Integrated Health Information System in Romania

A solution for improving the administration manner of the national unique fund of social health insurances

The Integrated Health Information System of the Social Health Insurances's goal is to ensure the computerized management of the economic and medical data necessary for an efficient Romanian health insurance system. Thus, it contributes to the development and improvement of the medical and pharmaceutical services.

The Consortium working for the Integrated Health Information System is composed of:

• Hewlett-Packard as a system integrator and supplier of information infrastructure - HP provides the Hardware infrastructure at national and international level, delivered and functional for 42 locations
• SIVECO Romania, which assures the analysis, design, development and installation of the 28 SIUI applications - The ERP "SIVECO Applications" System, is in production in most of the county locations and ensures the IT support for increasing the efficiency and control of activities
• the Special Transmissions Service supplier of the telecommunication services at national level - Ensures the WAN Infrastructure operational for 42 locations

System's coverage area

National Health Insurance House

• all the County Health Insurance Houses
• 53,910 Physicians           
• 10,304 Family Doctors  
• 95,286 Medical assistants           
• 509 Hospitals
• 38 Providers of ambulance services
• 328 Providers of homecare services
• 458 Out-patient recovery      
• 2,639 Providers of medical devices
• 15 Providers of rehabilitation sanatoria services
• 4,140 Providers of pharmaceutical services.

The Description of the Social Health Insurance System in Romania

The system is built in a hierarchical structure having at the top of the pyramid the National Health Insurance House, which:

• receives, collects and processes synthetical data at national level
• coordinates the activities of the County Houses of Health Insurances (CJAS)
• at the same time ensures the interface between the health insurance system and the other national record keeping systems (Ministry of the Interior, Ministry of Health, Ministry of Public Finances, etc.)

On the intermediate layers there are the County Health Insurance Houses, which:

• develop basic activities within the social health insurance system

At the base of the pyramid, from the point of view of the information system, there are the medical and pharmaceutical service suppliers, who collect and process:

• the medical information of the insurant
• the information with administrative character that shall constitute the base of the refunds between the suppliers and the County Health Insurances Houses.

The System's Objectives

The Integrated Health Information System of the Social Health Insurances implemented in Romania aims at substantially improving the social health insurance system of Romania by:

• Collecting and managing the economic and medical information necessary for the efficient operation of the Health Insurance System
• The transparency regarding the control and management of the budgetary funds of CNAS
• The evidence of the insured persons and of the medical services suppliers through creating and administering the National Registry of Insured Persons and the National Registry of Medical Services Suppliers
• Making the data reports to the medical services suppliers more efficient
• The Uniformity in the application of the norms and legislation at national level
• Record keeping and control of costs for each insurant
• The On-line and off-line interfaces for the interconnection with entities outside the system and with the medical and pharmaceutical service suppliers

The Main Functionalities Of The Integrated Health Information System

The main functionalities of the system are the following:

• The management of the social health insurance funds at the level of the National Health Insurances House and at the County Health Insurances Houses
• The management of the insurants at the level of the National Health Insurances House and at the County Health Insurances Houses
• The management of the medical and pharmaceutical service providers at the level of the National House of Health Insurances and of the County Houses of Health Insurances
• The evidence of the contribution payments (taxpayers) at the level of the National House of Health Insurances and of the County Houses of Health Insurances
• The Ensuring of the control of the medical services at the level of the National Health Insurances House
• The Computerized management of the following specific functions at the level of the National Health Insurance House:
  - The board panel for the management of the national social health insurance system
  - The production of unitary collections in order to broadcast them in the network
  - The management of internal communications and with partners in the system
  - The management of the relations with organizations from which information is received
• The Computerized management of the specific activities of the following medical and pharmaceutical service suppliers:
  - primary medical care suppliers
  - specialized ambulatories for clinical specialties
  - ambulatories for paraclinical specialties
  - ambulatories for dentist specialties
  - hospital units
  - ambulance and sanitary transport units
  - sanatoriums and health prevention institutions
  - ambulatories for health recovery
  - home care suppliers
  - pharmaceutical units
  - medical devices suppliers

The Benefits Of The Integrated Health Information System

The main beneficiaries of the system implementation are the citizens, that will gain, in this way, more efficient and qualitative services.

SIUI ensures a total transparency of the expenses made in the health system of Romania, allowing a quick progress in aligning to the European and global standards.

For the first time there will be Registers and National Data Bases, containing all data and information necessary for a rigurous history at the level of the entire system, allowing the unique identification of every insurant, an essential condition for reducing the errors in the system.

SIUI will benefit from a performant hardware infrastruture at national level, that will allow an efficient exploitation, as well as a platform of specific applications developed in accordance with NHIH needs, updated according to the legal changes in the field for a period of 13 years.

The Management, monitoring and support necessary to an efficient management of SIUI, will be ensured through the implementation of a call center of Help Desk type, available at national level both for the internal users of HNIH, and to the providers of medical and pharmaceutical services.

The NHIH and CHIH management will be able to achieve complex analysis on the data in the system.

The implementation of the project will allow the detection of errors in the social health insurance system.

The project implementation will allow to increase the efficiency of the health insurance system through the standardization of applying norms at national level, taking over reports from suppliers, taking over reports from CHIH to NHIH.

Implementing SIUI will allow a more efficient usage of the budget.

Realizing annual savings to the Health Insurance Budget generated by:

• The detection and the elimination of redundant insurants
• The detection and the elimination of nonconformities regarding the insurants
• The elimination of redundancies of delivered medical services
• The blocking of the attempts of frauds through a controlled access to SIUI
• The identification and the elimination of frauds attempts through data checking
• The detection and the elimination of reports

Savings regarding opportunity costs:

• Major impact to the NHIH business plan regarding amortization of SIUI system costs
• Diminishing of functioning costs due to introducing IT into the Health Insurance System