the "eEurope+" action
plan and has to be updated annually. [1]
Following is the part of the extract from ePolska AP that is focused on Health Care on-line. You can see the full
abstract concerning eHealth in Annex XIII or the full report at http://www.kbn.gov.pl/cele/epolska/epoland.html.

Specific tasks [2]


No

Task

Term
of
implementati
on

Implementing / coSource of financing


ordinating agencies

Creation of a uniform electronic data base on CSIOZ


medical establishments and facilities, available via
(Health

Care

MoH (Ministry
Health) budget

of

end of 2001

32

the Internet

Information
Systems Center)

Creation of an electronic data base on doctors, Supreme Chamber MoH and Supreme
with the location, medical specialty, surgery hours, of
Medical Chamber of Medical end of 2002
available in each medical facility
Practitioners
Practitioners budgets
Creation of a data base on patients covered by
Agency appointed MoH and/or Sickness
health insurance
by
Fund (Kasa Chorych) end of 2003
MoH
budget
Development and implementation of an electronic
system which supports reporting and presentation
of information on health care
CSIOZ

source of financing after


under agreements
consultations

Determination and co-ordination of standards of


electronic data interchange in medicine
CSIOZ

CSIOZ budget

Establishment of the legal framework allowing


payments for medical services to made over MoH
telematics networks

MoH, voivods and


Sickness
Funds end of 2001
budgets

after
consultations

Preparation of a plan for the implementation of Agency appointed


after
telemedicine
by
source of financing
consultations
MoH
under agreements
Development and implementation of pilot distance
training programmes

CSIOZ

Drawing up of legal and technical assumptions for


the system of verification and authentication of
CSIOZ
information on medical products and services

Source:

CSIOZ budget

after
consultations

CSIOZ budget

After
consultations

[1] eEurope+ Progress Report, Ljubjana 3-4.5.2002, http://www.kbn.gov.pl/cele/ljubljana/index.html

[2] ePolska Action Plan, http://www.kbn.gov.pl/cele/epolska/epoland.html

2.3.4 National Health Care Programme


The National Health Care Programme (NHCP) as it exists now doesnt contain any notion of telemedicine. The
current NHCP sets objectives and guiding principles of the public health policy in Poland by the year 2005. The full
version of NHCP can be viewed at http://www.medstat.waw.pl/nhp/index.html English version residing on
Department of Medical Statistics server (www.medstat.waw.pl)

2.3.5 Registry of Medical Services


The following information was given by Katarzyna Owieawska [kasia.swiezawska@asm-poland.com.pl] from
ASM - Centrum Badan i Analiz Rynku Sp.z.o.o. ,SIBIS national contact.

33

The construction of the integrated system of the Ministry of Health includes a currently realised set of projects,
under the name Register of Medical Services. This is the biggest IT investment in the Polish history. The RMS
project involves plans of issuing Health Insurance Cards for the entire society. The register of Health Care Institutes
is being developed, and the Register of Pharmacies is being prepared for implementation. Common access to
medical information will increase the participation of patients in the process of treatment. They will have the
possibility to find information e.g. about the location of a selected health-care institution, the specialisation of a
chosen doctor, the medical services offered etc.

2.3.6 National Pharmaceutical Portal


National Pharmaceutical Portal can be found at http://www.pharmacy.pl/fwp/fwp.htm. It contains several search
engines to search in address or drug databases, it contains calendar with local or national health events and it also
contains legal matters, information about pharmaceutical magazines, pharmaceutical organizations and other
pharmaceutical data. Unfortunately the whole project is in Polish only.

2.3.7 Informatization of hospitals in the Malopolskie province, 2002


The following are data describing IT in terms of hardware (in this case hospital's IT network), software (related to
medical and administrative activities) and degree of it's integration in the Malopolskie province hospital.
Malopolskie province is situated in the southeast of Poland with the capital city Crakow.
For the complete report please go to Annex XIV of the report.
The report contains the data about:
Types of IT personnel in hospitals
Information network coverage in hospitals
Range and level of the software integration used in hospitals
Planned time of introducing full integration
Forecasted costs for full informatization

2.3.8 Telemedicine at University Hospital in Krakow


The following article was written by Witold Poniklo from Academic Computer Center CYFRONET of the
University of Science and Technology in Cracow.
For the complete article please go to Annex XV of the report.
This memo consists of two parts one describing University Hospital in Krakow achievements and second, pointing
at the potential telemedicine systems users.

2.3.9 Telemedicine in Poland


Extensive report written by Mariusz Duplaga from CYFRONET can be found at Annex XVI of the report.
The report contains information about:

National action plan


Barriers to successful implementation of telemedicine
Telemedicine technologies used by hospitals/doctors

34

Status of HER
eHealth initiatives/pilots in Poland

2.3.10 Research and Development Units


Following is the list of the R&D institutes in Poland. As an example I chose Instytut Fizjologii i Patologii Sluchu
with their example of the successful project they participated in. The complete list of R&D Units can be seen in
Annex XVII of this report.

Instytut Fizjologii i Patologii Suchu


ul. Pstrowskiego 1
01-943 Warszawa
tel. (022) 835-66-70
fax (022) 835-52-14
sekretariat@ifps.org.pl
Internet page: www.ifps.org.pl
The Institute has organized and is the coordinator of the Program of Care over the Hearing-Impaired in Poland
(1997).
The general aim of that Program is to establish a uniform, complex system of care for all the hearing impaired
providing more effective services for the deaf and hard of hearing, meeting the needs in diagnostics, treatment and
rehabilitation, education and social welfare
One of the first is the program of universal hearing screening "Sysz..." (I can hear...) created to identify hearing
impairments in children and teenagers (age 6-19 years) as early as possible and to provide immediate proper
treatment and rehabilitation. In the next, original tools, diagnostic and rehabilitation systems, the latest achievements
in informatics technology have been used to fight hearing impairments, tinnitus, speech and vision disorders. The
prepared multimedia tools ("Mwi..." - I can speak...; "Tinnitus"; "Widz..." - I can see...) solve many technical
problems in audiological, phoniatric and speech and language pathology diagnostics and rehabilitation in a very
economical way which makes it possible to be introduced on a mass scale.
The institute has also recently been producing set of diagnostic and educational programs on CDs. The programs are
aimed at persons interested in rehabilitation of hearing impairments and communication disorders.

2.3.11 The Role and Advantages of Using the Tele-ECG System in Daily Medical
Practice - Telemedicine Project
Telecardiology has played a very important role in the first Polish activities in the field of telemedicine. Morbidity
from heart diseases in Poland is very high and the statistics show that they cause more than 50% of all deaths from
cardiovascular diseases.
In Poland the system of transtelephonic ECG has been developed since 1996. The system provides a nation-wide 24
hours a day the transtelephonic ECG support for patients under the supervision of on-call cardiologists. It enables
efficient remote monitoring of patients with some cardiac problems (arrhythmia, atrial fibrillation, chest pain) and it
seems to be easy and cost-effective. Within the system the patient is being equipped in the small mobile transmitter
which enables transmission of the ECG signal to the cardiologic monitor center. In the center the signal after
transforming by the use of PC computer into the ECG graph can be easily interpreted by the specialist on duty. In the
same time the system allows for teleconversation with the patient to collect all necessary medical data and give the
patient the professional advice. After each contact the medical record of the patient is updated.
There are several telesystems of cardiologic survey currently run in Poland: Kardiofon, Tele-Kardio-Med,
Cardiotel and others. Kardiofon, based in Warsaw, is the biggest one; it employs some 20 experienced
cardiologists and intensive care specialist. The system has involved 2.000 individual patients and over 12.000
patients from family doctors practices. The database contains over 22.500 records sent entirely by phone. During 5

35

years of research study showed the high compliance between preliminary diagnosis made on the base of tele-ECG
transmission and the final hospital diagnosis.
There were distinguished 3 main groups of interventions within the Kardiofon system:
1. Typical cardiac problems (chest pain, arrhythmia, hypertension) verified by tele-ECG records 40% of cases.
2. Check examinations (after therapeutic interventions, patients with implanted pacemakers, on the request of family
physicians) 32% of cases.
3. Interventions on initiative of the patients with non-specific ailments (weakness, fatigue, anxiety) and with no
changes in the ECG record 28% of cases.
Among cardiac problems heart rate disturbances was the most common (56% of events); the heart ischemia appeared
in 26% of events, hypertension problems in 13% of events and the heart failure in 5% events. The tele-ECG system
proved to be most effective in diagnosing patients with acute heart ischemia and paroxysmal atrial fibrillation (PAF).
In 1998 within tele-ECG system the research program of monitoring patients with PAF was implemented. It turned
out owing to medical interventions of cardiologists working in the system, in 80% cases return to the sinus rhythm
was obtained and patients didnt need further hospital treatment. The program enabled the reduction of
hospitalization rate from 5% of interventions in 1998 to 2% in 2000.
The tele-ECG survey showed its high usefulness in diagnosing and monitoring patients with cardiac problems. The
system is available for anyone who wants to closely monitor the condition of heart, whether he already need extra
support or just wants to take a more active role in his health care. It is also expected that telecardiology services can
eliminate unnecessary patients transport to the secondary care centers, reduce hospitalization rates and associated
costs.
Source: Maria BujnowskaFedak, Violetta Tobijasiewicz, Wojciech Drewniak, Dariusz Wojciechowski, Andrzej Steciwko, PROACCESS, July 2003, http://www.pro-access.org

2.3.12 Tele-ekg - CARDIAC MONITORING SYSTEM


The system is developed by PRO-PLUS company. The main goal is to develop system enabling distant ECG
monitoring of patients by specialist doctors. The companys website can be found at http://www.pro-plus.pl.
The example of the system and description of the software can be found at Annex XVIII of this report. The
complete list of the product can be found at the companys website.

2.3.13 Telewelfare.com
Telemedical portal offering an interactive service for diagnosis and rehabilitation of the senses responsible for
communication. The diagnosis and rehabilitation systems were conceived and prepared at the Sound & Vision
Engineering Department of the Technical University of Gdansk (http://www.akustyka.com) and the Institute of
Physiology and Pathology of Hearing in Warsaw (http://www.ifps.org.pl/). They are international patents pending in
all international patent treaty countries. The applications are located in the common portal
http://www.telewelfare.com .
I can hear
Programme of Care for People with Hearing Impairment in Poland. It is a multimedia system of testing patients
hearing.

36

The system "I CAN HEAR..." is a multimedia computer programme. The role of the "I CAN HEAR..." system is
mainly to test the hearing mainly in children and youth. The tests use automatic questionnaire analysis, audiometric
tone test procedure and testing speech intelligibility in noise.
Tinnitus
Diagnostic tests and information for tinnitus and hyperacusis sufferers.
The "Tinnitus" site provides diagnostic tests and information for tinnitus and hyperacusis sufferers. It is designed for
children, youth and adults. "Tinnitus" has examples of sound files
for comparing the sounds with those heard by tinnitus sufferers.
The site gives you an opportunity to listen to examples of background sounds used in tinnitus therapy.
I can speak
Universal System for Testing and Rehabilitation of Speech. The "I CAN SPEAK" site presents concepts and results
of computer tools applied in phoniatry and speech therapy.
I can see
Universal System for Diagnosing Visual Impairments. I CAN SEE is a multimedia computer programme.
It is designed for testing vision in adults, children and youth.
The vision testing on this website consists of automatic survey analysis, and tests that check your colour vision,
binocular vision and contrast discrimination.
The idea of the system is to carry out vision screening tests, mainly in children and youth.
The system also presents ample information about eye care, how vision problems originate and what methods are
used by ophthalmologists to diagnose and rehabilitate disorders.

2.3.14 PIONIER
The initiative of academic environment to develop backbone network in Poland. All the relevant information can be
found on the website: http://www.pionier.gov.pl.
International Cooperation
Stimulating International Scientific Cooperation
POLAND'S PARTICIPATION IN GRID PROJECTS (5TH FP)
CrossGrid (coordinated by CYFRONET) www.crossgrid.org
Eurogrid, iGrid (ICM) www.eurogrid.org
GridLab (coordinated by PSNC) www.gridlab.org
European Grid Projects funding sum - 35 mln Euro
Poland participates in projects worth 15 mln Euro
Stimulating International Scientific Cooperation
POLAND'S PARTICIPATION IN NETWORK PROJECTS (5th FP)
ATRIUM (PSNC) world.alcatel.be/atrium/index.htm
LION (UMM)
6Net (PSNC)
6Vinit (UMM)

37

SGIgrid
High Performance Computing and Visualization with the SGI Grid for Virtual Laboratory Applications
The SGIgrid project aims to design and implement:
state-of-the-art, broadband services for remote access to expensive laboratory equipment
backup computational center
remote data-visualization service
These services will be based on the national HPC infrastructure and advanced visualization.
The SGIgrid project will provide users of Polish HPC centers with high, aggregated computational power, bring
savings due to better utilization of software licenses and also bring other immeasurable savings since the
infrastructure will be used to build a backup computational center for IMiGW which is covered by the System of
Country Monitoring and Protection.
Important dates
Start date: Dec 1, 2002
Ending date: Oct 31, 2004 (for research and development works)
Ending date: Nov 30, 2005 (for implementation)
The web presentation can be found at http://www.wcss.wroc.pl/pb/sgigrid/en/index.php
List of project partners can be found at: http://www.wcss.wroc.pl/pb/sgigrid/en/partners.php
Extended list of contact details can be found at http://www.wcss.wroc.pl/pb/sgigrid/en/contact.php

2.3.15 Krakow Center of Telemedicine


The presentation of the centre can be found on the website: http://www.telemedycyna.krakow.pl/. All the
information is in Polish only.
The Krakow Telemedicine Center was established in Poland in the year 2000, as a consortium of leading institutions
in the field of informatics and telecommunication from the AGH University of Science and Technology and medical
centers associated with Collegium Medicum at Jagiellonian University. [1]
The consortium of institution and organizations representing medical and technical environment:
Jagiellonian University Medical College II Dept. of Medicine
Dept. of Cardiac Surgery
John Paul II Hospital
AGH Science and Technology University Dept. Computer Science
Dept. Telecommunication
Academic Computer Center Cyfronet AGH
Krakow Center of Telemedicine is part of PRO-ACCESS Project.
The PRO-ACCESS project was initiated in the late phase of 5th Framework Programme as supporting action. It
focused on the transfer of current concepts in health telematics to countries remaining in the preaccession phase. The
process of dissemination of up-to-date approaches to e-health environment development is carried out by the
Krakow Center of Telemedicine and is supported by leading health telematics centres in Europe. To accelerate the
dissemination activities the network of co-operating centres in CEEC was established. [2]
The main objective of the centre is to development of the regional health information network in Malopolska
voivodship.
The aim of the centre has been

38

the development of pilot teleconferencing and teleconsultation systems


establishing the tele-training network with the access to digital video libraries of operation and diagnostic
procedures
dissemination of validated telemedical solutions to other health care centres in the Malopolska voivodship and
whole Poland.
the Center aspires to the role of transmission point of new technologies and solutions from advanced partners
within European Community to Poland.

The range of activities applications and


implementation:
1. Videoconferencing systems
2. Wireless access to radiological databases with PDA (iPAQ)
3. Internet ambulatory registration system for patients.
4. Access to multimedia medical information via GPRS network.
5. Tele-negatoskop
6. Medical Digital Video Library
7. Web-based system for shared care and monitoring of patients with severe asthma
Example Project
The Presentation of Invasive Procedures in Chest Medicine within Digital Video Library

User Interface
1. Medical Digital Video Library in Krakow Center of Telemedicine as the tool of training in interventional
pulmonology, cardiac and thoracic surgery

39

2. Access to digital video resources increased motivation for peripheral centres to join
teleconsultation scenarios.
3. The double use of established links:
- For teleconsultation services
- Access to MDVL
Source: http://www.americantelemed.org/news/2003_presentations/M3b2.Duplaga.htm
Example Project
The Severe Asthma Patient Monitoring System
- Joint initiative of Polish Ministry and National Scientific Committee, scheduled for 2002- 2003
- The network of reference centres
- System of monitoring for patients
- Patients access to the system: PC with Internet connection, mobile phones
- Shared care (reference centre, local hospital, primary care shared care physician, other health professionals)
- Disease course trends tracing
- Alarm messages sent as emails and SMS to health professionals

Objectives
- Diminishing the rates of hospitalizations and emergency calls
- Improving quality of life of patients
- Harmonized co-operation between health care professionals
- Lowering expenditures for care of this group of asthma patients [3]
Conferences
In June 2003, the 1st Conference "E-Health in Common Europe" was held in Krakow as part of the PRO-ACCESS
project. The Organizing Committee is proceeding with preparations for the 2nd edition of this conference, which will
take place on March 11-12, 2004.
The details of the conference can be found at: http://www.pro-access.org/conference2/.
Source: [1] Krakow center of telemedicine developing the platform for regional telemedical networks, Krzystof Zielinski, Ehe@lth in Common Europe, PRO-ACCESS 2003;
[2] The need for transfer of up-to-date e-health concepts and technologies to Central and Eastern Europe countries,
Mariusz Duplaga, E-He@lth in Common Europe, PRO-ACCESS 2003
[3] http://www.univ-lille2.fr/cerim/colloques/e-sante/pdf/MDuplaga_Lille_24012002.pdf

2.3.16 PRO-ACCESS
The following are the abstracts from PRO-ACCESS project papers. The details can be found at http://www.proaccess.org.

Home Tele-Monitoring of Arterial Hypertension in Family Medicine


Arterial hypertension (AH) and all its sequels are one of the most serious threats to human health and life. AH
affects about 41% of the middle-aged population in Poland. Only 6% of people with AH have their disease
adequately controlled, 40% just know about it, 27% know without taking any therapeutics, and 27% are treated
ineffectively. Family doctors have a crucial role to play in the early detection of AH in their patients. They should
also start treatment as early as possible and recommend the necessary lifestyle changes.

40

Home telecare exemplifies the application of telemedicine in primary care/family practice, including remote
diagnosis and treatment, compliance monitoring, and tele-monitoring of vital signs. The experience gained from
different trials and studies shows that ambulatory blood pressure (BP) monitoring and self BP measurements at home
share similar advantages and can be successfully applied to the management of AH. Few randomized-controlled
trials, however, have been carried out to determine the efficacy of telemedicine in reducing BP. We identified
several recent studies on home tele-monitoring of BP and AH to present the specific telemedicine systems used for
this approach, with its advantages and disadvantages.
The aim of our project on Home tele-monitoring of hypertension in family medicine is the assessment of the
diagnostic and tele-monitoring value of home BP measurement (in the newly diagnosed patients with AH). This
randomized-controlled trial will be carried out in three family medicine settings. The patients will be recruited by
their doctors and divided into two groups: (1) conventionally managed in family practice, (2) making daily BP
measurements in their homes and transferring the results to the practice by phone. Office BP measurements will be
compared with those taken in the patients home. The assessment will also include: patient compliance, quality of
life, and cost-effectiveness of this approach. [1]

A Telemedicine Support for Diabetes Management The Pilot Project


Effective control of diabetes is known to delay or prevent the progress of this disease. Despite enormous efforts to
change the delivery of diabetes care, the outcome has not been satisfactory. However, telecommunication can
improve the quality of diabetes care by altering the caring environment and care delivery process. In telecare
applications the role of the patients become central, since they are actively involved in the process of managing care
and treatments and they are responsible for collecting some measurements and related information.
The aim of this project is to develop, demonstrate and evaluate a telemedicine system for diabetic patients
management. The system is designed to improve the daily care and intensive management of diabetic patients
through telemonitoring and telecare services. The paper presents architecture of the system, the technical solutions
adopted and the methodologies on which it is based. The system is composed of two modules a Patient Unit and a
Medical Unit connected by the telecommunication network. The Patient Unit and the Medical Unit are able to
communicate both over the Internet and the public switched telephone network. Using the system the patient is
allowed to automatically down load his monitoring data from the blood glucose-monitoring device and to send them
to the personal computer of his family physician.
Both units, in an integrated approach, offer tools to doctors and patients for data collection, data analysis and
decision support and enable them to send massages and/or therapeutic advice to the patients. The system will be
evaluated for usability, telemedical protocols, metabolic controls and quality of life. This pilot study demonstrates
the feasibility of the telediabetology supportive system in daily routine use and its potential benefits for diabetes
care: improving the availability of information necessary in treatment decisions, showing the better, more precise
metabolic control of patients. The study offers new physician-patient communication tools. It helps patients with
management in the daily care of diabetes and increases patients independence without decreasing the essential
continual support and supervision from the doctor. Moreover this telematic system seems to be not expensive and
simple in use. [2]

TEKOMED Mobile Teleconsultation System


In clinical practice essential quick consultation of patient's data with reference centre could be necessary to
undertake the decision regarding further diagnostic or treatment. Simultaneously, it could be useful to enable
medical consultation by the local expert who is actually outside his medical center. Such a system was created in the
National Institute of Cardiology. It makes possible to access the clinical data ECG, Holter ECG and coronary
angiography. In the short time also the Echo study could be presented by the system. The access to the TEKOMED
system is via Internet. It was also tested that sufficiently effective is also GPRS link by the mobile phone. In this way
TEKOMED system enables to view all of the stored medical data in every place and any time. It is possible to be
installed in any hospital over the Poland and other countries. TEKOMED gives the unique chance of the professional
consultation for the patients medical data at the National Institute of Cardiology. TEKOMED makes possible the

41

transfer of requested clinical data by cellular phone. The transmission of the one sequence of the coronary
angiography lasts about 1 minute. In the future, the development of the new cellular phone technology based on
UMTS will shorten the transfer to maximum 15 seconds. [3]
You can see the presentation of TEKOMED at http://box.ikard.waw.pl/tekomed/.

TELEDICOM Environment for Collaborative Medical


Consultations
The environment called TeleDICOM supporting remote collaborative consultations in medicine. The notion of
collaborative work although well known in distributed systems area is unfortunately still hardly present in medical
applications. Being able to process only local data or at most cooperate with databases they lack interactivity with
other users.
The functionality of TeleDICOM will be presented. The main usage scenario will allow a doctor from a local
hospital to consult patient examinations in form of various digital documents with specialists from a clinic hospital.
Supplemented with videoconferencing tools the whole environment will significantly improve access to highly
qualified medical professionals for peripheral medical centres. The application seems to be very helpful also in the
area of teaching medicine students which could
either passively participate in real consultations or take active part in teaching sessions arranged specially for them.
The system will use mainly DICOM images, which have high diagnostic quality and are generated by most modern
medical equipment.
The overall architecture of the system will be presented. The system is being developed using state-of-the-art
distributed systems technologies. The data security, efficiency of network communication and userfriendliness of the
application have been kept in mind. The idea of the application has been one of the laureates of a project Internet w
szkoach organized by Polish President. TeleDICOM is being developed in Institute of Computer Science of AGH,
which is an active member of Krakow Center for Telemedicine and Preventive Medicine. [4]
The complete report can be found at: http://www.pro-access.org/ConfMan/SUBMISSIONS/ 93-Czekierda.doc

2.3.17 The University Hospital in Krakow


The University Hospital in Krakow is one of the biggest hospitals in Poland, with over 200 years of history of
operation. The Hospital consists of 32 Departments and 60 Outpatient Clinics covering practically all medical
specialties.
There are above 42 000 hospital's admissions every year and about 300 000 medical consultations at different
Departments. The Hospital serves as a referral center for population of about 6 million from Southeast part of
Poland. Number of hospital's employees is equal to 4 200 persons.
The Hospital staff is involved not only into regular medical activities, but also into research, education and different
medical projects. An international cooperation plays an important role at the Hospital's strategy of development.
The University Hospital is considered as an institution, which effectively utilizes modern medical technologies and
is well equipped with modern, sophisticated medical equipment for diagnosis - such as 3 CT's, MRI, Gamma
Camera, CathLab's - and treatment. Also IT technologies play an important role at the Hospital's operation.
Additionally, the Hospital's staff is developing different IT projects - including telemedicine - which would make the
medical and administrative data flow and data processing easier.
The web presentation can be found at http://www.su.krakow.pl/english/index.html.
Source:

[1] Andrzej Staniszewski and Jadwiga Staniszewska, PRO-ACCESS, July 2003, http://www.pro-access.org;
[2] Maria Bujnowska-Fedak, Edward Puchaa, Andrzej Steciwko, PRO-ACCESS, July 2003, http://www.pro-access.org;
[3] Rafa Baranowski, Adam Koprowski, PRO-ACCESS, July 2003, http://www.pro-access.org
[4] Jacek Cala, ukasz Czekierda, PRO-ACCESS, July 2003, http://www.pro-access.org

42

2.3.18 Telemed
TELEMED Ltd. has been formed to perform research, system development and integration, and services involving
interactive videoconferencing systems, telecommunications systems, audio and video processing, information
systems, and Internet, with the main focus on the following applications:

telemedicine
distance education and training
distance work and control
distance promotion-information-marketing

We also offer technical, medical, and scientific consulting services.


Major activities of TELEMED Ltd. are directed towards the development and support of telemedicine. We organize
videoconferencing and Internet based sessions for telemedicine both within Poland, and between Poland and North
America. On the request of the medical and academic institutions as well as of privately owned medical clinics and
federally sponsored hospitals, we provide and secure all the necessary information technologies, audio and video
coders, diagnostic devices, and secure and reliable communications systems in order to support the medical care at a
distance. We assure an excellent voice and video quality, and secure, reliable two-way communications between
various centers in Poland, USA, and Canada.
Two ways, interactive audiovisual sessions enable the medical doctors and experts on both sides, not only for joint
professional meetings, education courses, seminars, conferences and scientific symposia, but also for medical
consultations, exchange of opinions, joint decision making in the critical situations, and assisting "on-line" in the
difficult medical procedures and operations.

2.3.19 E-rejestracja
eRejestracja online patient registration system
eRejestracja is a sample of online patient registration system developed by private company in Poland. The company
website can be found at http://e-rejestracja.pl/.
eRejestracja is a web-based service enabling patients to register online for medical check-ups or other medical
services. The system is addressed to all kinds of medical institutions, both public and private. So far, online
appointments in Poland have only been available to individual clinics or hospitals, usually private, via those
institutions' websites.
At our website (www.erejestracja.pl) patients have at their disposal various search engines, allowing users to narrow
down their search using multiple criteria, e.g. type of medical service or location (voivodship, town, district, etc).
Once the patients have found the service of their choice (e.g. a dentist located next to their office), they can make an
online appointment.
eRejestracja may be integrated with internal systems used in hospitals or clinics. Currently we are working on the
implementation of such integrated systems in major medical institutions. Our future projects include appointments
through sms (gsm-based short messaging system), a service which we shall introduce as one of the first in the world.
eRejestracja is also developing a system allowing for secure data transfer between co-operating medical institutions.
Our project is in accordance with the principles of the Electronic Health Record, as well as binding regulations on
personal data protection (i.e. our integration solutions are founded on XML-based data exchange).
Our project is in accordance with the requirements of the Wrota Polski (Gate of Poland), e-government policy.
Source: Marcin Straburzyski

MD, director of E-rejestracja

43

2.3.20 List of Contacts


Organization
National contact
point

Name
PYTKO, Anna (Ms.) LifeSciHealth
NCP

SIBIS national
contact

ASM - Centrum Badan i Analiz Rynku


Sp.z.o.o.
Elzbieta Syrda
ASM - Centrum Badan i Analiz Rynku
Sp.z.o.o.
Maria Goreczna
Ms. Elzbieta Piechna

SIBIS national
contact
Ministry of Science
and Informatics
Krakow Center of
Telemedicine
The University
Hospital in Krakow
TELEMED

Mariusz Duplaga, MD, PhD


Jagiellonian University Medical
College
Witold Poniklo
Modernization and development of the
hospital

Contact details
URL: http://www.npk.gov.pl
Tel: +48-22-8262502
Email: apytko@ippt.gov.pl
Email: syrda@asm-poland.com.pl
Tel ++48.24.3557715
Email: international@asmpoland.com.pl
Tel ++48.24.3557715
Email: epiechna@mnii.gov.pl
Email: mmduplag@cyf-kr.edu.pl
Tel: +48(012)4247073
witoldponiklo@su.krakow.pl
Phone: (+48 22) 872-16-44
Fax: (+48 22) 872-32-74
e-mail: telemed@telemed.pl

44

2.4 Slovenia
2.4.1 Governments Action Plans
In Slovenia, the commitment to the development of the Information Society was clearly expressed in January 2001
when the Ministry for Information Society was established. The ministry operates in close co-operation with the
Government Office for Informatics and with other ministries and government offices. On a general policy level, the
ministry contributed to the creation of the Slovene National Development Plan for the period 2001-2006. In spring
2002, the ministry prepared the National Programme Republic of Slovenia in Information Society as a policy
document for Public Administration, Economy and Civil Society.
Source: eEurope+ Progress Report, Ljubjana 3-4.5.2002, http://www.kbn.gov.pl/cele/ljubljana/index.html

2.4.2 Ministry of Information


The website can be found at http://www2.gov.si/mid/mideng.nsf.
The Ministry of Information Society holds the political responsibility for the information society, including egovernment. However, at an operational level, the Government Centre for Informatics (GCI) is the body in charge of
developing the countrys e-government infrastructure, and to support, control and coordinate government
departments ICT projects.
Slovenian eGovernment portal
The portal has been launch in March 2001. It provides access to a range of e-services and government information
for citizens, businesses and civil servants.
The web site of the portal can be found at http://e-uprava.gov.si/e-uprava/en/portal.euprava and http://egov.gov.si/e-uprava/english/index.jsp (English version).
Government Centre for Informatics
The website can be found at http://www.gov.si/cvi/eng/
Action Plan eGovernment up to 2004
Health is one of 12 e-services for citizens - Services connected with health service (interactive counseling on
available services in hospitals and interactive ordering for medical treatment).
And also one of the 15 areas of Action Plan.
Area

G2C

Subareas & E-Services


Waiting periods

Actor
MH

Deadline
2004

MH

2004

Health

Organization of working hours


Development of a management system
for health care
Definition of PIN immediately after
birth in a maternity hospital

MH,
IPH,
GCI,
MIA

Project
Waiting
Periods
Organization
of Working
Hours
e-SPP
Definition of
PIN
Immediately
after Birth in a
Maternity
Hospital

45

G2B
Health

Development of a management system


for health care

MH

2004

e-SPP

Source: http://e-gov.gov.si/e-uprava/english/docs/akcijski_nacrt_e-uprave_do_leta_2004_1_3.doc

2.4.3 Ministry of Health


The website of the Ministry can be found at http://www2.gov.si/mz/mz-splet.nsf.
Ministry of Healths National Health Sector Management Project
The main project goal is to secure long-term stability of the system and to found its managing on provable and
verifiable data focused on the patient. In Phase I, by the end of 2003, we aim to establish conditions required for the
national scale implementation, which is the subject of Phase II, to follow up to 2006, provided that the Phase I
outcome is successful. The budget for the project is 13,8 M EURO in the period 2001-2003 (phase 1) and 16,2 M
EURO in 2004-2006 (phase 2).
Complete description of the projects with the costs, names of the people involved can be found at
http://www2.gov.si/mz/hsmp/hsmpeng.nsf.

2.4.4. Ministry of Education, Science and Sport


The website of the Ministry can be found at http://www.mszs.si/eng/.
The extensive report was prepared by the Ministry and can be found in Annex XVIX of the report.

2.4.5 List of Other National Information Society Related Websites


Government (http://www.gov.si/).
Society Informatika (http://www.drustvo-informatika.si): Translations of key information society documents;
European driving license (ECDL) contact point

2.4.6 Institute of Public Health


The web presentation of the Institute can be found at http://www.gov.si/ivz. The institute performs Health Research
as one of the fields of work collecting, organizing and analyzing the health-related data.

2.4.7 Institute of Biomedical Informatics


The website of the Institute can be found at http://www.mf.uni-lj.si/ibmi-english/raziskovanje/index.html.
Projects
1. Informatics
Intelligent information storage and retrieval of Slovene and English medical documents on Internet
(Subproject of INCO-Copernicus Project: 960154, CRII)

46

Digital library of Slovenian medical documents


Evaluation of research in the field of biomedicine in Slovenia
2. Statistics
Theoretical (project: Regression Models in Survival Analysis)
Applied (IAEA project: Pain Relief In-Patients with Bone Metastases)

2.4.8 Slovene Medical Informatics Association


The website of the Association can be found at http://www.simia.org/.
The Association is sponsored by:

ZZZS - The Institute of Health Insurance of Slovenia (http://www.zzzs.si)


Nova Vizia d.o.o. Zalec Health Informatics company (http://www.vizija.si/)
Infonet d.o.o. Kranj Health Informatics company (http://www.infonet.si/)

Projects
PROREC.SI
Electronic Health Record (EHR)
For details see also Annex XX of the report.

2.4.9 SIZN - Nursing Informatics Interest Group


The website of the Group can be found at http://www.kclj.si/sizn/.
The work program includes:

Collaboration In International And National Projects


Informatics Meetings Provide
Advising And Issuing Expert Opinions
Collaboration By Related International Associations
Collaboration On Support At Base Of Research And Applicative Projects
Publishing
Annual Plan And Work Report

The complete work program of the Group can be found at http://www.kclj.si/sizn/work_program.htm.

2.4.10 Telemedicine in Slovenia report


Extensive report written by Bostjan Bercic from INFONET can be found at Annex XX of the report.
The report contains information about:

Historical review and major milestones in IST development and implementation 1993 2003
Review of the National and EU RTD activities and implementations
Barriers to successful implementation of telemedicine
Telemedicine technologies used by hospitals/doctors
PROREC Slovenia
Status of HER

47

Expenditure of IT in Slovene hospitals


The most important eHealth initiatives/pilots in Slovenia

2.4.11 Telemedicine Projects


2.4.11.1 Transtelephonic transmission of ECG
The transtelephonic transmission of electrocardiograms (ECGs) was introduced in Slovenia in 1996 and has been
used regularly since September 1997 by health institutions and patients with
cardiovascular diseases. Portable 12-channel ECG equipment weighing less than 200 g is generally used. The
diagnostic centre is located in the intensive-care unit at the University Medical Center
Ljubljana. In the first 12 months of regular operation we received 463 calls, 213 of which were diagnostic. The most
common reasons for calling were: ischaemic chest pain, atypical chest pain, palpitations and dyspnoea. The most
common diagnoses made on the basis of history
and the ECG were: acute myocardial infarction, angina pectoris, paroxysmal tachycardias and atypical chest pain. In
40% of cases the cardiologist's advice sufficed; 38% of patients were referred to the
emergency room, 29% immediately and 9% only if a suggested therapy did not prove successful; and in 21% of
cases new medication or a change of dosage of current medication was suggested. Transtelephonic ECG
transmission enables direct communication between general practitioner or patient and cardiologist. With its use,
time from onset of symptoms to initiation of treatment is shortened, which reduces disability and mortality due to
cardiovascular diseases and improves cost-benefit. Author.
Source: Journal of telemedicine and telecare {J-Telemed-Telecare} 2000, VOL:
6 (4), P: 205-8, ISSN: 1357-633X., http://www.sgmi-ssim.ch/medline/IM_00041.htm

2.4.11.2 Second Opinion


The complete information can be found at http://www.maat.si/so.htm.
Second Opinion Slovenia operates under the professional guidance and supervision of the largest health care center
in Slovenia, the Clinical Center in Ljubljana.
The project is called Second Opinion and with it, a second opinion of top specialists is attainable to patients from all
over the world. The Project uses the latest achievements of telemedicine.

2.4.11.3 Health Insurance Card Project Health Insurance Institute


The full details of the Health Card Project are available at http://www.zzzs.si/kzz/ang/ic_indx2.htm.
You can also see Annexes XX and XXI of this report for more details.
In the first phase of the Slovenian project, the Institute is introducing a card serving administrative purposes
(implementation of rights derived from compulsory and voluntary health insurance), supporting the procedures
regarding the selection of a personal physician, and carrying an elementary form digital prescription.
The health insurance card is the only document applicable in the implementation of the compulsory and voluntary
health insurance rights in Slovenia. A person is to present the card when visiting at the doctor's and at all other
occasions of implementing the rights deriving from health insurance.

48

2.4.11.4 PRIMACOM
In 1997 the project PRIMACOM1 was launched, within INCO COPERNICUS Programme. The aim of the project
was to supply health care professionals with systems and infrastructure for enhancement of communication between
primary and secondary care so-called Regional Health Care Networks or Community Health Information
Networks. The main task of the project was to establish and evaluate pilots in two Eastern European countries,
Slovenia and Hungary. The pilots upgraded the infrastructure and established direct communication between
hospitals and Primary Care General Practitioners in Primary Health Care Centres. In the second phase of the project
the software was adjusted to use European communication standards (EDIFACT) and electronic mailboxes were
established (source: HSMP Project Implementation Plan).
Source: http://www2.gov.si/mz/hsmp/hsmpeng.nsf/V/KC3155D1785DE23AFC1256B49002B4B9A/$file/Annex03_99-11-09.doc

Implementation of PRIMACOM
The following is the extract from e-mail correspondence from Mr. Bostjan Bercic.
In Slovenia the system (i.e. the network and tools for message exchange) was implemented (like it was planned and
like budget allowed) only in three pilot sites in a small region of Gorenjska. The system was being used in daily
work for a few months and discontinued after that. One problem was the small number of pilot sites (one hospital
and only about 6-8 GPs involved), as it was very inconvenient for the hospital to have 2 systems: to send electronic
discharge letters to only a few GPs, and for the majority of others doing it still manually, e.g. on paper. In other
words, the system was not practical, because it was not implemented generally, i.e. for all GPs and hospitals in the
region. The other problem was the legislation. There was no official approval for electronic documents (e.g.
signature) at that time.
Now, when the digital signature infrastructure is in place and officially approved for the whole country, we have set
a new project under the umbrella of PROREC Slovenia, using all the knowledge and experience from PRIMACOM,
as well as the same principles. Only the technology is more modern, for example: using Internet technologies instead
of X.400, XML instead of EDIFACT, etc. In comparison with PRIMACOM there are also many more technology
providers involved as before.

2.4.11.5 Security and Protection of the Data in the Slovenian Government including at the
Health Care Sector
Project supported by Government of the Republic of Slovenia Center for Informatics
Data security has been increasingly dealt with at various professional meetings and congress on informatics in
Slovenia and worldwide. Recently, a number of specialization workshops have been held with the aim of setting up
an effective system of data security. In the field of data security the following points need to be emphasized:
(1) Data security is an integral part of planning, creating and managing the health care information systems
at all levels; also both in public health institutions and in private practice.
(2) In addition to strictly medical information, a broad spectrum of personal, business and other databases,
which in the modern information society are closely interlinked, also need special protection.
(3) Current information systems make use of various media, including classical as well as computerassisted ones. Since in Slovenia, medical information systems are still in the phase of development, a
comprehensive and legally regulated system of security should be established in order to prevent
possible errors, abuse and organization inconsistencies.
(4)
All those concerned with the acquisition and protection of medical data, i.e. both clerical, nursing and
doctor staff, should be given adequate education, either through regular or periodical

49

trainingcourses,but first of all, they should be encouraged to apply the principles of data security to
their everyday work.
The purpose of this project is to stress some legal and ethical aspects of data protection, as well as the importance of
safe guarding the information privacy of each individual by taking into account the requirements of the profession
and the legal system and international standards and recommendations, especially WHO and European
Communities.
The Ministry of Health of the Republic of Slovenia and Institute of Public Health of the Republic of Slovenia has
prepared a draft of the new Health Care Record law that is now in parliamentary procedure, which deals with the
content and forms as a legally valid documents, regardless of electronic media, it also validates the electronic
signature and the extent of documents prescribed in health care. A group of experts in the field of Health Informatics
and experts from all Health Care levels have prepared a document: Principles and Guidelines for the Data Privacy
and Security of Health Information Systems.
The proposed project has the potential to supply the necessary platforms for the Health Sector Management Project.
Source:
http://www2.gov.si/mz/hsmp/hsmpeng.nsf/V/KC3155D1785DE23AFC1256B49002B4B9A/$file/Annex03_99-11-09.doc

2.4.12 InfoNet Healthcare Information Systems Company


The complete presentation of the company with the product range can be found at http://www.infonet.si.
INFONET was founded in 1991 as an information engineering company.
The main thrust of the company is the integration of our work, which is building and launching information systems
in the health care and pharmaceutical sectors. The development and implementation covers three basic fields:
hospital information systems
pharmacy information systems
information systems for Primary Health Care and GPs
You can also see more details in Annex XXII of this report.
Activities in Information Environment for Healthcare
a) Institute for Health Protection Ljubljana - at http://www.gov.si/ivz
Preparation Of Proposal For Uniform Definitions For The Field Of Hospital And Non-Hospital Activities
In the working group that was appointed by the Minister of Health and is managed by Dr. Tit Albreht we prepare the
uniform definitions for the basic conceptions which are used in the accounting/reimbursement system for obligatory
and for additional voluntary health insurance, as well as in healthcare statistics.
Health Statistics
We co-operate in work groups for optimum network performance, data collection, processing and transfer in
inpatient and outpatient statistics. We were initiators of its updating and we are satisfied that both fields have been
facing vital changes in the year 1997.
Data Collection, Aggregation And Analysis At Sick-Leave
We have developed the software used by regional and republic Institute for Health Protection for collection,
aggregation and analysis of data of sick leave.
Perinatal Information System
On the basis of requirements, connected with modernisation of in-patient statistics, we developed the software
application PerIS, which is used in Slovenian hospitals as information support to perinatal information system. The
software is developed on Windows platform and is one of the most contemporary application programs in the
Slovenian health care.
Standardisation And Classification Of Health Care Information System
We have co-operated in PROJECT GROUP for definition of information needs on national level - Ministry of
Health Care and Institute for Health Protection. In the continuation of the project we were included in: sub-project
for definition of data protection starting points sub-project for minimum data collection verification

50

b) Institute for Health Insurance of Slovenia (IHIS) at http://www.zzzs.si


Health Insurance Card
We were involved in two project groups for the project Health Insurance Card that started at the end of 1995 and is
now in the phase of finalisation. We co-operated in all the phases of the project execution as the largest software
house providing support to the healthcare providers information systems:
In the definition of required changes and the completion of software applications for healthcare providers.
In the definition of requirements for electronic data interchange between healthcare providers and IHIS.
During the pilot project in Posavje region we worked out all the required and needed program application
changes, as well as made the whole implementation in General hospital and in Pharmacy of Brezice. The
pilot project was a success!
In the phase of national wide deployment we adopted all the remaining applications, which now allow for
and confirm to all the business rules and logistics of the Health insurance card system. We have trained
over 5000 users (i.e. healthcare actors) and set up over 1800 card readers all over Slovenia.
Electronic Data Interchange
On our initiative and together with IHIS we started a joint project in 1993, in which we involved ourselves already in
the very phase of requirements' definition. Additionally, we initiated a pilot project with the Railway Health Center
Ljubljana. Successfully executed pilot projects accelerated the introduction of Electronic Data Interchange (EDI)
among our business partners (e.g. healthcare providers) and IHIS.
Presently, EDI for reimbursement purposes is being 100% used in all public healthcare institutions, as well as in two
thirds of private ones.
Elaboration of Software for Accounting and Invoicing Ihis
We were the selected software providers for IHIS at the beginning of 1993. We prepared all installation procedures,
developed all the required documentation and trained the users for the first software for accounting and invoicing
IHIS. Around 3000 medical workers in Slovenia got introduced to the information technology, by using the software
applications, for the first time.
c) Institute Josef Stefan, Ljubljana - http://www.ijs.si/ijs.html
Lab for Artificial Intelligence
Cooperation at the execution of the EXPERT SYSTEMS project, supporting the THERAPEUTIC ACTIVITIES IN
HEALTH CARE. Within the frame of this project we have developed software product PTAH, which is an aid to
doctors for preventing and for monitoring the phenomenon of hospital infect, as well as for decision making in
writing prescriptions for appropriate therapy. The project was co-financed by the Ministry of Science and
Technology.
International Projects in Medical Informatics
a) PRIMACOM http://www.primacom.dk
Cooperation in the project PRIMACOM, a part of EU project CoCo-INCO COPERNICUS, which is a strategic
project in the Telematics Application for Health program (HC1008). In a public-private partnership, two regions in
Hungary and Slovenia have established Regional Health Care Network for exchange of routine messages between
healthcare professionals.
b) Information System for Treating the Patient at his Home
The project was being run together with Faculty of Organisational Sciences Kranj and Faculty for medical personnel
Ljubljana. The software for supporting the work of home nursing was included into Information system of Primary
Healthcare and was developed by considering all international standards in this field, which arise within the project
TELENURSE.
c) Hansa East

51

The HANSA projects aim to promote the new technology and its standardised approaches through demonstrations
and dissemination activities. This project demonstrates that employment of a middleware based open architecture
yields reduction of working effort needed for interworking of existing systems capable to share ands exchange data.
Meanwhile this architecture has already been adopted as a European standard, i.e. CEN TC 251 ENV 12967-1
``Healthcare Information Systems Architecture (HISA Standard)
The overall objectives of HANSA EAST project were to transfer these distributed software technologies for open
health, healthcare, hospital, and insurance systems and adopted European standards to the CEE/NIS countries: to the
Health IT Authorities, and to Health IT providers for business development in order to create a local software
industry for the health sector. HANSA EAST consisted of three different countries, complemented by a Concerted
Action directed at the other countries, i.e. Albania, Bulgaria, Czech Republic, Estonia, Latvia, Lithuania, Slovak
Republic and Slovenia.
d) RETRANSPLANT (Regional and International Integrated Telemedicine Network for Medical Assistance
in End Stage Diseases and Organ Transplant - HC-4028)
RETRANSPLANT will implement a regional network to link different national organ transplant systems, to give online access to European transplant coordinators, donor centers, diagnostic specialists, to increase Europe-wide the
effectiveness of organ transplant services. RETRANSPLANT is stimulating partnerships between those who are
involved in research, development and implementation of information technologies, and user organizations of the
different tools of the Health Telematics. RETRANSPLANT consortium believes that the health care of tomorrow
needs to go to patients where they live, instead of patients going to the health care systems. Such a system will save
money and lives.
e) Leonardo da Vinci PROPRACTITION
The main and novel component of PROPRACTITION system is a new distributed architecture, comprised by a
collaborative toolkit to add audio conferencing, telepointing, window sharing, user's co-ordination and application
synchronisation facilities, either to existing or new medical diagnosis applications. In comparison with existing
products, mainly based on centralised architectures, our distributed toolkit is specially designed for telemedicine
applications: to allow different levels of sharing between participants, to improve user feedback in highly interactive
user interfaces, and to optimise the required communication bandwidth in order to implement a telemedicine
application on almost any telecommunication network. This system will be applied to build a co-operative medical
education application, in which two doctors, located in different hospitals, need to achieve a co-operative diagnosis
on cardio-vascular diseases.
f) WIDENET
WIDENET's mission is to promote the adoption and extended use of Standardised Electronic Health Care Records
and the required infrastructure. The project aims to provide a sound and effective instrument for promoting and
attaining such requirements. The plan is to form a European Institute for Healthcare Records and Management that
will represent the permanent network of National Centres and provide quality and affordable added value services to
the European market. Doing this fulfils calls from the European Parliament, the Council of Ministers, the
Commission, and the Council of Europe. There is also an important goal dealing with the collaboration with strategic
bodies (CEN, ISO, EC IST programme, EHTEL, WHO and national/international initiatives) to ensure that the
``European convergence" is appropriately conducted according to their guidance and standards.
g) PHARE (SL-9803.02.0001.03) - Further Alignment of Slovene Statistical Methodology with EC
Requirements
The overall objective of the project is the creation of a methodological, technical and operational basis and the
achievement of comprehensive competencies (on the side of IDP, statisticians and users) which will guarantee the
sustainability of the project outcome from all the sub-components and the further re-usability of the obtained results
within the statistical production and dissemination process.

52

2.4.13 Nova Vizia (New Vision)


The companys website can be found at http://www.nova.vizija.si/images/English/mi/default.htm.

Health Informatics Products


SOVA Computer aided medical information systems
ZUBSTAT Outpatient healthcare statistics
ICD International code of diseases
EMERGENCY Data processing in emergency medical activity
PP-NMP Learning and testing First Aid and Emergency Rescue
SIMKPR Cardiopulmonary Resuscitation Simulator
HEALTHCARE INSURRANCE CARD The HIC contractor for the pilot project of Posavje region
2.4.14 List of Contacts
Organization
Ministry of Education, Science
and Sport
Government of the Republic of
Slovenia
Center for Informatics
Center for Health and health
Research
Slovene Medical Informatics
Association
SIZN Nursing Informatics
Interest Group
IN Center for Intensive Internal
Medicine, University Medical
Center
Ljubljana, Slovenia
Second Opinion
ZZZS (Health insurance card
institute)
Primacom
Primacom
Primacom, INFONET
InfoNet

Nova Vizia

Name
TUSAR, Livija (Dr) National
contact Point

Contact details
Tel: +386-1-4784681
Email: livija.tusar@gov.si
Telephone: +386 (0)1 478 8600

Tit Albreht

Tel: +38612441406
Email: tit.albreht@ivz-rs.si
info@simia.org

Vesna Prijatelj

Email : vesna.prijatelj@mf.unilj.si
Email: vojka.gorjup@s-net.net.

AU Gorjup-V, Jazbec-A,
Gersak-B.
Transtelephonic transmission
of ECG

tel.: +386 1 437 74 64


Email: drugo.mnenje@maat.si
Phone: +386 13077324
Miran Rems
General Hospital Jesenice

Phone: +386 64 868 0


Email: miran.rems@guest.arnes.si

Janko Kersnik
Family Doctors Association
of Kranjska Gora
Bostjan Bercic

Phone: +386 64 881 426


Email: kersnjan@perftech.si

Mrs. Smiljana V. Slavec


General manager
Jozica Leskovsek

Phone: +386 64 331 131


Email: bostjan.bercic@infonet.si
Email: Smiljana.slavec@infonet.si
Tel. +386 42 800 900
jozica.leskovsek@vizija.si
+386 (0)3 712 18 00

53

Annex I
Telemedicine Implementation in CEE region Brief Overview
Country
Name
Legislati
on
Telemed
icine
impleme
ntation

Country
Name
Legislati
on
Telemed
icine
impleme
ntation

Cyprus
Plan to introduce an effective National health Insurance Scheme.
RTD funded projects
European funded: Ambulance http://ambulance.cpr.it
Emergency-112 http://www.biomed.ntua.gr/emergency112
HEALTHNET http://www.cs.ucy.ac.cy/healthnet
MEDICATE http://www.medicate-online.org
TELEPLAN and VIRTUOSO teleconsultation
National funded: EROS evaluation of risk of stroke by telemedicine
TELEGYN diagnostic telepathology network
DITIS home healthcare of cancer patients
Implemented services:
The Cyprus Institute of Neurology and Genetics, the Paraskevaidion Surgery and Kidney
Transplant Center, the Bank of Cyprus Oncology Center, the Makarios Hospital, and the Cyprus
Society of Medical Informatics carry out these activities: In August 1998, a new video
conferencing system was installed at the Paraskevaidion Surgical and Kidney Transplant Center
in Cyprus. The system allows Orthopedic doctors in Cyprus to efficiently communicate with their
assess difficult cases of children with orthopedic problems examined in Cyprus. The Clinic of
Oncology Radiation Therapy and Radiation Diagnostics of the Bank of Cyprus Oncology Center
is participating in the EU projects TELEPLAN and VIRTUOSO
Bank of Cyprus Oncology Center: http://www.bococ.org.cy/
Czech Republic
Laws of: - personal data security
- electronic signature
- health documentation, national health information system, and management of national health
registers
www.telemedicina.cz information platform for telecare projects
National Research programs
www.gacr.cz , www.ikem.cz , www.euromise.cz ,
www.cls.cz , www.cski.cz , www.crs.cz , www.ksrzis.cz
Ongoing Initiatives: At present time the pilot project called Ophthalmologic Register is carried
out. The project is equipped with the image database system for storage of eye ground images of
patients with danger of eyesight or life loss. Web technology is used for data transmission
through Internet with connection not only to the database in ophthalmic out-patient departments
but also to highly specialized workstations with image analysis, it is used also for diagnostic
evaluation and for setting of the operating term in case of need. In the metropolitan network of
the city Brno the image archive system PACS, which enables to evaluate findings from 8 healthy
instruments (e.g. CT) placed in 5 big hospitals is used. The system is very operable with the
central database placed in the Masaryk Oncological Institute.
EHTEL Virtual Demonstrator: Municipal Hospital Litomerice, Czech Republic
In this demonstration site is implemented health card system bounded with the Hospital
Information System (HIS).
http://www.ehtel.org/SHWebClass.ASP?WCI=ShowDoc&DocID=1221&LangID=1

Country
Name

54

Legislati
on
Telemed
icine
impleme
ntation

Country
Name
Legislati
on
Telemed
icine
impleme
ntation

Country
Name
Legislati
on
Telemed
icine
impleme
ntation

Hungary
Projects of: - document management system
- digital map database
- government portal
- electronic signature
There has been a fax-ECG communication system in the country operating as a pilot project for
several years and transtelephonic ECG (beeper) placed by the patient can also be found. Small
teleradiology R&D projects were done in the area of tele-traumatology, and tele-consultation
through web is available in limited areas. A significant financing reform initiative, resembling
HMOs were supported with electronic consulting in the Veresegyhaza Health Mission Project.
Further info:
www.eum.hu ministry of health
www.oep.hu national health insurance
www.gyogyinfok.hu healthcare info
www.medinfo.hu community health information portal
www.vitalitas.hu health portal
www.hazipatika.hu health portal
www.informed.hu - InforMed is a commercial Hungarian language Health & Medicine site
www.mok.hu Medical chamber
www.antszfov.hu National Public Health and Medical Offices Service
Cooperation on Bepro, Gaster 2, ITNict, Prorec-Hungary, Retransplant, Samta
Poland
Electronic signature
www.npk.gov.pl/prog_tem_2
The educational services using Internet are accessible in several sites, e.g. medical technology
https://medtech.eti.pg.gda.pl. There are several interesting medical Internet services available, as:
Allergy http://www.alergen.info.pl
Cardiology http://www.sccs.zabrze.pl/telekardio/informacje.html (ECG via phone);
http://www.ptkardio.pl; http://www.nadcisnienie.med.pl
Diabetes http://www.cukrzyca.pl/index.html
Testing of hearing and vision I Can Hear; I Can Speak, Tinnitus, I Can See
http://www.telezdrowie.pl; http://www.telezdrowie.pl/indexen.html
To show the importance of such services it is worth to know that for example the number of
patients using cardiology consultation via phone exceeded 20.000.
Every year the Medical Internet Conference is organized where one may find what is going on in
this technology http://www.ptkardio.pl/IV-KONF.
One of the main institutions supporting the medical Internet is the Stefan Batory Found
http://www.batory.org.pl/pl/data, where several initiatives already were financed pushing the
development of IT technology in medicine.
Romania
The Health insurance law, still needs to be adapted
Legal and ethic matters concerning telemedicine have been discussed. Legislative initiatives are
present but yet not discussed nor approved by the parliament.
www.kappa.ro
EU project funds (TelenurseID ENTITY, PROPRACTITION)
Public funding comes from Phare/World bank
RTD funded projects:
The Black Sea Tele-Diab: it is a multidisciplinary joint research project within the healthcare
information. It has been funded by EU as part of the INCO/COPERNICUS program to support
Research and Technical Development in CCE/NIS. The aim is to develop standardised software
for the collection, storage, architecture based on the Good European Health Record which was
developed within the Advanced Informatics in Medicine Program

55

www.telemed.ro/web_bstd/Trio_new.htm
TeleNURSE ID ENTITY: The main objective of the project is to strengthen and enlarge the
European consensus on the use of the International Classification of Nursing Practices as a
standard computerised nursing language http://atlas.ici.ro/ehto/TELENURSE
CDI Interdisciplinary Dialog Center: The project is a feasibility study for an interdisciplinary
centre for the Medical Informatics domain aiming to support the heath system, which now, in
Romania, is passing through major changes, by improving the communication between human
factors from health care, education, research and industry www.cdi.pub.ro
MGT Medical Guideline Technology: Representing, Interpreting and Sharing Cost-effective
Standards
Ongoing Initiatives
Through a World Bank project for rehabilitation of the health sector, the Health Management
Information System has been designed and implemented in 1999, linking in a public health
network all the district health authorities (NT and Unix servers, X25 communication standard,
dial-up connections of district public health authorities and the Computing Center of the Ministry
of Health). In this system, resources are managed through SAP R/3h; patients management in
hospitals and dispensaries is achieved trough the CHU-Grenoble software. At the level of the
MoH several software products are used as DSS or documents management (COMSHARE,
TeamLinks). In a pilot district the HEMATOS software is used in blood centers. Other pilot
applications are in the field of emergency services (dispatcher for ambulances, radio links
between regions and in-regions).
Several pilot applications have been developed in the frame of projects funded by the National
agency for Science, Technology and Innovation, the National Council for Academic Research,
the Romanian Academy or by EU R&D programs covering the following issues: image
processing and transfer, smart cards (diabetes, cardiology, neurology), information desks, calling
centers, promotion of the ICNP for structuring nursing data, citizens education for health. Several
web sites have been designed: http://atlas.ici.ro/ehto, www.ross.ro/EuroMed,
http://atlas.ici.ro/ehto/sanatate . There are also some telemedicine applications encapsulated in
long distance learning projects. A private company providing internet services has started in 1999
a tele-diagnostic program (www.kappa.ro) in collaboration with hospitals in USA and UK; they
also have patient discussion lists and educational web pages.
The MoH is in the process of evaluating a DRG pilot study. There are also other punctual
projects. For example, smart cards applications are designed in the framework of the scientific
and cultural co-operation agreement between Italy and Romania and the dispatcher system for
emergency calls has been developed with Swiss governmental help.
Country
Name
Legislati
on
Telemed
icine
impleme
ntation

Slovakia
Electronic signature
In order to assist health-care reform in eastern Slovakia, a partnership was established with
health-care institutions in Rhode Island. The aim of the partnership was to improve maternal and
child health in Slovakia. Thirty-seven telemedicine sessions were conducted via a satellite link. A
number of workshops, case studies, demonstrations and interactive discussions took place
between various health-care professionals. The use of telemedicine accelerated the adoption of
new procedures in Slovakia.
(http://www.sgmi-ssim.ch/medline/IM_00035.htm)
Project Nove Zamky AITKEN
Neurosurgery department in Nove Zamky is using image transfer of computer tomography
through Internet for the consultations of the patients with serious head injuries with the
professionals in Aitken Neurosurgery Center in New York

Country
Name
Legislati
on
Telemed
icine

Slovenia
Electronic signature
Smart Cards: http://www.zzzs.si/kzz/ang/enghtml/systemhtm/document.htm

56

impleme
ntation

EHTEL Virtual Demonstrator: Health Insurance Card (HIC) System in Slovenia implemented by
Health Insurance Institute Slovenia (HIIS)
http://www.ehtel.org/SHWebClass.ASP?WCI=ShowDoc&DocID=3010&LangID=1
EHTO
http://www.ehto.org/states/slovenia.html

Source: Telemedicine Glossary September 2003: Luciano Bolchi (editor)

Plans and organisations for Telemedicine implementation in CEE


Country
Name
Cyprus

Czech
Republic

Hungary

Plans and organisations for Telemedicine implementation


In 1989 the computerisation of the Health Information Support System (HISS) started as a
co-project with the Ministry of Health and the East Mediterranean Region Office (EMRO) of
the WHO. The Patient Administration System (PAS) modules were implemented in
Archbishops Makarios III hospital in Lefkosia and completed in 1993. Subsequently, the
Ministry of Health, in collaboration with the Department of Information Technology
Services, proceeded with further implementation at the Lemesos, Larnaka and Pafos General
Hospitals. This phase was completed in March 1995, December 1998 and March 1999
respectively. The system is currently being implemented at the three rural hospitals
Kyperounda, Paralimni, and Polis. The Ministry of Health has decided to continue with the
further implementation of PAS modules at all Government hospitals, outpatient departments
and rural health centers. The health information system will be expanded to cover all
disciplines, including clinical management support, order management, manpower, estate,
availability and use of facilities, etc.
To create organizational, professional and technical support to telemedicine technologies on
the national level by the form of solving individual tasks, including purchases of technique
and services. With a scope of the program, technical devices feasible in the Czech Republic
for safe communication among medical institutions and their information systems for
telemedicine purposes will be set up. Possibilities of communication utilization will be with
the goal to make recommended systems and procedures for purposes of:
On-line consultation of image information for medical examination purposes in radio
diagnostics, microbiology, nuclear medicine, pathology, and in similar applications,
Access to image databases of reference samples
Remote diagnosing in a professional medical institution by means of a mobile telephone
and a notebook from anywhere, including the use of a portable television camera,
Videoconferences,
Providing home care by a remote physician, including corrections of treatment,
monitoring critical conditions, activation of alarms (cardiology), etc.
Operational telemedicine sites are very rare, although experimental settings were and are
often announced. There has been a fax-ECG communication system in the country operating
as a pilot project for several years and transtelephonic ECG (beeper) placed by the patient
can also be found. Small teleradiology R&D projects were done in the area of teletraumatology, and tele-consultation through web is available in limited areas. A significant
financing reform initiative, resembling HMOs were supported with electronic consulting in
the Veresegyhaza Health Mission Project. The search for telemedicine on the Hungarian Web
returns 86 items, most of which reports plans, ideas and examples from abroad.

57

Poland

Romania

Healthcare information technology in Poland is still in the phase of early development. Many
technologies well known in other countries, as e.g. health cards, are practically not in use.
The main application accessibility to citizens is not properly developed, yet. Positive
aspects: the needs are well recognised, there is a lot of SME and academic institutions well
prepared to act on this market; society education is on proper level, there is a lot of
enthusiasm and the IT infrastructure is modern, although still not sufficiently prepared to
meet all needs.
The number of sites related to health care
Since 1990 the Ministry of Health (MoH) has initiated a process of health reform that
included also the strategy for telematics applications and telemedicine. This process is still
under development and has been slowed down by frequent changes at decisional level. 1999
Phare project for the reform of the financing in the health sector set up a framework and
issued recommendations for a national IM&T strategy for the health sector. Following these
recommendations the target topics will be: quality and coherence of health data, access to
information and communication infrastructure, management of health resources, medical data
management, decision support systems, management systems for documents and
regulations repositories, national and European integration, infrastructure and competencies
in health telematics. The main types of applications that are to be developed are considered:
information systems for all health units and for supporting and monitoring health
programmes, the Management Information System for the Health Insurance System,
research, documentation and training, data bases for health products and materials, directories
with professional associations.
NA

Slovakia
NA
Slovenia
Source: Telemedicine Glossary September 2003: Luciano Bolchi (editor)

58

Annex II
SIBIS report (abstract)
This report focuses primarily on presenting some statistics and indicator results from the SIBIS benchmarking
surveys. The survey fieldwork was carried out in April May 2002 and January 2003. A representative General
Population Survey (GPS) was conducted in 2002 in all 15 EU Member States, as well as Switzerland and the US,
involving a total achieved sample size of 11,832 and in the above 10 Newly Associated States in 2003, involving a
total sample
size of 10,407. A representative survey of establishments the Decision Maker Survey (DMS) - covered 7 EU
Member States, including the five largest Member States (Germany, Spain, France, Italy and the UK) as well as
Finland, expected to be an information society frontrunner, and Greece, expected to be less well advanced. This
involved a total achieved sample size of 3,139 establishments.
The report can be also found online at SIBIS website http://www.empirica.biz/sibis/.

Online search for health-related information (Internet users)


Online searching for health-related information amongst Internet users

In last 4 weeks
Not in last 4
weeks, but in
last 12 months
Did not search

In last 4 weeks
Not in last 4
weeks, but in last
12 months
Did not search

DK

EL

IRL

NL

FIN

UK

22
15

22
24

19
20

11
11

14
17

15
12

15
33

12
20

26
20

20
22

17
17

16
19

16
16

19
14

23
20

EU
-15
18
18

63

55

60

78

69

73

52

68

54

58

66

65

68

67

57

64

BG

CZ

EE

HU

LT

LV

PL

RO

SI

SK

NAS-10

CH

US

12
13

22
11

20
14

19
13

13
9

14
12

19
11

15
13

21
19

16
12

15
24

31
27

74

66

65

69

100

78

74

70

72

59

72

61

42

Base: All Internet users weighted column percentages

A little over one third of Internet users in the EU (36.4%) and nearly 30% in the NAS countries reported online
searching for health-related information during the 12 months reference period. Although this is a substantial figure,
it is a lot lower than the more than almost three in five (58.3%) of the US sample that reported this form of eHealth
activity. Within Europe, the prevalence of reported online health information seeking amongst Internet users varied
considerably across the countries, with highest rates in Ireland (48.1%) and lowest rates in Greece (21.6%).
Searching for health-related information online (% of all Internet users)

59

70
60
50
40
30
20
10

In last 4 weeks

LT

LV

PL

SI

O
R

FI
N

Z
C

EE

EU

-1
5

L
N

K
D

IR

Not in last 4 weeks, but in last 12 months

Online search for health-related information (population)


Online searching for health-related information amongst the population overall

In last 4 weeks
Not in last 4
weeks, but in
last 12 months
Did not search
Non Internet
user

In last 4 weeks
Not in last 4
weeks, but in last
12 months
Did not search
Non Internet
user

DK

EL

IRL

NL

FIN

UK

12
8

17
18

12
12

4
4

6
7

6
5

10
22

5
9

15
11

15
16

10
10

5
6

11
11

14
10

16
14

EU
-15
10
10

33
47

42
23

37
39

27
66

30
56

31
58

34
35

30
56

31
43

43
26

39
41

22
66

47
30

50
26

40
30

35
46

BG

CZ

EE

HU

LT

LV

PL

RO

SI

SK

NAS-10

CH

US

3
3

9
5

12
8

4
3

5
4

4
3

4
2

7
6

7
6

4
3

10
16

24
21

20
74

26
61

39
41

15
78

35
65

29
63

18
75

14
81

33
55

18
69

19
73

40
34

32
23

Base: All respondents weighted column percentages


Almost one in five (19.8%) of the EU-15 population aged 15 years and over reported searching online for healthrelated information in the 12 months before the survey. Although this is a substantial figure, it is a lot lower than the
more than two in five (44.9%) of the US sample that reported this form of eHealth activity. There were also
considerable variations across European countries, ranging from more than one in three of the adult population in
Denmark (34.7%) to about one in seventeen in Romania (5.9%). Although its importance varies across countries,
online searching for health information is clearly becoming a significant element of the health-related
activities of the population and needs to be given due attention in public health policy.

60

Searching for health-related information online (% of population)

In last 4 weeks

S
U

LT

PL

U
H

-1
0

AS

SI

Z
C

-1
5

EU

L
N

50
45
40
35
30
25
20
15
10
5
0

Not in last 4 weeks, but in last 12 months

Success in finding suitable health-related information


Was the information which you found online suitable for your needs?

Was suitable
Was not suitable
Was not able to
find healthrelated
information

DK

EL

IRL

NL

FIN

UK

86
11
3

83
13
4

83
8
9

*)
*)
*)

83
10
7

89
6
5

88
8
3

80
13
6

83
12
5

89
8
3

86
8
6

87
8
5

89
8
3

87
6
7

90
5
5

EU
-15
86
8
6

CH

US

85
7
8

94
3
3

Base: Internet users, who have searched online for health-related info, weighted column percentages
*) data suppressed due to too small N
The majority of those who searched online for health-related information reported
that they had been successful in finding information that was suitable for their needs.
In all countries, more than 80% of users reported successful searching. Greatest levels
of success were reported by US users (94.4%) and lowest levels of success were reported
by Italian users (80.5%)
Success in finding suitable health-related information on the Internet
(% of Internet users who have searched online for health-related info in the last 12 months)

94
92
90
88
86
84
82
80
UK NL

F IN IR L

E
U15

DK

E L CH US

61

Annex III
The use of the Internet in the Czech health institutions in 2002
The information about the access of the health institutions to the Internet is based on E(MZ)4-011 processed reports.
From 2001 the survey is done in order to monitor whether the health institutions have an access to the Internet and in
case of positive reply for what purpose it is used. It is also monitored from where the Internet is accessed, whether
from home or office. From the total number of 26 267 health institutions, 13512 (51,4%) responded to the survey.
From the complete number of 26267 health institutions the report was filled in by 13512 (51.4%) institutions in
2002. The health institutions that had the access to the Internet and also filled the report used Internet for gaining of
information 2 (86.3%) rather than for communication 3 (74.0%). In comparison with 2001 the number of health
institutions using the Internet for communication became 13% higher and the number of institutions searching for
Information on Internet was 9% less than previous year.
From 11667 health institutions that used Internet as an information source 5216 searched other information
(legislation and general information from various areas), followed by pharmaceutical information (4510). 9996
health institutions communicated through the Internet, especially with insurance companies (4776) and other
administration (4537).
1 The data come from the information bulletin no. 13 from 3.4.2003 of UZIS CR (Institute of health information and statistics CR)
2 Information about practical medicine, theoretical medicine, pharmaceutical information and other information as legislation and
general information from various areas
3 Communication with pharmacies, health institutions, patients, insurance companies and other administration

The use of the Internet for acquiring information

about
theoretical
medicine
22%

about practical
medicine
23%

other
information
29%

pharmaceutica
l information
26%

62

The use of the Internet for the communication with:

pharmacies
10%
health
institutions
19%

other
administration
29%

patients
11%
insurance
companies
31%

From all the health institutions 39% (5254) had the access only from the health institution, 38% (5174) only from
home and 23% (3072) from both institution and home.
There were 10372 (55,2%) GP and 1452 (0.2%) pharmacies respondents. GP used twice as much Internet to search
for information than for communication. GPs mostly communicated with health insurance companies (3248).
In the Pharmacies the proportion of the use of the Internet for information search and communication was the same.
Pharmacies usually communicated with other administrative (834) and Pharmacies (781) and were searching for
pharmaceutical information (1138). While in the case of GP the access to the Internet was done from home, in the
case of Pharmacies it was done mainly from the health institution.

63

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ot from HI
h
h
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nf o m
he
e
o
ri
fr o
nf
m
o
fr o
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ab

nt
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ho

H
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ro

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m

If

ro
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in

ti e

nt
s

fro

m
e
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s
f
in ur. rom HI
su
co
r.
m hom
co
p
m . fr e
o t p . f om
he
ro
H
ot
I
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he r a d
ho
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dm i n f
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Ph
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The use of the Internet in pharmacies and at GP office in 2002


70%
60%
50%
40%
30%
20%
10%
0%
GP

Pharmacies

HI = Health Institution

The use of the Internet for gaining the Information

90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
GP

Pharmacies

HI = Health Institution

64

Annex IV
Survey of the Information Systems (IS) in the Czech hospitals 2003
The survey was conducted by Ministry of Health CR and IPVZ (Institute of postgraduate education in health),
Prague.
Acronyms used
CLS JEP
IPVZ
IS
HIS

Ceska lekarska spolecnost Jana Evangelisty Purkyne


Institut postgradualniho vzdelavani ve zdravotnictvi, Praha
Information System
Hospital information system

About the Survey


Motive of the Survey
The motive for conducting this survey was the preparation of the health information systems courses that are for
many years provided by department of clinical biology at IPVZ Prague. The attendees of the course pointed the fact
that the data about HIS market that are used at the course are coming from the companies and these information is
not adequately balanced by the data coming from hospitals. Thats why the professional guarantors agreed with the
Department of Informatics of Ministry of Health to conduct this pilot survey. The data acquired are so far the biggest
survey about the state of health informatics, that was every done in the Czech Republic, although the original
purpose was to only improve the data used at the above mentioned course and the authors fully acknowledge the
limitations that these data have.
Purpose of the Survey
1. To acquire the basic overview about the building of HIS in Czech bed health institutions and about the state of
market in this area
2. To confirm the usability of this method to regularly monitor the state of the market
3. To improve the documents for the attendees of the HIS course at IPVZ
4. To gain the impulses for the activity of Department of Informatics of Ministry of Health and Czech society of
Health Informatics and scientific information at CLS JEP
The Execution of the Survey
1. Written enquiry was sent to the addresses of Health Institutions with beds. The addresses came from the database
of Ministry of Health CR and were addressed to the Head of Informatics Department with the request to voluntarily
answer the questions. The data protection was guaranteed. (Jan March 03)
2. The returned questionnaires were preliminarily evaluated and the conclusion was reported at IPVZ course. (April
03)
3. The survey was processed in detail for this evaluation (June Aug. 03)
4. The survey has been made public sent to the responders and posted on the Ministry of Health web site. (Sept 03)
5. Supposed error correction and release of the new version (Oct. 03)
6. Dissemination of the results at the seminars and literature (Oct. 03 Jan. 04)
The Results
General questions
Respondents, Return, Respondents Data

65

The questionnaires were sent from Ministry of Health to all the health institutions found in the database of the
Ministry. The return of 24% is considered by authors as the bottom line for the results of the survey to be considered
as relevant the return of 25-30% was expected for the return to be considered as satisfactory. From the analysis of
the various ratios of return in the various types of institutions it is clear that the higher return came from the
institutions directed by the Ministry of Health. The situation in the rest of the institutions in respect to the lower
return of the questionnaires can be due to the generally shared distrust in the role of the Ministry as a systematic
organ and reluctance to share the not-required-by-law information with state institutions.
Return
Number of sent questionnaires
Number of answered
questionnaires
Number of refusals

380
92

100%
24%

0.3%

Types and size of the health institutions


Type of
institution
Total

Faculty
Hospitals
6

County
Hospitals
4

Medical
Institutions
22

Military
Hospitals
2

Other
Hospitals
56

Other
Institutions
1

Category of
institution
Total

< 100 beds


13

100 500 beds


46

501 1000 beds


19

1000 < beds


12

State and perspective of building IS


From the institutions that answered to the survey it is surprisingly high percentage of those who state high degree of
completion of HIS (70% state the state of the solution to be complete or at least in the half way to completion). The
probability is that the tendency to participate in the survey is rather in case of the higher success rate of the
institution in the building of its IS. Thats why we cannot extrapolate the result on all the health institutions. This
presumption needs to be verified by objective evaluation of the sample of the health institutions.
It is also obvious that the satisfaction rate is also influenced by the rate of HIS completion. Only 3% of the
institutions with already finished HIS consider the change of the system. 40% of the institutions with unfinished HIS
look for the change of the system and only 17% of them are satisfied with the current solution. The institutions
without any HIS state lack of finances (61%) as a major reason for the absence of the system. This was an expected
reply especially in the survey initiated by Ministry of Health.
Current state of building of integrated HIS in the health institution
Complete or almost complete and functional
We are trying to complete the solution, we are in the middle or closer
We have only partial solution, disparate solution, low level of integration
We are in the beginnings
Other: We dont have IS yet, but we want to plan in within 6 months
Other: very poor state
Other: We plan the complete solution, we are in the beginnings
Total number of the answers
Satisfaction with complete HIS
We are satisfied apart from minor technicalities

Total
29
36
17
7
1
1
1
92

Total
33

66

It is not optimum solution but usable


We would like to get rid of the current system
Total number of the answers

33
2
68

Satisfaction with unfinished HIS


We are satisfied with the solution
It is not optimum solution but usable
We would like to get rid of the current system
We are actively looking for replacement
Other: its very difficult to use
Other: we are in the beginning of the
implementation
Other: We consider change, we are looking for
economically and technically acceptable system
Total number of the answers

Total
5
12
6
4
1
1

The reasons for not implementing HIS


We are not interested
We doubt the sense of the HIS investment
We are waiting for better solution than the one
currently on the market
We lack the finance
Other: not interested in expansion in certain areas
Other: we are actively looking for suitable
supplier
Other: we are waiting for the change in financing
and reporting
Other: We are in the beginning of the
implementation
Other: We are in the middle of the
implementation
Total number of the answers

Total
2
3
5

1
30

25
1
2
1
1
1
41

The opinions about the perspective of the various types of applications


This is an answer that can be considered as representative. It reflects the opinions of the respondents about the need
for various types of applications and thus giving the idea about the future demand in the institutions that are at least
in certain advanced stage in building their HIS. For simplicity there are 2 indexes counted in the last two columns.
They present ratio between the positive expectation and negative expectation (in one case including already realized
module). Higher the number is more perspective the module seems. The clear preference lies with PACS-type
solution. The surprising result is that there is very low interest in the modules supporting management and for the
communication solutions. This result should inspire the discussion within the professional public.
Information
System
Prospects
Electronic
patient
appointment
Communicati
on with health
inst. Over
Internet
PACS

A
Certainly
no

B
Rather
no

C
Rather
yes

D
Essential

Index I
=(C+D)/(
A=B)

Index II
=(C+D+
E)/(A+B)

E
Already
implemen
ted
16

25

35

1.4

1.9

20

38

13

2.4

44

23

19

11.2

14.3

67

Electronic
prescription
IS integration
with
monitoring
systems
Modules of
management
support (EIS)
Spec. modules
for intensive
care
Spec. modules
in surgery
domain
Spec. module
for maternity
hosp.
Spec. module
for dentists

11

33

29

3.2

5.5

13

24

37

1.1

1.1

16

35

10

12

2.6

20

18

26

0.9

1.1

23

21

23

0.7

0.8

31

11

14

18

0.5

0.9

46

18

0.1

0.2

Interest in further IS
DMS
Economic extension of HIS
Communication and integration with accounting
system
Communication with complement
Pharmacy
Dialysis module
Psychiatry module
Rehab module
Rehab module, reporting support, nurse
documentation
Connection of HIS on lab systems
PACS
Evaluation of DRG
Total sum

Total
1
1
1
1
1
1
3
1
1
1
1
1
14

HIS personnel
The tables show the overview about the formal position of the Information scientists in the health institutions and
subjective feeling of this position. From the tables it is clear that the position of the IT department is without any
realistic influence on the management. It is considered as inadequate. While it is not necessary that this influence is
connected to the function in the top management it is however necessary to have the possibility to take part in
decision making processes. More then 1/3 of the Informatics respondents were in the role of deputy or director of
the department with the obligation to take part in the management meetings.
Position of head of IT dept.
Deputy for Informatics (CIO)
Head of department with the
obligation to take part in
management meetings
Head of department
Single employee

Total
5
28

Percentage
5.4
30.4

30
11

32.6
12

68

We dont have our own


Informatics dept.
Other position
Total
outsourced from total

14

15.2

4
92
10

4.3
100%
10.9

This position is considered regarding to


the importance and competence as
Deputy of Informatics (CIO)
Head of department with the obligation to
take part in management meetings
Head of department
Single employee
External worker
We dont have our own Informatics dept
Other position

inadequate

adequate

Much too high

Total

5
23

5
28

11
2
4
4
1

19
9
6
9
3

30
11
10
13
4

Education level of heads of IT dept.


University degree in Informatics or Electrotechnics
University degree in Economics
Medical degree
Other University degree
Secondary education
University degree in Informatics and Economy
Total number

Total
42
4
5
14
22
2
89

Information and their relation to the institutions


Incorrect construction of this question allows us only to evaluate the most felt priority, not the complete need of
information. The answers confirm the assumption that the need for legislative information has today the same or
higher priority as the information of technical nature.
The most important information for the work
of Informatics
IT market overview, business info
Practical technical info
New IT trends
Legislation, legal aspects
Other

Total
12
36
18
40
13

The requests to Ministry


Type of request
Methodical work, standards
creation, legislation, etc.
Information and education
Financial help, IT subsidies
General requests about health
management (mainly connected
to the relation to insurance co.)
Concrete projects support, help
with grants, EU projects

Number
34

%
27

15
13
12

12
10
10

69

Help in business activities,


selection of HIS
No request

39

31

39 respondents stated no request. The rest had the most interest in methodical activity of the Ministry, creation of
legislation, standards, coordination of IT activity. The concrete suggestions were handed to IT department of
Ministry of Health.

Text of the 2003 survey questionnaire


Current opinion about the information system in your hospital
1. In what stage is according to you the building of integrated HIS in our hospital:
a) Complete or almost complete and functional
b) We are trying to complete the solution, we are in the middle or closer
c) We have only partial solution, disparate solution, low level of integration
d) We are in the beginnings
e) Other
2. If you have HIS completed or you are building it, then
a) We are satisfied apart from minor technicalities
b) It is not optimum solution but usable
c) We would like to get rid of the current system
d) We are looking for replacement
e) Other
3. If you have partial disparate parts of HIS, then
a) We are satisfied with the solution
b) It is not optimum solution but usable
c) We would like to get rid of the current system and replace him with unified HIS solution
d) We are looking for replacement
e) Other
4. If you dont have HIS or you are missing the important parts, the reason is
a) You are not interested in expansion
b) You doubt the sense of the investment
c) You are waiting for suitable solution and you dont like any that is on the market
d) Lack of finances
e) Other
5. What IS from the recently developed you consider in the near future (3 years) for you institution as
potential prospect (check the relevant field):
Already Implemented

Certainly
no

Rather
no

Rather yes

Essential!!

Electronic patient
appointment
Communication
with health inst.
Over Internet
PACS
Electronic
prescription
IS integration with
monitoring systems
Modules of

70

management
support (EIS)
Spec. modules for
intensive care
Spec. modules in
surgery domain
Spec. module for
maternity hosp.
Spec. module for
dentists
6. Concrete HIS in your institution
The survey tries to monitor the coverage of individual hospital departments with the information systems. Please
state with every department the name of the application and application supplier and estimate of the number of the
stations where the product is running. Please estimate the assumption of the percentage of the coverage of the given
department by the information system (for example the use of IS on 5 clinical departments from 10 is 50%
coverage). If the given department is not present in your hospital, please cross out the name in the column A. If you
dont have the IS for this department but you are thinking about it, please write YES in the column G.
A
Department

B
Name
of the
system

C
Supplier

D
No. of
stations

E
Percentage
of
Coverage

F
Satisfaction
1-5

G
Considerin
g the
implement
ation

Administrative
patient recordkeeping and
statistics
Insurance comp.
processing
Clinical operation
Biochemical lab
Hematology
Transfusion clinic
Microbiology
Other lab, type:
Other lab, type:
Radiodiagnostic
Catering service
Pharmacy
Transport
Accounting
Payments and HR
Storehouse
management
Other systems
Hospital top
management

71

IT personnel
7. What is the position of the head of the IT department in the hospital
a) Deputy for Informatics (CIO)
b) Head of department with the obligation to take part in management meetings
c) Head of department
d) Single IT employee in the hospital
e) External worker
f) We dont have our own IT department
g) Other possibility:
8. Do you consider the position to be (as far as importance and competence):
a) Inadequate
b) Adequate
c) Much too high
9. What is the professional education of the head of IT?
a) University degree in Informatics or Electrotechnics
b) University degree in Economics
c) Medical degree
d) Other University degree:
e) Secondary education
10. Please state, what type of information (education) is now the most important for your work but you are
missing it:
a) IT market overview, business info
b) Practical technical info
c) New IT trends
d) Legislation, legal aspects
e) Other:
11. How many workers ensure technical operation and user care of the IS in your hospital:
12. Do you consider this number to be adequate?
13. What number would be optimal in the current state of HIS and when the implementation is finished?
14. What do you expect from Ministry of Health for your work?
15. Are you a member of CSZIVI?
a) Yes
b) No but I used to be
c) No and Ive never been
d) Im interested about the information
16. What do you expect from CSZIVI?
Contact for the person responsible for IT
Employee, that will be getting the information from Ministry of Health
Name, telephone, email, job title
Contact for the HIS administrator (in case the person is not identical to the above person)
Name, telephone, email, job title
Number of the beds in your hospital at present time:
END OF SURVEY

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Annex V
Telemedicina.CZ - Telemedicine Projects in Czech Republic
There has been an interesting project of Information platform organized by Prof. Rosch Foundation with the support
of Czech Telecom. The aim of this project was a support of new technologies through the pilot project that were
mainly focused on the clinical applications (teleconsultations of the doctors during the surgery or the transmission of
these surgeries for the purposes of distant education and training of the doctors). The site is available at
http://www.telemedicina.cz.
FH = Faculty Hospital
CT = Computer Tomography

A) Main projects
Interventional teleradiology
Time Frame: 1998 2000
Description: Interconnection of radiological workplaces IKEM Praha, FH Hradec Kralove, FH Olomouc and FH
Brno-Bohunice on the base of euroISDN services for the provision videoconferencing (pool of 6 B channels of 3
basic euroISDN2 terminals with 384 kb/s) and videoconferencing terminal Polyspan
http://www.polyspan.com/ps/xx/en/products/video/video_medium.html,
http://www.polyspan.com/ps/xx/en/downloads/products/video/128&512_data_sheet.Pdf .
The purpose is to videoconference the surgery with mini-invasive method of interventional radiology for the
purposes of teleconsultation during the surgery or to use it for distant teaching/training of the radiologists.
http://www.telemedicina.cz/intervencni_teleradiologie.htm
Acute Neurotraumatology
Interconnection of Ostrava region hospitals for acute nerotramatological consultations
Time frame: 2000 2001
Description: Interconnection of neurochirurgical workplaces of Ostrava region hospitals (FH with policlinic Ostrava
Poruba, State Salesian hospital in Opava, Hospital Havirov, Hospital Karvina 4, Hospital Karvina 6, Hospital
Krnov, Municipal hospital Ostrava, Hospital Frydek-Mistek, Vitkovice hospital of blessed Maria Antonina, Hospital
Trinec-Sosna, Hospital Novy Jicin) on the base of euroISDN services for transmission of CT images.
http://www.telemedicina.cz/akutni_neurotraumatologie.htm
Home (tele-) working for neurosurgeons
Time Frame: 2001
Description: Interconnection of neurosurgeons from home to euroISDN2 terminals on the PC of neurosurgery clinic
of FH with polyclinic of Ostrava Poruba for the execution of consultancy services from the homes of
neurosurgeons, enabling the possibility of teleconsultation of health documentation (CT images, etc.). The purchase
of PC was supported by AutoContCZ a.s. Communication processes are supported by software pcAnywhere

B) Other projects
The following projects dont have their own web presence or they are in the discussion phase.
Telepathology
Telepathology 1st phase (2001)

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Initiator of the project was MUDr. Jana Dvorackova (dvorackova@pathology.cz) from Cytological and bioptical
laboratory in Ostrava. The purpose of the project was to provide financially accessible instrument of static
telepathology with the use of web. The following pathological workplaces are involved in the project: FH with P
Ostrava, FH Hradec Kralove, Hospital Pardubice, VFH in Prague, State Salesian hospital in Opava, Hospital FrydekMistek, BioLab Praha, Pathology Litomysl, LF University of Palacky and Cytological and bioptical laboratories
Ostrava. Pathologists had 2 web applications at their disposal: www.telepathology.cz created by Olympus C&S
(www.olympus.cz) and www.telepatologie.cz created by Optoteam (www.optoteam.cz) and the possibility of using
euroISDN2 or LAN network in the respective hospitals.
The results of the project were not completely unambiguous because the given method of static telepathology
requires the specific access of the user and doesnt provide sufficient amount of information needed for reliable
diagnosis, especially with more complicated cases. Because of this reason the 2nd phase of the project hasnt started
where 12 health subjects were supposed to be involved and further considerations in this direction are in cooperation
with System602 (www.system602.cz). They are oriented on enforcing the methods of dynamic telepathology that
enables pathologists in the real time to share bigger amounts of image information.
Conclusion: The static and quasidynamic web applications are freely available on the web for the pathologists
connected to the Internet.
Interconnection of the Olomouc county hospitals with euroISDN service (2002-2003)
The Interconnection of the Olomouc county hospitals (OL) based on euroISDN service (2002-2003)
The initiators of the project were MUDr. Michal Filip from Neurosurgery clinic FH with polyclinic Ostrava and
MUDr. Martin Gabrys (gabrysm@fnol.cz) from Neurosurgery clinic FH Olomouc. The purpose of this project was
to use the experience from the realization of this application in Osrava region and its adoption for fast and reliable
CT images transfers for the needs of acute neurotraumatological consultations of head and spine injuries among the
country hospitals and FH Olomouc. Apart from this solution there is also available the web version of the image
transfer that is preferred by some users. The involved subjects are: FH Olomouc, Military hospital Olomouc,
Hospital with policlinic Prerov, Hospital Sumperk, Hospital Bruntal, Country hospital Vsetin and Municipal hospital
Valaske Mezirici. Additionally Hospital Prostejov became involved, where CT is run by the company ProMedica,
sro.
Conclusion: The project was finished 04/03 and the solution is available for the users.
Telecardiology 1st phase (2003)
The initiator of the project is MUDr. Jiri Krupicka (krupicka@fnkv.cz) from Cardiocenter FH KV Prague. The
purpose of the project is to provide the transfer of echocardiographical images based on euroISDN and their
teleconsultation among 3 workplaces of FH KV Prague: Cardiocentrum, ARO and Cardiosurgery. In case of positive
results of the pilot project, the 2nd phase will be enlarged to other cooperating hospitals in the Central Bohemian
region. IKEM Prague is also interested in the solution.
According to the e-mail correspondence with MUDr. Jiri Kupicka the project hasn't started yet as of November 2003
due to the lack of financing.
Telehemathology 1st phase (2002 2003)
Initiator of the project is prof. MUDr. Miroslav Penka, CSc. (miroslav.penka@fnbrno.cz), chief of OKH FH Brno.
The purpose of the project is to use the experience from static telepathology and provide the means for static
telehemathology using the web instrument (http://www.telehematologie.cz) and to ensure the available instruments
of dynamic telehemathology using the euroISDN services. The hematological workplaces involved in the project
will be: FH Brno, Infantile hospital FH Brno, P&R Lab, sro Novy Jicin, MFH (VFN) in Prague, Municipal hospital
Ostrava and FH Olomouc.
In 03/03 web application www.telehematologie.cz was put up. It serves all hematologists as a instrument for
consultations and demonstrations of their cases analogically. The same way the www.telepatologie.cz is at disposal
for pathologists.
Teleortography 1st phase (2002 2003)

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Initiator of the project is MUDr. Vilem Bruk (vilem.bruk@fnol.cz), deputy of the chief of cardiosurgery department
of FH Olomouc. The purpose of the project is to use the experience from the project Interconnection of the Ostrava
region hospitals for the transfer and teleconsultation of orthographic images with the use of euroISDN. The
hospitals involved in the project are: FH Olomouc, Vitkovice hospital of Blessed Marie Antonina, FH of St. Anna in
Brno, FH Brno, Batas hospital Zlin and Municipal hospital Ostrava.
Teleconsultation and treatment of acute myocardial infarction 1st phase (2003)
The project initiator is MUDr. Jan Hartman (jan_hartman@quick.cz), GP from Rtyne in Podkrkonosi with
catheterization unit of Cardiocenter FH Hradec Kralove on the base of fixed and mobile telecommunication network
provided by Cesky Telecom as and EuroTel sro. Technically and operationally the teleconsultations will be tested by
GP with the nearest Cardiocenter. The purpose is to increase the number of the patients with acute myocardial
infarction treated with the help of direct PTCA. This application will enable the cooperation on the decision process
(direct PTCA or classic approach) directly with the cardiologist from PTCA center. The patients from the distant
regions would benefit most from the success and wider use of this application. (2nd phase)
Teleconsultation of laparoscopic executions 1st phase (2003)
Initiator of the project is MUDr. Michael Vrany (vrany@nemjbc.cz), head surgeon of Surgery department of
Jablonec nad Nisou hospital (http://www.nemjbc.cz ). The purpose of the project is to connect Surgery department of
Jablonec nad Nisou Hospital with Urological clinic of MFH (VFN) in Prague (http://www.vfn.cz) with the use of
videoconferencing connection based on euroISDN service with the possibility of image and voice transfer to the
lecture hall for the needs of education of medics and doctors. The solution could be also used for sharing the
videoconferencing device and its accessories for other telemedicine applications inside of MFH (VFN).
Interconnection of Brno region hospitals (2003)
The initiators of the project are MUDr. Michal Filip from Neurosurgery clinic FNsP Ostrava and doc. MUDr.
Vladimir Smrcka, CSc. (vsmrcka@fnbrno.cz), the chief of Neurosurgery clinic FH Brno. The project is in the set-up
phase and will take the experience from the similar projects realized in the Ostrava and Olomouc region. It is
assumed that the following hospitals will participate: FH Brno, Hospital Breclav, Country hospital with policlinic
Znojmo, Hospital of TGM Hodonin, Country hospital Kyjov, Country hospital Nove Mesto na Morave, Hospital in
Kromeriz, Hospital in Trebic, Hospital Havlickuv Brod, Hospital Boskovice IN, as, Hospital Blansko, Hospital
Jihlava and Batas hospital Zlin.
Teletraumatology 1st phase (2003)
Initiator of the project is doc. MUDr. Leopold Pleva, CSc. (leopold.pleva@fnspo.cz), chief of Traumatological
center FHwP Ostrava (http://www.fnspo.cz/kliniky/tra/index.html) and member of the committee of Czech society
for injury surgery (http://www.csuch.cz). The project is in the set-up phase and should solve the interconnection of
13 traumacenters in Czech Republic (FHwP Ostrava, FH in Plzen, HwP Ceske Budejovice, Mararyks HwP in Usti
nad Labem, HwP Liberec, Country HwP Pardubice, FH Hradec Kralove, Injury hospital Brno, Batas hospital Zlin,
FH Olomouc, FH Motol Praha, FH Kralovske Vinohrady Prague and Central military hospital Prague) with the use
of videoconferencing interconnection based on euroISDN.
Teleconsultation in the area of pediatric auxomology and syndromology (being discussed)
The project is base on euroISDN services. The initiator of the project is Dr. Jan Vejvalka
(jan.vejvalka@lfmotol.cuni.cz). In the 1st phase the following subjects should be involved: FH Motol
(http://www.fnmotol.cz), Hospital Havlickuv Brod, Hospital Ceska Lipa, Hospital Litomerice and Hospital Most.
Interconnection of Injury hospital Brno with cooperationg hospitals (being discussed)
The project is based on euroISDN service with the use of videoconferencing communication. The initiator of the
project is doc. MUDr. Peter Wendsche, CSc. (p.wendsche@unbr.cz), chief of spinal unit UN Brno

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(http://www.unbr.cz). The purpose of the project is to provide teleconsultation activity of UN Brno in the area of
injury surgery in the 1st phase with Batas hospital Zlin, Country HwP Znojmo and Hospital Havlickuv Brod.
According to the e-mail correspondence with MUDr. Jiri Kupicka the project hasn't started yet as of November 2003
due to the lack of financing and interest of hospital management.
Teleendoscopy (being discussed)
Teleendoscopy teleconsultation of endoscopic executions based on euroISDN services and videoconference
transfers. The following subjects are preliminary interested: FH Hradec Kralove, IKEM Praha, FH Olomouc and FH
Brno.
Teledermatology (being discussed)
Teledermatology teleconsultation of dermatological findings with the help of dermatoscop and transfer of digital
images with the use of web application or direct PC connection of dermatologists based on euroISDN service. The
preliminary interest is by FH Motol and FHwP Ostrava.
Telearthroscopy (being discussed)
Teleartroscopy teleconsultation of artroscopic executions at ortopedic surgery executions based on euroISDN
services and videoconferencing transfer. Preliminarily are interested FH Motol, FH Hradec Kralove, FH Olomouc
and FH Brno.
Telebronchoscopy (being discussed)
Telebronchoscopy teleconsultation of bronchoscopic executions based on euroISDN services and
videoconferencing transfers. Preliminarily is interested. Pneumological clinic Prague 6 - Veleslavin

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Annex VI
IZIP Internet Medical Database, Czech Republic
The following text is extracted from the English version of the IZIP web site: www.izip.cz.
The abbreviation IZIP in Czech language means Internet Access to Patient's Medical Information.
As you already suspect, the objective and substance of the IZIP project is to place the medical database of the
insured patient into the public information network - the Internet.
The database consists of selected parts of medical documentation written into IZIP by the attending physicians. Both
the doctor and the patient may at any time use a computer with internet access to view the results of clinical
examinations, laboratory tests and X-ray pictures as well as a list of prescribed and used medicaments. Users may
insert a record into IZIP within a few tens of seconds. However, it saves hours of phone calls needed for seeking
information from traditional filing cabinets.
Only the patient has access to data for reading in IZIP. However, he/she can designate which other persons will have
the right to view his/her data. Therefore, every medical facility, which has the patient's consent, may share the
records describing the provided care. The patient thus becomes an active element of health care while at the same
time saving money in the public medical insurance system.
The IZIP project has been devised by doctors for doctors. In line with the worldwide trend the team of authors has
materialized their belief that when a patient comes to a medical office the doctor should have a source of up-to-date
and reliable information about the provided health care.
The IZIP project complies with the Act of the Czech Republic no. 101/2000 about personal data security. It
corresponds to the objectives of national health care and information technology policies.
The IZIP project is executed by a private company IZIP Ltd., Prague, with the support of General Health Insurance
Fund of the Czech Republic (VZP CR) and other partners such as IBM, Czech Telecom, Eurotel, Komercni banka
and others. The application solution, software and implementation are supplied by IBM, and the Czech Telecom and
Eurotel look after the data transfer.
Why Use IZIP
The quality of health care attracts much interest from patients as well as doctors and medical insurance companies
and it can be assessed from several perspectives.
The creators of the IZIP project claim that one factor for the assessment of the quality of health care is the fact
whether the insured patient and his physician have reliable and up-to-date information on the provided health care. A
well-informed patient is able to make better decisions, cooperates better and gains a better understanding of the
technical and possibly even financial limitations of the proposed procedures.
In accordance with the act on personal data security, the only person with the authority to decide, who may view his
medical data, is the patient himself. If the patient extends these rights to his physicians, laboratories, pharmacies etc.
he may thus create his own "virtual hospital" within which he and all his future doctors have access to his complete
medical history. After entering the access password, the IZIP provides systematically ordered information about the
performed examinations, their results and the advancement of the therapy.
The project opens new communication pathways between doctors. While at the present time doctors often have only
inadequate information about the health care provided by other medical workers, the IZIP system may enable them
to access the results of clinical examinations as well as laboratory and other tests in real time. A greater set of such
information contributes to better decisions made by the physician concerning the diagnosis and the therapy. The
exploitation of the IZIP system improves the quality of health care since a physician, who has been authorized by his
patient to access the patient's IZIP, will assess the situation more easily and virtually resume where the previous
doctors have stopped. The physician receives all necessary information on time right when he is with the patient.
The Internet record is highly efficient especially for patients who suffer from chronic illnesses and who frequently
undergo various examinations and tests.
Information from the IZIP system enables the patient and his physician to anticipate unnecessary repetition of
procedures which often present a risk to the patient's health. Moreover, the interception of unnecessary repeated jobs

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leads to important savings in the public medical system while maintaining the quality of the provided care. The IZIP
project enhances the efficiency of public medical insurance tools.
The IZIP project supports a chip card system and the usage of electronic signatures. IZIP uses the most advanced
information security methods for safeguarding the data against loss, misuse or damage. Information security in the
system is higher that the current security of medical data in medical and other facilities.
How does IZIP work
IZIP is an Internet medical file with selected information about the patient's health. IZIP therefore does not replace
the entire medical documentation in medical facilities (hospitals), however it presents a valuable selection
constructed upon the patient's wish.
In order to record data into IZIP, the physician uses his ambulatory software in his office. The interface to the IZIP
system is developed either by medical software producers or the physician may use a special "button" in the ledge on
the screen constructed to mediate writing into IZIP from the ambulatory site.
Specialists may write into IZIP through an interface which allows for data transmission from emergency rooms,
laboratories, complementary services and pharmacies.
Records in the IZIP system contain:
- Anamnesis Results of examinations performed by General Practitioner or Specialist, in chronological order
- Results of laboratory tests and examinations
- List of prescribed and issued medicaments
- X-ray and sonograph pictures
- Reports from hospitalisation, vaccination history etc.
In emergency situations when the patient is e.g. unconscious, the IZIP system offers the so-called "Emergency
Access" to the system. The first-aid physician receives a special access code which allows him to find the IZIP
record even without the patient's consent using the patients personal identification number. A thorough record is kept
on the access and is followed by a revision of the justification of such access.
In terms of the information security of the medical records, IZIP draws on the most advanced tools for the protection
of sensitive medical data against loss or misuse. This implies that the security of data in Internet medical files is
higher than the security of information in common filing cabinets in medical offices and is on the same level as the
security of electronic bank accounts.
All data is located on secured servers that are subject to constant surveillance. The only staff members who can
access the demarcated database areas are database administrators with authorization and special training. In addition
to the access code, each patient may set up a second password, i.e. personal password, when entering the IZIP
system on the internet. All information is therefore protected using two passwords and a limit on the number of
access attempts. Consequently, as a result of this principle the only way the system may fail is when the user himself
discloses both passwords. All patients are alerted of this risk.
The Authority for Personal Data Security, which has been continuously consulted with respect to the technical and
legal matters of medical records in IZIP, has granted consent with the operation of the IZIP project.
The IZIP project is open to the expert community as well as the public. This fact has led to the establishment of the
IZIP Project Council with its members being representatives of individual project partners, medical facilities and
organizations, and the representatives of public administration, patients and the public. The members of the Council
receive detailed information about the project and they act as natural contact persons between the project and the
organizations which they represent.
Experience with the pilot and testing operation
During the pilot phase in the period January to July 2002 the project has registered approximately 10 000 clients in 4
regions of the Czech Republic. Partner companies IBM, Czech Telecom and Eurotel have supplied information
technology equipment to registered doctors who did not have the sufficient apparatus. The pilot phase has revealed
that 62 % of doctors use a computer for their work. 29 % of doctors have Internet access and 60 % doctors are
interested in the IZIP project. A flexible team and a marketing strategy have been set up for the testing phase over
the whole territory of the Czech Republic with the objective of extending the project to 50 000 clients by the
beginning of the year 2003.
After this date the IZIP project should start operating under regular mode.

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Dynamic trend of clients registration till 30.11.2003


Initiators
Initiators of the projects were Pavel Hronek otorhinolaryngolog, Milan Cabrnoch pediatrician and Miroslav Ouzky
rehab doctor.
Current state
IZIP system has been implemented throughout the Czech Republic from the beginning of 2003. The people
registered in the system are doctor and other health workers (from laboratories, pharmacies, rehabilitation places,
hospitals). Large hospitals has been also involved Homolka, Masarykuv onkologicky ustav, Imumed,
Centromed and others. There are other specialized projects being created as for example IZIP-DIA (cooperation with
Czech diabetological society), IZIP-COV(Czech olympic committee)
General partner of IZIP system is VZP, the biggest health insurance company in CR (70% of population). At the
moment system is available exclusively for the ensured VZP patients.
Future
IZIP is preparing cheaper connection among health workers, clients and companies providing the communication
among these subjects. The IZIP system stays open to further enhancements.
Demo version
http://www.izip.cz/demo/
Contact details
IZIP, Ltd.
Hybernsk 1271/32 110 00 Prague 1
Czech Republic
tel.: 00420 224 212 200
e-mail: info@izip.cz
www.izip.cz

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Annex VII
MEDTEL & NetC@rd, Czech Republic
MEDTEL, o.p.s. is a non-profit organization that was founded with the purpose to become pernament democratic
and neutral forum where the various participants (authorities in healthcare, healthcare providers, health insurance
companies, patients and citizens associations, interest groups, business companies) could meet and together form the
constructive approaches profitable to everyone. MEDTEL is a member of EHTEL.
MEDTEL is open to everyone who is interested in taking part in activities in the area of health informatics and
telematics with compliance with the status of MEDTEL.
Contact details:
MEDTEL, o.p.s.
Veletrzni 67, 170 00 Praha 7
tf: 233 376 194
fax: 233 379 192
e-mail: medtel@medtel.cz
MUDr. Mgr. Petr Struk - struk@medtel.cz
Ing. Jiri Ochozka - ochozka@medtel.cz
Ing. Tomas Trpisovsky - trpisovsky@medtel.cz
NetC@rd project
Czech Republic prepares countrywide introduction of new health insurance cards for the ensured persons of VZP
(70% of population) at the middle of 2004. The card reverse will have European health onsurance card (EHIC)
format and CR will be one of the first countries where EHIC will be implemented.
Goal of the pilot project
To verify transborder application of EHIC and eventually citizen health card containing the data about health
insurance issued in the EU countries in the conditions of the Czech Republic. The goal is to securely identify the
insured person and to create the pre-requisite for the automated authorization of the transactions.
The verification will be done in two ways.
A. Acceptation of the EU citizens cards in CR
The selected health institutions in the tourist-attractive locations will be able to identified EHIC enabled cards. These
institutions will be equipped by the multifunctional terminal or by a card reader and SW enabling them to read and
verify the cards data.
B. Acceptation of Czech card (EI VZP) abroad in the EU countries
VZP ensured patients will be equipped with new health card with EHIC format and they will be able to present this
card when requesting healthcare in EU states. Hot line and/or Internet service will be available for the foreign
partners.
The scope and structure of the pilot project
Pilot place: Prague
Participants: VZP
Selected health care providers in Prague

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Subject of the pilot project:


The EU citizens will be able to identify themselves with the EHIC card (in various versions) at the selected
health institutions in Prague. This way of identification will be accepted and billing of the patient will be done
based on this procedure.
Vseobecna zdravotni pojistovna (VZP) is getting ready to issue a new health card in 2004. This card will
comply with EU requirements: plastic card with EHIC design on one side. The subject of the pilot project will
be preparation and realization of informational, organizational and technical background for issuing, distribution
and administration of these cards, verification of the acceptation these cards abroad and related functions of
billing and compensation for the provided health care.
The use of the card, the acceptation of the card by health personnel, treatment of the card holder and the way of use
and processing of the data acquired from the card will be a subject of the evaluation as a part of the pilot project.
Participants in CR

Prime contracter:
Member of consortium:
Supporter:

MEDTEL, o.p.s.
VZP R
Ministerstvo zdravotnictv R (Ministry of Health)
CM Centrum mezisttnch hrad

Costs related to the Czech part


310,000,- EUR

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Annex VIII
National Health Registers, Czech Republic
IS TRANICON
IS TRANICON gathers data to:
Waiting lists for kidney transplantation, combined transplantation of kidney and pancreas, liver, heart and
lungs
Register of dead organ donors
Register of patients after the transplantation has been done
IS TRANICON is used for selection of the most suitable recipients there organs.
KSRZIS is responsible for technical part of the system. It ensures technical management, maintenance and
support 24/7/365.
IKEM CZ is responsible for the correctness of the data contained in IS TRANICON and for effective, correct
and competent handling with these data.
Transplantcenters in CR connected to IS TRANICON:
TC Institutu klinick a experimentln medicny v Praze,
TC Fakultn nemocnice v Brn,
TC Fakultn nemocnice v Hradci Krlov,
TC Fakultn nemocnice Praha Motol,
TC Fakultn nemocnice v Olomouci,

National cardiosurgery registry (NKCHR)


It came into existence because of the need of all the involved cardiosurgery workplaces to gain the information about
the number of heart surgeries in the individual centers. Later it was expanded with the evaluation of the quality of
the surgeries incl. Mortality rate, time for hospitalization and stratification of the risk factors.
The purpose of NKCHR is:

To monitor the development, causes and consequences of the serious cardiovascular diseases and states of
determination, monitoring and evaluation of the national quality coefficients, results of doctors and nurses
cardiovascular care
Determination of qualitative accreditative coefficients based on scientific ground
To provide individual prognostic information for each cardiosurgery intervention, needed for the clinical
decision processes of the doctors
Evaluation of the needs and state of cardiosurgery interventions as far as quality, effectiveness, results and
expenses
Identification of inadequate, potentially unsuitable interventions and therapeutic methods that dont
accomplish the expected results

National cardiosurgery registry is a part of National medical information system (NZIS). Administrator is Ustav
zdravotnickych informaci a statistiky CR (Health Information and Statistics Authority CR) It guarantees the
methodological and structural unity of the registry.

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Registry manager is KSRZIS that is responsible for smooth operation of the registry, state of the database, data
control, technical security and data security. It also provides the information technology (HW, SW,
communications), authentication and authorization.

National oncology registry (NOR)


National oncology registry of Czech Republic (NOR) is whole-area population registry run by Ustav zdravotnickych
informaci and statistiky CR (UZIS CR) from 1976. NOR is integral part of complex oncological care. The NORs
task is to register oncological affection, that means to gather data, their verification, storage, protection and
processing. NOR offers complete data for statistical summaries on national and international level, further for
epidemiological studies and medical research. The NORs data servers also as a support for early diagnose and cure
of new growths and pretumor states, for monitoring trends and their occurrences, causal factors and social
consequences.
National oncological registry is part of National medical informational system (NZIS). The Administrator of NOR is
UZIS CR. It guarantees the methodological and structural unity of the registry.
Registry manager on country level is Koordinacni stredisko rezortnich zdravotnickych informacnich systemu
(KSRZIS) that is responsible for smooth operation of the registry, technical security and data security. It also
provides the information technology (HW, SW, communications), authentication and authorization.
Registry managers on subcountry levels are NOR workplaces with determined area of responsibility, with obligation
of maximum documentation of all new and old oncological disorders.
National registry of vascular surgery
From 1988 based on the decision of Committee of Cardiovascular section CS surg. Society (from 2001
Cardiovascular society) the vascular surgeries were monitored in CR vascular registry.
In the National registry of vascular surgery (NRCCH), that maintains the continuity with vascular registry from
previous years, the numbers of vascular surgeries and interventions in CR are being observed, including risk factors.
The types of operations, meaning vascular reconstruction and specialized vascular operations, the frequency of
complications, incl. Amputations and deaths, time and date of operations till patient release are being observed.
NRCCH is helping the evaluation of the quality of treatment, sick rate in regions, monitoring the accessibility of
professional care for vascular patients in the regions. It is a foundation for improving care for vascular patients in CR
with direct economical impact. It also serves to Ministry of Health and professional society for necessary
organizational measures. NRCCH is a part of National medical information system
National cardiosurgery registry is a part of National medical information system (NZIS). Administrator is Ustav
zdravotnickych informaci a statistiky CR (Health Information and Statistics Authority CR) It guarantees the
methodological and structural unity of the registry.
Registry manager is KSRZIS that is responsible for smooth operation of the registry, state of the database, data
control, technical security and data security. It also provides the information technology (HW, SW,
communications), authentication and authorization.

National registry of arterial replacements


National registry of arterial replacements (NRKN) is whole-area register focused for acquirement and gathering of
information about the performed surgeries with the use of artificial joint replacement. This registry is a new element
in the documentation, monitoring and overview in such focused orthopedic care and it is its indivisible part. The task
of NRKN is the registration of the data about the patients with surgery with utilization of endoprothesis and specific
information specifying this treatment. NRKN provides summarized data for statistical overviews for the national and
international comparisons, for epidemiological studies and medical research. Registry provides also the information
about the attributes of the used implantation materials, mainly from the point of their durability and costs for these

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materials. The summarized data are the base for creation, realization and evaluation of preventive medical programs
and for estimation of necessary financial costs for provision of complex orthopedic care. Anonymous individual data
can be provided for epidemiological studies and medical research only in compliance with valid laws and with
agreement of NRKN council. NRKN is part of National medical informational system (NZIS).
National cardiosurgery registry is a part of National medical information system (NZIS). Administrator is Ustav
zdravotnickych informaci a statistiky CR (Health Information and Statistics Authority CR) It guarantees the
methodological and structural unity of the registry.
Registry manager is KSRZIS that is responsible for smooth operation of the registry, state of the database, data
control, technical security and data security. It also provides the information technology (HW, SW,
communications), authentication and authorization.
Ophthalmology registry (OFR)
Ophthalmology registry (OFR) is one of the pilot projects of telemedine in CR. OFR is image archiving system that
solves the support of medical consultancy and decision process for treatment of serious eye diseases that require
professional consultancy or manipulation at superkonsiliary ophthalmologic workplace. By using it one can achieve
effective way to evaluate findings and ordering patients, which enables decreasing the danger of delays of ocular
and/or life threatening stages. The purpose is to improve the communication between the ocular clinics of the faculty
hospitals, ocular wards at hospitals and ambulatory specialists.
Ophthalmologic Society of CLS JEP is the professional sponsor of the project.
Nosocomial Infection registry (RNI)
Nosocomial Infection registry (RNI) was establish by Ministry of Health CR for the purpose of using unified
information instrument for monitoring and evaluation of clinical cases of nosocomial infection in CR.
1. Purpose and justification of the registry
The creation of the RNI was initiated for the purpose of installing the method for measuring and monitoring of the
quality and effectiveness of the care inside the individual institutions with the goal of finding important standards of
conditions of precaution, providing and financing the care about the states complicated by nosocomial infection (NI)
With the help of IT it is possible to effectively gather necessary data from microbiological laboratories and other
information sources in the data center and to provide the base for needed analysis and also maximally shorten the
time from the first detection of the concrete problem till the time of specific intervention. Local data gained,
evaluated and interpreted according to the standard methodologies (management of quality) can be used as an
indicator of the quality of care for comparison of incidence and level of the control of NI among the institutions. The
results of surveillance in the central RNI acquired for the specific and mutually comparable groups of patients with
comparable level of risk are priceless source of information for hospital management and public health
administrators.
In the stage of registry set-up there was unique interest indicated for its creation from the side of interested
professional societies, health installations and public health institutions.
The purpose of RNI is:
Registration of clinical cases of NI according to the standard definitions and criterions, optimization of
procedures and methods of collection
Registration and evaluation of clinical data for the purposes of standard local surveillance of NI. The results are
to be used at the same time locally (effective control of NI in given institution) and centrally (formulation of
methodological processes, optimization of directives)
Quality care management creation and maintenance of statistically representative data base for calculation of
key indicators of quality and effectiveness of care and states of potentially and realistically complicated NI
Application of methods DST (Decision Supporting Tools) in this area
Location, implementation and optimization of economical aspects of NI and antibiotic resistance (incl. System
of covering the care at states of complicated NI)

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Executive bodies of RNI and their competencies


RNI Administrator
RNI Administrator is department of health care of Ministry of Health Czech Republic (OZP MZ CR). The
Administrator determines access rights to the registry.
RNI Operator
Countrywide registry operator is KSRZIS Coordination department for departmental medical information systems,
which is responsible for smooth operation of the registry, state of the database, data control, technical security of the
data. It provides information technologies (HW, SW, communications), authentication and authorization.
RNI council
RNI council is advisory body and professional guarantee of RNI. The members of RNI council are nominated and
withdrawn by the RNI Administrator OZP MZ CR. The members of RNI are usually representatives of OZP MZ
CR, KSRZIS and representatives of professional microbiological companies.
The RNI is headed by elected chairman, vice-chairman and executive secretary.
The RNI Council
Suggests the access rights and user roles to the Administrator
Suggests conceptual and content changes
Suggests the methodology and control relationships in the registry
Is involved in increasing the level of quality of each data in the database registry (by direct validation or
specifying the methodology explanation)
Suggest the aggregated output forms of presentation of the data from the registry for the professional society
and civilians
Controls the performance of the Administrator and Operator
RIP registry of Intensive care
Registry of intensive care (RIP) was established by Ministry of Health Czech Republic for the purpose of using the
unified information instrument for monitoring and evaluation of the intensive care in CR.
The purpose and justification of the registry
Intensive care registry was drawn up as an instrument of information support for introducing quality and
effectiveness standards of the intensive care system in CR. Its origin was initiated for the purpose of creation and
optimization of the system of acquisition, monitoring and evaluation of the given clinical, demographic and
economic data as a necessary pre-requisite for standards definition for provision and financing of this type of
medical treatment. The parties interested in creation of this registry were mainly the medical institutions of
government, professional societies (Czech society of anesthesiology, resuscitation and intensive medicine), health
insurance companies and it is assumed that the newly created regional centers will be also interested. The creation of
this registry is a reaction of Czech Republic to the intensive medicine initiative of EC within EU.
The purpose RIP is:

Registration of clinical cases of intensive care according to the standard definitions and criteria, optimization of
the methods of acquisition
Design of implementation and optimization of the structure of the monitored parameters, method of measuring
and evaluation the quality of intensive care and their reconciliation with European standards
Evaluation of the results of the system of intensive care, incl. The survival of patients and provision of these
data for the following domains

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Assessment of the input and output conditions for indication and termination of intensive care in various clinical
states.
Creation and maintenance of statistically representative data bases for :
Calculation of key indicators for quality and effectiveness of care
Application of DST methods in intensive care (mortality prediction, SMR etc.)
Accreditation, education and research in the area of intensive care
Location, implementation and optimization of economic aspects of intensive care

Executive bodies of RIP and their competencies


RIP Administrator
RIP Administrator is department of health care of Ministry of Health Czech Republic (OZP MZ CR). The
Administrator determines access rights to the registry.
RIP Operator
Countrywide registry operator is KSRZIS Coordination department for departmental medical information systems,
which is responsible for smooth operation of the registry, state of the database, data control, technical security of the
data. It provides information technologies (HW, SW, communications), authentication and authorization.
RIP Council
RIP council is advisory body and professional guarantee of RIP. The members of RIP council are nominated and
withdrawn by the RIP Administrator OZP MZ CR. The members of RNI are usually representatives of OZP MZ
CR, KSRZIS and representatives of professional companies. The RIP council is headed by elected chairman, vicechairman and elective secretary.
The RIP council:

Suggests the access rights and user roles to the Administrator


Suggests conceptual and content changes
Suggests the methodology and control relationships in the registry
Is involved in increasing the level of quality of each data in the database registry (by direct validation or
specifying the methodology explanation)
Suggest the aggregated output forms of presentation of the data from the registry for the professional society and
civilians
Controls the performance of the Administrator and Operator

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Annex IX
e-Health care in Hungary, report no. 1
Hungarian health care is a traditionally under-financed public system. The financial reform of the social security
system and a deep organizational reform of the institutions of health care are on the agenda of all consecutive
governments of Hungary since the political changes of 1989.
The ongoing activity and the development of its institutions - hospitals, outpatient stations and general practitioners
- are jointly financed by the Social Security Fund, local governments, and projects of the central Government and
directly by the public. Hungarian general practitioners (house doctors or "haziorvosok") operate their praxis in an
entrepreneurial legal framework, whereby the income stems from the Social Security Fund and is approximately
proportional with the number of patients who have chosen the general practitioner. This choice is free by legislation.
As preceding strategy documents, the National Development Plan of 2002 (NFT) also stresses the importance of the
modernization of electronic health care. It states that the efficient operation of the health care system requires the use
of opportunities provided by information systems. Currently there is no systematic connection between the service
providers, data is missing and incompatible. There is a need of an integrated sectoral system, in terms of
communication, guidelines, protocols, central case studies and registration. The Plan attaches substantial resources to
the development of electronic health care in Hungary.
The development of the computer systems of hospitals and outpatient stations ("rendelointezetek") has begun in the
70s by a series of weakly co-ordinate local developments. Today many health care institutions, e.g. hospitals and
clinics possess an isolated, but integrated information processing system. The offer is wide, since within the
Hungarian software producing and informatics system integrating sector a wide range of providers of health care
application systems has evolved. The core of these systems is the database consisting of the files of the patients.
Some of these systems are run by the Informatics Departments of these institutions, other systems are outsourced,
i.e. they have been developed and maintained by subcontractor companies.
Outpatient health centres run by local governments have only recently introduced integrated software systems. But in
many such institutions the files of the individual dispatched patients still have to be carried by nurses to the special
departments. It is to be noted that hospitals, clinics and outpatient stations have to cope with a continuous shortage of
nurse manpower - due to chronic underpayment of medical personnel.
A survey made in 2001 by GKI Economic Research Inc. (http://www.gki.hu) has revealed that while all of the
Hungarian outpatient centres possess and operate computer systems, only three-quarter of them is able to
systematically lead the medical history of the patients by a suitable software system.
Additionally - although the pace of technical development of Hungarian health care institutions is slow - since the
70s a growing number and an ever wider selection of specific medical devices is connected to a digital computer.
This background is important for the interpretation of the appearance and usage of the Internet in Hungarian health
care institutions.
A survey conducted in 2001 by GKI Economic Research Inc., Westel Mobile Communication Inc. and Sun
Microsystems Hungary Ltd. on hospitals, outpatient stations, general practitioners and other health care institutions
has revealed the following facts.
The survey has revealed that in September 2002 nine-tenth of hospitals and one-third of outpatient stations had an
Internet access. Electronic communication between different institutions - e.g. between the laboratory attached to an
outpatient station and a general practitioner - is rather an exception as a rule. Employees of hospitals and outpatient
centres mainly use the Internet for searching for professional information, developing contacts with Hungarian and
foreign clinics and scientific centres and libraries.

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About one-quarter of the general practitioners are able to access the Internet from their cabinet, and some 4 per cent
of the general practitioners operate their own website. General practitioners operating their own websites use this
facility to spread medical information and consultancy. According to the survey the development of Internet access
and webpage creation among general practitioners has a very positive tendency: in 2003 the respective indicators are
expected to be doubled. For this professional segment the quickly provided patient-specific information offered by
local outpatient centres is very important. Such information can help to formulate much needed early diagnoses.
Local outpatient centres with Internet access are searching for the following information:

social security rules

laws, decrees and other regulations

professional articles

description of drugs
Moreover, local outpatient centres with Internet access regularly make electronic contacts with the Ministry for
Health, the Social Security Fund, other hospitals and laboratories. There are no local outpatient centres, which
operate a service empowering patients to check in via Internet for a medical examination.
There are many Internet based medical applications and contents available, some of them run by private firms, others
by education institutes or benevolent organizations. In particular, a wide selection of medical journals, consultancy
websites, product related sites with more or less open and covert advertisement purposes, and special, illness-related
applications (e.g. high blood pressure related sites) are available in Hungarian language. These webpages compared
to similar international sites are less interactive but they still represent a promising segment of the local Internet
market. It is noteworthy that the possibility of online purchase of any type of medical drug is still missing.
There is a wide selection of Government sponsored tenders in order to disseminate digitally based devices, methods
and activities in the field of e-Health care.

There are regularly repeated Government tenders with the aim of providing direct support for doctors,
nurses, social care workers and others in the form of granting for them PCs, Internet access or ISDN
connection cheaply or for free. In some case the co-financing of the tenders by private companies is
available.

A tender issued by the Ministry of Children, Youth and Sports in 2002 invites applicants to participate in
the activity of e-health information dissemination. Applicants are invited to create web pages in the
campaign aimed at drug prevention.
E-health care is also promoted by various professional organizations such as the Hungarian Foundation for Medical
Informatics and the Hungarian Society for Medical Informatics.

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Annex X
eHealth care in Hungary, report no. 2
Development and Implementation of Information Society Technologies and Activities in Hungary from 1996-2003
Sandor G. Vari1, Tamas Gergely2, Pal Simon3
1

Sandor G. Vari M.D., VARIMED Ltd., Budapest, Hungary


e-mail: varimed@axelero.hu
2

Prof. Dr. Tamas Gergely, Applied Logic Laboratory, Budapest, Hungary


e-mail: gergely@all.hu
3

Dr. Pal Simon MD Ph. Sc., Senior expert in health informatics


Templar Partnership Company, Budapest, Hungary,
Adviser on Information Strategy in Ministry of Informatics and Communication, Hungary
e-mail: templar.bt@chello.hu
Historical review and major milestones in the progress of IST development and implementation in Hungary from 19962003 with the assistance of the European Commission Directorate General Information Society Technologies eHealth Unit

1.

Introduction

(Sandor G. Vari, Pal Simon)


Computers like the X-ray and stethoscope can be seen as clinical tools that provide physicians with improved expertise in
solving patient management problems. As tools they enable us to extend our clinical information base, and they also
provide facilities that improve the delivery of the health care we provide.
Automation (computerisation) in the health domain will cause the computer to become a more integral part of health care
management and delivery in 21st century. To understand how the computer assists those who deliver and manage health
care, it is important to be aware of its functional capabilities and how we can use them in medical practice.
The rapid technological advances in computers over the last two decades have had both beneficial and counterproductive
effects on the implementation of effective computer applications in the delivery of health care in Hungary. The major
controversial issue in the health care sector that, the rapid technological advances, which have produced a quantum leap in
our ability to store and process information, have tended to make us overlook the need for effective computer programs
which will meet the needs of patient care. As the 21st century began, those delivering health care (eg, physicians, nurses,
pharmacists, administrators) need to become more involved in directing the effective implementation of computer
applications that will provide the tools for improved information management, knowledge processing, and ultimately better
patient care.
Increasing use of the Internet by consumers in Hungary in general is being reflected in greater reliance on this medium for
health information and health care. Patients are consulting the Web for medical information and resources from databases
that are generally accessible to the public as well as physicians. In addition, interactions between physicians and patients
via e-mail present an opportunity for greater efficiency in medical practice at this moment rarely used in Hungary. Though
physicians have been somewhat reluctant to embrace this modality, it offers significant opportunities for enhancing patient
care without undue liability. The general public also questions confidentiality and security of medical information. The
number of health-related Web sites on the Internet is increasing in Hungary. Incorporating these sites into clinical decision
support systems and other health care applications can significantly enhance the educational and instructional value of such
systems.

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The health care information systems market has grown to a multibillion-dollar industry, with a predicted average annual
growth rate of 12% through the year 2000. In Hungary we could not observe similar growth. Nevertheless in the EU (15)
we can witness positive trends and issues in health and in the information and communication technologies (ICT) market as
they relate to the deployment of eHealth solutions in the member states. In the European Union eHealth solutions are being
proposed as an answer to a variety of health-system management problems and health care demands faced by all health
organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational
support of the new health care models being implemented in many countries. Hence in the new member states the healthsector organizational preparedness and technological infrastructure are not convincing, and proposed policy and
organizational actions to foster the development of eHealth solutions in those countries are not reflecting the needs of the
struggling health care systems.

Modernisation of the healthcare system is a continuous political task of the governments. It is a prerequisite for the
improvement of the healthcare system to have information about the needs of the population and the patients, to ensure
immaterial and material conditions of healthcare, to organise and direct the process of healthcare. In this process it is
essential to analyse the outcome of care, to evaluate the efficiency of care and to make a comparison of the original needs
and the changing demands to pave the ray of further steps.
Advancements in the Information Technology offer a vast range of tools and methods that can help the improvement of
medical IT systems. However, when satisfying the needs of care, the professional medical rules must have the priority. We
are convinced that the fundamental aim of eHealth is to support quality-assured, cost-effective medical care in a
comprehensive way. In order to be able to meet the requirements of the Information Society a number of development
projects have started in the field of Medical Informatics in Hungary. Many of these initiatives have resulted in working
pilots as well as in systems operating regionally.
2. The current situation of health informatics in Hungary
(Tamas Gergely)
Though the development of health informatics in Hungary dates back to the 1960s, the proliferation of Information
Technology began in the early 1990s, and the development started at a fast pace, spurred by the buzzing research scene in
the decades before and the growing interest on the users part (i.e. Neumann Colloquia, Health Information Technology

90

Travelling Seminars), and the funding reform. As a result, databases were developed and have been operating to grant a
complete coverage of events at hospitals and then of all specialist care events. The standard report layout which was topof-the-range at the time enabled the customised development of systems for hospitals and clinics to address the local
needs and possibilities without disrupting the uniform reporting system.
Obviously, the fulfilment of local needs led to a mixed result, and the ad hoc nature of funding brought about a lot of
heterogeneous environments. Therefore, the existing systems though operational on their own with varying levels of
quality cannot fulfil the requirements set for a nationwide information system. They typically operate with an
administrative focus (i.e. the data is stored in alphanumeric files that are not very convenient for further processing) and
have limited degrees of integration (with mediocre communications at the inter-departmental level and only minimum
communications with financial and management systems).
The National Health Insurance Fund Administration (NHIFA) possesses an information system and the IT devices that
enable it to meet its current mandatory tasks; it also has the staff to operate them yet the situation cannot be regarded as
satisfactory. It cannot, because a great part of its currently used IT systems was designed to deliver individual functions
and operate in an island mode as demanded by the situation at hand. Data communication between various levels of service
(primary health care, outpatient specialist services, inpatient care) is not reliable, in fact, rather uncertain and cumbersome;
and the systems are both difficult and expensive to update. Meeting the challenges posed by technological advancement is
significantly hindered by the absence of tangible and intangible resources, as well as the limited nature of development.
This is one of the reasons why the development projects launched end up on their own.
The last major investment project also supported by the state in the health sector took place in 1997-99 (World Bank
Project for Hospital Management Information Support System). Since then the individual hospitals have spent varying
amounts toward IT projects. The functionality of a great part of the existing systems is not fully utilised. It should also be
noted that the sector did not promote the roll-out of the health information systems implemented in the framework of IT
R&D programmes.
The systems installed in the past five years or so have practically used the same technology, whilst Information
Technology has registered ever-faster advancements in the same period. All in all, we may say that the rate of technology
development decreased relative to past levels, and that this setback has resulted in existing systems that look as though they
predate the Internet Boom but in practice, they do not even fully utilise the capabilities of that legacy technology. The
network connectivity of healthcare institutions (i.e. Internet access, secure communication network) is far from the
desirable level.
International statistics suggest that the web pages offering health-related information rank among the hottest sites.
However, there are few websites in Hungary to offer high quality but easy-to-understand information with certified content
to patients despite the fact that there are thousands of websites addressing health issues.
Specifics regarding the current situation

The prevailing attitude does not regard information and knowledge as an asset, and does not consider Information
Technology as a production tool.
The information deficit of the public, the profession and decision-makers compromises the quality of decisions
regarding the health status, social position of individuals and the public at large, and leads to less substantiated
decisions concerning the care provision systems:
The patients or customers often do not know where to go with their complaints, and have no information about the
quality and availability of services.
Healthcare staff does not have electronic access to leading international knowledge bases. Instead, they are to
remain up-to-date in medicine using outdated course books, guidelines published on paper, dozens of scientific
periodicals, and the often distorted information received from pharmaceutical sales agents; there are hardly any
decision support systems at the office.
The prerequisites for sectarian policy decisions to be scientifically substantiated and based on credible data are
scarcely available.
The tools are mostly obsolete and the systems only offer limited interconnectivity, because of the deficiencies in
technical and organisational conditions, and co-operation.
The Internet penetration is low, and access to the websites that would satisfy the information needs of the public and
the requirements of professionals is both costly and limited.
The application of Hungarian IT research and development results is unresolved.
The promotion and management of implementing up-to-date technologies in the sector in a co-ordinated fashion is
unresolved.

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The sectors information management situation


The information regarding health with the different players at various levels is currently amassed in an island mode, with
very little of that information gets processed. The vast majority of the information gets deposited some in data banks but
most in archives in a form that does not support post-processing. Utilising the sectors information assets requires
knowledge management, whose implementation is only at an embryonic stage in the sector.
In order to organise and implement forms of care around the needy as such care is likely to play an ever increasing role
in the health organisations of the future it is necessary to grasp the health status of an ill person in a complex way, and to
tailor therapy and other services to the individuals needs. The foregoing requires the efficient implementation of the datainformation-knowledge flow, where adequate IT support is essential.
It is clear from the assessment above that the elimination of pitfalls in this field requires more than Information
Technology or reorganisation in the sector in fact, it is only possible through concerted action by the relevant
Ministries.
3.

Implementation and use of the IST by hospitals/doctors today


(Tamas Gergely)

Legal environment of e-Health sector


There is a complex legal environment regulating the handling of health data, an environment in which direct and indirect
legislation may apply at various levels in combination.
The following is a description of the key elements in this environment, followed by a list of highlighted areas where
progress seems important.
The level of direct acts includes:

Act LXIII of 1992 on the protection of personal data and the publicity of data of public interest, and

Act XLVII of 1997 on the handling and protection of health data and related personal data.

Mandatory data reporting indirectly involving the handling of data and the applicable provisions is regulated by:
National Statistical Data Collection Program (NSDCP),
the Health Act,
the Statistics Act,
the applicable funding regulations,
the annual NHIFA budget,
the acts and regulations prescribing data collection and storage regarding the operation and tasks of National Public
Health and Medical Officers Service (NPHMOS),
other regulations (such as Ministry of Health Decree 24 of 1999 (VII. 6.) on the reporting procedures for certain
timorous diseases)
Act XXXV of 2001 on electronic signatures must also be mentioned as an indirect piece of legislation whose implications
for this field are not quite clear today.
It is generally true for the legislative situation that this issue is regulated very appropriately independently from the
technology that is used to handle the data. In other words, the provisions do not vary depending on whether paper or an
electronic data carrier is used. However, the legislation does not adequately reflect the attitude change necessitated by the
propagation of electronic data management. This mainly manifests itself in focussing data protection on the physical
storage of data, though the place of data or making copies are neither decisive concepts in digital data management, nor
can they be interpreted well (e.g. simply displaying the data on a screen requires the making of a copy). The physical
location of data must be replaced by access authorisation. This would also resolve a current issue, i.e. physicians currently
violate the law by taking home the data in their own memory from the hospital.
It is not a technological but another attitude-related issue that the current legislation does little to define the mandatory
minimum content of basic documentation it just prescribes the data items to report. Due to the lack of clarity regarding
basic documentation, some reporting requirements may occasionally contradict each-other. The imprecise regulation of
basic documentation makes it to hard to improve the quality of data any further.

92

It is important to clarify the notion of use linked to a purpose, because the current definitions cannot be interpreted strictly
for IT systems. For instance, it is impossible to decide what data is necessary and what is not necessary to achieve the goal
of a consult.
The use of Social Insurance Numbers is regulated by specific rules under taxative legislation with reference to purpose, and
the rules need to be amended all the time. Currently, it is a difficult issue to link updated demographic databases with the
Social Insurance Numbers for applications like the TB screening system. The recording of deaths in the National Cancer
Register is another unresolved issue. By virtue of Ministry of Health Decree 24 of 1999, the Central Statistical Office
(CSO) should report deaths, but the CSO does not have the Social Insurance Numbers and cannot release any information
about private persons.
A more reasonable specification should be provided regarding the mandatory data preservation period. The current
provision does not specify the minimum retention period, but it prescribes that patient charts and discharge summaries
must be preserved for exactly 30 and 50 years, respectively, which is practically unfeasible.
The data collection practices of certain professions and national institutions must be mapped and harmonised with the
regulations much as those practices are useful from a professional point of view, they are legally unresolved.
For reasons that have to do with history, the data content (lists, codes, code systems, classifications, nomenclatures, etc.) of
the annexes to the acts, regulations, and rules is inconsistent, and does not allow for the development of a uniform data
model to support the regulations electronically, i.e. the eGovernment initiative.
The Information and Communication Technology environment of the Health sector
A few features of healthcare and IT in Hungary
poor process control

attempts to implement electronic patient records

development driven by reporting requirements set by the authorities

low integration levels

development projects in island mode

absence of knowledge-based systems

absence of care management systems

insufficient resources for ongoing development, innovation, regulation and funding

The development and current situation of health information in Hungary are determined by the reporting of funding data to
the National Health Insurance Fund Administration in an electronic form. Although that defined the health-related data
content concerning the different forms of care (MBDS2) and established the national code system, the information system
thus developed is inappropriate as yet for the sufficiently detailed and true-to-life representation and storage of the medial
content collected about the patients, due to the substantial simplification measures used at present.
Due to the above reasons, the data structure of many patient administration systems hardly provide any more than what is
mandatory under law, and the funding-centred changes in the central code systems have a major impact on the medical
content of patient records, occasionally causing major distortions and generally truncating the medical content.
It is also typical of the sector that the documentation of patient care events is supported by separate subsystems. As a
consequence, application integration is patchy, often even the traditionally stand-alone diagnostic systems are not
integrated yet (general chemistry and microbiology laboratories). The medical functions and data content missing from the
basic systems are mostly covered by stand-alone applications.
The same applies to support systems such as the pharmacy module or financial management module. There is no
computer support for nursing care activities either. The actual costs of care cannot be allocated to the individual cases and
the expenditures of the care provider do not combine automatically to make up a patient bill including all cost elements.
The result of the above is that the information generated at various levels cannot encompass the full spectrum of care. For
many systems, even the aggregation of available data into management information that goes beyond a case mix analysis
and other listing functions represents a problem.

Minimum Basic Data Set

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Development projects typically do not implement the desired platform-independent and vendor-independent solutions. Cooperation with the industry is hindered by the absence of mutually accepted standards, and the ongoing dynamic changes in
the legal environment. Consequently, product upgrades are not seamless, which may give rise to disputes. It is partly due to
this that healthcare institutions are exposed to the suppliers who offer integrated solutions.
National projects were launched in the past to remedy the typical situation outlined above, such as the Hospital
Management Information Support System (HMISS) funded by the World Bank, which entered the implementation stage in
1998. The projects covered 15% of inpatient care based on the number of hospital beds opened the markets to complex
IT systems, and contributed to the enhancement of the know-how of IT experts and users. However, the application of
results has been limited by the absence of central resources for further development in terms of the internal integration of
the systems implemented, and the connectivity of additional sites.
Electronic communication between healthcare providers remains unresolved, which currently disables the implementation
of a uniform ePatient Records System. The importance of regulation is highlighted by the fact that the implementation of
the uniform ePatient Records System is hindered by the absence of an approved standard to ensure vendor-independent
data communications between the middleware of the local systems.
The only example of uniform nationwide electronic communications is the healthcare providers data reporting system to
the commissioners, a system that has been in operation for nearly a decade. However, neither the content nor the
implementation of this system supports medical purposes.
Local development projects have been implemented over the past few years, achieving significant progress in the
interconnection of various levels of care (e.g. hospitals and family practitioners) and in horizontal co-operation (e.g. patient
administration within a group of hospitals) and might even serve as a starting point for a solution that covers the whole
sector. However, the systemic application of local development results would require nationwide co-ordination. This could
ensure that the standards selected, naturalised, utilised, and co-ordinated with the knowledge representation models (e.g.
with medical ontology dictionaries) developed simultaneously, to support the development of uniform nationwide
recommendations.
The hardware infrastructure shows a lot of heterogeneity. Nearly two thirds (64%) of the IT assets owned by the healthcare
institutions (including hardware and software) are more than three years old. This ratio is 66% for PCs and terminals, 67%
for software, and 52% for mainframes, networks and accessories. Needless to say, the launching of a development
programme would mean that two thirds of the ICT tools should be replaced, due to obsolescence.3
There are some institutions where the penetration of workstations is significant even by international standards. But
replacement due to depreciation is a problem for the majority of even those sites. The intranet is generally limited to just
one site, and upgrades represent a problem in this field. Network interconnectivity is not generally unavailable (Internet,
extranet) even within an institution with multiple sites. The majority of the systems with Internet access use data
communications solutions that do not ensure adequate privacy. For the above reasons, the Internet penetration of the health
sector is low, so users do not have sufficient access to the information, education, and Information Technology
opportunities offered by the new medium.
Health and healthcare on the Internet
The number of Hungarian websites related to health status and healthcare has grown very rapidly in recent years. The first
web pages providing content services and pursuing portal ambitions have emerged and are apparently developing.
However, their numbers and importance, as well as the volume of content, are less than desirable. There is a major backlog
in services with HON (Health on the Net) certification, an international voluntary certification system designed to
guarantee the reliability of the information made available through the websites. At the same time, there are many websites
purporting to be scientific but actually featuring parascientific or fake information.
Institutions handling healthcare information
The Centre for Healthcare Information GYGYINFOK of Ministry of health, Social and family Affairs (MoHSFA)
was established as a stand-alone budgetary organisation in 1974. It is the basic organisation, methodology and scientific
research institute of the Ministry of Health in health information and economics. Its fundamental tasks also include data
acquisition and processing on behalf of the Health Insurance system. Its role in developing and operating the funding
system for healthcare organisations is governed by regulations (government and ministerial regulations).
3

Source: The IT tools with an investment cost of above 50,000 HUF gross in the possession of the healthcare institutions
(reporting to the Institute for Medical and Hospital Engineering), 2001

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The National Institute and Library for Health Information (MEDINFO) evolved out of an institution that had served as a
national medical library earlier on. It started to focus on IT when the computer-based literature research systems emerged.
Currently, its key task is to provide complex information about the Hungarian healthcare system, including traditional
library information services, international health statistics, a knowledge centre function for the sector, the development of a
Health Data Warehouse, and the implementation of authentic public electronic registers. Its organisational structure keeps
changing as its tasks change. In that context, its IT unit has become stronger.
The National Health Insurance Fund Administration (NHIFA) is a central public administration organisation reporting to
the Government. It has a nationwide mandate, and manages the Health Insurance Fund as the central organisation
responsible for social insurance. NHIFA is a fully empowered budgetary organisation in the social insurance field with its
own budget. It was established by the Government acting on authorisation by Parliament on 12th June 1993. The Health
Insurance Fund, i.e. the central organisation in charge of health insurance, is supervised by the Government through the
Minister of Health Social and Family Affairs.
NHIFA is responsible for maximising the health gain of insured people and for managing health hazards by delivering and
commissioning services that allow for the maintenance, restoration and improvement of health, for the compensation of
wages lost temporarily or permanently, and for promoting return to work. NHIFA as the managing body of the Health
Insurance Fund operates the health insurance system by fulfilling the fund management tasks, and actively participates in
the maintenance of the contribution system, eligibility rules, and the services of the healthcare system.
NHIFA and its administrative organisation, as well as service providers, collect and register the following data:

Administrative certification of the Social Insurance Numbers, issuance of Social Insurance Cards, and the related
registration tasks.

NHIFA signs and registers the funding contracts regarding the healthcare services as specified by law.

NHIFA adjudicates books and registers cash health benefits.

Healthcare providers, retail pharmacies and medical device distributors maintain the registers prescribed for funding and
accounting purposes regarding the patients treated, the services delivered, and medication provided. They report data under
their funding contracts to NHIFA regarding the healthcare services that serve as the basis for reimbursement.
So NHIFA processes, adjudicates and analyses growing volumes of data that is also becoming more and more important.
There have been efforts for years to implement electronic data communications between the networks of NHIFA,
healthcare provider and pharmacies. The development of communications between the funding organisation and service
providers is a common interest whose realisation requires central co-ordination.
Scientific organisations of health informatics
One of the scientific organisations in Hungarys health informatics field, the Biomedical Section of the John von Neumann
Computer Society, was established in 1968. This was among the first forums established in Europe. The international
professional community recognised the achievements of Hungarian researchers at an early stage, which is one of the
reasons why the Section became a member of the international organisation (International Medical Informatics
Association, IMIA) and the European organisation in this field (European Federation for Medical Informatics, EFMI). The
other scientific forum in Hungary, the Hungarian Medical Informatics Association, was established in the early 90s, and
has assumed a major role in the modernisation of the IT field. The two associations have held their annual conferences in
turns since the 80s, with 100-150 participants. These events have become the scientific forums of the health informatics
field in a narrow sense (Neumann Colloquia and HMIA Travelling Seminars). In addition to those organisations, training
and valuable workshops take place in some universities. There are also some technical and scientific associations dealing
with borderline domains (e.g. MATE Medical Engineering Department). Unfortunately, however, the values of scientific
and training organisations do not receive recognition, one reason for which is the absence of a policy concept.
3. Review of the National and EU RTD activities and implementations
(Simon Pal, Sandor G. Vari)
The purposeful research and development activities on health (medical) informatics started more intensive in the middle of
the nineties in Hungary. The first episode of RTD on the territory of information and communication technology (ICT) was

95

the governmental initiative in the framework of the competition system on ICT Applications of Public Utility (IKTA). The
Health Policy was not in possession of the independent financial sources and well-defined aims.
Besides IKTA other funds have opened to support Hungarian research, development and applied research activities and are
still available. In a direct or indirect way these tenders contain RTD topics, as well. As a part of this, health informatics
topics have also been present in tender invitations.
Reviewing the successful health informatics projects we get the following picture:
From the end of the nineties until today 33 projects have been launched. A third of these have already ended successfully,
the rest terminates in 2004 or 2005. The topics of the projects already closed include: telemedicine, telemetric, quality
control and controlling, diagnostics, standards, electronic records structures. Topics of the projects still running: analysing
of moving, smart emergency care system, tumour diagnostics and interactive monitoring, knowledge base management,
medical ontology, non-invasive diagnostics.
The value of the results of research realized in the framework of these projects: 5.178.539 , the value of subsidy received
from various government sources: 9.036.928 .
It is to be underlined that among the health informatics topics of the Framework Programme for European Research &
Technological Development (EUfp-IST) there are 5 successful projects, where Hungarian researchers took an active part as
members of the consortium.
The total value of the results of the 5 projects 1.170 000 , the subsidy is: 1.616.000 . The Hungarian partners received an
average of 8-12% of the subsidy; the value of their contribution and innovative work usually exceeds this amount.
All the same the health informatics themes and consortiums with scientific and technological centres were presented one
after the other on the invitations to competitions. The main theme-groups were:

Hospital information systems


Health managements and controlling,
Electronic Health Care Records and standards
Imaging, sign making and analysing
Medical semantics and ontology,
Smart card applications,
Knowledge base and science management.

The following figure presents the division of the projects for the above theme groups (the summary includes also EUfp
IST projects and proportion received by Hungarian participants):
DISTRIBUTION OF HEALTH INF RTD PROJECTS BY TOTAL BUDGET
(TOTAL VALUE)
Science Manag
HI S [5 pr]
10%

[7 pr] 25%

Health Manag &


Control [6 pr]

Sm Card Appl [1 pr]


1%

Med Semant & Ont


[2 pr] 4%

28%

Imaging, Sign
Making and

EHCR& Stand
[2 pr] 6%

Analysing [13 pr]


26%

The real value of the project results is realized only if they are implemented in practice in the widest possible range and
their innovative value can be directly applied at medical work places , the place of patient physician meetings ( the
realization of best practice in relation to the patient and to the doctors practice, as well ). At this moment we do not have

96

any exact calculations but according to estimations the implementation of the systems can increase the utilization value of
the results even by one order.
The situation of Hungarian health informatics cannot be considered favourable, the bases for research and development are
quite straitened, and the results are usually not implemented in practice because of missing funds. The state, efficiency and
innovative value of information systems at the service of health care, health insurance is of mixed quality. In case of a
conscious utilization of the research and development results the level of innovation is expected to increase.
DISTRIBUTION OF HEALTH INF RTD PROJECTS BY ASSISTANCE
Science Manag [7
pr]

HI S [5 pr]
8%

Health Manag &


Control [6 pr]
24%

32%

Sm Card Appl [1 pr]


1%

Med Semant & Ont


[2 pr]
4%

Imaging, Sign
Making and

EHCR& Stand
[2 pr] 4%

Analysing [13 pr]


27%

The aim is the foundation of an interactive knowledge base, a so-called innovation map that would create the possibility
of monitoring various R & D projects later on and in parallel the maintenance of the information needs of health care and
health insurance systems based on the information strategy and the utilization of research and development activities for
the satisfaction of these needs, the planning of their directions.
It is evident that within the European Union it is not enough to solve the utilization of research and development results at a
domestic level. The so-called innovation maps should be extended and common interests and common values have to be
found between researchers, developers, solution suppliers and users.
The Fourth RTD Framework Programme - 1994-1998
INCO-COPERNICUS PROGRAMME
PRIMARY CARE PHYSICIANS COMMUNICATION NETWORK
#PL961090 PRIMACOM

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In a public-private partnership, two regions in


Hungary and Slovenia have established
Regional Health Care Network for exchange
of routine messages between professionals.
Discharge letters are now daily exchanged
between Hospitals and General Practitioner.
PRIMACOM have used European standards,
developed by CEN TC 251, for exchange of
medical data and experience by implementing
Regional Health Care Networks from
Denmark and Italy. PRIMACOM has paved
the way for establishing Regional and
National Health Care Networks in Hungary
and Slovenia.
Setting the Scene
On average, each hour of consultation with a general practitioner (GP) results in more than one message to another part
of the health care sector. This generates a large flow of routine messages, such as prescriptions, referrals, examination
requests, discharge letters and laboratory results. The accurate, fast and safe communication of information has, therefore
become decisive to the cost, quality and patient service of the entire health service.
Until now, there has been very little attention paid to the development of systems, which support the sharing of
information between members of the multi-disciplinary team in health care.
Approach
The aims of the PRIMACOM project have been to establish Regional Health Care Networks in Hungary and Slovenia
based on European standards and experiences from the European Communities.
From the beginning of the project it has been planned to implement one standard for electronic exchange of discharge
letters between Hospitals and General Practitioners clinic.
Later on it is easy to expand with new messages for exchange of laboratory request and reports, referrals, prescriptions,
reimbursement claims and many more.
Results and Achievements

These goals were achieved by


providing the necessary tools and applications (handbook, implementation guidelines, trainingguidelines, expertise),
establishing links between software companies in Denmark, Italy, Hungary and Slovenia
establishing electronic links between health care professionals, and
using structured messages communication to ensure re-use of data in different systems building on European
standards and existing infrastructure and systems in the regions

Conclusions and Plans for the Future


PRIMACOM provided valuable experience for all participants in the project. Health care professionals came in contact
with health care delivery of the future, in which communication will be an integral part of the care process. They became
more prepared to, and are now better able to see, the possibilities of the future.
The experiences and expertise needed for the development of regional health care network has been carefully
documented.
PRIMACOM has documented that once a technical solution has been developed it is possible to transfer the knowledge
across borders and promote establishment of regional and national health care networks.

98

The positive experiences from everyone involved in PRIMACOM will be certainly be disseminated to others. The
technical and standardisation work achieved in PRIMACOM will make it easier for software industries to adopt
information exchange, and adapt these in other regions.
Finally, it cannot be stressed sufficiently that all these results are valuable irrespective of the technology used. All
standardisation and consensus activities, and all experiences gained will remain valid whether EDIFACT, HL7, XML, or
any technology emerging in the future, is used.
Contact Details
Project Name:
PRIMACOM Primary Care Physicians Communication Network
Research Area:
Telematics Applications for Health INCO COPERNICUS
Timescale:
01.12.97 - 30.11.99
Budget:
Overall cost: ECU 436.366
European Commission contribution: ECU 300.000
Keywords:
Healthcare, communications, integration, standardisation, Regional Health Care Networks.
Key Project Participants:
Danish Centre for Health Telematics, County of Funen (DK)
Ramboll (DK)
TSD-Projects (IT)
VARIMED (HU)
FADAM (HU)
FAGOR (SI)
Project Co-ordinator:
Morten Bruun-Rasmussen
Tel:+45 66 13 30 66
Fax:+45 66 13 50 66
E-mail: mbr@health-telematics.dk
Project URL:http://www.primacom.dk
INTERactive HistoPATHology Consultation Network
#PL 96 1121 INTERPATH
SHORT DESCRIPTION
The INTERPATH project enabled Hungarian and Russian pathologists and surgeons to perform site experimental
casting of histological and cytological multimedia documents between hospitals and university institutes of pathology.
INTERPATH promoted the use of telemedicine over Central and Eastern Europe and facilitated dissemination of
spectral images that cant be generated only in a few places.
This could be a model for further development of a regional and nation wide telepathology network joining to
European network.
SETTING THE SCENE
A considerable number of studies have been made on diagnosis and prognosis reproducibility in histopathology with
respect to WHO classifications. In the overall medical strategy, improvement in the quality and reproducibility of
microscopic examinations is of continuous concern. It has come to the point where pathologists are eager to accessing
the imaging microscopy, remote control of a microscope, as well as image transmission via ISDN lines. The purpose
of the INTERPATH project was thus to demonstrate the use of ISDN network for local and international transmission
of both high-resolution digital images (pathology) and teleconsultation in real-time.

99

Pathology is one of the most demanding computer areas of medicine and, as a result, diagnostic histo-pathologists
have often been at the cutting edge of computer literacy. The majority of laboratories use HIS to issue and store
pathology reports. Many of these systems provide the diagnostician with the ability to retrieve reports and cases using
a code-based system such as SNOMED, but more advanced computer facilities that might assist the pathologist in the
diagnosis or interpretation of a case are often lacking. In recent years, advances in computer technology have begun to
have a much wider impact on the practice of medicine and newer technologies are beginning to find their way into the
reporting area. The INTERPATH project covers some of the recent and emerging advances in IT that have the
potential to revolutionize the practice of diagnostic histopathology and which were partially developed in the
European Telematics for Healthcare project called EUROPATH, (HC 1038). Owing to INTERPATH, the ntechnology
has been transferred into the participating Central and Eastern European Countries (CEEC).
Diagnostic support systems aim to help reaching a diagnosis and yet none have been incorporated in widespread
routine practice. During the project partners were considering where the impact of information technology and
imaging spectroscopy in the future could be useful ? Perhaps the most obvious answer is that for the majority of
pathologists, most diagnoses are straightforward and can be reached without requiring any computer-based support
system. The benefit of IT for most pathologists thus come from enhancements to the reporting process; improving
efficiency and accuracy and accessing an expert at a distance for difficult or rare cases. It must be ensured that there is
good standard coding of the diagnosis, and that any new information available on the clinical condition of a particular
patient it is made available to the pathologist.
Additionally, imaging spectroscopy has the potential to greatly enhance practice, but at present the few available
systems require prolonged training for both users and computers and spectral images must be combined with good
conventional images. However, it is clear that as a new diagnostic method like multispectral imaging is introduced,
pathologists will move even further away from the simple recognition of morphological patterns, which are inevitably
subjective, although they have been the gold-standard for several centuries in the daily practice. Until we reach the
stage of purely molecular diagnosis, seeking expert opinion through telepathology and multispectral imaging systems
is likely to be of more value, than lengthy automated decision support.
APPROACH
During the 3rd and 4th Framework programme, the IMPACT and the EUROPATH projects have developed a
telepathology system using the commercially available Integrated Services Digital Network (ISDN). The main
software and hardware elements of INTERPATH systems were from EUROPATH project and it included: Axioplan 2
workstations, a SAMBA software for simultaneous transfer of image, voice and data, and a data bank for storage of
patients' data and microscopic images. The pathology multimedia workstations were then interconnected in Hungary to
develop a pathology consultation network, HugaroPath including : the 1st Institute of Pathology and Experimental
Cancer Research, the 2nd Institute of Pathology, the Transplant and Surgery Clinic of Budapest, the Szent Gyrgyi
Albert Medical University, Institute of Pathology of Szeged, and the Central Hospital Ministry of Interior in Budapest.
The following step was to use of telecommunication via ISDN line and satellite in order to transmit pathology
information from Medical University of Semmelweis in Budapest, to pathologists and clinicians at Institute Albert
Bonniot, Facult de Medicine, Grenoble and to the Moscow State University. Pathologists and surgeons examined the
validity and accuracy of telepathology services in the histological diagnosis of biopsy specimens from transplanted
kidney and liver using traditional imaging techniques. Then, given the assistance of Laser and Medical Technology
Institute in Berlin, the spectral imaging techniques were implemented and tested.
ACHIEVEMENTS
During this project, the use of medical multimedia image transmission in pathology and telepathology was applied
mainly;

To enable rapid diagnosis of kidney and liver biopsies during organ transplant using spectroscopic imaging
method integrated into a multimedia imaging microscope.

To establish on-line and off-line consultation with experts of Joseph Fourier University Grenoble, Albert Bonniot
Institute and Moscow State University, Department of Pathology, on difficult and rare cases of histopathology and
cytopathology.

THE INTERPATH consortium developed the first international telepathology consultation system in the Central and
Eastern European Countries (CEEC) and in the new independent States (NIS). This project included imaging
microscope, imaging spectroscopy and communication networks. Laser und Medizin-Technologie GmbH, Berlin

100

(LMTB) has developed the spectroscopic imaging system. The imaging and spectroscopic imaging systems evaluated
with reference to conventional practice. Tele-consultation and peer discussions were performed in difficult domains of
diagnostic activities of organ transplantation for optimal use of expertise from LMTB, SOTE, Albert Bonniot Institute,
Joseph Fourier University Grenoble and Moscow State University. This telepathology project was successfully
established with the assistance of the EUROPATH project : European Pathology Assisted by Telematics for Health,
(HC 1038) driven by the Comission of the European Union (DG XIII) in the 4th framework Programme : Telematics
for Health Care.
The INTERPATH consortium developed telepathology network which can be combined with spectroscopic imaging
and successfully used for expert consultation of intra-operative frozen sections, panel discussions of difficult
carcinoma cases, and in assistance to organ transplantation.
Contact Details
Project name: INTERPATH
INTERactive HistoPATHology Consultation Network
Reasearch Area :
Tele-consultation for health professionals and health organizations.
Timescale :
01/01/98 30/06/2000
Budget:
Overall cost: 360 725 Euro
EU Commission contribution:
246 000 Euro
Keywords :
Telepathology Spectral Imaging
Remote Consultation Diagnostic pathology
Key project participants :
Laser und Medicine Technologie GmbH (DE)
VARIMED Ltd., (HU)
Universit Joseph Fourier (FR)
Semmelweiss Medical University (HU)
TriTech GmbH (DE)
Moscow State University (RU)
Contact Person:
Pr. Gerhard MULLER
Tel: +49 30 844 9230
Fax:+ 49 30 844 9239
E-mail: g.muller@lmatb.de
REgional and International Integrated Telemedicine Network for Medical
Assistance in End Stage Diseases and Organ TRANSPLANT Project.
www.varimed.hu
HC 4028 RETRANSPLANT
SUMMARY
The RETRANSPLANT project aimed to develop and install telematics tools to
bridge
the various and geographically dispersed institutions playing a role in the
complex process of organ collection from a donor and transplantation into one or several recipients. The generic model
used was kidney transplantation and the information and communication technologies developed so far networked
dialysis centers, organ transplant surgery clinics, tissue typing laboratories, organizations coordinating recipient to

101

donor selection, and other health care facilities for organ transplant services in the Central and Eastern European
Countries.
SETTING THE SCENE
Organ transplant is an increasingly successful and viable treatment for patients suffering from chronic end stage
diseases and from irreversible failure of organs such as kidney, liver and heart. It offers new life to thousands of
people in Europe. In response to the steeply rising demand for transplantation, both the number of transplant centers
and the number of patients on waiting lists have grown rapidly. Graft rejection is still a major problem in kidney,
liver, and heart transplantation. The financial cost of organ transplant made it imperative to develop health telematics
tools for the patient selection and matching and early identification and treatment of graft rejection. The fast and
efficient communication between the many medical actors is both a paradigm and a challenge for health telematics.
In Europe, as a rule, donor organs are matched to recipients by national or multinational organ-sharing organizations.
For example, EUROTRANSPLANT, serves medical institutions in Germany, Austria, and the Benelux states,
HUNGARO-TRANSPLANT in Hungary, and SLOVENJA-TRANSPLANT in Slovenia. There is an increasing
demand to improve the operational effectiveness and inter-operability of these entities at both the national and
international levels having in mind the on-going integration of European countries.
APPROACH
The starting point is the implementation of a networked electronic patient database playing a pivotal role to combine
information from transplant waiting list, donor-recipient immuno-logical typing, organ allocation, and patient selection
in the Czech and Slovak Republics, Lithuania, Hungary, Slovenia, and Poland.
Such networked facilities for the final Recipient to Donor Selection is required for an optimal use of available organs
and tissues over Western and Central Europe so that any potential donor in any country might become matched
against a recipient anywhere and vice versa.
Kidney transplantation was selected as a generic model since it is the most frequently transplanted organ and follows
well established guidelines. Recipients are well identified in Dialysis centers and the whole health telematics process
could start with The DialysisCard and TransplantCard to be seen as an electronic identification support with additional
data storage and management tools for dialysis and transplantation candidates at least in Hungary and Slovenia. The
adopted communication model thus allows different types of PC-based workstations in several points of care to
exchange data with these active memory Smart Cards that are a secure and updated channel to relevant medical
information.
RESULTS AND ACHIEVEMENTS
The most complex aspect was the development and installation of an Electronic Medical Record system at the organ
transplant centers in Hungary (Budapest, Szeged), and Slovenia (Ljubljana) that can be accessed through the web and
that compiles all clinical records including diagnostic codes (ICPC/ICD10), drugs, procedures, investigations,
laboratory tests, etc. in the working language. To ensure standardized and consistent information that must be
mobilized and checked in a very short time, the indexing had to be updated centrally and on a regular basis to ease and
secure the data exchange and consultation about the patients from one health care facility to another.
The major integrated achievement of the project was to create a continuum between the patients and health
professionals SmartCard, the Electronic Patient Record shared through Internet and a Transplant Information Portal
including several web-based services that are actually used by the concerned healthcare actors.
CONCLUSIONS AND PLANS FOR THE FUTURE
With respect to the Health Telematics Application of the 4th Framework Programme, the RETRANSPLANT portal and
connected resources can serve as a very concrete and realistic basis for any further step toward actual use of ICT in any
medical activity requiring multiple access over regional, national and international networks. The take-up of the
technology by the medical actors will be strengthen in the framework of the BePrO take-up action supported by the EU
Commission. The Transplant Information Portal is on the way to be distributed to any potential users. The major
advantage is that, owing to the open-source technology used and the low cost for implementation, the translation into
any regional language and the implementation in any hospital environment are easy, feasible and of obvious cost
benefit to the patients and the health professionals. Nevertheless, it remains questionable, whether the business model
could prove its strength within the fast evolving picture of medical informatics that is slowly abandoned by the large
companies in Europe as a consequence of the inability of European institutions to establish a clear health strategy and
policy.

102

CONTACT DETAILS
Project Name: RETRANSPLANT, Regional and International Integrated Telemedicine Network for Medical
Assistance in End Stage Disease and Organ Transplant Project.
Research Area:
Healthcare Organ Transplant Medical Information Portal
Timescale:
01.10..98 - 31.03.91
Budget:
Overall cost: 2185 k
E C contribution: 1530 k
Keywords:
Healthcare Organ Transplant Medical Information Portal
Key Project Participants:
Universite Joseph Fourier (F)
VARIMED (HU)
Laser und Medizin Tech. GmbH (D)
EUROTRANSPLANT
(HU)
Inst Immunology, Bratislava(SK)
TELES AG
(D)
HUNGAROTRANSPLANT(HU)
SLOVENJA-TRANSPLANT(SJ)
FORTH
(GR)
BULL SA
(F)
BULL Hungary
(HU)
North Eastern Health Board (IE)
VITAMIB sarl
(F)
Project Co-ordinator:
Prof. Grard Brugal,
University Joseph Fourier Grenoble 1
38706 La Tronche Cedex, France
Tel: +33 4 76 54 94 01
Fax: +33 4 76 54 95 49
E-mail: Gerard.Brugal@imag.fr
Project General Manager,
Dr. Sandor Vari
VARIMED Ltd
1124 Budapest, Hungry
Tel: +36 1 487 0430
Fax: +36 1 487 0430
E-mail: varimed@exelero.hu.hu
The Fifth Framework Programme (1998-2002)
Enabling Best Practices for Oncology
BePrO
N 25252

103

Summary
The BEPRO project aimed to provide reference cancer centers
with resources to extend the pilot use of results from previous
European projects in Information Technologies for Health. They
deployed IT applications, integrated them into their routine
environment, and received appropriate training. The resulting best
practice was demonstrated in use.

PROBLEM
The multiplicity of developments and fast evolution of the Internet technology play against the smooth integration of
health telematics into medical practice thus providing arguments to support waiting attitudes and conservatism. The
decision to use ICT tools is finally made by medical actors who do not have the time and evidences for fast integration
of fully digital support systems for prevention, detection, diagnosis, treatment and follow up of patients. How the use
of information and communication technologies impact the best medical practice is still a challenge and a prerequisite
for cost-benefit analysis with regard to social and medical interests.
AIM
The BEPRO project demonstrated best practice in action enabled by the use of innovative ICT applications in
Oncology. Five influential centres, each at the heart of a Regional, National or European network of cancer specialists
experimented these ICT applications for sake of integration in their respective working environments. Co-operative
services allowed sharing experience and reaching consensus at inter-application and trans-national levels. Results
disseminated to the relevant medical community and submitted, whenever applicable, to standardization bodies.
TECHNICAL APPROACH
The project dealt with data exchange procedures based on XML and DTD kept at the most generic and re-usability
levels dealing with state-of-the-art data exchange technologies independently of the medical applications. BEPRO
followed 3 successive phases to reach its main objectives. A SETUP PHASE reviewed the environment and networks
with respect to industrial standards. A MEDICAL EVALUATION PHASE monitored the medical use of ICT tools
in close collaboration with the industrial partners and concentrated on the medical and organisational impact of the
selected applications. A CONSOLIDATION PHASE assessed the extent of the use of ICT tools impact medical
practices.
RESULTS
The BEPRO project ended with 4 medical reference platforms in FRANCE, UNITED KINGDOM, HOLLAND and
HUNGARY each at the heart of a professional network where the information and communication technologies for
health had been integrated in routine work. It carried out in a way consistent with European safe and secure integration
of medical best practices in several respects: reference diagnostic, consensus on electronic forms and remote data
entry to report to epidemiological centers and clinical trials coordinators, guidelines and continuous medical
education.
Co-ordinator: Universit Joseph Fourier, Grenoble I - France
Samba Technologies SARL SAMBA - France
Institut Gustave Roussy - France
InferMed Limited INFERMED - United Kingdom
Medizinische Einrichtungen der Universitt Essen - Germany
VARIMED LTD - Hungary
VITAMIB SARL VITAMIB - France
Het Nederlands Kanker Instituut - Holland
Maxim VOF - Holland
Medical Research Council MRC United Kingdom

104

Project contract number:


Project start date:
Project duration:

IST-2000-25252
01-Jan-2001
18 months

ProRec
The main goal of the European ProRec initiative (Promote Records) is to promote and co-ordinate the European wide
convergence towards comprehensive, communicable and secure Electronic Healthcare Records (EHCR). This is
achieved by co-ordinating and supporting the European Commission's Telematics Applications for Health projects and
other initiatives in the area of EHCRs, both nationally and internationally. The primary objective of this initiative is
that within a reasonable timescale a EHCR is installed in all Member States such that healthcare data originating from
various sources are communicable and understandable.
ProRec's mission is realised by undertaking monitoring, assessment and dissemination activities. Better collaboration
between the different healthcare providers is critical for achieving the level of quality and continuity that European
citizens increasingly expect. Efficient exchange of information is the key element for managing resources, evaluating
quality, and raising cost-effectiveness. I t is commonly recognised that IT is essential to providing such data, and the
use of standards-based record elements is crucial for interoperation. In order to support this process, ProRec centres
have been established in different European countries, These centres leverage the EHCR activities across Europe and
help to co-ordinate the convergence between the countries.
The Hungarian ProRec centre has been set up in order to act as a link between the European ProRec initiative and the
domestic healthcare actors. One of the key issues has been to reach and connect all potential players involved in the
field of application of electronic healthcare records, and to concentrate efforts on the co-ordination of Hungarian
EHCR related activities, This work has been carried out in further cooperation with other (national) ProRec centres,
within the PROREC and WIDENET projects, i.e. the frame of the 4th and 5th RTD Framework Programs of the EU.
The ProRec objectives are fully in line with those declared and supported preferences of the Hungarian government,
The coincidence of the goals of the general national healthcare policy and the ProRec mission was also expressed
through a valuable grant received from the National Committee for Technological Development that helped the
operation of the Hungarian ProRec centre.
The core task of the Hungarian ProRec centre is to collect and make publicly available information about different IT
products and developments in this area, as well as to raise the awareness of the developers of the individual domestic
healthcare telematics applications so that these systems become interoperable both inside Hungary and between the
country and the EU. The system vendors and the users of medical information systems in their everyday work shall use
the information disseminated by the Hungarian ProRec centre. The acquired knowledge must help the responsible
management in making proper strategic decisions. The measures also consist of building independent criteria and
offering services for evaluating IT solutions, and a degree of accreditation of health telematics services and products.

FOR MORE FIFTH FRAMEWORK


PROGRAMME
(1998-2002)
PROPOSALS
AND
PROJECTS
PLEASE REVIEW THE APPENDIX
SECTION OF OUR PAPER

105

IST strategies and action plan for eHealth in Hungary 4

4.

(Tamas Gergely)

The Hungarian Government approved the Ministers report on restructuring healthcare and the related
implementation schedule. The key targets of the Government programme are as follows:

Improve quality of life through health promotion.

Enhance the equity of the healthcare system by reducing regional inequalities and by eliminating roadblocks to
access (i.e. in care, and in financial, social and mental terms).

Make professional standards of care consistent, enhanced and accountable through quality management;
disseminate technologies;

Improve the efficiency of the care provision system and individual service providers (by improving allocation
efficiency and technical efficiency in parallel) and to that end, design, implement and organise regional care
based on the principle of progressive care.

Restructure the care provision system to make it patient friendly, i.e. improve the conditions of care, grant
patients more choice, and make patients more informed.

The key tools to implement the above targets include:


2.

Implement the public health programme approved by Parliament.

3.

The consolidation and development programme linked to the regional restructuring of the healthcare system.

This programme package implements a development environment in a complex way, by creating regional planning for
care, development policy, and the related institutional system. This development environment ensures balanced access
to healthcare, uniform technical standards, including the replacement of obsolete key equipment (for ambulance and
emergency services, diagnostics and oncological therapy) and the installation of such equipment where necessary. The
programme integrates various funds, including EU funds, national development funds, ministerial development funds,
municipal funds, and private investment for public purposes (Public Private Partnership programmes).
The integration of the health care provision systems, and ensuring co-operation between organisations and funding
arrangements are key tasks in restructuring the care provision system.
1.

The Human Resources programme group includes improved recognition for staff in the sector (thereby reducing
the attractiveness of job-shifting), the simplification of professional training, and support for IT-based distance
learning in ongoing continued training.

2.

The financing reform is aimed at reinforcing the current public funding system and improving its efficiency. In
order to enhance the equity of the system, we wish to promote private funding arrangements. The Government
expects this initiative to help reduce gratuities and distribute the public burden more equally.

3.

Information and Communication Technology (ICT) development. The key targets of ICT development are to
propagate the application of knowledge-based solutions in therapy and in strategic planning at the Government
and regional levels, to improve the efficiency and quality of healthcare, and to promote uniform healthcare
services. Other directions for action include improving the level of information available to patients and the
healthy public, the application of ICT solutions in health improvement and patient information.

4.

Domestic Trends
Health monitoring

Source: Care and Social Sector Information Strategy, Ministry of Health, Social and
Family Affairs
4

106

The collection, processing and publication of data regarding the health status of the public or the key health factors
jointly referred to as health monitoring is an important support tool for health policy making in most developed
states.
The collection of health information and operational data regarding the care delivery system in Hungary falls within
the competence of several organisations. The key organisation in charge is the Central Statistical Office. Analysis
regarding the care delivery system is undertaken by the organisation supervised by the Ministry of Health, including
NPHMOS, Centre for Healthcare Information (GYGYINFOK) and National Institute and Library for Health
Information (MEDINFO). The analysis performed by NHIFA is also becoming more and more important.
The health monitoring and reporting system in Hungary is predominantly about mandatory statistical data collection
prescribed by the Act and Statistics and the National Statistical Data Collection Program i.e. quantitative
information about various forms of care and with a few exceptions paper-based publication mostly in statistical
tables.
In recent years to satisfy modern requirements, i.e. a growing demand for prevalence data regarding chronic
incommunicable diseases and their key factors many new initiatives have emerged in the health monitoring field.
Examples include the National Population Health Survey (OLEF2000) and the Program of Morbidity Data
Collection in Family Practice (PMDCFP). Regular health surveys and data collection based on the ongoing verified
reports by certain family practitioners are not part of the domestic health monitoring and reporting system as yet.
One of the key developments in recent years in health monitoring has been the development of partnership between
the institutions. This is evidenced by the Forum for Health Statistics held twice to date and co-operation of
NPHMOS and CSO in order to improve the quality of mortality statistics, and the co-operation between NPHMOS
and DE OEC School of Public Health in PMDCFP. By now most players have realised that an efficient health
monitoring and reporting system can only be based on institutional co-operation with a division of tasks and
collaboration.
In addition to the development of partnership, the key directions of development include the implementation and
ongoing improvement of the domestic health indicator system, in line with international requirements; and in that
context, a rethinking of data collection, with special regard to whether it is necessary and credible; the extension of
analysis capacity; publication of data, information and know-how; the development of communication methods,
their adaptation to the needs and absorption capacity of the target audience, as well as the development of electronic
knowledge bases.
The international benchmarking and analysis of the correlations between healthcare and economy are enabled by the
National Health Account project, a CSO programme based on a set of indicators used by OECD.
In line with the tools and purposes stated in the Hungarian Information Society Strategy (HISS) and the societal
tasks regarding the implementation of eHealth, the following targets have been set for the sector:
4.1

To produce health information and knowledge

Equal opportunities in access to information i.e. ensure balanced access to information and knowledge.

Produce professional information and knowledge of public interest regarding health, and healthcare services.

Develop electronic content services and make them available to the professional target audience.

Deliver information services to the public over the Internet and through call centres.

Develop the information content of the virtual health marketplace.

4.2

To provide the resources

Information and Communication Technology environment


Laying the foundations for eHealth by providing the infrastructure, standards and tools:

Build the infrastructure that serves as the foundation of eAdministration.

Expand the scope of basic registers and authentic records and electronize those registers.

Develop the glossary of terms and term management technology, as well as standards for the sector.

Develop and naturalise standards for eApplication.

107

Improve the information management of healthcare providers; implement integrated IT systems/solutions to


improve the safety, quality and efficiency of medical and preventive care.

Lay the foundations for using the Public Key Infrastructure (PKI) in healthcare sector.

Develop the capacities required for integrating telemedicinal applications (telediagnostics and telemedicine) in
solutions.

Provide incentives for the implementation of community access solutions (such as Telehouses).

Support the use of electronic document management systems in the sector.

4.3

Knowledge management in the sector

Develop health status monitoring systems, harmonise them with the ongoing public health programme and
international reporting obligations.

Develop systems to monitor the quality, effectiveness and efficiency of health services, and harmonise them
with European recommendations.

Implement decision support systems to facilitate evidence-based professional planning for the sector.

Promote research and development efforts, and the culture of innovation in the sector through the pilot projects
implemented in the field of eHealth.

Expected impact of achieving the targets


Target

1.

2.

Expected impact
Develop the information framework for the
modernization of healthcare. In this context,
every stakeholder in healthcare will acquire
new resources. The stakeholders equal
opportunities in terms of access to
Produce and
information will improve:
deliver
information assets of public interest will
information and
evolve in the health sectors;
knowledge in the
the knowledge bases required for
sector
informed decision-making will evolve and
will be maintained on an ongoing basis;
information services will evolve for the
public and professionals;
the information base will evolve for the
eHealth Marketplace.
The network infrastructure will evolve
for the sector as part of the PublicNet
programme.
The appropriate communication channels
Create the
and access opportunities will become
environment for
available.
eHealth: provide
The professional background will evolve
the
for the electronic personal health archive.
infrastructure,
The background standards will evolve
standards and
for electronic and virtual patient records, and
tools
other eHealth applications.
The basic registers and authentic records
will evolve and expand; and they will be
digitalised.

Problems to solve
Reduce the information deficit and
ensure balanced access to the
information.
Assess the existing information
requirements among the public and
professionals.
Collect, naturalise and disseminate
quality information.
Make the stakeholders in
healthcare and ICT interested in
implementing the virtual marketplace.

Create the ICT background


required for using the services.
Create the standards, code systems
and object models required for the
interoperability of the systems and for
data interchange across applications.
Implement secure communication
solutions to ensure the privacy of data.
Enhancing the Internet
penetration.

108

Target

Expected impact
Uniform legal and regulatory terms and
conditions will evolve for the management
and storage of data, information and
knowledge.
A group of trained users will evolve.
The users and commissioners of ICT
solutions will be more informed.
The human and institutional conditions
will evolve for the development and
implementation of eHealth applications.
The culture of bidding and innovation
will evolve and ensure development.
The Communication Strategy to
support the information strategy will be
implemented.
The implementation of the strategy will
be facilitated through the involvement of
private capital.
The incentive system to support the
information strategy will evolve, along with
motivated stakeholders.
The IT specialists will develop for the
sector.

3.

Social
environment:
legal, human
resource,
organisational
and cultural
conditions

4.

Information and knowledge become


accessible to and applicable by the
stakeholders in healthcare, the information
base will evolve for public administration as a
service providers, since:
the healthcare monitoring system will
Utilise
operate;
knowledge in the
the quality monitoring system will
sector
operate;
the applications to analyse and present
the information, and to support decisionmaking are available;
the eHealth applications reflecting the
best practices will be implemented.

Problems to solve
Enhance the expert base for
training and research.
Enhance the number of trainees
and their qualifications.
Improve the management of
information and R&D.
Strengthen information
consciousness.
Enhance the understanding of the
key buyers.
Create equal opportunities for
disadvantaged groups.

Exploit the information assets


developed for the sector.
Develop and propagate best
practices for IT in the profession.
Modernise the national health
monitoring and reporting system.

109

5.
What general comments therefore can be made regarding eHealth in Hungary?
(Sandor G. Vari)
Linking different record systems to each other sometimes raises criticism (primary secondary care), in
particular in cases, which may involve personal/patient records. The systems are in place designed to fulfill the
requirements of the National Health Insurance Fund Administration (NHIFA). The main feature of these
systems (Primary Care, HIS) to able to deal with the diagnostic (ICD 10) and intervention (WHO) codes on a
way the health care facilities able to report the most cost effective coding for reimbursement. The database for
patient records, which will provide medical information and history on the patient from cradle-to-grave, is less
important and very heterogeneous. Hence electronic medical records need to be stored in standard format not
only translatable departments and health care facilities, but also universally comprehendible by any practitioner
who must use the information system. Today there exist many different types of medical records within the
clinical environments to cover specific areas of care and treatment. The patient is normally connected to
numerous monitoring and therapeutic devices. Thus there can be difficulty in gathering data from these diverse
sources to enable the most effective clinical decisions to be made.
There is need to secure standards and qualities and for appropriate steps, nationally and internationally, to be
taken in the search for solutions. Also, lack of guidance from central authorities has in many instances led to a
mish-mash of non-compatible computer-based patient record systems in the Primary Care in Hungary. Such
circumstances have caused problems to arise in the smooth processing of patients between health service units,
even within the same health authority (or equivalent).
For the civil community, one can envision an eventual central, cradle-to-grave, medical information
management system containing records on each citizen of the country, for every country in the world, with
appropriate security and control measures instituted according to local laws and regulations is a dream in this
day. There are certainly important ethical concerns in relation to composition of health records and access to
the same.
In spite of the many positive aspects of devolution / decentralization, there is a need for central coordination
based on the National eHealth Strategy. This observation may also have some bearing internationally with the
high volume of people travelling across national boarders in the European Union and sometimes needing
emergency health treatment outside of their respective countries. In these cases, quick and efficient transfer,
electronically, of medical records may be essential for achieving delivery of good quality acute care.
Most relevant changes are needed in Hungary to implement nationwide eHealth access
eHealth is the use of modern telecommunications and information technologies for the provision of clinical
care to individuals at a distance, and transmission of information to provide that care. eHealth can be used for
collaborative arrangements for the real-time management, decision making, and remote monitoring of
patients.. The use of telecommunications and information technologies in providing health services is
determined. eHealth is described as combination of topics from the fields of medicine, telecommunication, and
computer technologies. The medical systems infrastructure consisting of the equipment and processes used to
acquire and present clinical information and to store and retrieve data are explained in details. The challenges
existing in eHealth development in the European Union in different countries differ by technological, political,
and professional barriers. Nevertheless in the progress of the integration of health care services the eHealth
solutions are crucial and will play a pivotal role in the future.
Integrated Health Care System
Information and communications technology (ICT) is increasingly being used in management of illnesses to
facilitate shared services (virtual health networks and electronic health records), knowledge management (care
rules and protocols, scheduling, information directories), as well as consumer-based health education and
evidence-based clinical protocols. The integration of health care services with the use of eHealth solutions
holds for both clinicians and health care leaders the real possibility of stimulating fresh insights and approaches
to health and medical care-both its provision and its organization. Clinicians and leaders of health care
organizations must understand the complexity of the integration process. They have to consider difficult
challenges in both patient and organizational management. Nevertheless there are some basic eHealth solutions

110

they can use in this extraordinarily complicated task of jointly creating integrated health care systems. In
Hungary we shall implement an eHealth application tightly integrated with electronic medical record system
that provides physicians and patients with a convenient, continuously available communication channel to the
health care system. Physicians and patients can view summary data from medical record, including the results
of diagnostic tests, and request medical advice, prescription renewals, appointments, or updates to their
demographic information. Online tools for physicians and patients, when integrated with an electronic medical
record, can provide better access to health information, improve patient satisfaction, and improve operational
efficiency.
Computer-based medical records
The main application in Hungary is computer-based medical records (Primary Care and HIS), nevertheless
very few computer-based patient records that are able to axchange data with other record systems and
facilitating clinical decision-making. These records may be linked to knowledge-oriented systems that may
contribute to quality control of clinical processes. Such a decision support has been demonstrated to improve
outcomes.
Computer-based population or community health records
Computer-based population or community health records do not exist at this moment in Hungary, however
these systems are particularly valuable in public health where one is trying to trace different types of health
hazards, linked either to medical, environmental or social agents.
Disease management
Disease management has been described as a comprehensive, integrated approach to care and reimbursement
based on the natural course of a disease. It requires a management approach, which brings together research
evidence, best practice and inter-professional and inter-agency working. Starting with the ideal of continuity of
care for individual patients, it implies structured co-ordination of care over time and across primary, secondary
and tertiary settings. The appeal of disease management is that it promises reduced costs, combined with
increased quality of care and patient satisfaction. But the concept is open to different definitions and
interpretations and its effectiveness in the Hungarian healthcare is untested.
Decision Support
With rapid changes taking place in the practice and delivery of health care, decision support systems have
assumed an increasingly important role. More and more health care institutions are deploying data warehouse
applications as decision support tools for strategic decision-making. By making the right information available
at the right time to the right decision-makers in the right manner, data warehouses empower employees to
become knowledge workers with the ability to make the right decisions and solve problems, creating strategic
leverage for the organization. Nevertheless the web based decision support systems linked to Hospital
Information System (HIS) are not used in the daily practice in Hungary. While search engines exist for finding
sites and criteria are available for assessing site quality, few tools are available for managing Web-based health
care information. Management of Web-based information is particularly challenging because the information is
continually changing and new resources are continually being added.
Nursing and Home Care
Since 90% of people's health needs require nursing, not medical care, it is important those nurses be appointed
to management positions and participate in national health services, that research on nursing education includes
primary health care. The new member states, with all their differences, face strikingly similar problems in
administration and nursing administration in particular:

emphasis on hospitals
top-down hierarchies
undeveloped human resources
lack of high performance systems
lack of infrastructures for health service delivery
ineffective rural-urban links

Now the focus in Hungary is on the appropriate use of resources, cooperation between public and private
sectors, and sustainability. It is important to emphasize developmental process rather than targets, and to work
at the local level. Home health care is an expanding area within the health care system. The idea of moving

111

parts of the health care process from expensive specialized hospital care to primary health care and home
health care might be attractive in a cost perspective is a very important issue in the Hungarian health care
system.
Common applications of ICT include home monitoring of vital signs for patients with chronic disease, as well
as replacing home visits by nurses in person with telemedicine videophone consultations. A patient-managed
Home Telecare System with integrated clinical signs monitoring, automated scheduling and medication
reminders, as well as access to health education and daily logs, is presented as an example of ICT use for
chronic disease self-management does not exist in Hungary. A clinical case study demonstrates how early
identification of adverse trends in clinical signs recorded in the home can either avoid hospital readmission or
reduce the length of hospital stay.
ePharmacy
Pharmacy is one of the key health care professions that must adopt Information and communications
technology (ICT). A stepwise structure for pharmacy informatics has to be proposed in Hungary; it should
consists of establishing a relationship with the patient, establishing a database, listing and ranking problems,
choosing among alternatives, and planning and monitoring. Pharmacists will need to use ICT to enhance their
worth on the health care team and to improve patient care. It includes determining the consequences of less
than optimal drug therapy, improving drug therapy, and reengineering pharmacy departments and services
across all patients care settings to deliver optimal pharmacotherapy. Prevention and reduction of adverse drug
events, disease state management, and other methods to improve quality of care are of major importance.
Patient self-management
Self-management is an essential but frequently neglected component of chronic illness management that is
challenging to implement. Available effectiveness data regarding self-management interventions tend to be
from stand-alone programs rather than from efforts to integrate self-management into routine medical care in
Hungary. We have to make tremendous efforts to integrate self-management support into broader health care
systems change to improve the quality of patient care in the chronic illness. Available data suggest that teams
from a variety of health care organizations made improvements in support provided for self-management.
Improvements were found for both diabetes and heart failure, suggesting that this improvement process may be
broadly applicable.
Evidence based health care management.
The health care providers must introduce a new approach for health care management called Evidence Based
Management. This approach promises to improve the practice of health care management, at the same time as
it may stimulate research on the organization and management of health care. Evidence Based Management
means that health care managers should learn to search for and critically appraise evidence from management
research as a basis for their practice. This will require some new managerial skills that should be included in
the education and training of health care managers. It will also require a new orientation for research on health
care management. There will be a demand for more applied research, and also for research with a more
positivist orientation.
Health care management must plan and implement data warehousing strategy using a best practice approach.
Through the power of data warehousing, health care management can negotiate better managed care contracts
based on the ability to provide accurate data on case mix and resource utilization. Management can also save
millions of dollars through the implementation of clinical pathways in better resource utilization and changing
physician behaviour to best practices based on evidence-based medicine.
Modelling-based health care management ought to become just as popular as evidence based medicine. Making
managerial decisions based on evidence by modelling efforts is certainly could be one of the major steps
forward. Examples can be given of many successful applications in different areas of decision-making:

disease process modelling


screening and prevention policy development
resource allocation
waiting lists and waiting times
patient scheduling

112

Also examples shell be given which would have benefited by prior modelling, for example adverse effects of
health care system reform decisions in Hungary. The advantage of mapping modelling applications in this way
is that we are able to position contributions within a reference framework with a focus on processes, with the
patient process at the top. The acceptance of process-orientation as a basis for modelling has consequences for
the way models are developed. Close cooperation between modeler and manager and a profound insight into
the dynamics of the modelling area concerned are important requirements for developing successful models.
eHealth ethics
The Internet is changing how people receive health information and health care. All who use the Internet for
health-related purposes must join together to create an environment of trusted relationships to assure high
quality information and services; protect privacy; and enhance the value of the Internet for both consumers and
providers of health information, products, and services. The next step has to be in Hungary the implementation
of the "e-Health Code of Ethics" that is to ensure that all people in the country can confidently, and without
risk, realize the full benefits of the Internet to improve their health. The National e-Health Code of Ethic should
reflect the results of the "eHealth Ethics Summit," which convened in Washington DC on 31 January 2000 - 2
February 2000. The Summit was organized by the Internet Healthcare Coalition and hosted by the World
Health Organisation/Pan-American Health Organisation (WHO/PAHO), and attended by a panel of about 50
invited experts from all over the world. It sets forth guiding principles under five main headings: candor and
trustworthiness; quality; informed consent, privacy, and confidentiality; best commercial practices; and best
practices for provision of health care on the Internet by health care professionals.

113

Appendix
Information and Communication Technology Applications of Public Utility (IKTA)
Information and Communication Technology Applications of Public Utility 2
Project i
title
sta duration support
total cost
IKTA2/001
Knowledge-based
2000.05.01.
23
15595
22879,5
administration system
IKTA2/002
Improvement of the software
2000.02.01.
16
25800
36900
system performing video
graphics and television
transmission
IKTA2/005
Simplex coded communication
2000.02.01.
12
18438
32860
IKTA2/008
Development of machine
2000.03.01.
23
39900
73800
learning methods for logicbased knowledge management
applications
IKTA2/010
Regional knowledge pool
2000.07.01.
23
15000
51000
development for the sustainable
management of natural
resources
IKTA2/013
CODEX: the toolkit of the
2000.02.01.
22
56066
80095
document-based knowledge
management
IKTA2/014
Electronic commerce solution
2000.04.01.
13
108000
240000
based on Web technology
especially for book distribution
IKTA2/017
Development of knowledge and 2000.06.01.
23
63600
102000
software base for e-commerce
and launch of a reference emall
IKTA2/020
Foundation of insurance e2000.02.01.
16
26075
52150
commerce solutions
IKTA2/029
EU-conform data-collecting,
2000.03.01.
19
20000
40000
registering and analysing
system, assisting regional
development monitoring
IKTA2/037
Internet- and intranet-based
2000.04.01.
23
93800
143800
knowledge-based information
system for the Association of
County Righ Cities
IKTA2/044
Advisor - Knowledge-based
2000.10.01.
23
48900
99000
ERP implementation consulting
system
IKTA2/055
Intelligent partner system for a
2000.05.01.
23
26880
38400
virtual clinical department

Information and Communication Technology Applications of Public Utility 3


duration support
total cost
project id
title
start
(month) (KHUF)
(KHUF)

114

Information and Communication Technology Applications of Public Utility 3


duration support
total cost
project id
title
start
(month) (KHUF)
(KHUF)
IKTA3/004
Creation of value-added sample
2000.10.01.
17
28000
56000
products and service development
from digital aerial imagery
IKTA3/008
Development of Virtual
2000.10.01.
17
21390
43935
Supercomputer Service using the
Academic Network
IKTA3/009
Testing Experimental IPv6
2000.10.01.
16
18790
37996
Services (BEI6)
IKTA3/010
Examination of high resolution
2000.10.01.
17
23400
46800
image processing and GIS service
system
IKTA3/011
Application opportunities of high 2000.10.01.
17
15900
32800
resolution remote sensing data in
the forestry management
IKTA3/012
"netMedia" - High-bandwidth,
2000.11.01.
11
20640
41735
multiuser multimedia applications
on the Internet backbone
IKTA3/014
Pilot for the introduction of
2000.11.01.
12
20000
40000
advanced IP technology
IKTA3/019
TRICLOPS hw-sw system - 3D
2000.09.01.
17
32150
64300
surface modelling
IKTA3/022
Monitoring of Quality of Service 2000.09.01.
14
18000
36000
in IP (QoS IP) networks
IKTA3/027
Development of Part-of-speech
2000.10.01.
21
36750
73500
Tagger Method for Hungarian by
Applying Machine Learning
Algorithms
IKTA3/029
Cluster Programming Technology 2000.10.01.
23
43955
88358
and its Application in
Meteorology
IKTA3/030
Theoretical model, calculation
2000.10.01.
17
27852
69630
procedure and prototype of health
institutions controlling system
IKTA3/033
Developing exportable quality
2000.10.01.
13
5700
11400
insurance service for anti-virus
systems
IKTA3/041
Hungarian Education and
2000.12.01.
24
20110
40220
Information portal system
IKTA3/044
Development of equipment for
2000.10.01.
18
55000
111200
saving nitro-celluloid films
2000.09.01.
20
22000
44000
IKTA3/063
Linguistic Feedback for OCR,
2000.10.01.
17
9600
19200
Hand-writing and Speech
Recognition Systems
IKTA3/065
Design and test framework for
2000.11.01.
29
27220
54440
dependable, safety critical
systems
IKTA3/074
Shared Medical Knowledge
2000.11.02.
23
29699
59997
Management System

115

Information and Communication Technology Applications of Public Utility 3


duration support
total cost
project id
title
start
(month) (KHUF)
(KHUF)
IKTA3/082
Determination of object-sub
2000.10.01.
19
41200
85400
sequential area precipitation with
radar, creation of precipitationrunoff model
IKTA3/086
Development of data analysis
2000.11.01.
14
14500
29000
software for processing
"multiplex micro bead assay" data
IKTA3/098
Bibliotheca eruditionum 15002001.02.01.
17
39360
131320
1700 (A Library of the Reading
Material in the Carpathian Basin)
IKTA3/101
Photorealistic rendering in CAD
2001.02.01.
15
20000
40700
systems
IKTA3/110
Testing of Security Methods and
2001.03.01.
8
14590
29180
Equipment in IPv6 Environment
IKTA3/111
"DemoGRID" Connecting
2001.10.01.
17
98750
200977
Heterogeneous Systems to Solve
Data and CPU Intensive Problems
IKTA3/112
Developing Ecological Modelling 2001.04.01.
17
11000
22000
by Three Dimension Digital
Images
IKTA3/113
Development of Network
11
25075
52625
Management in the Academic
Computing Environment
IKTA3/114
Regional Public Collection
2001.05.01.
17
48937
133860
Documentation and Information
System
IKTA3/119
Theoretical model and prototype
2001.06.01.
17
22768
56920
of controlling system for Local
Governments
IKTA3/121
Customer friendly information
2001.10.01.
13
23309
79746
system model for public
administration
IKTA3/128
Multifunctional road vehicle
2001.06.01.
17
52700
105400
detector system based on 3D
space reconstruction
IKTA3/135
Planning and Development of
2001.03.01.
14
43000
93000
Four-Tier Regional Information
System
IKTA3/140
Development of Time-frequency 2001.02.01.
12
14070
28140
Analysis Software
IKTA3/144
Health quality dissection model
2001.06.01.
22
51944
129860
with portable records on database
networks
IKTA3/149
Development of Remote Security 2001.03.01.
20
44240
98000
Management System
IKTA3/151
Object research base for GIS
2001.03.01.
14
19500
39800
model formation
IKTA3/154
Pictorial database for the
2001.03.01.
29
8573
17146
recognition of emotional facial

116

Information and Communication Technology Applications of Public Utility 3


duration support
total cost
project id
title
start
(month) (KHUF)
(KHUF)
expressions
IKTA3/162
GIS-based intelligent search2001.03.01.
17
25000
51490
engine
IKTA3/163
Decision Supporting Information 2001.03.01.
16
32000
72500
System supported by orto-photo
and digital catastral map
IKTA3/164
Application of Modern Info
2001.11.01.
17
29425
58850
communication Technology in
Intelligent Sensors
IKTA3/167
Intelligent employment agency
2001.02.01.
34
16028
40072
and general fuzzy expert shell
IKTA3/173
BPM based robust e-business
2001.02.01.
23
36600
73200
application development

117

Information and Communication Technology Applications of Public Utility 4


duration support total cost
project id
title
start
(month) (KHUF)
(KHUF)
IKTA4/006
MEDIP - Platform independent 2002.01.01.
35
52000
87500
software system for medical
image processing
IKTA4/026
Dynamic broker service for
2002.01.01.
23
25000
69260
improving the quality of
database access and resource
usage
IKTA4/030
3D display platform for
2001.11.05.
23
68550
136900
professional IT applications
IKTA4/042
Detection of statistical structure 2002.01.01.
23
44200
88780
of large databases and
development of a human
interface
IKTA4/044
Robot eye pair: an ultra high
2002.01.01.
15
56050
106100
speed CNN technology based
visual system
IKTA4/049
Development of EFTR (Unified 2001.11.01.
12
60000
140000
Administration System for
Higher Education) with threelayer technology
IKTA4/055
Machine learning and its
2001.11.15.
24
28700
49700
application to speech
impediment therapy
IKTA4/059
Web-based communication
2001.11.01.
15
10601
21621
system between health service
providers
IKTA4/061
Electronic and web account to a 2002.01.21.
18
16915
29762
museum-collection and building
of a specialised internet portalsite
IKTA4/068
Transplant Information Portal
2001.11.01.
23
17450
34900
IKTA4/072
General purpose, high reliability 2001.11.01.
18
30000
60000
personal identification system
IKTA4/074
Clinical information and
2002.01.01.
29
33000
98000
decision support intranet system
IKTA4/075
Hungarian supercomputing
2002.01.01.
23
69595
154980
GRID
IKTA4/085
On-line disaster recovery
2002.01.01.
27
62600
126200
management of distributed
databases
IKTA4/086
Information and
2001.11.01.
22
33000
66000
communications technology
development for the
improvement of traffic
circumstances
IKTA4/088
Equipment for the recognition of 2002.01.01.
17
70800
141600
original handwriting and
signature identification

118

Information and Communication Technology Applications of Public Utility 4


duration support total cost
project id
title
start
(month) (KHUF)
(KHUF)
IKTA4/089
E-ticket: electronic ticket sales 2001.12.03.
16
57153
109897
system
IKTA4/091
Framework for the modelling
2002.01.07.
23
47300
95200
and simulation of energy
markets
IKTA4/095
Development of customer
2001.12.01.
12
35000
74500
information system in the
Academic Network
IKTA4/101
Development of medical
2002.01.15.
20
30900
62200
decision support system based
on picture processing
IKTA4/102
Advisory system for medical
2002.01.01.
35
60000
137685
diagnosis using images
IKTA4/111
Development of an open
2002.01.07.
16
24750
49700
interface to connect different and
distant diagnostic systems
IKTA4/113
Wastewater treatment expert
2002.04.01.
18
34000
68000
system
IKTA4/121
Integrating Web resources into 2002.01.01.
17
35000
111352
the Agent Cities Multi-Agent
Initiative of the EU
IKTA4/128
Cardiovascular diagnostics on
2002.01.01.
29
33000
90000
the Internet
IKTA4/133
Internet-based communication 2002.02.01.
17
45000
113500
among hospital and general
practitioners
IKTA4/136
ECRIME - Judicial judgement 2001.12.03.
21
55377
110754
supporting expert system
IKTA4/137
Integrated decision support
2002.01.01.
26
12000
24000
geographical information system
IKTA4/138
Human movement analysis using 2002.01.01.
35
42000
127060
3D methods

119

PRO_TITLE

IST K 1.1.
1 IST- WIDENET Offering worldwide Services
- A I 2.1999through an
991.2
14203
International
2Network on Health 2B
Records
2 ISTHMCHUNGARIAN
IST K 1.1.
1999- MSCS
MEDICAL
- A I 2.12095
CHAMBER
991.2.
MULTIFUNCTIO 11
NAL SMART
1A
CARD SYSTEM
IST K 1.1.
3 IST- REHAROB SUPPORTING
REHABILITATIO - A I 2.1999N OF DISABLED 991.2.
13109
USING
11
INDUSTRIAL
1A
ROBOTS FOR
UPPER LIMB
MOTION
THERAPY
4 ISTCORSHE CITIZEN_ORIEN IST K 1.1.
1999TED ROADMAP - A I 2.10208
OF SENSORS
991.2.
FOR
11
HEALTHCARE 1A

A. KEY_
ACTI
ON_LI
NE_D
ESC

Health

Personal health
systems

Personal health
systems

Personal health
systems

COUNTRY

PRO_ACR
ONYM

CP_ACRON
YM
KEY_ACTI
KEY_
ON
ACTION_
LINE

Serial
number
Pr_NUMB
ER

EU IST eHealth Total Proposals from 1999 2003 (Highlighted project was funded by the European Commission)
FIR
TIT ST_ LAST_ TELEPH
ORG_NAME CITY
FAX
LE NA NAME ONE
ME

Hungary Computer And


Dr.
Automation
Research Inst, Budapes
Hungarian
t
Academy Of
Sciences
Hungary Digital
BUDAP
Banking
EST
System Ltd
Hungarian
DR.
BUDAP
Medical Centre
EST

Peter INZELT+361-209- +3615257


4667503

EMAIL
peter.inzelt@sztaki.
hu

GYO GASPA 00-36-1- 00-36-1- mail@dbr.hu


RGY R
212-1668 4576945
GEZ GYENE +361+361- groenewald@fl.org
A
S
2694391 2694392 a.com

Hungary Technical
DR GYO HORVA36-1
University Of
VIC RGY I
4632271
BUDAP
Budapest
E
EST
REC
TOR
National
PRO LAJ KULLM36-1
Institute For BUDAP F. OS ANN 3945733
Medical
EST
Rehabilitation
Hungary Technical
VIC GYO HORVA(36 1) 46
University Of
E
RGY I
322 71
Budapest
BUDAP REC
EST TOR
PRO
F

36-1
manyi@tuo.bme.hu
4632270

36-1
oori@visio.c3
2008834
(46 1)
46 322
70

5 ISTEURODIAL Integration of
IST K 1.1.
1999Dialysis and
- A I 2.12183
Kidney
991.2.
Transplantation
12
Units and
1A
Improvement of
KidneySubstitutive
Treatment
Efficiency
6 ISTKERATO- KERATO-BRAIN- IST K 1.1.
- A I 2.1999- BRAINNET - a High
991.2.
12698 MED
Performance
12
Competence
Network to support 1A
Diagnosis,
Teledesign and
Therapy planning
in the Keratorefractive and
Brain Surgery

Clinical,
biological,
managerial and
imaging systems
for health
professionals

Jozsef Attila SZEGE PRO IST KENES (36 62) 45 (36 62) tudrh @ jate.uUniversity
D F
VAN EI
40 22
42 04 12 szeged.hu
dr jean BERKA (36 1) 34 (36 1)
Komed
Manufacturing
claud
03 115
34 02
1555
And Trading
e
325
Co
Eco-Technik HATVA MD BAR BOZE (36 209)
lordbuc @
2000 Ltd
N
NA
42 16 59
freemail.c3.hu
PRO LAJ IZSAK (36 1) 266 (36 1) IZSAK @
Eotvos Lorandt
BUDAP
F
OS
47 16
267 08 Ludens.elte.hu
University
EST
DR
20
Hungary Applied Logic
Prof. Tam GERGE (36-1) 326 (36-1) gergely@all.hu
Laboratory
Dr. s LY
9056
326
9056

Clinical,
Hungary Kando
biological,
Polytechnic
managerial and
imaging systems
for health
professionals

Budapes
t

Prof. Dezs SIMA


Dr. o

(36-1)
(36-1) sima@novserv.obu
3684610 3659632 da.kando.hu

BUDAP
EST

121

7 ISTINTEGRA Electronic Health IST K 1.1.


1999Record Based
- A I 2.13043
Integrated Services 991.2.
12
1A

PRO JOZ FURES (36(36Clinical, biological, Hungar Institute


F. SEF Z
1)6401144 01)340
managerial and
y
Preventive
BUDAP
DR.
1144
imaging systems for
Medicine,
EST
health professionals
Hungarian
Defence Forces
DR. GEZ NAGY (36Medaninfo
(36MISKO
A
Health Care
30)951555 30)362
LC
Service Ltd
4
640
DR. JAN MACSU (36(36Kronon
FELSO
OS GA
46)384273 46)384
Planning And
ZSOCA
273
Consultant
JOZ LETEN (36(36Mt-System
BUDAP
SEF YEI
1)4311142 1)2602
EST
166
AN DECKE (36(36Dti Consulting
DRA R
1)3024375 1)3024
Management
S
370
Consulting
BUDAP
And
EST
Information
Technology
Limited
PRO TA GERGE (36(36Applied Logic
BUDAP
1)3209056 1)3209
F. MA LY
Laboratory
EST
DR. S
058
Medinet
LAS SZERE (36(36MISKO
ZLO NYI
46)431394 46)431
LC
394
Bull Hungary
MS GABAVAR (36(36BUDAP
Ltd.
C.E. OR
30)970191 30)437
EST
E.
80
5151
DR. GABCSIBA (36(36Hospital
MISKO
OR
46)321211 46)323
Informatics
LC
694
2000

h12679fur@ella.hu

medaninf@alpha.bzl
ogi.hu
fizcsuga@gold.unimiskolc.hu
letenyei@mtsystem.
hu
andras.decker@dti.h
u

gergely@all.hu
praxinfo@elender.hu
gabor.avar@bull.hu
korh0502@mail.data
net.hu

122

8 ISTCHIN1999- EUROPE
10105

9 ISTEMSI
199911589

10 IST- M2DM
199910315

NEXT
IST K 1.1.
GENERATION - A I 2.COMMUNITY
991.2.
HEALTH
13
INFORMATION 1A
NETWORKS FOR
EUROPE
EMERGENCY
IST K 1.1.
MEDICAL
- A I 2.SERVICE
991.2.
INITIATIVE
13
1A

Multi-Acces
Services for
telematic

New generation
tele-medicine
services

New generation
tele-medicine
services

IST K 1.1. New generation


- A I 2.- tele-medicine
991.2. services

Bay Zoltan
MISKO PRO LAS TOTH
Foundation For LC- F. ZLO
Applied
TAPOL
Research
CA
DR. SAN VARI
Varimed
BUDAP
DOR
Variable
EST
Medicine
Hungar Matav
y
Hungarian
Telecommunic
Budapes
ations Co Ltd
t

(36(36tlaszlo@alpha.bzlogi
46)560113 46)369 .hu
438
(36(36varimed@mail.mata
1)1215636 1)2125 v.hu
and/or
636
vari@cshs.org

Prof AkosDetrekoi +36


+36
REKIKT@rektori.b
Hungar Technical
Budapes
essor
74632221 746322 me.hu
y
University Of
t
20
Budapest
University
Prof. Luka Zsolt
36/42/404- 42/408/ h8625luk@ella.hu
Medical
M.S csko
403
656
Nyiregy c.
School Of
Debrecen
haza Dr.U
niv.
Ph.D
Content Studio
MD Tibo Nemes +36 96
+36 96 imolnari@matavnet.
Gyr
Bt.
r
420-912 420- hu
912
Hungarian
DR GABGOBL +36
+36
GOBL@BP.MENT
National
OR
13506720 135003 OK.HU
BUDAP
Emergency
87
And
EST
Ambulance
Service
Hungar Applied Logic
Prof. Karl- Hepp ++49-89- ++49- ugl42cq@mail.lrzBudapes
y
Laboratory
Dr. Diter
9270-2111 89muenchen.de
t
9270-

123

11 ISTEPIN
200026325

12 IST"EROS"
200025302

Management of
Diabetes Mellitus
European Patient
Information
Network

13
1A
IST K IST Intelligent
- A I - environment for
00200 patients
301A
1.1.
2

2116
Budapes Dr. Jano GLANZ 36139455
Hungar Medincorp
Ltd.
t
s
95
y
Dr Miha MAKA 36138620
Melania
Budapes
(MD ly RA
84
Publishing Ltd.
t
)
Dr. PterINZELT 36146654
Computer And
35
Automation
Research
Budapes
Institute Of
t
The Hungarian
Academy Of
Science
Hungar Variable
Dr. Sand VARI 36148704
y
Medicine
or
30
Budapes
Limited
Liability
t
Company

Evaluation of the IST K IST Intelligent


Risk of Stroke by - A I - environment for
Telemedicine
00200 patients
301A
1.1.
2
Pr
13 ISTINTERCAR Integrated Services IST K IST Advanced
Hungar Semmelweis
Budapes
2000- DIO
for Interventional - A I - interactive
y
University
t
26337
Cardiology
00200 environment for
Budapest
30- doctors and nurses
Applied Logic Budapes Pr
1A
1.1.
Laboratory
t

361200 janos.glanz@ella.hu
9921
361365 melania@melania.hu
8055
361466 inzelt@sztaki.hu
7503

361487 varimed@matavnet.
0430 hu

Erno MAKO 36121003 361210 mako@radi.sote.hu


07
0307
Tam GERGE 36132690 361326 gergely@all.hu
as LY
56
9058

124

Pr Istva PREDA
Semmelweis
n
University
Budapest,
Faculty Of
Healt Sciences
Budapes
Departement
t
Of Cardiology
And Internal
Me Cardiology
And Internal
Me
Mr Gyul AGOST
Atlantic
Szekesfe
a
ON
Intertrade
hervar
Limited
Dr Sand VARI
Variable
or
Medicine
Budapes
Limited
t
Liability
Company
Dr Imre UNGI
University Of
Szeged,
Faculty Of
Szeged
Medicine,
Cardiology
Center
Bull Hungary Budapes Mr Gasp STARK
Limited
t
ar Jr.
Dr GezaNAGY
Medaninfo
Healt Care
Miskolc
Service
Limited
14 ISTEURONEP Development of a IST K IST Advanced
Hungar University Of
PRO JUD NAGY
2000- HRONET user-friendly data- - A I - interactive
y
Pecs, Second
F. IT
PECS
26398
base and
00200 environment for
Dept. Of
telemicroscopy
30- doctors and nurses
Internal
3

36135047 361350 preda@hiete.hu,


40
2011 duray@hiete.hu

36209520 362250 intercardio@atlantici


529
0609 t.com
36148704 361487 varimed@matavnet.
30
0430 hu

36625450 366254 ungi@in2nd.szote.u00


4563 szeged.hu

36143751
10
36309515
554

361437 gasparjr.stark@bull.
5151 hu
364636 medaninf@alpha.bzl
5411 ogi.hu

36723335 367233 nagyju@bel2.pote.h


33
3533 u

125

system for renal


biopsy on the
INTERNET : a
new tool for
diagnosis,
reporting and
epidemiology.

15 ISTMULTI
2000- PORT
25276

1A

1.1.
3

Medicine And
Nephrological
Center

Dr
Multiple Access to IST K IST Advanced
Hungar Variable
Medicine,
Transplant
- A I - interactive
y
BUDAP
Limited
Information Portals 00200 environment for
EST
Liability
30- doctors and nurses
Company
1A
1.1.
3
Medaninfo
Dr
Legal Health MISKO
Care Service
LC
Ltd
Dr
University Of
Debrecen And
DEBRE
Health Science
CEN
Center Faculty
Of Medicine

Sand VARI
or

36148704 36148704 varimed@matavnet


30
30
.hu

GezaNAGY 36309515 36463654 medaninf@alpha.b


554
11
zlogi.hu
Lsz ASZTA 36524188 36523160 Asztalos@jaguar.d
l LOS
55
98
ote.hu

126

Dr
University Of
Szeged,
Medical And
Health Science
Szeged
Center,
Department Of
Surgery,
Transplant
Division
Medical Center
Pr
Pcs
Pcs
University
Pr
Semmelweis
Budapes
University
t
Budapest
Bull Hungary Budapes Mr
Ltd.
t
Mt-Systems
Budapes Mr
Ltd.
t
16 ISTOPEN-EMS Concept of open IST K IST Advanced
Hungar Hungarian
DR.
2000application
- A I - interactive
y
National
26236
interface for the
00200 environment for
Emergency
BUDAP
EST
digital patient data 30- doctors and nurses
And
in emergency
1A
1.1.
Ambulance
medical services
3
Service
IST K IST Best Practice and Hungar National
Dr
17 IST- STEMNET Information
Technology for
- A I - Demonstration
y
Institute Of
2000Budapes
Stem Cell
00200 actions in Regional
Haematology
26117
t
Transplantation
30- Healthcare
And
1B
1.1. Networks
Immunology
4
Variable
Dr
Medicine,
Budapes
Limited
t
Liability
Company

Pl SZENO 36624206 36624206 sp@surg.szote.uHRADS 43/363022 43


szeged.hu
ZKY
920

rs HORV 36723240 36723240 ophorvath@iseb.po


Pter TH
83
83
te.hu
Fere PERNE 36126760 36131721 negi@mailtrans.sot
nc R
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66
e.hu
Gsp STARK
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Jozs LETEN
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GABGOEBL
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36143751
10
36143111
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36135067
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36143751 gasparjr.stark@bull
51
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36126021 letenyei@mtsystem
66
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36135003 gobl@bp.mentok.h
87
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Mikl BENCZ 36137243 36137243 m.benczur@ohvi.h


os UR
29
50
u

Sand VARI
or

36148704 36148704 varimed@matavnet


30
30
.hu

127

18 IST- BEPRO
200025252

19 ISTHNCTS
200025372

Enabling Best
Practices For
Oncology

IST K IST Best Practice and


Variable
- A I - Demonstration
Medicine
00200 actions in Regional
Limited
30- Healthcare
Liability
1B
1.1. Networks
Company
4
Best Practice
IST K IST Best Practice and Hungar Department Of
Action in Regional - A I - Demonstration
Cardiology,
y
Healthcare
University Of
00200 actions in Regional
Debrecen
Networks for
30- Healthcare
Cardiovascular
1B
1.1. Networks
International
4
Teleconsultation
Society For
Cardiac Care
Ltd.
Tomahawk
Research,
Development
And Service
Ltd.
Hungarian
National
Emergency
And
Ambulance
Service
Department Of
Family
Medicine,
University Of
Debrecen
Mona System
Ltd.

Dr

Sand VARI
or

36148704 36148704 varimed@matavnet


30
30
.hu

Budapes
t
Prof Istva Edes
Debrece essor n
n
Debrece
n

Budapes
t

36524149 36524149 edesi@jaguar.dote.


28
28
hu

Dr. Lsz Zsonda 36523113 36424650 monafax@elender.


l
54
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Istva Tothmat 36139417 36120093 tmihil@qwertynet.
n
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98
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AkosMoro

36146520 36123978 moro@bp.mentok.


26
48
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36523143 36523143 ilyes@gyermek.dot


88
88
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Nyiregy Dr. Lsz Zsonda 36424650 36424650 monafax@elender.


haza
l
00
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hu

128

Prof Jozs GYULA 00361395 00363959 gyulai@mfa.kfki.h


20 ISTMOBICHIP Mobile Continuous IST K IST Intelligent
Hungar Research
essor ef I
9253
284
u
2001High Blood
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32299
Pressure
01200 citizen centred
Technical
Budapes
Prevention
61- health management
Physics And
t
1A
1.1.
Materials
1
Science
Budapest
Prof. Zolta GAAL 36884226 36884238 rekti@almos.vein.h
University Of
n
17
66
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Veszprem,
Vespre
Department
m
Information
Systems
Meditech Ltd Budapes
Lasz MELEG 36128082 36128293 meleg@meditech.h
t
lo
32
88
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Personalised
IST K IST Intelligent
Hungar Bull Hungary
Andr Beke
(036(036andras.beke@bull.h
2001- WELTH
Service Packages - A I - environment for
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Ltd.
as
1)4375130 1)437515 u
33519
for the Wellness 01200 citizen centred
Budapes
1
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61- health management
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Hungar Stratis Sa
MR. Mikl JUHS 4373400 4373401 info@stratis.hu
22 IST- ASTHMA ASTHMA Public IST K IST Intelligent
Awareness
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2001- WEB
Enhancement and 01200 citizen centred
33296
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23 ISTEDevelopment and IST K IST Best practice and Hungar University
Prof. Judit Nagy 36723335 36723335 nagyju@bel2pote.h
2001- CONSOR- creation of a
- A I - trials in e-Health
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33
33
u
h
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teleconsultation in 61Dept. Of
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1B
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3
Nephrology
Center

129

24 ISTCOBALT
200132225

COBALT:
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Collecting and
- A I - trials in e-Health
Building Advanced 01200
Learning and
61Training material 1B
1.1.
for Evidence-Based
3
Medicine
25 ISTTELEBPCA TELEmonitoring/r IST K IST Best practice and
2001- RE
eminder system on - A I - trials in e-Health
32447
Blood Pressure
01200
61control as
1.1.
compared to usual 1B
office based CARE
3

26 ISTMY
2001- MED.CC
33431

my med.cc - my IST K IST Best practice and


medical care center - A I - trials in e-Health
01200
611A
1.1.
3

27 ISTARES
200132652

Aneurysm Rupture IST K IST Best practice and


Evaluation
- A I - trials in e-Health
Software
01200
611B
1.1.
3

dr
Hungar Info-Nux
y
Kereskedelmi
Es Szolgaltato
Budapes
Beteti Tarsasag
t

Jozs Szlamka 36140007 36140007 szlajozs@freemail.


ef
88
88
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Hungar Tensiomed
Dr. Mikl Illyes 36129601 36129526 tensiomed@tensio
y
Tudomanyos,
os
29
76
med.com
Informatikai Es
OrvosBudapes
Elektronikai
t
Korlatolt
Feleloessegue
Tarsasag
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36121002 36131302 dechat@bell.sote.h
1st Department
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50
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Of Medicine,
Faculty Of
Budapes
t
Medicine
Semmelweis
University
Hungar Stagel
Dr. Jeno Toeroec 36145656 36145656 tj@telemedia.hu
y
Technologiai
e
sik
66
57
s
Uezletfejleszt Budapes
si Inkubator
t
Korlatolt
Felelossgu
Tarsasag
Hungar Semmelweis
Prof Csab Dzsinich (36(36y
University
a
1)3553611 1)355388
Budapest
Budapes
5
t

130

Annex XI
Department Of Informatics, National Institute And Library For
Health Information, Hungary
The Medical Documentation Centre, established in 1949 by the Hungarian Academy of Sciences, was
founded with the purpose to provide the Hungarian medical community with the latest achievement of
foreign medical sciences. In 1957 the institute called the National Documentation Institute and
Library of Medicine functioned as a background institution of the Ministry of Health; since 1960 it
operated as a national medical and health reference library and as the centre of the Hungarian network
of medical libraries. Today the National Institute and Library for Health Information is sponsored by
the Ministry of Health and is the professional information centre of the healthcare field in Hungary. Its
function is to provide information and literature to healthcare institutes, the community at large, and
experts working in the healthcare profession.
Health communication
The Ministry of Health formulated its national health promotion strategy in 1999. An essential element
of this strategy was the decision to create a communication centre and network that covers the entire
country and ties together the whole of Hungarian health communication. Central to health
communication activities at MEDINFO will be the development of the structure and content of an
Internet-based network and the operation of a user-friendly system. This will be closely connected with
the preparation of publications that supplement Internet services and with the organisation of
professional conferences that allow personal exchange of information. An additional goal is to establish
co-operation with the health communication media market, both in the visual and the printed media.
Healthline
The services of MEDINFO - as a mediator of healthcare and health promotion information - is called
Healthline. Healthline is a comprehensive health information service provided to a wide spectrum of
users and is built upon 3 pillars:
Internet access
Professional publications

Professional forums, conferences


Some of the services already available on the Internet
European Union news
Health informatics newsletter
Health promotion information
Primary care information service
Online library catalogue
Hungarian Medical Bibliography
Community health information database
Career information for medical school graduates
Journal for nurses
Library information services
Computerised literature searches
Reference services
Interlibrary lending
Preparation of studies on the healthcare system of countries around the world
National documentation centre and deposit library of the European Regional Office of the World
Health Organisation
Co-operation with the UK Cochrane Centre
Marketing activities
MEDINFO engages also in marketing activities:
Translation and interpretation service

Publishing and editing activities


Market surveys
PR programs
Organisation of meetings and conferences
National Library of Health Sciences
The National Institute and Library for Health Information (MEDINFO) operates a special library
providing nationwide services to doctors, nurses, Ministry of Health staff, healthcare managers and
other health workers. The library also fulfils the information needs of professionals working in
educational and healthcare institutes, as well as users of community health information.
The library has a full range of collection of Hungarian publications on medical science and related
fields, social and family affairs, health promotion and health communication. Selected publications
from the foreign literature in the above fields are also available.
Proprietary databases
The Magyar Orvosi Bibliogrfia (Hungarian Medical Bibliography) provides complete coverage of the
Hungarian medial literature.
The Hungarian Medical Bibliography contains reference and bibliographical information of selected
journal articles in the Hungarian medial literature in the English language..
Community Health Information is a database of articles, health care services and news from the lay
media.
The Clinical Practice Guidelines bibliography is a database of diagnostic and therapeutic procedures
and recommendations.
We also have access to international literature databases: Medline, Embase, HealthStar, Justis, OECD
etc
.
Other services
Our library is a national documentation centre and deposit library of the European Regional Office of
the World Health Organisation. We collect and organise information on the healthcare systems and
social policies of the countries around the world. We maintain a central catalogue of foreign books,
annals, serial publications, congress publications and computerised databases available in all health and
medical libraries in Hungary.
Library use
The library is open without restriction to any Hungarian and foreign citizen over 16 and can be used in
person, on the telephone/fax or via e-mail. The reading room is available for using the international and
Hungarian pe riodicals and monographs on the premises. Journals, materials from the reference
collection and CD-ROM databases can be used only in the reading room. Photocopies of documents
can be obtained upon request.
Books and videotapes can be borrowed for a period of four weeks, 4 items taken at a time. It is
permitted to renew material once for another four weeks provided there is no claim for the publications
by other patrons. Renewals can be done in person, over the telephone or fax. Requests for interlibrary
loans are filled from the collection of our library and the associated libraries. We undertake the
borrowing of foreign books or articles from international journals through the British Library.
Informatics Department
The basic task of the Informatics Department is to fulfil Medinfo's information technology needs, to
strengthen the institute's informatic autonomy and competence, and to build appropriate partnership
with outside health care and IT institutes. These activities are performed in concert with the other
departments and divisions.
Other tasks

132

Implementation of the objectives of Health Communication Division as defined in the Division's


strategy Performance of OLIB webmaster tasks for the National Library of Health Sciences
Co-operation with the Publishing and Service Division in the electronic publication of Medinfo's
marketing tasks Performance of software and hardware monitoring for the Finances Department
Other activities covering the whole institute:
Publishing Medinfo products on the Internet and providing the technological background for the
edition of the web portal called Healthline
Maintenance of PCs, peripherals and application software
IT development, preparation of informatics procurement, supervision of its implementation
The objective of the Department is to initiate and maintain professional partnerships with
Sectoral and intersectoral partners: participation in laying the foundation for the health communication
of the institute
Partners in the private sector: laying the professional foundation for building partnership of the
institute, supervision of co-operation

133

Annex XII
Regional and International Integrated Telemedicine Network for
Organ Transplant, Hungary
Abstract:
A substantial proportion of future medical practice will depend greatly on improved collaboration
between the providers throughout the healthcare sector, and effective sharing of data and expertise
by different healthcare professionals. In organ transplant it is a rule, donor organs are matched to
recipients via national or multinational organ-sharing organizations. Only through close cooperation between transplant surgeons, immunologist, nephrologist, pathologist, radiologist and
other physicians could increase the efficiency of organ transplant. Information technology (IT)
became an inevitable and inherent part of transplantation medicine. RETRANSPLANT project
interfaces and integrates information technologies (IT) from the European Union Fourth
Framework projects to support the development of regional organ transplant information networks
in Central Europe.
The RETRANSPLANT project aims to facilitate the development of Telematics tools for dialysis and
organ transplant centers, organisations coordinating recipient-donor selection, and other health care
facilities for transplant services in the Central Eastern European Countries (CEEC). In Europe, as a
rule, donor organs are matched to recipients by national or multinational organ-sharing organizations.
EUROTRANSPLANT, for example, serves medical institutions in Germany, Austria, and the Benelux
states, HUNGARO-TRANSPLANT in Hungary, and SLOVENJA-TRANSPLANT in Slovenia. During
the project lifetime the RETRANSPLANT consortium will carry out the following outcome: First the
partners will implement an electronic patient database for transplant waiting list, donor-recipient
matching, organ allocation, and patient selection in the Czech Republic, Lithuania, Hungary, Slovak
Republic, Slovenia, and Poland. Recipient - the Donor Selection (RDS) network will help an optimal
use of available donor organs and tissues. It is obvious that such activity is useful for both parties i. e.
the EU and CEEC. Any potential donor in the CEEC countries might become matched for a EU patient
and vice versa. The DialysisCard and TransplantCard have to be seen as an identification card,
additional data storage and management tool for dialysis and transplant patient in Hungary and
Slovenia. The communication model allows for different types of workstations for the different
environments to communicate with these active memory Smart Cards. Implementation of an Electronic
Medical Record (EMR) system at the organ transplant centres in Hungary (Budapest, Szeged), and
Slovenia (Ljubljana) comprises all clinical records. The EMR contains standardised codes and
information about diagnoses (ICPC/ICD10), drugs, procedures, investigations, laboratory tests. etc. To
ensure standardised and identical information, it is recommended that these indexes are updated
centrally. This makes it easier to transfer information about the patients from one health care facility to
another.

134

Annex XIII
Health care on-line abstract from ePolska Action Plan, Poland
Assumptions
Modern medicine, which intensively exploits growing information resources, faces a necessity of using
processing and data transmission technologies. The technological progress has enabled distance
diagnostic examinations and consultations. The best known examples are the possibility of distance
heart examination (EKG, assessment of heart stimulators implanted). Already commonplace, the
endoscope operation technique, during which visual control of the course of an operation is possible
simply on a monitor screen, is a certain forerunner of that type of treatment virtual procedures.
Thus, an area called telemedicine* has emerged, which is a blessing especially for people who are not
self-dependant and who cannot leave their homes on their own.
As a result of the technological progress, some activities associated with the treatment process, hitherto
reserved for doctors and specialist laboratories, will be so automated and simplified that it will be
possible for patients to carry them out on their own, and a doctor will only be a teleconsultant
overseeing the course of treatment.
Another process which will raise a conscious participation of patients in treatment-related decisions
will be universal access to medical information. Thanks to the existence of data bases with medical
information in the Internet, the patient will be able at any time to obtain such information (e.g., the
location and speciality of a doctor, medical services on offer, surgery hours, etc.).
Therefore, the existing traditional paternalistic doctor patient relation, which has been predominant
until now, will be a more symmetric relation in the future.
The globalisation of medical tasks, and free and increasingly faster flow of information within
medicine itself, as well as owing to economic processes taking place outside medicine, will result in the
standardisation of treatment. It will have an impact both on the improvement of medical services
quality and the possibility of reducing health services costs.
An enormous progress in health care and treatment, with the simultaneous lengthening of human life
and ageing populations, inevitably leads to an increase in spending on health care.
Thus, there is double challenge: to improve the quality and accessibility of health care for citizens,
while constraining overall costs. These challenges will be impossible to meet without the deployment
and widespread use of fully integrated, interoperable and modernised health systems. The
dissemination of software supporting hospital and health care management in the macro scale,
facilitating data collection and analysis (results of examinations, diagnosis, etc) or supporting the work
of individual surgeries, would enhance effectiveness of health care.
The effectiveness of health care exploiting digital technology capabilities will be conditional, to a great
extent, upon co-ordination activities of the Health Care Information Systems Centre, established by the
Minister of Health in September 2000. In accordance with principal tasks provided for in its charter, the
Centres activities are focused on:
establishing standards in the area of health care information systems, which incorporate European
Union regulations and solutions,
preparing and expressing opinion on legal acts which govern the functioning of health care in the
process of its going digital,
monitoring material and human resources, as well as the degree of accessibility to medical services,
preparing projects relating to the development and enhancement of the medical services registration
system,

135

co-ordinating the operation of the RUM *(Medical Services Register),


informing, educating and putting out publications relating to the tasks performed.
Alongside the Health Care Information Systems Centre, a data base on medical establishments and
facilities was created. An essential change is a new, i.e., electronic form of the register of health care
establishments and the use of identification codes. The register of health care establishments, and in the
future ambulance fleets, individual medical practices and pharmacies, will become a universal source
of knowledge on the functioning of the sector and a starting point for any analyses and projections.
The combination of modern information and communication technologies with medicine will facilitate
contact of the patient with the doctor, and will be instrumental in fast interchange of information
between medical facilities and personnel, what will undoubtedly improve the quality of patients lives
and efficiency of health care services.

Objectives
To prepare the society to consciously use information on health care and health prevention based on
modern IT tools,
To develop consumer information (for patients) as regards health care using IT tools,
To use IT tools to promote healthy lifestyles and health education,
To reduce costs of specialist medical care and enhance the medical care level by implementing
telemedicine tools, in particular, outside large metropolitan areas,
To ensure protection of patients personal data in electronic systems of medical data storage and
exchange..

Planned actions
Determination of standards for information collection and interchange, as well as data analysis in
health care,
Creation of a uniform electronic data base on medical establishments and facilities, also incorporating
the scope of services provided by them, available via the Internet,
Creation of a data base on medical emergency services units, available via the Internet,
Preparation of data bases containing information on persons covered by health insurance,
Creation of a patient data base,
Introduction of an electronic patient card,
Development and implementation of an electronic system which supports reporting and
presentation of information on health care,
Establishment of the legal framework allowing payments for medical services to made over
telematics networks,
Development of a plan for the application of telemedicine in health care,
Implementation of a pilot programme for the application of telemedicine in supporting treatment
processes,
Launch of telediagnosis, teleconsultations, emergency teleservice, teleteaching, teleoperation,
Implementation of pilot programmes of health care personnel distance training,
Conduct of surveys on the impact of information and communication technologies on human psyche,

136

Creation of conditions allowing the development of Internet-addiction prevention schemes and the
establishment of therapeutic groups for addicts.

Specific tasks
No

Task

Term
of
implementati
on

Implementing / coSource of financing


ordinating agencies

Creation of a uniform electronic data base on CSIOZ


medical establishments and facilities, available via
(Health
Care MoH (Ministry
the Internet
Health) budget
Information
Systems Centre)

of

end of 2001

Creation of an electronic data base on doctors, Supreme Chamber MoH and Supreme
with the location, medical speciality, surgery of
Medical Chamber of Medical end of 2002
hours, available in each medical facility
Practitioners
Practitioners budgets
Creation of a data base on patients covered by
Agency appointed MoH and/or Sickness
health insurance
by
Fund (Kasa Chorych) end of 2003
MoH
budget
Development and implementation of an electronic
system which supports reporting and presentation
of information on health care
CSIOZ

source of financing after


under agreements
consultations

Determination and co-ordination of standards of


electronic data interchange in medicine
CSIOZ

CSIOZ budget

Establishment of the legal framework allowing


payments for medical services to made over MoH
telematics networks

MoH, voivods and


Sickness
Funds end of 2001
budgets

after
consultations

Preparation of a plan for the implementation of Agency appointed


after
telemedicine
by
source of financing
consultations
MoH
under agreements
Development and implementation of pilot distance
training programmes

CSIOZ

Drawing up of legal and technical assumptions for


the system of verification and authentication of
CSIOZ
information on medical products and services

CSIOZ budget

after
consultations

CSIOZ budget

After
consultations

137

Annex XIV
Informatization of hospitals in the Malopolskie province, Poland
The following are data describing IT in terms of hardware (in this case hospital's IT network), software
(related to medical and administrative activities) and degree of it's integration in the Malopolskie
province hospital. Malopolskie province is situated in the south-east of Poland with the capital city
Crakow.

Summary of the survey


Final report:
1. Comparison of the results gained from the survey
2. Recapitulation
3. Enclosure detailed comparison of the hospitals

Part I Comparison of the results of the survey


In the 2nd half of 2002, from the initiative of Departament Polityki Spoecznej Urzdu
Marszakowskiego Wojewdztwa Maopolskiego (Department of Social affairs of Malopolskie
province) the research has been carried out to establish the level of IT in the Malopolskie hospitals.
The collected data of the research are available in the Conclusion part of the report. The questionnaire
with 5 questions has been sent to 50 hospitals. 49 hospitals have sent their reply.
The following conclusions are with the level of reference (100%) to the 49 hospitals that accepted the
survey.

1. Types of IT personnel in hospitals

IT has been acknowledged as an important area for the function of the hospital in all surveyed units.
All the institutions have at their disposal IT personnel. In some they are employed as contractors in
others they are part of permanent staff. Hospitals also use the services of external IT companies.
The following table and diagram show the differences in the way the IT personnel is employed in the
hospitals.

Type of employment
IT contractor
IT employee
IT employee and external firm
External firm

Number of hospitals
5
23
15
6

138

External firm
12%
IT employee
and external
firm
31%

IT contractor
10%

IT employee
47%

2. Information network coverage in hospitals


Surveyed hospitals declare different level of coverage of their information network. The following
table and diagram show the different level of network coverage.
The worrying fact is that 4 hospitals stated complete lack of computer network. Also the statements
about partial network can raise concerns. In some cases particularly hospitals where only single
organizational units have network the quality of implemented solutions can turn out insufficient for
the connection to the overall hospital information network that has to emerge in the future.

Level of hospital network


Complete network
75% of network
50% of network
Single units
In the course of realization
Lack of network

Number of hospitals
9
11
16
7
2
4

Lack of network
8%
In the course of
realization
4%

Complete
network
18%

Single units
14%
75% of network
22%
50% of network
34%

3. Range and level of the software integration used in hospitals

139

The full informatization of the hospital means the hospitals are fully equipped with complete IT
network and have implemented the relevant software for the needs of medical staff and for
administrative purposes. Both of the parts must be integrated.
Certain level of hospital IT level has been demanded by institutions such as Zakad Ubezpiecze
Spoecznych (Social insurance office) program Platnik and Kasa Chorych (Health insurance
office) program Start .
The below surveyed hospitals are ordered depending on a level of their software integration. Small
number of hospitals (3) state the full integration of the software. 6 hospitals stated to be close to
integrate medical and administrative parts. The rest of hospitals (40 institutions) are still a long way
from integration. Lack of integration of the medical and admin parts can mean further requirements to
implement additional software enabling the communication between the modules. The remaining
hospitals didnt have at the time of the survey software enabling the use of integrated computerized
information system. Apart from this only 2 institutions stated work to be directed to the system
implementation.
The findings have shown that implementation of the medical software is regularly harder then of the
administration. The fundamental element is the level of cooperation and acceptation of the software by
medical staff.
Reimbursement of the medical services by payer (Health Insurance Company) based on medical
performances that is planned for the year 2004 has a consequence that there will be a need for
integrated information hospital system for effective payment management. By not complying with this
condition hospitals are risking big complications that are proportional to the size of the unit and the
range of provided services.
It is good to pay attention that among the number of hospitals (9 units) that are stating the ownership of
full computerized network there are 3 hospitals having full software integration a 6 hospitals near the
integration.

Software and level of integration


Full integration
Close integration of medical and administrative
software
Medical and administrative software is not
integrated
Administrative software and incomplete stage of
medical software
Administrative software. Medical software being
implemented
Administrative software
Incomplete medical and administrative software
Partially administrative software
Single programs
In the course of realization

Number of hospitals
3
6
19
3
1
5
7
3
1
1

140

Number of hospitals

Close integration of medical


and admin

2%
2%
6%

Full integration

Medical and admin softw . not


integrated
Admin softw are and incompl.
stage of medical softw .
Admin. softw . Medical softw .
being implemented
Administrative softw .

6%
12%

14%

Incomplete medical and admin


softw .
Partially admin softw .

10%
2%
40%

6%

Single programs
In the course of realization

4. Planned time of introducing full integration


Hospital management is conscious of the importance of IT execution. Such affirmation can be based on
the wish of completing informatization in a range of forthcoming 3 years. However it is necessary to
notice that the formal and organizational steps must be granted (bid procedure, installation of the rules
of cooperation with software company, transfer of database, process of customization and training of
users and introduction of every change in the software) causing the process of informatization to take
many months.
The change of the way of contracting medical services should present the powerful impulse enforcing
informatization. The question remains open on who is going to finance these ventures.
Planned time for informatization
3 years
5 years
Lack of data
Not concerned

Number of hospitals
30
13
3
3

Not concerned
6%
Lack of data
6%

5 years
27%

3 years
61%

5. Forecasted costs for full informatization

141

The questionnaire included opinion of the hospital management about the cost for the introduction of
full informatization. The received results can be seen in the form of table and graph below.
Approximate costs (PLN)*
Number of hospitals
100.000
11
300.000
11
500.000
10
1.000.000 or more
12
Lack of data
4
Not concerned
1
* In the time of writing the document 1 EUR = 4.6 PLN
The costs for the informatization of the hospital in the level of 100.000 PLN (22.000 EUR) or 300.000
PLN (65.000 EUR) needs to be recognized as low. Network set-up, hardware purchasing, license and
software purchasing and finally the overall implementation costs (process lasting many weeks and
sometimes many months requiring intensive training for the system users and administrators) are not
possible to be covered by the stated figures. It is good to note the fact that some compositions of the
above mentioned costs (for example license costs) are not directly proportional to the size of
infomatized institution.
Out of the stated figures we can consider the quotes beginning from 500.000 PLN (if we presume a big
involvement in the informatization) as realistic ones.

Not concerned
2%
Lack of data
8%

100
23%

1.000.000 or
more
25%
300
22%
500
20%

When we sum the quotes that by the opinion of the hospital managers - are needed to incur for the
informatization of the hospitals in Malopolska region we come to the figure of 21.4 million PLN
(4.600.000 EUR). If we take into consideration the above thoughts these quotes has to be recognized as
low.
Besides it is proper to note the fact that in spite of declared achievements by 9 hospitals that claim to
have the full network and by 3 hospitals claiming to have a full integration of software only 1 hospital
does not plan to incur costs for informatization.

Part II - recapitulation
Informatization of hospitals could be considered until recently as a luxury instrument, being use, first
of all, for the advanced scientific purposes. External conditions beginning from the requirement of
the institutions cooperating with hospitals to the expectation of the fast access to the data, implemented

142

with relatively low costs forced the traditional view to be changed. The way of contracting the
medical services through the National Fund of Public Health from the year 2004 causes that the
informatization of hospitals in a necessity. It is good to pay attention to the summary data on the
informatization of 49 hospitals in the Malopolska province described in the following steps:

The level of hospital informatization in Malopolska province is regarded as low. Only 3 hospitals
declare full medical and administrative software integration enabling description of the costs of a
single medical procedure.It should be positively evaluated that other 6 hospitals declare full
network ownership which means a precondition for the full informatization.
Hospital management is conscious of importance of the informatization of the institutions.
However the process of informatization requires not only employment of permanent IT staff but
also an external company. It results equally from the scale of the task, as well as professional
potential and experiences with implementation. The cooperation of 21 hospitals with external IT
companies can by considered as a positive information.
A big concern can be caused by serious insufficient expenses that are planned for acquiring of
informatization in individual hospitals. In the same way it is concerning that in 4 hospitals the
answer came without any data.
3-year time of introduction of informatization declared by the hospitals seems reliable only in case
that the implementation work has begun in year 2003. It is good to indicate the potential risk of
running out of the possibilities of efficient reliable and expert IT companies in case of 30 (!)
hospitals are going to place offer on the service market for the implementation work
simultaneously.
The key condition for the success of hospital informatization is effective implementation of
medical software, which is dependent on inducing the medical staff (mainly physicians) for the use
of it.

The scale of expenses for informatization of the hospitals in the scale of the province (based on the
surveyed data) is equal to approximately 1% of health care expenses in Malopolska province. If the
process of IT implementation is going to experience errors than there is an existing danger of big rise in
these costs and a considerable delay of the whole process.
It is suggested that the Marshal Office (Urzad Marszalkowski) get involved in the informatization
process through the organization of information conference. It should be addressed to the managers and
informatics employed in these institutions. In the situation when 3 hospitals in the Malopolska province
declare to have full information network the creation of the forum seems very valuable as it enables
exchange of experience related to this process. Suggested conference could serve exactly to this
purpose, making additional conditions for the integration of hospital IT personnel. Simultaneously in
the group of specialists it would be possible to decide on the following related questions connected to
informatization:

Should hospitals in the whole Malopolska province can/should use unified software?
Are there formal possibilities and will of the hospitals to carry out informatization as regional task?
Is it possible based on the collected experiences- to indicate optimal schedules/scenarios for
informatization and conditions in which it should be carried out?

Enclosure

Description of
software used in
the hospital
3

Forecasted costs
for the full
informatization
[z] PLN

Planned time for


introducing full
informatization

What is the
coverage of
hospital
information
network?

Institution

In what way is the


IT service sorted
in the hospital?

Comparison of the data

143

Centrum Rehabilitacji w
Zakopanem

Employed IT
contractor

Single
Medical and
organizationa administrative
l units
software is not
integrated
Orodek Profilaktyczno
External company Lack of
Medical and
Rehabilitacyjny dla Dzieci w
network
administrative
Nowym Targu
software is not
integrated
Dziecicy Szpital
External company Lack of
Medical and
Uzdrowiskowo
network
administrative
Rehabilitacyjny w Rabce
software is not
integrated
Zakad Dugoterminowej
External company Lack of
Medical and
Opieki Medycznej w
network
administrative
Makowie Podhalaskim
software is not
integrated
Krakowskie Centrum
Employed IT
Single
Administrative
Rehabilitacji
contractor
organizationa software
l units
Krakowski Szpital
Employed IT
Full network Administrative
Reumatologii i Rehabilitacji contractor
software
Krakowski Szpital
Informatics
75%
Close
Specjalistyczny im. Jana
Employee
integration of
Pawa II
medical and
administrative
software
Orodek Rehabilitacji
Informatics
75%
Administrative
Narzdu Ruchu w
Employee
software and
Krzeszowicach
incomplete
stage of
medical
software
SPZOZ im. J. niadeckiego Informatics
75%
Administrative
w Nowym Sczu
Employee
software
Szpital Ginekologiczno
No data
No data
No data
Pooniczy im. R.
Czerwiakowskiego
Szpital Specjalistyczny im. Informatics
Full network Medical and
J. Babiskiego
Employee
administrative
software is not
integrated
Szpital Specjalistyczny im. Informatics
Full network Full integration
J. Dietla
Employee
Okrgowy Szpital Kolejowy Employed IT
Lack of
Medical and
w Krakowie
contractor
network
administrative
software is not
integrated
Szpital im. w. ukasza w
Informatics
50%
Administrative
Tarnowie
Employee
software and
incomplete
stage of
medical
software
Szpital Rehabilitacyjny dla Employed IT
Full network Medical and
Dzieci Solidarno w
contractor
administrative
Radziszowie
software is not
integrated
Wojewdzki Szpital
Informatics
Full network Medical and
Okulistyczny
Employee
administrative

3 years

100 000

5 years

100 000

5 years

100 000

5 years

500 000

5 years

300 000

3 years

300 000

3 years

500 000

3 years

300 000

5 years

1 000 000

No data

No data

3 years

300 000

3 years

1 000 000

3 years

1 000 000

3 years

100 000

3 years

100 000

144

Wojewdzki Szpital Chorb


Puc i Grulicy w
Jaroszowcu
Wojewdzki Szpital
Dziecicy im. w. Ludwika

External
Company

Single units

Informatics
Employee

Single units

Wojewdzki Szpital
Specjalistyczny im. L.
Rydygiera

Informatics
Employee and
external company

75%

Wojewdzki Szpital
Psychiatryczny w
Andrychowie
SPZOZ Szpital Powiatowy
w Bochni
SPZOZ w Brzesku

Informatics
Employee

50%

Szpital Powiatowy w
Chrzanowie

Informatics
In the course
Employee and
of realization
external company
Informatics
50%
Employee and
external company
Informatics
75%
Employee

ZOZ w Dbrowie
Tarnowskiej
Szpital Specjalistyczny im.
H. Klimontowicza w
Gorlicach
Szpital Specjalistyczny im.
S. eromskiego
Szpital Miejski
Specjalistyczny im. G.
Narutowicza
Szpital Powiatowy w
Limanowej
Szpital w. Anny w
Miechowie
SPZOZ w Mylenicach

SPZOZ Szpital im. J. Dietla


w Krynicy
SPZOZ w Rabce

SPZOZ w Nowym Targu

Informatics
Employee
Informatics
Employee

Single units
Single units

software is not
integrated
Partially
administrative
software
Incomplete
administrative
and medical
software
Incomplete
administrative
and medical
software
Administrative
software
Administrative
software
Medical and
administrative
software is not
integrated
In the course of
realization

3 years

100 000

Lack of
data

300 000

3 years

1 000 000

5 years

500 000

5 years

1 000 000

5 years

1 000 000

Lack of
data

1 000 000

Administrative 3 years
software

300 000

Close
3 years
integration of
medical and
administrative
software
Informatics
Single units Partially
3 years
Employee and
preparation
administrative
external company for realization software
Informatics
75%
Full integration 3 years
Employee and
external company
Informatics
50%
Medical and
3 years
Employee
administrative
software is not
integrated
Informatics
50%
Medical and
3 years
Employee
administrative
software is not
integrated
Informatics
75%
Medical and
5 years
Employee
administrative
software is not
integrated
Informatics
Full network Single
3 years
Employee
programs
Informatics
Full network Medical and
3 years
Employee
administrative
software is not
integrated
Informatics
50%
Medical and
3 years
Employee and
administrative

500 000

1 000 000
1 000 000
No data

300 000

500 000

300 000
No data

500 000

145

external company

ZOZ w Olkuszu

software is not
integrated

Full network Close


integration of
medical and
administrative
software
Zesp Zakadw
Informatics
50%
Medical and
Zdrowotnych w Owicimiu Employee and
administrative
external company
software is not
integrated
SPZOZ w Proszowicach
Informatics
75%
Close
Employee and
integration of
external company
medical and
administrative
software
ZOZ w Suchej Beskidzkiej External company
50%
Close
integration of
medical and
administrative
software
ZOZ w Tuchowie
Informatics
50%
Medical and
Employee
administrative
software is not
integrated
Szpital Specjalistyczny im. Informatics
50%
Incomplete
E. Szczeklika w Tarnowie
Employee and
medical and
external company
administrative
software
SP Szpital Specjalistyczny
External company
75%
Medical and
Chorb Puc w Zakopanem
administrative
software is not
integrated
SPZOZ w Zakopanem
Informatics
50%
Incomplete
Employee and
medical and
external company
administrative
software
Zesp Zakadw Opieki
Informatics
50%
Incomplete
Zdrowotnej w Wadowicach Employee and
medical and
external company
administrative
software
V Wojskowy Szpital
Informatics
Single units Incomplete
Kliniczny z Poliklinik
Employee
medical and
administrative
software
Szpital Uniwersytecki w
Informatics
75%
Administrative
Krakowie
Employee and
software.
external company
Medical
software being
implemented
Uniwersytecki Szpital
Informatics
50%
Incomplete
Dziecicy
Employee
medical and
administrative
software
Szpital Kliniczny nr 2
Informatics
Full network Full integration
CMUJ w Zakopanem
Employee
Zakad Opieki Zdrowotnej

Informatics
Employee

Informatics

50%

Close

3 years

100 000

3 years

500 000

3 years

100 000

5 years

100 000

3 years

300 000

3 years

500 000

3 years

100 000

No data

No data

3 years

500 000

5 years

500 000

3 years

1 000 000

5 years

1 000 000

Not
concerne
d
3 years

Not
concerned
300 000

146

MSWiA

Employee and
external company

Instytut Chorb Puc im. J. i Informatics


I. Rudnikw
Employee

75%

20 Wojskowy Szpital
Uzdrowiskowy w Krynicy

Informatics
Employee and
external company

50%

Centrum Onkologii Instytut Informatics


im. M. Skodowskiej - Curie Employee and
external company

50%

integration of
medical and
administrative
software
Medical and
administrative
software is not
integrated
Medical and
administrative
software is not
integrated
Incomplete
medical and
administrative
software

5 years

300 000

No data

100 000

3 years

1 000 000

147

Annex XV
Telemedicine at University of Krakow hospital, Poland
The following article was written by Witold Poniklo from Academic Computer Centre CYFRONET of
the University of Science and Technology in Cracow.

I.

University Hospital in Krakow (www.su.krakow.pl)

The University Hospital (UH) in Krakow (Poland), has been interested in telemedicine for a long time.
Since the Hospital should be considered as a referral medical center for Southeast part of Poland,
telemedicine is as a natural way for providing medical consultations to local hospitals.
To the date, 3 major telemedicine projects have been implemented:

1. TV transmission (analog signal) of surgeries. After a cycle of trials, at the Surgical


Department UH a surgery consulted by specialist from Vienna has been performed. The
Surgical Department of UH is equipped in a close circuit television system, which allows for
such transmission as well as for internal monitoring of ORs activities. This is mainly
educational project, which is (technically) equal to a videoconference (via ISDN or IP). The
UH owns all the equipment necessary to perform such transmissions.

2. Transmission of dynamic pictures of coronarography examinations.


Department of Cardiology at the UH cooperates with hospitals in Kielce (1 hospital) and
Tarnw (2 hospitals) in the field of invasive cardiology. Coronarography examinations which
are performed at the above mentioned hospitals could be consulted 24 hours a day by a
specialist from UH. The system utilizes:

hardware (servers, routers, firewalls) own by UH. Each project participant has got
installed a dedicated set of hardware.
telecommunication network. Connections to Kielce and Tarnw are done by: a
fiberoptic cable, radio-bridge connection, regular telecommunication cables, local
Internet provider and (back-up) regular telephone lines (ISDN). Considering the
transmission speed critical in the case of dynamic pictures the necessary network
capacity must be at least 512kB/s, with recommended value equal to 1MB/s.
Transmission costs are carried by local hospitals.
software. The network utilizes AcomWeb software made by Siemens. AcomWeb
utilizes DICOM3 radiological pictures transmission standard. A consultant from
Krakow has access to the medical data gathered in the server at one of the local
hospitals. These data are transmitted to Krakow, but not copied - staying at the place
of their origin (generation). AcomWeb allows a consultant for all the data processing
which could be done on the local operators console (zooming, geometrical
measuring, viewing speed changes etc.). The software is owned by Siemens Medical
Solutions Poland. Data (pictures) gathered during examination could be transmitted
to the consultation network on line (hospital in Tarnow has installed an additional
module to its angiography unit) or with an insignificant delay (data from the
angiography unit are recorded on a CD, which is next manually moved to the system
server Kielce).

The project should be considered as an activity in the final stage of medical/technical trials. In
fact, currently, there are monthly about 100 consultations (about 30 per local hospital).
Based on the telemedicine system success, UH plans its further development. There are
negotiations in this subject with hospitals in Rzeszow, Nowy Targ and Przemysl.

148

Additionally, The Cardiosurgical Hospital in Krakow which has been trying implementation
of its own telemedicine system is negotiating implementation of UH telemedicine model.
The telemedicine system operation requires also implementation of logistic solutions chain
the consultant must be informed (by SMS) that consultation data await him/her at the server.
After consultation, certified e-mail message is send to the local hospital. All the logistic
activities are a part of the telemedicine system network and all of them are stored at the server
memory.

3. Emergency ECG data transmission.


Department of Cardiology UH has got installed a telemedicine system which allows for ECG
curve consultation. 6 ambulances (which are dedicated for cardiological cases) in Krakow are
equipped with defibrillator with diagnostic ECG (12 leads) module. An ambulance physician,
could consult cardiac diagnosis with a specialist at UH. Defibrillator contains of a dedicated
module (hardware) and software with are designed for ECG curve transmission by a GSM
mobile phone (HSCSD). A single ECG curve is transmitted from an ambulance to UH in less
than 1 minute. Transmission is activated by a single button. The data (message) are received at
the Cardiology Department at UH and audio signal informs about it a consultant. The ECG
curve is displayed on the consultants computer screen. Consultation is held by a mobile
phone. Main purposes of the system are as follows:
to provide a diagnostic support a physician at an ambulance;
to decide about the way of emergency treatment (selection of anticoagulants);
to prepare the angiography room staff for an intervention before patients admission.
Currently, Krakows area is covered by the system. It is planned to extend it to the Krakows region
(voivodship).

Additionally, UH IT staff has performed a pilot study of telemedicine system for CT and MRI pictures
consultations (connections to: Sucha Beskidzka, Jaslo). This project is especially important for
emergency neurological patients, who may have an examination at one of local hospital (transportation
is avoided). Neurosurgical Department at UH is capable to consult all the necessary cases. UH IT staff
works also on implementation of CT, MRI pictures transmission inside the UH (the Hospital is located
in scattered buildings).

II. Other telemedicine centers


Despite vast interest of physicians in telemedicine, there is practically not successful implementations
of such a system in Poland. It is worth to notice the following project/institutions:
The Cardiosurgical Hospital in Krakow (Szpital Specjalistyczny im. Jana Pawla II w Krakowie) was
trying to develop its own telemedicine system. As it is mentioned above, it is very likely that they will
adapt UH telemedicine system (interventional cardiology, cardiosurgery).
Krakows Telemedicine Center (Krakowskie Centrum Telemedyczne). This is a research institution.
They were trying to implement their own software for medical images transmissions. Currently due
to my knowledge they are focused on a telemedicine theory.
Hospital in Przasnysz sends to Warsaw, to a commercial medical institution Centrum Medyczne
ENEL-MED the following pictures: CT, MRI, ultrasound
(http://www.mp.pl/kurier/show.php?aid=15236) for consultations.

149

Annex XVI
Telemedicine in Poland
1. Is there any formally written Action plan for eHealth in Poland?
If yes, who are the people involved from the side of government?
What are the areas/projects supported?
What is the timeframe?
How much financial resources are dedicated to eHealth in these plans?
There is no formal Action Plan for e-Health available in Poland. The only document which addresses ehealth area on national scale is ePoland. Its chapter Health online is devoted to the area of Internet
applications in healthcare. However, its more like the list of expectations without realistic plan of
development.
Poland started radical changes in economy in the beginning of 1990s. Even though the changes in
economy were quickly implemented, consecutive governments were afraid of changes in the healthcare
system. The reforms in healthcare lagged off behind the main changes in economy in Poland. The first
reform of health systems undertaken by post-solidarity government team resulted in establishment of
Health Insurance Funds assigned territorially to main administrative units. . The system was not perfect
but after first three years, the healthcare providers adjusted to the new requirements and situation in
healthcare seemed to be stabilised. With new governmental team based on political coalition
representing opposite political option, the concept of the National Health Fund was developed to
substitute Health Insurance Funds. The new reform was introduced in the hurry and it became clear in
the beginning of the 2004, that National Health Fund is not able to assure smooth access to healthcare
services for Polish population. The prospects for the improvement of the status of Polish hospitals and
other medical institutions remain also vague.
Unsuccessful reform of healthcare system and general shortage of the resources for medical services
add to poor financial situation of healthcare institutions in Poland. This in turn, translates into relatively
insignificant interest in investments in telemedicine and related technologies. Furthermore, the main
problem is still the poor access to sophisticated medical equipment. Healthcare providers seem do not
see opportunities in the telemedicine and related applications as the salaries of medical professional
remain low and the expenditures for the computer equipment and telecommunication fares prevail
considerably above the expenses for workforce.
Additional factors shaping unfavourable environment for e-heath development are:
- low penetration of the Internet (the estimations from 2001-2002 say that only 10% of households
have got the access to the Internet)
- the political scene is changing radically with every new governmental team; so quickly that no
coherent e-health action plan is expected
- the essential problems with financing the traditional medical services results in relatively small
interest in widespread use of new technologies.
In summary, even if consecutive governmental teams declare high interests in Information Society
development in Poland, only few actions are made to support it. The community of medical
professionals are generally positive about the use of information technologies in practice. The same
trends may be observed among the patients, but only few of them have got access to Internet. The
position of the National Health Fund about e-Health has not been defined yet.
Conclusions:
1. The action plan focused on e-Health is needed urgently in Poland to indicate priority areas for
development.
2. The awareness of the opportunities related to e-health should be developed in National Health Fund
environment and related organizations.
3. The pilot implementations should be spread in the cooperation with medical professional
organizations and local authorities.

150

4. The best practices should be disseminated in target groups (politicians, local authorities, health
professionals) on great scale. The education on e-health and medical informatics should be carried out
systematically on various levels of education.

2. What are the most significant barriers to successful implementation of telemedicine in Poland?
Barriers:
- poor financial standing of the healthcare providers institutions, e.g. hospitals
- unsuccessful reforms of healthcare system
- high costs of IT infrastructure development in relation to the payment for medical personnel
- lack of formal regulations of telecare and telemedicine services
- undefined reimbursement issues for telemedical services not official policy expressed so far neither
by Health Insurance Funds previously nor National Health Fund currently

3. What are the telemedicine technologies used by hospitals/doctors today and what they are
likely to adopt in next 3 years?
Telecommunication infrastructure
ISDN connections are available on nearly whole area of Poland. The service is offered mainly by
Telekomunikacja Polska S.A., but also by other telecommunication providers aspiring for the market
like Netia S.A. or Dialog S.A.
The access to broadband fiberoptic connections is generally possible in main metropolitan areas due to
the infrastructure developed by academic computer centre. Relatively good broadband connections is
available in university hospital and some hospitals in greater cities.
Peripheral hospitals, outside main voivodship centre must rely mainly on the ISDN connection, if they
are going to develop telemedical communications. Most healthcare providers, both individual and
institutional maintain some forms of access to Internet, generally through POTS with modem or fixed
connections (ISDN, SDI, cable TV networks or radiolinks).
The rates for band use are generally perceived as limiting for standard use, also in relation to
telemedical interactions.
Medical community and Internet
Medical professionals, mainly physician, use the Internet access for browsing general content portals
and portal targeting specifically this group of users. The communication between physician relies
mainly on the traditional papers correspondence.
The process of shaping the information infrastructure in healthcare providers in Poland was
accompanied by the growing competition in the market of health-related portals. The dotcom rush that
occurred in the USA and other markets influenced also considerably the trend for e-health initiatives in
Poland. The pressure in the market resulted in the development of new Internet portals addressed to
health professionals or to patients and citizens. Most of these initiatives relied on the provision of the
content and business model based on attracting commercial partners interested in the advertisements
targeted on the specific users. The competition between portals focused on health professionals as the
main users appeared to be really intensive. Finally, after the dotcom bubble evaporated, only several
Internet portal for physician survived in Poland.
The main portal focused on health professionals include following websites: www.mediclub.pl,
www.esculap.pl, www.mp.pl, www.clinika.pl , www.lekarze.com.
Consumer e-health
The access of general population to Internet is remains limited. The estimations indicate that only 1015% of household have got the access to Internet. The number of users accessing Internet randomly
(several times a month) is greater, but usually these are not regular episodes.

151

There is quite developed offer of Internet portals focused on delivery of health-related contents to
general population. Their main revenue is based on the web-based advertisements. There are also some
type of educational course offered.
The portals addressed to patients are maintained by patients associations, non-profit organizations or
industrial organizations, e.g. pharmaceutical companies interested in the promotion of specific
products. One should remember that direct medication advertisement addressed to patients and all
citizens is not allowed in Poland. So, pharmaceutical companies must avoid direct naming of the
medications supplied by them to the market. Keeping the patients aware of available therapeutic
options is one of possible solutions. Another of course, is developing advertising policies aimed on
health professionals, mainly physician. Portal addressed to the patients could be classified into two
groups: portals offering health-related contents, rarely services, aimed on health-related topics in
general and websites focused on specific problems, e.g. addressed to patients with diabetes, arterial
hypertension or sclerosis multiplex. Some of the websites offers additional benefits some forms of
teleconsultations or telemonitoring of patients health status.
Websites focused on specific disorders deliver current information, educational contents, some type online advice and calculators for patients with one disease, e.g. arterial hypertension, diabetes
(www.cukrzyca.pl, www.nadcisnienie.pl). Some medical centres and specialised Internet-based
enterprises offer the on-line booking service of medical services (www.przychodnia.pl).
The examples of general health-related portal addressed to all citizens encompass websites:
- general health-related portal: www.mediweb.pl, zdrowie.medicentrum.pl, www.dbajozdrowie.pl
- pharmaceutical-medical portal for patients www.pfm.pl
- family health www.poradnikmedyczny.pl
- information about healthcare providers according to location and speciality www.medycy.com.pl
4. What is the current status with EHR? Do you believe its likely to be adopted by health sector
in next 3 years?
The market of EHR software for individual healthcare providers and medical practices was developing
according to clients needs. There are many potential products offered by great IT companies and
numerous SMEs. The electronic communication between software used in physicians officies and
hospitals does not exist.
The World Bank Project conducted from early 90ies by Polish Ministry of Health through its
specialised Agency for Foreign Projects resulted in the purchases of Admission-Discharge-Transfer
and Pharmacy modules to most of hospitals with at least 200 beds. The bid for the delivery of the
information system was divided into 2 phases. In the first phase, every hospital participating in the
Project was supposed to look into general proposals of solutions prepared by 6 consortia. The first
phase resulted in choice of the 3 providers offering the best products from the view of the hospital.
Then classic bid for proposal between 3 providers was conducted and the best proposal was chosen.
The providers offering their products are enlisted below:.
Consortium
Software package
AMIS, APEXIM
MISS
ALMA, ComArch
Eskulap
Computerland Zdrowie (SQLab, ComputerLand, InfoMedica
PIK)
Optimus
OPTIMed
RADCOMP
Hipokrates

The further development of information infrastructure, with specific aim of building comprehensive
electronic healthcare record system was to be undertaken by every hospital. However, progress of this
process is seriously hampered by the shortage of funds occurring in most Polish hospitals (see barriers
discussed in point 2).

152

5. What is the expenditure for information technologies in Polish hospitals in general today?
It is really difficult to estimate. The poor financial status of hospitals results on modest investment in
information technologies. Most hospitals use information systems for running administrations and
financial departments.
The World Bank Project enabled the purchases of ADT and Pharmacy modules for hospitals with
above 200 beds in Poland. Some hospitals follow the track and try develop other parts of the Hospital
Information Systems, however the financial difficulties hamper the development of comprehensive
Electronic Patient Record.

6. Would you please quickly mention the most important eHealth initiatives/pilots in Poland and
the appropriate contact points or background documents/websites.
B. TELEZDROWIE. Telemedical diagnostic and rehabilitation systems.
The project maintained by:
Prof. Andrzej Czyewski, Sound & Vision Engineering Department of the Technical University of
Gdansk, Gdansk, Poland, http://sound.eti.pg.gda.pl/STAFF/acz.html
Prof. Henryk Skaryski, Insitute of Physiology and Pathology of Hearing, Warsaw, Poland
http://www.ifps.org.pl
Portal established in years 1999-2001 enabling access to diagnostic and rehabilitation tools for the area
of impairments of human senses. The tools and solutions available on this website enable for quick online examination of the vision, hearing as well as screening for tinnitus and speech disorders. The tool
I can hear is based on automatic questionnaire analysis, audiometric tone test procedure and testing
speech intelligibility in noise. The tool I can see was prepared for the screening tests of vision. Two
other tools enable also on-line screeining for tinnitus and speech problems. Portal is available under the
address: www.telezdrowie.pl.
Krakow Centre of Telemedicine (established as Centre of Excellence)
Coordinator: Prof. Krzysztof Zieliski, Academic Computer Centre CYFRONET , UMM Science and
Technology University, Krakow, Poland
The Krakow Centre of Telemedicine was initially formed within the SCITECH II project. The Centre
was established in the results of the agreement between several partners representing medical and
technical university environments in Krakow. The main objectives of the centre include the
development and implementation of the teleconsultation scenarios conducted with diversified
information infrastructure, the application of wireless solution for access to medical databases and
telemonitoring of the patients as well as building the medical digital video library supporting teleeducation and training of health professionals in invasive procedures.
Contact details:
Prof. Krzysztof Zieliski, Institute of Computer Science, UMM Science and Technology University,
Al.Mickiewicza 30, 30-059 Krakow, Poland
off.ph.: +48 12 6173966, fax: +48 12 6339406, e-mail: kz@ics.agh.edu.pl
Mariusz Duplaga, MD, PhD, Department of Medicine, Jagiellonian University Medical College,
Skawinska Str. 8, 31-066 Krakow, Poland
off.ph.: +48 12 4305339, fax: +48 12 4305115, e-mail: mmduplag@cyf-kr.edu.pl,
Project: Improvement of Care Delivery for Severe Asthma Patients
Coordinator: Prof. Andrzej Szczeklik, Department of Medicine, Jagiellonian University Medical
College, Krakow, Poland
Project co-financed by Polish Ministry of Health and Polish Ministry of Scientific Research and
Information Technology, carried out in years 2001-2003. It resulted in the establishment of the webbased system focused on the concept of sharing of asthma-related medical information of severe
asthma patients among health professional as well as the support for patients empowerment and

153

telemonitoring. The system is available on the page www.astma.med.pl for registered users only
including health professionals and patients.
The initiative is based on the activities performed in 6 referential centres delivering care to population
of asthma patients. Authorized health professionals taking care of their patients may access the
electronic patient documentation online and browse the results of self-observations and selfmeasurements performed by patients on regular basis. Diversified access interfaces were offered to
users, particularly patients involved in self-monitoring activities, like Internet browser, mobile phones
with WAP protocol or SMS.
The activities of the project were extended due to support from Ministry of Health for next years.
Contact details:
Mariusz Duplaga, Department of Medicine, Jagiellonian University Medical College, Skawinska Str. 8,
31-066 Krakow, Poland
off.ph.: +48 12 4305339, fax: +48 12 4305115, e-mail: mmduplag@cyf-kr.edu.pl,
National Register of Healthcare Providers.
Centre for Information Systems in Healthcare, Ministry of Health, Warsaw, Poland
http://www.csioz.gov.pl/
Centre for Information Systems in Healthcare prepared the register of healthcare providers including
information about address, medical infrastructure, organisational structure, scope of specialities and
health professionals employment in medical facilities. The register was designed as the tool improving
the availability of healthcare information for administration supervision. It includes the solutions
enhancing the monitoring of changes occurring in structure of healthcare organizations and institutions.
Database of healthcare providers quicken also the process of proposal verification to National Health
Fund during contracting healthcare services.
Contact details:
Centre for Information Systems in Healthcare
Al. Jerozolimskie 155, 02-326 Warszawa, Poland
ph.: . +48 22 8242727, fax: +48 22 824-27-37, e-mail: biuro@csioz.gov.pl

154

References

Central Statistical Office. Concise Statistical Yearbook of Poland. 2001


[http://www.stat.gov.pl]

Central Statistical Office. Demographic yearbook 2000. Warsaw 2000.

eEurope+. A co-operative effort to implement the Information Society in Europe. June 2001
[http://www.kbn.gov.pl/cele/ppt.html/01.ppt]

ePolska Plan dziaa na rzecz rozwoju spoeczestwa informacyjnego w Polsce na lata


2001-2006. (Action plan for development of information society in Poland in years 2001-2006).
[http://www.kbn.gov.pl/cele/ppt.html/02.ppt]

European Communities and World Health Organization. Highlights on Health in Poland.


Copenhagen, December 2001 [http://www.euro.who.int/countryinformation]

European Survey of Information Society. Extension to Central and Eastern European


Countries and Mediterranean Area. 2000 [http://www.ispo.cec.be/esis/]

Filipiak J., Goliski J., Zacher L.W. Aims and directions of the information society
development in Poland. State Committee for Scientific Research and Ministry of Posts and
Telecommunication, November 28th, 2000 [http://www.kbn.gov.pl/en/cele_en.html]

Government Population Council. Demographic Status of Poland. Sytuacja demograficzna


Polski raport 1999-2000. Warsaw 2000

IDG Poland.: ComputerWorld. The Annual Report 2002. June 2003

Ministry of Health. National Health Programme 1996-2005. Intersectoral Task-Force for the
National Health Programme Coordination. Ministry of Health. Warsaw 2000

Polish Ministry of Economy ePolska (ePoland) The Action Plan for the Information Society
Development in Poland for the years 2001-2006.

Rychlewski J., Wglarz J., Starzak S., Stroiski M., Nakonieczny M., Lesynga B., Noga M.,
Niezgdka M., Ssiedzki P, enkiewicz J.: PIONIER: Polski Internet Optyczny Zaawansowane
Aplikacje, Usugi i Technologie dla Spoeczestwa Informacyjnego. (PIONIER: Polish Optical
Internet Advanced Applications, Services and Technologies for Information Society). September
2000 [http://www.kbn.gov.pl/analizy/ pionier/new/index.html]

WHO Regional Office for Europe (European Observatory on Health Care Systems). Health
care systems in transition. Poland. Copenhagen 1999.
WHO Regional Office For Europe. Health for all Database. January 2001
[http://www.euro.who.int./hfadb]

155

Annex XVII
Research and Development Units, Poland
Instytut Fizjologii i Patologii Suchu
ul. Pstrowskiego 1
01-943 Warszawa
tel. (022) 835-66-70
fax (022) 835-52-14
sekretariat@ifps.org.pl
Internet page: www.ifps.org.pl
Instytut Grulicy i Chorb Puc
ul. Pocka 26
01-138 Warszawa
tel. (022) 691-21-28
fax (022) 691-24-53
instytut@igichp.edu.pl
Internet page: www.igichp.edu.pl
The person responsible for teleconsultations and telepathology is prof. dr hab. med. Janina
Sodkowska, tel. 43 12 256 faks 43 12 452 e-mail: j.slodkowska@igichp.edu.pl

Instytut Hematologii i Transfuzjologii


ul. Chocimska 5
00-957 Warszawa
tel. (022) 849-85-07
fax (022) 748-89-70
hematol@cdit-aids.med.pl
Instytut Kardiologii
im. Prymasa Tysiclecia Stefana Kardynaa Wyszyskiego
ul. Alpejska 42
04-628 Warszawa
tel. (022) 815-25-24
fax (022)815-25-24
zreliga@aorta.ikard.pl
Internet page: www.ikard.waw.pl
Instytut Lekw
patrz: Narodowy Instytut Zdrowia Publicznego
Instytut Matki i Dziecka
ul. Kasprzaka 17a
01-211 Warszawa
tel. (022) 632-68-58
fax (022) 632-68-58
sekretariat@imid.med.pl
Internet page: www.imid.med.pl
Instytut Medycyny Morskiej i Tropikalnej
ul. Powstania Styczniowego 9b
81-519 Gdynia
tel. (058) 622-33-54
fax (058) 622-33-54

156

poczta@immt.gdynia.pl
Internet page: www.immt.gdynia.pl

Instytut Medycyny Wsi im. Witolda Chodki


ul. Jaczewskiego 2
20-950 Lublin
tel. (081) 747-80-27
fax (081) 747-86-46
imw@galen.imw.lublin.pl
Internet page: www.imw.lublin.pl
Instytut Medycyny Pracy im. prof. dr Jerzego Nofera
ul. w. Teresy 8
90-950 d
tel. (042) 631-45-02
fax (042) 656-83-31
impx@imp.lodz.pl
Internet page: www.imp.lodz.pl
Instytut Medycyny Pracy i Zdrowia rodowiskowego
ul. Kocielna 13
41-200 Sosnowiec
tel. (032) 266-06-40
fax (032) 266-11-24
j-sokal@imp.sosnowiec.pl
Internet page: www.imp.sosnowiec.pl
Centrum Onkologii - Instytut im. Marii Skodowskiej-Curie
ul. W.K.Roentgena 5
02-781 Warszawa
tel. (022) 644-02-00
fax (022) 644-02-08
mpn@coi.waw.pl
Internet page: www.coi.waw.pl
Instytut Psychiatrii i Neurologii
ul. Sobieskiego 1/9
02-957 Warszawa
tel. (022) 842-68-02
fax (022) 642-53-75
dyrektor@pin.edu.pl
Internet page: www.ipin.edu.pl
Instytut Reumatologiczny
ul. Spartaska 1
02-637 Warszawa
tel. (022) 844-95-22
fax (022) 844-95-22
instytutreumatologiczny@wp.pl
Instytut ywnoci i ywienia im. prof. dr med. Aleksandra Szczyga
ul.Powsiska 61/63
02-903 Warszawa
tel. (022) 842-21-71
fax (022) 842-11-03
l.szponar@izz.waw.pl
strona gwna: www.izz.waw.pl
Pastwowy Zakad Higieny IN-B

157

ul. Chocimska 24
00-791 Warszawa
tel. (022) 849-76-12
fax (022) 849-74-84
k.ludwicki@pzh.gov.pl
Internet page: www.izz.waw.pl
Pomnik-Centrum Zdrowia Dziecka
Al. Dzieci Polskich 20
04-736 Warszawa
tel. (022) 815-40-40
fax (022) 815-40-15
dyr.@czd.waw.pl
Internet page: www.czd.waw.pl

Centrum Zdrowia Matki Polki


ul. Rzgowska 281/289
93-338 d
tel. (042) 645-11-14
fax (042)646-66-53
iczmp@iczmp.edu.pl
Internet page: www.iczmp.edu.pl
Centralny Orodek Techniki Medycznej
ul. Boduena 4
00-950 Warszawa
tel. (022) 827-82-51
fax (022) 827-87-91
poczta@cotm.pl
Internet page: www.cotm.pl
Centralne Laboratorium Surowic i Szczepionek
patrz: Narodowy Instytut Zdrowia Publicznego
Narodowy Instytut Zdrowia Publicznego
powsta 1 padziernika 2002 r. z poczenia:
Instytutu Lekw oraz Centralnego Laboratorium Surowic i Szczepionek
ul. Chemska 30/34
00-725 Warszawa
tel. (022) 851-43-69; (022) 841-29-40
fax (022) 841-06-52
sekretariat@il.waw.pl
Internet page: www.nizp.edu.pl

158

Annex XVIII
Tele-ekg - CARDIAC MONITORING SYSTEM, Poland
The system is developed by PRO-PLUS company. The main goal is to develop system enabling distant
ECG monitoring of patients by specialist doctors. The companys website can be found at
http://www.pro-plus.pl. The following text shows examples of the systems. The complete list of the
product can be found at the companys website.

1. ECG SIGNALS TRANSMITTING METHOD


The System provides two methods of transmitting ECG signals: acoustical and
digital.
The acoustical method consists in creating by the TELE-ECG device a ranging
acoustical sound in a telephone band, which is frequencially modulated by an analogical
ECG signal coming from electrodes attached to a patients body. This method is very
easy to apply and requires only a regular telephone. This kind of transmission is also
applicable with use of some cell phones.
Digital method consists in changing an analog ECG signal coming from electrodes
on a patients body into a digital signal and furthermore in sending it with use of
modem. It can be a modem adjusted to work in PSTN public telephony, ISDN or an
internal GSM cell phone modem.
a) TELE-ECG PS devices with acoustical transmission
These are analog single-channel devices, which enable sending ECG signals live as
an acoustical signal.
Size: 105x55x30mm
Weight: 130g
PS1 device.

Twinned electrode
Single offtake
Powered with 9V battery
Used battery signaling
Option of making I, II, III Einthoven limbal offtakes - and V1Rcal-V6Rcal (relating to the right
arm)

Destined for patients with heartbeat disturbance.


System user (patient, nurse at patient's house,...) attaches two electrodes to a patient's body (on wrists
or a chest), connects them to the TELE-ECG device and calls the doctor. The doctor from the Health

159

Service Centre talks to the user, asks him to turn on the device and bring it closer to the telephone
microphone.

It is possible to send an ECG signal through a cell phone.


The doctor can inform patient to change the placement of electrodes, to get more data from other
offtakes. During transmission you can always see only one offtake.
At the end of transmission the whole examination with all offtakes is being recorded in the computer
database. All the data contained in records of all patients are allowed to be processed.
b) TELE-ECG EHO devices with digital transmission
These are digital multi-channel devices, which enable sending ECG signals live, or after registering
them in an internal buffer memory. The examination results can be sent through a stationary analog
network (modem), stationary digital ISDN network, mobile digital GSM network (cell phone), and in
an acoustical form through a regular telephone microphone.
The device software contains information for patient identification, phone number of
Diagnostic Centre, codes of the registered ECG offtakes and the event registration date and hour.
These devices can be used as EventHolter devices.
In such case the device records successively patients heartbeat and fills the memory
of the device, which works in a loop. The lenghth of the buffer memory is programmed
by the doctor according to the patients individual needs. The recording is initiated by
the patient in every moment by pushing the record button. Each recorded event contains
ECG signals of heartbeat before extortion, and a heartbeat record after extortion of registering.
Total recording time amounts 17 minutes.
Total registering time can be programmed and divided into many parts (a dozen or so). The recording
can be made anytime, f.e. within 24 hours every hour, or on each patients request.
In any moment the patient can attach his cell phone to device and send recorded events by pushing
SEND button.
If during the transmission theres an electrodal cable attached to the device, the transsmission is being
sent live.
Size: 110x70x30mm
Weight: 160g
EHO6 device

Three electrodes
Two or six offtakes
RECORD button
SEND button
Powered with 2x1,5V battery

160

Used battery signalling


Option to make two heart Wilson offtakes from among V1-V6, or six I, II, III, aVR, aVL, aVF
limbal offtakes.

After transmission the ECG picture on the doctors computer screen is shown as on illustration. Six
synchronical limbal offtakes (or two heart offtakes).
c) TELE-ECG PP-05 device with digital transmission

Ten electrodes
Twelve offtakes
Graphical display
High resolution
Powered with internal batteries
Used battery signalling
Option to make twelve offtakes: I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6.

Destined mainly for the Cardiological Diagnostics Centre in order to archive the first record of
patients full electro-cardiogram, which is being saved in the SYSTEM.

After transmission the ECG picture on the doctors computer screen is shown as on illustration. Twelve
synchronical offtakes: Six limbal and six heart offtakes.

161

2. CardioScp SOFTWARE
a) Software for Medical center
The software installation can be performed by any PC user.
Computer requirements:
PC with WINDOWS9x operation system
Clock speed - minimum 160MHz
HDD-20GB; FDD-1,44
RAM-64MB
Internal modem
PS mouse
Two free RS232 COM ports
Monitor 17
Ink printer
On the Installation Disc theres a Manual and video presentation of the basic system working in a
Medical Clinic, where the TELE-ECG system users are the patients of this and other clinics, which
finish work at certain hours.
CardioScp software enables:
Receiving ECG examinations transmitted acoustically and digitally with an option of direct
telephone contact between SYSTEM user and doctor.
Automatical method of receiving ECG examination records no service required.
ECG records archiving in database.
Keeping the patients records containing illness history and treatment methods.
Comparing the received ECG pictures with records in database.
Printing electro-cardiograms with use of any printer and paper.
In network version - cooperation between many receiving stations.
CardioScp software installed f.e. on the personal doctor s computer (Local Diagnostic Centre)
enables almost immediately initiation of cardiological monitoring with use of TELE-ECG PS devices
with acoustic transmission.
As the number of patients and assortment demand grows, f.e. for EHO (event-holter) devices, no
computer modifications are necessary. In case when the number of patients embraced with service will
grow considerably (over 2-3 thousands), it is advisable to connect the second computer (receiving
station) or to connect to a Local Centres database via Internet. In last case the online connection is
necessary.
In the Local Centre, beside the server database software, theres the same CardioScp software at use.
b) CardioScp_e-mail software for patients using Internet
For the Internet users (patients, working places, schools, etc.) theres a
CardioScp_e-mail software created.
It allows receiving transmission directly with use of transmitting cable from any
TELE-ECG PS or EHO device to the users computer and next sending the record via e-mail to the
Centre.
After the Centre estimation the description is sent back via e-mail to the user.
The gathered ECG records in the users computer can be printed as in the Diagnostic
Centre.
c) Software main utilizing features
CardioCsp software offers many functions, which make diagnosis much easier for the doctor. They
are (among the other things): an option magnify on the ECG fragments, scaling characteristic
fragments, filtering network disturbances, printing in various formats etc.

162

Annex XIX
Telemedicine in Slovenia MESS report
Questions:
1. Is there any formaly written Action plan for eHealth in Slovenia?
If yes, who are the people involved from the side of government?
What are the areas/projects supported?
What is the timeframe?
How much financial resources are dedicated to eHealth in these
plans?
6. Would you please quickly mention the most important eHealth
initiatives/pilots in Slovenia and
the appropriate contact points or background documents/websites..

MESS
Ministry of Education, Science and Sport
Trg OF 13, SI-1000 Ljubljana, Slovenia
Phone: +386 1 478 46 00, fax: +386 1 478 47 19
The Ministry of Education, Science and Sport in Slovenia is responsible for the preparation of
legislation, policy, funding of science activities on the basis of calls published in Slovenian
Official Gazette and monitoring of the implementation of research activities. The calls for
instruments, 5-years research programmes, Basic and Applied research projects,
Targeted research programmes, Young researchers programme, Research
infrastructure, International co-operation, are published in Slovenian Official Gazette
where the details and forms for proposals are explained. Together with Slovenian participants
could apply also partners from abroad but for the implementation of projects they should used
their own budget. Foreign experts are also invited in the evaluation procedure of proposals.
The Republic of Slovenia allocates 1,51 % of GDP for science and technology. In Year 2002
the budget of MESS amount was 129 Mio. EUR.
In Slovenia no special programme for eHealth exists at the moment but the research
programmes and projects are spread between two scientific fields: Engineering Sciences and
Medical Sciences. The other fields are Natural Sciences, Biotechnical/Agricultural Sciences,
Social Sciences and Humanities.
5-years research programmes: 3 (some of their activities) of 334 programmes in the field
Engineering (2) and Medical Sciences (1).
Head of the
research
group
Dr. Nada
Lavra

Budget in
The field of
Research Institution Title
2002 (EUR) Science
Jozef Stefan
Intelligent data analysis, computer logic
Engineering
Institute
and linguistics
154.753 Sciences

Dr. Janez
Stare

University of
Biometrical, scientometrical and
Ljubljana, Faculty of scientific computer data treatment and
Medicine
information in medicine

Medical
97.494 Sciences

Dr. Ivan
Bratko

University of
Ljubljana, Faculty of
Computer and
Artificial intelligence

Engineering
60.232 Sciences

163

Information Science

Total

312.479

Research Programmes in Total


Natural Sciences
Engineering Sciences
Medical Sciences
Biotechnical/Agricultural Sciences
Social Sciences
Humanities
Total

Budget in 2002 (EUR)


13.767.922
14.075.475
1.995.371
3.735.804
3.589.269
5.289.664
42.453.505

Basic research projects

Project
leaders

Budget in
The field of
2002 (EUR) Science

Research Institution Title

University of
dr. Alenka Ljubljana, Faculty of
Maek
Numerino modeliranje elektroporacije
Electrical
Lebar
Engineering
tkiva za elektrokemoterapijo

Engineering
15.932 Sciences

University of
Ljubljana, Faculty of
dr. David Electrical
Ekspertni sistem za napovedovanje
Cukjati
asa celjenja kroninih ran
Engineering
dr. Ciril
University Medical Umetna inteligenca v stopenjski
Groelj
Centre Ljubljana
diagnostiki
Total

Engineering
15.932 Sciences
Medical
15.957 Sciences
47.821

Basic Reseach Projects in Total


Natural Sciences
Engineering Sciences
Medical Sciences
Biotechnical/Agricultural Sciences
Social Sciences
Humanities
Total

Budget in 2002 (EUR)


1.385.575
1.479.058
2.672.605
250.437
769.645
2.386.001
8.943.320

Applied research projects


Project
leaders
dr. Ciril
Groelj

Research Institution Title


Ljubljana Medical
Centre
Assurance of quality in diagnostics

Budget in
The field of
2002 (EUR) Science
Medical
10.045 Sciences

dr. Igor
Bartenjev
dr. Marija
Molan

Ljubljana Medical
Centre
Ljubljana Medical
Centre

TELEDERM-Contemporarily
diagnostics of tumours and selected
dermatosis
Medical profession model for advising
children with some medical troubles

Medical
17.870 Sciences
Medical
13.112 Sciences

dr.
Valentin
Fidler

Ljubljana Medical
Centre

Development of picture capture with


gamma camera and nuclearmedicalradiology graphic station

Medical
25.198 Sciences

164

dr. Brigita
Drnovsek Ljubljana Medical
Olup
Centre
Total

Action of laserradiation on eye tissue in


pericular area

Applied Reseach Projects in total


Natural Sciences
Engineering Sciences
Medical Sciences
Biotechnical/Agricultural Sciences
Social Sciences
Humanities
Total

Medical
23.243 Sciences
89.468

Budget in 2002 (EUR)


359.080
2.402.853
1.107.785
720.296
437.197
517.830
5.545.040

2. What are the most significant barriers to successfull


implementation of
telemedicine in Slovenia?
In Slovenia significant barriers to successful implementation of telemedicine do not exist at
the moment.
3. What are the telemedicine technologies used by hospitals/doctors
today
and what they are likely to adopt in next 3 years?
At the moment official plan on eHealth development does not exist but the National Research
Programme (NRP) is in the preparation phase. NRP will include also eHealth research topics.
The Ministry of Health is also preparing the white book about eHealth.
4. I've read something about EHR (Elektronski zdravstevni zapis) and
PROREC.SI in Slovenia.
What is the current status with EHR? Do you believe it's likely to be
adopted by health sector in next 3 years?
The first stage of the project on Health Insurance Card (HIC)is finished. All Slovenian
residence have this card for at least one year. HIC includes basic information on the health of
the particular person. Some improvements and additional functions are also planned and are
in the prepartion phase. Some explanations of the HIC are available on:
Projekt.KZZ@ZZZS.SI
5. What is the expenditure for information technologies in Slovene
hospitals
in general today?
Total MESS
Total MESS budget for ebudget in EUR Health in EUR
Ljubljana Medical Centre
363.623
75.512
University of Ljubljana, Faculty of Medicine
113.228
148.930
Blood transfusion centre of Slovenia
36.720
36.720
Institute of rehabilitation
10.865
10.865
524.436
272.027

Research Infrastructure
Natural Sciences

Total MESS
budget in EUR
732.911

165

Engineering Sciences
Medical Sciences
Biotechnical/Agricultural Sciences
Social Sciences
Humanities
Total

232.569
524.436
371.682
176.227
83.131
2.120.955

The total budget of Slovenian hospitals on information technologies is not available only the
MESS budget on information technologies needed for the implementation of the research
work.

166

Annex XX
Telemedicine in Slovenia
Introduction
Historical review and major milestones in the progress of IST development and implementation in
Slovenia from 1993-2003
A major step in the development of Medical Informatics in Slovenia was made at the beginning of
1993, when the Institute of Health Insurance of the Republic of Slovenia bought 2750 IBM personal
computers and distributed them to public health institutions, as well as to the first private ones. In
addition to hardware, health care institutions received a computer program for accounting and
invoicing the health care services (reimbursement), free of charge. During the following months, over
5000 users were trained to work with computers, mainly administrative staff and nurses.
Among the projects that followed, the following are worth to mention:

Health Insurance Registry

National Health Insurance Card (http://www.zzzs.si/kzz/ang/hic_indx.htm)

Electronic Data Interchange (EDI) Project

The Elements of Uniformity in Hospital and Outpatient Health Care Statistics at the national level

Institute for Health Protection Project

HANSA EAST - EU-HANSA

TELENURSE

PRIMACOM

RETRANSPLANT

PROPRACTITION

WIDENET

Health Sector Management Project (HSMP)

List of selected research projects (national and EU) with a brief indication of the overall goals.
Name of the PI, Title, ID No:

Dates of Project
(Entire Period of
Support)
12/2000 12/2003

Smiljana V. Slavec,

WIDENET,
Promotion of the adoption and extended use of standardized Electronic Health Care Records and
the required infrastructure,
IST-1999-14203
Bostjan Bercic,
RETRANSPLANT (Regional and International Integrated Telemedicine Network for
Medical Assistance in End Stage Diseases and Organ Transplant),
5FP HC4028 IN4028

10/1998
03/2001

167

Bostjan Bercic

PROPRACTITION, Co-operative medical education toolkit


Leonardo da Vinci programme,
Contract # HU/99/1/083138/PI/III.3.a/CONT, Id No: 83138
Bostjan Bercic,
HANSA East - Healthcare Advanced Networked Systems Architecture for the Countries of
Central and Eastern Europe and New Independent States (CEN TC 251 ENV 12967-1
Healthcare Information Systems Architecture - HISA Standard),
HC1019, INCO COPERNICUS Project No. 96-0096
Bostjan Bercic,
PRIMACOM- PRIMAry Care physicians COMunication Network,
(Regional Health Care Network for exchange of routine messages between healthcare
professionals),
4FP CoCo-INCO COPERNICUS, HC1008, PL961090
Smiljana V. Slavec,
Health Insurance (Chip) Card Project,
Introduction and deployment of Health Insurance (Chip) Card in Slovenia.
National project
Smiljana V. Slavec
TELENURSE- Information System For Treating The Patient At His Home
International (EU) Project
Smiljana V. Slavec
EXPERT SYSTEM for THERAPEUTIC ACTIVITIES IN HEALTH CARE
National project
Smiljana V. Slavec,
Electronic Data Interchange (EDI) Project,
Introduction and implementation of Electronic Data Interchange (EDI) between healthcare
providers and IHIS in Slovenia. Messages: INVOIC, MEDREP, MEDREQ, MEDDIS.
National project
Smiljana V. Slavec,
Perinatal Information System, (Modernization of in-patient statistics),
National project

07/1999
07/2001

04/1997
10/1999

04/1997
10/1999

10/1995
06/2000

1997 - 1999
1997 - 1999
12/1995
12/1999

1997 - 2003

Review of the National and EU RTD activities and implementations


Assignment Name:
Health Insurance Registry
Start Date (Month/Year):
Completion Date (Month/Year):
10/1993
7/1996
Narrative Description of Project:
The National Health Insurance System was re-established in Slovenia in 1992. The previous System based on
Independent Regional Health financing Organizations. With re-establishment of National Health Insurance the
newly established Health Insurance Institute of Slovenia was faced with decentralized Insured Persons
Registries and applications on various platforms.
In order to reorganize and integrate databases well defined business model was provided by the Health
Insurance Institute Management. Main project goals were:
Health Insurance Institute of Slovenia Information and data model development,
Centralize ten regional databases/applications into integrated Health Insurance Information System,
Develop a secure, stable and state-of-the-art Client/Server application, Central Database Server and
Private Wide Area Network Establishment,
Develop and Maintain Internal Information Standards

168

Assignment Name:
National Health Insurance Card
Start Date (Month/Year):
9/1995

Completion Date (Month/Year):


10/2000

Narrative Description of Project:


The Project was started in order to achieve:
to improve the quality of services and treatment of insured person, within HIIS and by health care service
providers;
to simplify and improve communications between HIIS, the physicians and health care institutions;
to reduce the volume of (unnecessary) procedures involved in implementing the insured person's rights;
to improve security of personal data within information systems;
to reduce administrative chores and thereby, to increase efficiency of operation of HIIS and of the health care
service;
with reasonable financial investment, to secure long-term economic benefits at the national economy level.
The health insurance card is the only document applicable in the implementation of the compulsory and
voluntary health insurance rights in Slovenia. This electronic document on a smart card was issued to all
persons dully covered by the compulsory health insurance in Slovenia, i.e. to the entire population of close to
2 million.
A person is to present the card when visiting at the doctor's and at all other occasions of implementing the
rights deriving from health insurance.
The health insurance validity is updated by the card holder, through 275 self-service terminals nationwide.
The updating of insurance validity also updates card data from the central databases. The card is a means of
easy and direct transfer of data between the insured persons, Health Insurance Institute of Slovenia and the
health care organizations. Data electronically recorded in the card are accessible for reading only to authorized
health professional card holders. Procedures associated with the card are fast and ensure high service quality
and data security. The card system is aligned with the Slovenian health care and health insurance sector
conditions and regulations and it duly observes international recommendations and standards.
A detailed project description can be found at http://www.zzzs.si/kzz/ang/hic_indx.htm

Assignment Name:

Electronic Data Interchange (EDI) Project


Start Date (Month/Year):
12/93

Completion Date (Month/Year):


12/99

Narrative Description of Project:


Introduction and implementation of Electronic Data Interchange (EDI) between healthcare providers and
Health Insurance Institute of Slovenia in Slovenia. Messages: INVOIC, MEDREP, MEDREQ, MEDDIS.
On Infonets initiative and together with Health Insurance Institute of Slovenia we started a joint project in
1993, in which we involved ourselves already in the very phase of requirements definition. Additionally, we
initiated a pilot project with the Railway Health Center Ljubljana. Successfully executed pilot projects
accelerated the introduction of Electronic Data Interchange (EDI) among our business partners (e.g.
healthcare providers) and Health Insurance Institute of Slovenia.
Presently, EDI for reimbursement purposes is being 100% used in all public healthcare institutions, as well as
in two thirds of private ones.

169

Assignment Name:

The Elements of Uniformity in Hospital and Outpatient


Health Care Statistics at the national level
Start Date (Month/Year):
10/99

Completion Date (Month/Year):


07/2001

Narrative Description of Project:


The preparation of the uniform definitions for the basic conceptions that are used in the
accounting/reimbursement system for obligatory and for additional voluntary health insurance, as well as in
healthcare statistics.

Assignment Name:

Institute for Health Protection Project


Start Date (Month/Year):
10/95

Completion Date (Month/Year):


06/00

Narrative Description of Project:


- Health statistics
- Data Collection, Aggregation and Analysis of Sick-leave
- Perinatal Information System
Health statistics
We co-operated in work groups for optimum network performance, data collection, processing and transfer in
inpatient and outpatient statistics.
Data Collection, Aggregation and Analysis of Sick-leave
We have developed the software used by regional and republic Institute for Health Protection for collection,
aggregation and analysis of data of sick-leave.
Perinatal Information System
On the basis of requirements, connected with modernization of in-patient statistics, we developed the software
application PerIS, which is used in Slovenian hospitals as information support to Perinatal information
system. The software is developed on Windows platform and is one of the most contemporary application
programs in the Slovenian health care.

Assignment Name:

HANSA EAST - EU-HANSA (Project Nr. HC1019)


Start Date (Month/Year):
01/98

Completion Date (Month/Year):


06/99

Narrative Description of Project:


The HANSA projects aimed to promote the new technology and its standardized approaches through
demonstrations and dissemination activities. This project demonstrated that employment of a middleware
based open architecture yields reduction of working effort needed for interworking of existing systems
capable to share ands exchange data. Meanwhile this architecture has already been adopted as a European
standard, i.e. CEN TC 251 ENV 12967-1 Healthcare Information Systems Architecture (HISA Standard)
The overall objectives of HANSA EAST project were to transfer the distributed software technologies for

170

open health, healthcare, hospital, and insurance systems and adopted European standards to the CEE/NIS
countries: to the Health IT Authorities, and to Health IT providers for business development in order to create
a local software industry for the health sector. HANSA EAST consisted of three different countries,
complemented by a Concerted Action directed at the other countries, i.e. Albania, Bulgaria, Czech Republic,
Estonia, Latvia, Lithuania, Slovak Republic and Slovenia.
Through a series of RTD-projects, initiated from 1987 onwards and co-funded and supported by the CEU
DGIII ESPRIT the basic distributed software technologies were available for open healthcare and hospital
information systems based on European standards (i.e. HISA). EU-HANSA (Project Nr. HC1019)
demonstrated and promoted these in 20 hospitals in 9 EU Member States.
HANSA EAST applied, and evolved from results obtained through previous RTD (in HANSA WEST) and
industrial activities:
Architectural specification for open, modular healthcare and hospital information systems, offering
interoperability of their constituent parts, stability of evolvement to future completion, and flexibility to
replace or add modules in accordance with needs;
Middleware of common services, i.e. the Distributed Health Environment (DHE), conformant to the HISA
standard CEN/TC251 ENV 12967-1, already developed and demonstrated in the life scenarios in 10 EUMember States, as a suitable platform for the integration of existing systems as well as for the implementation
of new solutions;
Methodological and technical experience gained by the organisations that particiapted in HANSA WEST.
Description of Services
Training in the DHE middleware,
Installation of DHE middleware and migration of existing legacy systems to an open,modular architecture,
including training of local technical staff and technical support;
Study with regard to the feasibility of the transfer of technology.
Demonstrations to health IT authorities, health IT users and health IT suppliers, representing the CCE/NIS,
and explanation of the benefits of the new technology.
Health IT Strategy: identification, verification and publication of strategies to improve healthcare and to
support healthcare reforms in CCE/NIS by the application of distributed software technologies for open HIS.
Dissemination of Information: transfer of technology, promotion, documentation and dissemination of
information about the application of distributed software technologies for open HISs in CCE/NIS.
Market Creation, Implementation and Exploitation: collaborative action with and technical support to health
IT authorities (for policy and setting the standards)
and to health IT users (for practical
implementation) in order to create growth markets of health IT in CCE/NIS;
Identification of CCE/NIS health IT industries that are interested to invest, to adopt distributed software
technologies for open HISs, and to collaborate and to transfer to these industries the new technology and
support them with regard to business development to ensure successful exploitation;
Creation of business opportunities in CCE/NIS to Western health IT industries and consultancies.
Establishment of an international West-East network of excellence, including follow-up.

Assignment Name:

INCO-COPERNICUS PRIMACOM (PRIMAry Care


physicians COMunication Network) - PL961090
Start Date (Month/Year):
Completion Date (Month/Year):
04/97
10/99
Narrative Description of Project:
In a public-private partnership, two regions in Hungary and Slovenia have established Regional Health Care
Network for exchange of routine messages between healthcare professionals. Discharge letters are now daily

171

exchanged between Hospitals and General Practitioner. PRIMACOM have used European standards,
developed by CEN TC 251, for exchange of medical data and experience by implementing Regional Health
Care Networks from Denmark and Italy. PRIMACOM has paved the way for establishing Regional and
National Health Care Networks in Slovenia and Hungary. PRIMACOM has supplied health care professionals
with systems and infrastructure for enhancement of communication between primary and secondary
healthcare.
In Slovenia the role was to provide and implement the IT for the pilot regions, i.e. Hospital Information
System , Primary Healthcare IS, integration with EDIFACT converter and mailer, as well as the establishment
of a national Mail-box Server, connections to the virtual private healthcare network, and education and
training of the end-users (i.e. doctors and nurses).
Project PRIMACOM has provided standard for the discharge letter and demonstrated the use of best practice.

Assignment Name:
RETRANSPLANT (REgional and International Integrated
Telemedicine Network for Medical Assistance in End Stage Diseases
and Organ TRANSPLANT Project) - HC4028 IN4028
Start Date (Month/Year):
Completion Date (Month/Year):
10/98
03/01
Narrative Description of Project:
The RETRANSPLANT project aimed to develop and install Telematics tools to bridge the various and
geographically dispersed institutions playing a role in the complex process of organ collection from a donor
and transplantation into one or several recipients. The generic model used was kidney transplantation and the
information and communication technologies developed so far networked dialysis centers, organ transplant
surgery clinics, tissue typing laboratories, organizations coordinating recipient to donor selection, and other
health care facilities for organ transplant services in the Central and Eastern European Countries.
RETRANSPLANT implemented a regional network to link different national organ transplant systems, to
give on-line access to European transplant coordinators, donor centers, diagnostic specialists, to increase
Europe-wide the effectiveness of organ transplant services.
In the project we aimed to facilitate and realize introduction of information technology in the national (virtual
private) network. We are sharing internationally developed IT tools, and provide support to establish networks
in European countries and regions, as well as educate the end users for the use of information technology. Use
of IT in everyday healthcare resulted in significant improvements in the care process and outcomes. We build
the transplantation system on existing conventional clinical informatics systems by providing clinicians with
network and multimedia health record-based decision support in Transplantology.
We were involved in the following Work Packages (WP) and their corresponding deliverables:
WP1 Technology Implementation
Objectives:
To implement a generally applicable system for the communication between heterogeneous relational
database systems. Flexibility, safety, security, confidentiality performance and cost effectiveness are key
issues of its design.
Deliverables:
TI 1
Implementation of Local Area Networks in CEEC.
Tool
TI 2
Electronic medical record (EMR) at the tissue typing and
Dialysis centers.
TI 3
Implementation of the Multimedia Systems (PC/ISDN)
in Ljubljana.
TI 4
MEDANINFO Critical Care System in Ljubljana.
TI 5
Implementation of Multimedia Imaging Systems.

Specification, Report
Tool, Report
Tool, Report
Specification, Report

WP2 - Active Memory Card


Objectives:

172

To register the patients on dialysis converted to an electronic patient database on chip card. Dialysis and
Transplant Card enables an open architecture, which means it can easily be integrated into existing
information systems and networking environments.
Deliverables:
AMC Implementation of Dialysis and Transplant Card in
Budapest and Ljubljana

Tool, Report

WP3 Electronic Medical record


Objectives:
To implement a program where all clinical records can be registered. The program must contain standardized
codes and information about diagnoses (ICPC/ICD10), drugs, procedures, investigations, laboratory tests etc.
To ensure standardized and identical information, it is recommended that these indexes updated centrally.
This makes it easier to transfer information about the patients from one health care facility to another.
Deliverables:
EMR1 Implementation and adaptation of the Electronic
Medical Record (EMR) in Ljubljana
EMR2 Validation of EMR in and Ljubljana.

Tool, Specification
Report

WP4 Recipient Donor Selection


Objectives:
The electronic patient database (transplant waiting list, donor-recipient matching, organ allocation, patient
selection) will help an optimal use of available donor organs and tissues in Czech, Slovak Republic, Hungary,
Slovenia, Poland, Lithuania.
Deliverables:
RDS4 On line Access to HLA laboratories in CEEC
RDS5 ICD support.

Tool
Specification, Report

WP5 Multimedia Medical System


Objectives:
The ISDN/PC-integrated Multimedia Medical System (MMS) provides integrated network of complementary
services, i.e. Teleradiology, Telepathology, Telematics for anaesthesia, for organ transplant at Budapest and
Szeged in Hungary and at Ljubljana in Slovenia.
Deliverables:
MMS Integration of Electronic Medical Systems including
Active memory card, electronic patient record,
Multimedia patient record in Budapest, Szeged and Ljubljana.

Tool, specification
Report

WP6 Regional Transplant Network


Objectives:
Fifteen medical units of the Central and Eastern European Countries participate in the project. The quality of
the integration with existing devices (PC, Images, EMG, ECG) and basic functions of the RTPN System will
be evaluated for quality assurance.
Deliverables:
RTPN1 Integration of MMS, including Telepathology, Teleradiology
Among Budapest, Szeged and Ljubljana
Tools, Report
RTPN2 Interconnect Recipient - Donor Selection system and the
Transplant Centers In CEEC
Tools, Report
RTPN3 Validation of MMS among Budapest, Szeged and Ljubljana,
Including EMR, Telepathology, Teleradiology
Report
WP7 International Transplant Network
Objectives:
Interconnect and integrate the national networks and link to an existing international service result in to an
International Transplant Network (ITPN).

173

Deliverables:
ITPN1 - Interconnect the national RTPN and validate
the International Transplant Network.
ITPN2 Demonstration to the authorities and the public.

Prototype, Report
Specification, Report

WP8 Integration of Transplant Networks on the European Level


Objectives:
The integration of networks: tissue typing and patient selection and matching laboratories, national transplant
organisations, transplant clinics and the connected institutes will be achieved in the framework of the
ACTION cluster of projects
WP9 Transplant Information Portal
Objectives:
The infrastructure for the deployment of TPweb (servers, routers, physical network, etc.) has been prepared.
An English version of the TPweb would be implemented in Slovenia. Infonet provided the necessary technical
support

Assignment Name:
Health Sector Management Project (HSMP)
Start Date (Month/Year):
11/2000

Completion Date (Month/Year):


Ongoing

Narrative Description of Project:


The Health Sector Management Project (HSMP) has as its the primary objective to secure the long term
stability of the (health) system and to found its managing on provable and verifiable data focused on the
patient.
The Project is formally an initiative of the Slovenia Ministry of Health and is funded by the Ministry. The
Ministry has entered into a loan agreement with the World Bank for access to capital funds to complete the
Project. The Project loan agreement became effective in November 2000 and the Project Office was formally
established in April 2001.
Major stakeholders working closely in concert with the Ministry include the Health Insurance Institute of
Slovenia, the Public Health Institute, the Medical Chamber of Slovenia, the University Medical Center
Ljubljana and the General Hospitals of Maribor and Jesenice. Additional stakeholders include professional
organizations in the health sector, primary care centers and other hospitals.
The Project has four primary components:
C1: Health Policy Support
C2: Health Information Systems Standards Formulation
C3: Testing and Implementing Solutions in Pilot Organizations and Establishing a National Health
Information Clearing House
C4: Project Management
Description of some Services:
New Health Financing Development and Introduction
Health Informatics Institute Scope and Functionality Definitions
Validation of the common HISA model according to the national requirements
To define Standard Interface for data exchange for NHICH network
Organization and implementation of training and hands-on
Documenting the modeling in Common Concept Library

174

Barriers to successful implementation of telemedicine


Although no significant barriers to successful implementation of telemedicine exist at the moment in
Slovenia, there are perhaps some obstacles that are slightly holding back its development. Some of
them might be:
-

Not enough awareness of its benefits from the user (e.g. doctors) side

Still not enough support from the Government side?

Organisational issues: who is responsible for what; the lack of good project management
(institutions)

Telemedicine technologies used by hospitals/doctors


Applied research projects
Project
leaders
dr. Ciril
Groelj

Research Institution Title


Ljubljana Medical
Centre
Assurance of quality in diagnostics

dr. Igor
Bartenjev
dr. Marija
Molan

Ljubljana Medical
Centre
Ljubljana Medical
Centre

TELEDERM-Contemporarily diagnostics
of tumours and selected dermatosis
Medical profession model for advising
children with some medical troubles

dr.
Valentin
Fidler

Ljubljana Medical
Centre

Development of picture capture with


gamma camera and nuclearmedicalradiology graphic station

25.198Medical Sciences

Action of laserradiation on eye tissue in


pericular area

23.243Medical Sciences

dr. Brigita
Drnovsek Ljubljana Medical
Olup
Centre

Budget in
2002 (EUR)

The field of
Science

10.045Medical Sciences

17.870Medical Sciences
13.112Medical Sciences

PROREC Slovenia
Design and setting up of the National Centre (for Health Informatics)
Several activities were taken in the first half of 2001:
Setting up a Widenet-SLO project team - staffing
Presentations for the Slovenian Medical Informatics Society members
Settling some financial and organisational issues at the national level
Two presentations have been made for the state Minister of Health and his Secretaries. The
Minister has promised his full support for the proposed Widenet activities.
Discussions and analyses have been initiated regarding the national Widenet centre and its statute
on the basis of the Belgiums statute.
Prorec.SI statute drafted
Internet prorec-si.org domain acquired
An extensive draft version of the document Promotion activities plan for the Widenet-Slo has
been prepared.

175

A promotional workshop organised for the potential Widenet project team members. Widenet-SLO
project organisation structure and staffing have been set up. Promotional white-paper drafted.

Widening and consolidating the network


The following activities where taken in years 2001 and 2002:
- Workshop on different aspects and possibilities of EPR data exchange in Slovenia
- Co-organisers of the SMIS's conference Telecommunications in Healthcare;
- Workshop and assessment of EPR and Health Risk Factors
- Co-operation with the Slovenian national Health Sector Management Project (HSMP), dealing
with healthcare data modelling and Clearinghouse activities
- Taking an active part in the Slovenian info-conference (INFOS), health informatics session
- Widenet activities and meetings held during the MEDINFO 2001 conference, London
- Prorec.Si Web page redesigned;
- Participation in the Widenet web-site testing
- Presentation and meetings of the 4 major Slovenian healthcare software providers consortium
organised. Planned activities for joined EHR activities.
- Several meetings held managing PROREC.SI issues: project team, legal issues
- Participating at the EuroRec 2001 and a Widenet Consortium meeting, Nov.2001, Aix enP, France
- SMIS's part of the deliverable 4.2 Strategies and Promotional Plans for National Markets prepared
and delivered, Jan 2002
- An International Prorec.Si EHCR event organised and held at Bled; jan-apr2002;
- Prorec.SI legally established; a very successful kick-off event held.

Prorec.SI first projects started in 2003


A feasibility and technical study has been started regarding the lab results and discharge letter
HL7/XML implementation. International experiences have been studied and compared. The first
technical documentation was presented on a workshop for major Slovenian software providers.
In the first quarter of 2004 the pilot project will be executed and evaluated.
Members of the Slovenian Widenet project team have taken an active position in the:
Preparation of a proposal for the national informatics and standardisation body
Restructuring governing bodies of the Prorec.SI
Advising in several local IT tenders regarding EHR issues.

Conclusion
As a result of the Widenet project, a national Prorec centre (Prorec.SI) was established. Beside
organisational and financial issues, the first project has already started.

Status of EHR
About 70% of all Slovenian hospitals are using an IT solution (e.g. Hospital Information System)
developed in compliance with HISA pre-standard. This seems a good foundation for the development
of a adequate EHR system, which would be based on the emerging European EHR standards, and
implemented when they are available. The same fact is valid for around 60% of Primary Healthcare
providers.

Expenditure for IT in Slovene hospitals

176

How Much to Invest


SLOVENIA
Investments in Healthcare - 8,6% GDP
Recommended investments in healthcare informatics: 1% of 8,6% of GDP yearly
Proposed Slovenian direct investment in healthcare informatics (Ministry of Health) for
year 2004

BDP in M EUR
21.829,0
1.877,3
18,8
4,3

Projection of Costs (in EUR):


Purpose
IT equipment for hospitals
IT equipment & support for the Center
For Health Informatics (CHI)
Human Resources (CHI)
Applications
Application support (10% of total)
Total per year

Year 1
Year 2
Year 3
Year 4
Year 5
Total
1.375.500 1.929.400 2.746.500 2.959.300 2.180.800 11.191.500
601.400
122.000
122.000
122.000
130.400
1.097.800
217.500
2.030.000
203.000
4.427.400

435.000
3.220.000
525.000
6.231.400

435.000
3.340.000
859.000
7.502.500

435.000
3.260.000
1.185.000
7.961.300

435.000
3.730.000
1.558.000
8.034.200

MESS Budgets

Ljubljana Medical Centre


University of Ljubljana, Faculty of Medicine
Blood transfusion centre of Slovenia
Institute of rehabilitation

Total MESS
Total MESS budget for ebudget in EUR Health in EUR
363.623
75.512
113.228
148.930
36.720
36.720
10.865
10.865
524.436
272.027

MESS - Ministry of Education, Science and Sport


The most important eHealth initiatives/pilots in Slovenia
E-Health related Initiatives
http://www2.gov.si/mz/hsmp/hsmpeng.nsf/V/KC3155D1785DE23AFC1256B49002B4B9A/$file/Anne
x-03_99-11-09.doc

The HSMP Project


The description of the project and many other information can be found at:
http://www2.gov.si/mz/hsmp/hsmpeng.nsf
Health economics and quality of care perspectives and applications in the HSMP are explained in:

177

1.957.500
15.580.000
4.330.000
34.156.800

http://vestnik.szd.si/st2-12ang/st2-12ang-757-759.htm
Other task to be carried out before the end of HSMP project (and accepted and confirmed by the
Ministry of Health) are also the following:

Information Support to the System of Financing based on DRGs

All Slovenian hospitals were successfully connected to secure computer network owned by
Governmental Centre for Informatics.

Hospitals have already adopted/updated their IT solutions to support the DGR system, and have
already sent the data for the first 3-monthly period

The data is being collected and processed on the national level. The responsible organisation is the
National Institute for Health Protection/Public Health. Technical support is provided by
Governmental Centre for Informatics.

Setting up the new bodies/entities to be responsible for health informatics on strategic and operational
level

Health Informatics Standards Board


It should be noted that the Board is one of three key components of the national health informatics
capability (the other components being the Health Informatics Council and the Centre for Health
Informatics). The scope of the Board is informatics standards which are required and undertaken at the
national level i.e. those standards which are in common to all entities, agencies and institutions
within the health system. The Board will engage in the identification of both standards (mandatory) and
guidelines (optional but desirable). It will focus on the identification of standards and guidelines which
promote and enable effective and efficient health information sharing. In most instances, this focus will
result in standards and guidelines in the areas of data (e.g. data definitions, coding schemes),
technology (e.g. data communications) and security (e.g. encryption). The Board will support and
enable the achievement of Slovenian health sector goals by improving the quality, value, availability
and accessibility of health information and provide proactive leadership in the cost effective use of
informatics at the national level.

Health Informatics Council


The scope of the Council is informatics activities which are required and undertaken at the national
level i.e. those activities which are in common to all entities, agencies and institutions within the
health system. The Council is accountable for all informatics activity required and undertaken in
support of, and to enable, national level health system objectives. The Council reports, through the
State Secretary, to the Minister of Health. The mandate of the Council is to support and enable the
achievement of Slovenian health sector goals by improving the quality, value, availability and
accessibility of health information and provide proactive leadership in the cost effective use of
informatics at the national level of the Slovenian health sector

Centre for Health Informatics


The Centre itself is a professional agency operating on behalf of the overall health system (not just
public health) but which is organisationally housed within the structure of the National Public Health
Institute. As such, the Centre takes direction, for different aspects of its activities, from both the
national health system and from the National Public Health Institute. The scope of the Centre is
informatics activities which are required and undertaken at the national level i.e. those activities
which are in common to all entities, agencies and institutions within the health system. The mandate of
the Centre is to support and enable the achievement of Slovenian health sector goals by improving the
quality, value, availability and accessibility of health information and provide proactive leadership in
the cost effective use of informatics at the national level of the Slovenian health sector.

178

Additional initiatives

National Healthcare Portal

IT support for standardization with data dictionary

Applications on the national level

Support for Clinical Pathways

Electronic Health Record

Data Interchange Referrals, results,


Telemedicine
Computer at bed side

DRG Support

e-DRG (already running)

DRG Grouper (already running)


Support for the DRG coding

179

Annex XXI
Health Insurance Card Project Health Insurance Institute, Slovenia
In September 1995, the Health Insurance Institute of Slovenia, in conformity with the European and
global development trends, and with its own business goals, defined the plan of substituting the health
care identification booklet for a modern, computer-readable document - health insurance card.
The health insurance card is an electronic tool of communication between the insured person,
physician, health care center, hospital, health insurance provider, and pharmacy. The card transmits the
key and stable data that are required in the implementation of health insurance.
Ever since its foundation, the Institute has been systematically modernizing and promoting efficiency
of operations in cooperation with its partners in the health care system, through an adequate
information system and continuous upgrading of the system with state-of-the-art information
technology. These efforts are also incorporated into the objectives, which served as the basis in the
conception of the health insurance card project:
1.
To improve the quality of services and of treating of insured persons both at the Institute
and by other health care service providers.
2.
To simplify and improve communication between the Institute, the physicians and health
care institutions.
3.
To cut down the number of various (unnecessary) procedures now required when the
insured person implements their rights.
4.
To improve the security of personal data within the information processing systems
5.
To reduce the extent of administrative tasks and thereby achieve a higher efficiency of
operations at the Institute and within the health care service.
6.
With reasonable financial investment, to provide long-term economic benefits at the
level of the national economy.
In the first phase of the Slovenian project, the Institute is introducing a card serving administrative
purposes (implementation of rights derived from compulsory and voluntary health insurance),
supporting the procedures regarding the selection of a personal physician, and carrying an elementary
form digital prescription.
These functions involve legally incontestable identification details and their application for
administrative purposes, the field where relatively modest organizational effort and costs promise to be
repaid in clear and tangible benefits, due to a widespread use of the card.
The card is designed to comply with the legal regulations and with the relevant Slovenian and
international standards in force. The card is in accordance with the level of development of the
information technology infrastructure in the Slovenian health care and health insurance networks. And
its design also accommodates future expansion of the data set.
Health Card
The health insurance card is the only document applicable in the implementation of the compulsory and
voluntary health insurance rights in Slovenia. This electronic document was issued to all persons dully
covered by the compulsory health insurance in Slovenia, i.e. to the entire population of close to 2
million.
A person is to present the card when visiting at the doctor's and at all other occasions of implementing
the rights deriving from health insurance.
The health insurance validity is updated by the card holder, through the self-service terminals. The
updating of insurance validity also updates card data from the central databases.
The card is a means of easy and direct transfer of data between the insured persons, the insurance
company and the health care organizations. Data electronically recorded in the card are accessible for
reading only to authorized health professional card holders. Procedures associated with the card are fast
and ensure high service quality and data security.
The card system is aligned with the Slovenian health care and health insurance sector conditions and
regulations. Furthermore, it duly observes international recommendations and standards. Similar card

180

infrastructure is introduced in other European countries, in the framework of their efforts to create
applicability of such electronic documents across national borders.

181

Annex XXII
InfoNet healthcare information systems company, Slovenia
INFONET was founded in 1991 as an information engineering company. The company founders were
three mathematicians that have been dealing with computer science in various environments for more
than 10 years, and have resulted in a coordinated team with many experiences.
The main thrust of the company is the integration of our work, which is building and launching
information systems in the health care and pharmaceutical sectors. The development and
implementation covers three basic fields:
hospital information systems
pharmacy information systems
information systems for Primary Health Care and GPs
A major step in the development of Medical Informatics in Slovenia was made at the beginning of
1993, when the Institute of Health Insurance of the Republic of Slovenia bought 2750 IBM personal
computers and distributed them to public health institutions, as well as to the first private ones. In
addition to hardware, health care institutions received a computer program for accounting and
invoicing the health care services (reimbursement), free of charge. The program was developed entirely
by INFONET. During the following months, over 5000 users were trained to work with computers,
mainly administrative staff and nurses.
In the years when we were building information systems in the health care we have:
Implemented into our systems all requirements of our legislation.
Tried to understand specific problems of medical information science and we learned to solve
them
Very well recognised the way of thinking and particularities of medical staff, and learned to
listen to them and comply with their requirements.
Assumed the role of advisers for the field of information systems at majority of our partners,
as well as for the organisation changes.
Joined with important companies from the computer science field in Slovenia, which grants us
and our business partners the latest technology and quality information service.
Included in our projects a lot of experiences and knowledge acquired on international
congresses and at various other forms of international co-operation with several partners from
abroad.
Through our contracts in the medical professions, we are generally able to anticipate changes related to
the legislature and are therefore able to provide application modifications and updates so as to avoid
potential delays to our customers business processing. INFONET is assisted by medical specialists
from different fields. Within the team there are in addition specialists for the different platforms and for
the different applications. These professionals are also responsible for maintenance related to law, as
well as for programming modifications and enhancements.
In 1995 INFONET's development migrated to Graphical User Interface (GUI), to Client/Server model
and to object oriented technologies, encapsulating OO paradigm in all areas of software development:
from project planning, analysis, design, prototyping and data modelling to actual programming and
testing.
The original programme name was InfoMed (INFOrmatics in MEDicine), which has been lately
renamed to InfoMed21 and complemented with E-Med21. The development and implementation still
covers three basic fields: Hospital Information Systems, Information Systems for Primary Health Care,
Pharmacy Information Systems.
We are committed to the latest standards in distributed relational databases and object oriented
development, as well as relying on the healthcare application standards such as HISA (CEN-TC251),
ECHRA, HL7, CORBA and XML.
Following the latest trends in object oriented design, distributed relational databases, and using the
latest generation of object oriented programming languages and tools, we are able to offer the products

182

that conform to required standards and meet the immediate needs and that are adaptable to the future
evolution.
The use of this technology resulted in three different, extensive software applications (Multimedia
Electronic Patient Record & Management System for Hospitals - BIRPIS21, Information System for
Primary Healthcare (ISOZ21) and Healthcare Decision Support System.
Furthermore, within the frame of E-Med programme, Internet and intranet (i.e. Web, Java and XML)
solutions are being developed to remotely support information exchange between medical specialists,
patient data inquiry, creation and examination of Medical Knowledge-bases and other general medical
and administration information retrieval, using the latest IT, and based on intelligent interfaces and
mobile multimedia.
In April 2000 INFONET received an ISO 9001 Certificate for Quality System on ``Development and
implementation of IS, consultations in the field of IS, integration, technical support and maintenance of
IS".
Infonet now has 27 employees, with expertise in mathematics and computer science, many of them
being young engineers with a lot of knowledge, and fresh, original ideas.
The company's turnover has increased steadily since it was established in 1991, particularly since four
years ago. In 1999, consolidated net revenues were over 1.5 million USD.
Activities in Information Environment for Healthcare
International Projects in Medical Informatics
References and Products - The InfoMed System
Name and Contact Details

183