Central Information Health System of the Republic of Croatia
The development of the Central Information Health System of the Republic of Croatia, (cro. Centralni zdravstveni informacijski sustav Republike Hrvatske, CEZIH), began with a scientific research project in 2002. The first contract on the delivery of the System was signed with the Government of the Republic of Croatia the following year, and after that maintenance and continuous upgrading of the System were also contracted. Since February 20, 2007, the Central Information Health System has been in production, connecting healthcare providers in Croatia. According to the 2019 Act on Health Data and Information, all exchange of health information within Croatia must take place through the Central Information Health System.
Over the years, the System has digitized and transformed numerous processes in healthcare and made the healthcare more accessible to patients. A large part of the System's services is made of integration interfaces that enable the communication of other systems and their users, and from this point of view, the Central Information Health System of the Republic of Croatia functions as a national integration platform for all other information systems and applications in the country. Out of quite a number of different applications that are available to end users within the System, here we highlight the following two:
- Electronic Helathcare Record (EHR) – intended for authorized healthcare professionals; enables the review of the patient's medical data generated in different parts of the healthcare system in one place
- A Health Portal that enables citizens to access their own medical data and provides them with numerous services such as sending requests for prolongation of chronic therapy, exchanging messages with selected doctors, managing orders, etc. Citizens can use the services of the Portal for themselves and for minors in their care.
Almost all healthcare professionals in the Republic of Croatia use the Central Information Health System on a daily basis.
The web version of the Health Portal is used by over 800,000 people and is one of the most used services on the Government's eCitizens Portal (e-Građani - statistika - Skupovi podаtаkа - CKAN (gov.hr)).
An Overview of the Most Important Functionalities of the Croatia's Central Information Health System Services and Applications
| eReferral | ||
| Referral to the biochemical laboratory of primary health care | ||
Abbreviations
HL7 - Health Level Seven International
FHIR - Fast Healthcare Interoperability Resources
IHE – Integrating the Healthcare Enterprise
eReferral
- Digitized exchange of structured data (referral, reservation and sending of findings)
- In production since 2011. The paper “red” referral was abandoned in 2020, more than 15 million eReferrals are issued annually
- Medical reports are forwarded to the application of the prescriber of the referral and are available to people through the Health Portal,
- Medical reports are also available in the EHR application.
Health Portal
- Patients can see their medical record and manage the doctor's access rights to their data and allow or prohibit the cross-border exchange of medical data (prescriptions and medical summary).
- More than 800,000 users of eGrađani statistika
- More than 20,000 people use the service every day
- From 2020, a mobile application is also available
Insurance Check
- Retrieving patient data, checking insurance status and certain rights based on insurance at a given moment (e.g. right to assistance)
- More than 1.5 million checks per day.
eMedical Aid
- Digitized process of prescription, approval (automatically or by a committee), reservation and registration of the issuance of medical aids
Electronic prescribing of more than 1 million devices a year means that people no longer have to wait in queues to have certificates validated.
eHeathReport
- Medical records* of all patients in the Republic of Croatia are available to all registered doctors.
It contains information on diagnoses, visits to selected doctors, laboratory tests, prescriptions, referrals and findings from polyclinics and hospitals, discharge letters, allergies, special notes, etc. - A mobile application available from 2022
*In the scope of data sent to CIS from all institutions from January 1st, 2016 and if the patient has not expressly prohibited access to his data.
Referral to the biochemical laboratory of primary health care
- Digitized exchange of structured data (sending a referral, sending data about the sample - if the sample is taken immediately in the doctor's office, and sending the findings
- 15,000 people no longer need to collect the results from the laboratory every day in order to take them to their chosen doctor. The findings are visible to the doctor in the medical application and to the person in the Health Portal.
- Mechanism in production since 2011, when paper forms were abandoned.
ePrescription
- Digitized exchange of structured data (sending a prescription, booking a prescription and sending information about the medicine taken at the pharmacy).
- Patients pick up more than 61 million medicines in one year.
- ePrescription has been in production since 2011, when prescribing on a paper form was abandoned.
Registers
Institution
Employee
System
Persons (Patients)
Physical therapy at home
Every report on the health care provided at home is available to the doctor who prescribed the therapy.
Report after visiting the chosen doctor
Registration of selected medical data in a structured format. The structure of EHR rests on these reports, which have been in production since 2007. More than 300,000 reports are received daily.
Payment to primary care physicians relies on these reports.
Helpdesk applications and cancellation
Helpdesk applications, used by the system operator, enable the monitoring of individual digital processes and the provision of the first-line support to end users.
Cancellation, which enables the correction of errors and going back a step in digitized processes, is built into all services.
Healthcare at home
Every report on the health care provided at home is available to the doctor who prescribed the therapy.
Safety
Authentication
Authorization
Audit Record
VPN
Digital Signature
PKI Infrastructure
Cross-border exchange of health data
Since 2014, as part of the epSOS project, the Republic of Croatia has been exchanging ePrescriptions and patient health summaries with other EU countries.
https://health.ec.europa.eu/ehealth-digital-health-and-care/european-health-data-space_en
Code lists and terminologies
ICD10
ATC
DRG
National Preventive Programs
National Lung Cancer Screening and Early Detection Program
National Cervical Cancer Early Detection Program
National Breast Cancer Early Detection Program
National Colon Cancer Early Detection Program
Standards
HL7 v2
HL7 v3
HL7 CDA
HL7 FHIR
IHE
Other
- Report of a malignant neoplasm
- Notification of an infectious disease
- Onko+ message
- Croatian oncology database
- Free communication among doctors
- Recommendation of sick leave for a parent of a sick child
- Specialist consultation without the presence of the patient
- Register and repository of documents
- Abbreviated Pompidou form
- Vaccination register
- Contact information
