Josipa Kern
Health and medical informatics in Croatia
Andrija Stampar Teaching Institute of Public Health|University of Zagreb
feature surveys developments ehealth croatia josipa kern professor medical informatics university zagreb school medicine describes croatia set creating modern ict infrastructure case study like others series generic messages librarians health science librarians need keep abreast national regional ehealth strategies initiatives librarians key role play assessing training needs clinicians librarians students general public era ehealth librarians relevant skills teaching generic information skills aspects health informatics hence participate designing education training programmes contribute teaching jeannette murphy josipa kern andrija stampar school public health school medicine university zagreb zagreb croatia many failures health care sector result right information right time1 owing lack technology knowledge use although many differences countries challenge identify common problems faced big small countries search solutions managing problems2 aim article survey past current uses information communication technology ict croatian health education sectors see whether provides basis healthy management health information covering area 56 000 km2 republic croatia 45 million inhabitants gni per capita 8060 usd 2006 considerable disparities 20 counties adult literacy high 981 2004 10 persons aged 20 attained tertiary education 2001 census life expectancy birth 754 years 2005 croatia total 802 health institutions 512 inhabitants per medical doctor 20053 information technology croatia began used business sector late1960s time universities began provide education future professionals however real impetus develop came april 1971 establishment university computing centre university zagreb sought provide computer infrastructure base academics whole croatia first conference promoting computers university later information technology interface iti held 1974 zagreb continues present day networking capacities started late1980s two networks real start ict croatia dates 17 november 1992 croatian academic research network carnet established another milestone development ict croatia ecroatia 2007 programme whose main objectives enable state provide transparent quick efficient services citizens4 ii provide comprehensive exchange information experience business entrepreneurial world another push towards information society establishment croatian society medical informatics csmi 1989 httpwwwhdmihr csmi member european federation medical informatics efmi international medical informatics society imia current national strategy developing croatian health system 2011 identifies complete computerization health care system one important prerequisites improving health care system whole5 process health care computerization croatia started early1970s6 electronic data processing health insurance institute7 health centre city zagreb model electronic data processing outpatients institutions holy spirit general hospital model electronic data processing hospitals chronic disease registers created cancer psychosis alcoholism along hospital registers trial registries patients suffering tuberculosis diabetics8 first periodic health statistics reports covered morbidity mortality health service910 integrated health information system project zagrebs health care system11 first systematic approach computerization late1980s similar approach adopted county istria primary health care1214 early1990s croatia experimented telemedicinestarting telepathology similar applications1522 followed telemedicine isolated areas23 number islands adriatic sea provided test sites trials light difficulties encountered building networks lack interoperability different systems need health medical informatics standards health medical informatics recognized major challenge consequently croatian society medical informatics initiated establishment local technical committee medical informatics tc 215 hl7 croatia initiated established csmi croatian medical biological engineering society crombes second organization responsible standards health medical informatics2425 croatian society medical informatics organized biannual symposia since 1993 ministry health committed developing national health information system croatia key drivers behind decision previous experience computerized applications coupled growing understanding importance health information making appropriate decisions health care health information used treat individual patients population groups plan health care estimate health problems requiring intervention ensure better use resources 2001 group experts consisting health professionals medical informatics professionals jurists established start new projectan integrated national health information system requirements system centralized cover primary health care gate keeper croatian health care system well hospitals main generator expenses health care need centralization derives fact croatian small population 5 million people croatian public health institute croatian health insurance institute require reports health health service status well surveillance costs security standardization sine qua non requirements integrated health information system25 first phase pilot project based gp offices agreed participate several hospitals clinics general hospitals successful evaluation pilot results hospital part project halted primary health care component continued develop2627 primary health care project designed two levels central kernel system local individual doctors office kernel run one vendor local applications given several vendors time process certifying local applications established outcome process several vendors certified develop install applications gp offices gp offices holding contracts croatian health care insurance institute obliged install one certified software systems end 2008 end 2007 50 started real work using applications recent information end april 2008 indicates implementation systems target finish end year croatia mindful importance regulatory framework computerization health care system several relevant laws passed one personal data protection law28 addition agency personal data protection established ensure compliance law important legislation covers issues relationship electronic paper documents digital signatures standardization2931 ethical aspect personal data protection covered code ethics health information professionals passed international medical informatics association imia translated croatian society medical informatics csmi published website32 document relating protection health information produced working group also website httpwwwhdmihr although hospital part national integrated health information system project halted hospital directorates continued develop implement particular ict applications hospitals3236 maintain progress inform rest europe developments croatia csmi efmi organized international meeting efmi special topic conference 2007 island brijuni four efmi working groups represented primary care informatics electronic health record security safety ethics nursing informatics organized sessions participation local regional european speakers37 effective use ict especially new specialized applications demands educated developers end users although croatia highly literate population 98 ict literacy high less 40 adults use internet rate higher big cities among highly educated groups ict education croatia started mid1970 university computing centre established university zagreb occasional education programs organized high schools universities ecroatia education programme started early years 21st century4 introduction information science national curriculum levelsfrom elementary schools universities development appropriate ict infrastructure first step involved building computer classrooms creating broadband access internet via adsl 600 libraries 700 primary schools secondary schools higher education institutions imia38 recommends health professionals acquainted ict able use technology responsibly daily work health professionals educated medical health informatics medical informatics part medical curriculum early awareness need health medical informatics education health professionals6 formal education medical students croatia began early1970s two computer terminals installed andrija stampar school public health school medicine university zagreb university computing centre use students researchers initially education programme simply demonstrated students computers work use statistical programs processing medical data middle 1980s computer laboratory established giving students chance handson use computers access internet gave benefits motivated students learn use ict similar developments occurred universities medical schools croatia started later able build experiences university zagreb april 1999 four croatian medical schools using internet able organize first videoconference telemedicine croatian medical students39 using results survey attitudes medical staff health care computerization university zagreb school medicine together faculty electrical engineering faculty science started programme postgraduate education medical informatics 1984 programme called health information systems 120 students enrolled 30 finished programme thesis students medical graduates also pharmacists mathematicians economists librarian engineers many years medical informatics included also postgraduate curricula several postgraduate programmes university zagreb school medicine example epidemiology public health occupational medicine school medicine family medicine emergency medicine paediatrics etc several computer laboratories university zagreb school medicine students teachers began introduce elearning several subjects pathology brain research physiology etc however medical informatics medical statistics subjects make greatest use ict educational tool also way solving information problems medicine health care medical informatics programmes medical students start basic ict skills elective course sixth year study aims medical informatics component are40 familiarize students concept tasks medical informatics interdisciplinary profession deals theory practice information processes medicine health care research increase awareness importance standards classifications ethical principles using ict everyday medical health care practice special attention data system security enable students identify evaluate data information flows health practice also ensure understand importance information ict support health care decision making provide insight existing ict applications enable students assess appropriateness usefulness information systems designed support patients public policy managers enable students find relevant information internet assess reliability enable students create prototype website health institution curriculum delivered lectures seminars practical full details programme available author present specialized postgraduate programme medical informatics university zagreb suspended however several medical informatics courses postgraduate doctoral programmes include methods medical informatics knowledge discovery medical domains statistical analysis free text health information system management simulation modelling public health information systems biosignal processing medical image processing although unlikely librarians participate directly computerization health care systems still important role play implementing national ehealth programmes first foremost teachers disseminators information help prepare future physicians manage health information librarians provide news alerts recent ictbased information sources help improve information sources eg incorporating multimedia encourage students health professionals use sources working partnership health informatics professionals librarians ensure health professionals health authorities aware happening rest world initiatives link health systems different countries eg newest initiatives eu construct patient summaries eprescribing make possible achieve continuity care era globalization greater mobility citizens starting premise little step knowledge small piece information could help solving big problems purpose review demonstrate achieved small country croatia respect computerization health care education using developing icts health care medical informatics education health professionals croatia national plan ict education41 national strategy health care system5 includes goal greater use information communication technologies next logical step join two initiatives create croatian ehealth programme would compatible eu ehealth strategies far croatia achieved high level computerization primary care adopted international standards interoperability eg hl7 en 13606 etc begun train future health professionals medical informatics skills knowledge needed cooperation health sector ministry health social wellbeing education sector ministry science education sport gain recognition medical informatics professionals needed develop ehealth turn requires educational programs new profession based imias recommendation experiences european countries42 josipa kern phd professor medical informatics university zagreb school medicine croatia president croatian society medical informatics csmi national representative european federation medical informatics efmi international medical informatics association imia main interests medical informatics public health published 100 papers journals proceedings medical informatics conferences participated scientific programme committees organizing committees several international national medical informatics congresses conferences eg medical informatics europe efmi special topic conference iasted international conference telehealth medical informatics croatia initiated establishment local technical committee standardization medical informatics hzntc215 president