EHR Systems Use and Quality in Turkey

1. EHR Systems Use and Quality in Turkey Dr. Ali Kemal ÇAYLAN Ministry of Health, Turkey, Deputy Director 21-22 November 2011 Belgrad

2. Presentation plan • Basic information about Turkey. • Transformation Program and ehealth projects • How data is collected • Standards of the data • Market • Initiatives and plans 21-22 November 2011 Belgrad

3. Country details 21-22 November 2011 Belgrad • Basic facts about Turkey: • Population: 73.7 million people (2010) • 814.578 km2 • 81 Provinces • 1469 Hospitals • 893 Public hospitals • 496 Private and NPO • 125 University, Private and NPOrg. • 103 000 Physicians • 90 000 Nurses

4. Health Transformation Programe 21-22 November 2011 Belgrad • Initiated in 2003 • Objectives • Restructuring of the ministry • Administrative • Functionally • Covering all the citizens by general health Insurance • Implementing Family Medicine • Promoting private sector to invest in health • Realizing the e-transformation in the field of health • Mission is to lead innovation in the direction of current improvements, also to develop an active, rapid, trustworthy, accessible healthcare systems which is not only respectful to individual rights but also appropriate to international quality standards in order to provide various solutions to our citizens for better health care.

5. Main e-helthprojects 21-22 November 2011 Belgrad • After 2005 • Family Medicine System(AHBS) • Health-Net(Sağlık-Net) • Public Health Centre(TSM) • Centered Hospital Appointment System(MHRS) • Drug Tracking System(İTS) • Tele-medicine • Health-Net, is a central repository for EHRs, • Operational since January, 2009 • By December 2010, 98% of the public hospitals and 60% of the private and university hospitals are connected to Health-Net sending the EHRs of their patients on a daily basis

6. Who sends data? FAMİLY DOCTOR II. and III. Level Public Hospitals University Hospitals Private Hospitals HOSPITAL FORMAT CONTROL CONTENT CONTROL MINISTRY OF HEALTH EHR DATABASE LABORATORY HEALTH CENTRE PROVİNCİAL DİRECTORATE OF HEALTH Malaria and/or Tuberculosis Control Dispensaries Alcohol and drug addiction treatment institutions

7. taking a big step…EHR systems: Integration 21-22 November 2011 Belgrad • Family Physician System • 20.000 family physicians • 73 million population • 65 million patients data • Over 40 different vendors • Over 15 different functioning program • Health-Net with 1589 healthcare organization

8. EHR systems:legal/regulatory 21-22 November 2011 Belgrad • Health data is collected MoH • MoH determines legislations and standards to collect data. • Integration to Health-Net is accepted as performance criteria for hospitals in a circular order since 2009. • Family Physicians has an obligatory to send EHR to Family Physicians Information System(AHBS) since 2005. • Sharing of health data • Health data is own by MoH • EHR of a citizen can not be shared unless given permission by the citizen

9. EHR systems:standarts 21-22 November 2011 Belgrad • The standards used in Health-Net: • The National Health Data Dictionary (USVS v2) determines the data elements, their data types and the sections in an EHR • 65 data sets • 413 data elements • 53 data packages • HL7 CDA for the EHR content structure • HL7 Web service profile for transportation • National Code System Server (SKRS) which includes ICD-10 *UlusalSağlıkBilgiSistemi/Sağlık-NET EntegrasyonuİleilgiliGenelge 2008/18, http://www.saglik.gov.tr/TR/belge/1-6257/eski2yeni.html

10. EHR systems: quality assessment 21-22 November 2011 Belgrad • Health-Net • There is rapid increase in the amount of health institutions sending data to Health-Net. • The 81 provincial health directorates were included to the quality assessment and evaluation process to deal with this growing. • Health-Net Quality Assessment application is opened to them to make cross check between registered hospital records and Health-Net data. Comparison is done both quantitatively and qualitatively. • Every month, "province Health-Net quality assessment commission" compares registered hospital records and NHIS data. • A health institution receives a passing grade if registered hospital records match Health-Net records over 90 percent for every dataset • AHBS • Quality tests are performed at MoH

11. EHR systems: quality assessment 21-22 November 2011 Belgrad

12. Market history 21-22 November 2011 Belgrad • Market penetration • The EHR system used in the primary care is the Family Medicine Information System(AHBS) available both from MoH as well as from vendors • For secondary care(HBYS), there are a number of local EHR system vendors (more than 80) • The top three vendors have about 60% of the market share • Almost all hospitals use locally developed EHR systems

13. EHR systems: market testing 21-22 November 2011 Belgrad • Current actions • The need for requiring the use of quality assessed EHR systems is well recognized • The EHRs received by Health-Net are checked at random intervals for quality and punitive actions are enforced • Before Health-Net became operational, the interoperability of the vendor EHR systems to Health-Net is tested with a testing tool, namely, TestBATN • TestBATN is also used for checking the capabilities of an EHR system • Using TestBATN for EHR certification is being considered • Turkish Standards Institute

14. EHR systems: initiatives, plans 21-22 November 2011 Belgrad • To improve the interoperability of EHR systems to Health-Net, the following actions are considered: • Communicating with the Turkish Standards Institute to set the EHR standard for Turkey • Establishing the body for certification of EHR systems • Setting the certification mechanisms

15. Thank you … Do you have questions? 21-22 November 2011 Belgrad Ministry of Health, Turkey, Deputy Director Dr. Ali Kemal ÇAYLAN alikemal.caylan@saglik.gov.tr