The hospital of the future

Healthcare in a digital environment in Estonia

As a care provider in all medical fields, Tartu University Hospital operates a near fully digital process both inside the hospital and also in interacting with its environment. Nearly all exchanges of data, be they med-ical, financial or operational with administrators, other care providers and patients is digital. Inside the hospital, a central process-driven solution unifies and simplifies the complex diagnostics processes for hospital’s staff in order to help them provide patients with high-quality medical services even more efficiently.

The Hospital Information System created by Nortal significantly reduced the administrative workload of hospital staff, enabling the clinical personnel to focus more on the actual diagnosis and treatment. This improved the quality of the hospital’s medical care. Thanks to the Patient Portal, part of the new e-service, patients can now access their medical data more conveniently and are therefore engaged in the process early on. All crucial data are also accessible securely on mobile devices.

Lithuania’s health records system was in desperate need of modernization. Patient files were kept on paper and hospitals had their own procedures for keeping records. Doctors from one institution had to wait several days to retrieve records from another, receiving lab results took hours and patients faced difficulties accessing their own medical files.

To help Lithuania bring its healthcare system up-to-date and pave the way for further digital development, Nortal created ESPBI IS, a centralized national health record system that serves as the foundation for the country’s entire electronic healthcare ecosystem. Using the latest data exchange standard, HL7 FHIR makes sure the system is future proof, and connecting new clinics will be easy. A crucial aspect of the system is its web-based portals for doctors, administrators, pharmacists and patients. The easy-to-use portals not only allow doctors to enter and retrieve information quickly, view lab results in real time, etc., they also allow patients full access to their own medical files and those of their children. The immediate benefits of implementing a national health record are easy to see: doctors can provide better care when they have instant access to patient’s information and when that information is complete. Lithuania has alsoo levied the power of a national health record to launch a paperless electronic prescription system that has proven popular among patients, doctors and pharmacists alike.

On-demand Data Access

Technological innovation often fails to deliver the expected impact due to issues with data access rights. We propose to using a Dynamic On-Demand Data Security model. The basic concept is to enable patient empowerment through a 2-way process for data rights. All actors who have data access rights according to the current operational model would retain their rights. In addition, we provide a tool for stakeholders to request data access from the patient dynamically, as well as dynamic break-the-glass data access options with patient notifications. Patient benefits and self-determination is the main focus: the patient decides who has access to his or her medical records. Such access would be granted for a limited time, and patients have the opportunity to request more information about why the access is needed and to specify the data available. Stakeholders and beneficiaries for On-Demand data access should, in addition to medical specialists, include other public servants and pension and potentially insurance providers among others.

Patient portal – positioning patients at the center of the healthcare delivery

The patient’s portal opens up medical data, which is an enormous game changer by empowering patients and giving them control over their own data. Through the digital portal, the patient not only owns the data in a form of a patient diary (e.g. on blood glucose measurements), but can also store data from wearables such as fitness bracelets is stored. These applications are successful and tested by Nortal. Combining data access with additional value added services such as online appointment management, administration of personal data and communication with medical professionals will further position the patient at the center of the healthcare delivery process.

Transparency through technology

A key element for innovation to enable efficiency increases is systematic trust. We propose to achieve this via transparency – provide tools for patients to be able to monitor data access history and evaluate the use of their data by different stakeholders.

Patient-centric presentation of medical information

In order to facilitate effective communication between patients and medical specialists, Nortal aims to implement and test novel ways of presenting clinical information for patients and specialists. Increased focus on visual design supports comprehension and adherence to recommendations.

Big Data and IoT enabled hybrid storage to enable a new generation of analytics

Increased use of telemedicine and personal healthcare devices is resulting in a flood of information being available from patients. In addition to traditional structured data, there will be streams of unstructured data from devices such as heart rate monitors, motion sensors and others.

For example, sleep pattern data from a personal wearable device can amount to gigabytes of data and does not suit conventional database structures. This data should also be available for medical specialists for analysis, when they consider it important. The new data is also made available for machine learning solutions to deliver insights into the care process.

Interconnectivity and automation to deliver process efficiency and care quality

Major inefficiencies are present in all healthcare environments due a lack of data integration models. The same lack of data interconnectivity is also a qualitative risk in healthcare.
We propose to implement HL7 FHIR as the next generation medical data exchange standard, enabling atomic data exchange between traditional clinical systems, but also modern mobile applications and other services.