Long-term health care

General information

The Long-term Health Care module is part of the electronic health record in NHIS (National Health Information System). It manages processes related to preventive care/screening, medical risks, long-term health conditions, and their monitoring. Goal of this module is to proactively assist personal care, so users can have a long and fulfilling life.*At this stage, filling in one’s health history in the personal plan is not envisaged.

  • Electronic healthcare as a precondition for a long and healthy life

    Instructions image

    A future is possible where electronic healthcare can ensure quality, personalized care, and proactive assistance for citizens, thus enabling a long and healthy life. Making this future a reality is the goal of providing a 360-degree view of citizens' health status and 24/7 access to one’s NHIS electronic health record to both public users and their doctors.

    Here is a hypothetical success story of a patient from the future where healthcare has transitioned from analog to digital. *Text is based on excerpts from the "Transition to Digitalized Healthcare" keynote speech by Boris Kostadinov, Director of Software Integration at Information Services, during the 10th Annual "Innovations and Best Practices in Health Sector" Conference.

  • Health Record

    Instructions image

    Sonya, a 35-year old patient from the future, leads a sedentary lifestyle and works in an office. Due to lack of physical activity, unhealthy diet, and constant stress, she is overweight and suffers from two chronic diseases – high blood pressure and diabetes, for which she regularly takes medication. Her attending physician has entered her diagnosed diseases and prescribed treatment into her electronic health record.

    The electronic health record contains information about her complete medical history – preventive measures taken; past illnesses; current problems and diagnoses; use of medical devices and implants; performed procedures; and dispensary care. It also includes a brief summary of taken medication, vaccines, test results, and imaging diagnostics.

  • Personal Plan

    Instructions image

    NHIS uses the information registered in Sonya's electronic health record to create and maintain an up-to-date personal health care plan. This plan is the main mechanism for tracking both her diseases over time and the impact prescribed treatment has on them. The personal plan marks important events for the citizen – starting from mandatory child check-ups immediately after birth and continuing with regular preventive examinations, vaccinations, screening tests, and many others. Each of these events sends timely notifications to patient/parent and general practitioner, and allows for appointment scheduling through the relevant integrated system.

    In addition to standard events, Sonya's personal record includes additional regular examinations, specialized tests, and daily measurements of indicators critical to her condition. The personal plan and its implementation results are easily accessible to both Sonya and her physicians. She and her doctors can receive timely reminders for follow-up examinations, upcoming tests, and necessary prescriptions.

  • Diagnostic Card

    Instructions image

    During a visit to the doctor's office, for each examination, NHIS offers the doctor a list of mandatory and optional indicators, tests, and questions compiled in an electronic diagnostic card. Both the plan and each diagnostic card are created based on predefined health standard rules, as well as individual characteristics such as risk factors, family history, recent test results, and more. During a regular examination, based on predefined NHIS indicators and new health complaints – constant fatigue, skin rashes, and joint pain, the GP suspects Sonya may be suffering from a new disease.

    He begins the process of differential diagnosis and supplements the diagnostic card with an extended panel of tests, including glycated hemoglobin, 24-hour urine for microalbuminuria, and creatinine clearance. Doctor's goal is the speedy diagnosis of a potentially new disease during its early symptoms. When these tests’ results are registered in NHIS, system identifies deviations from the norm and marks them in her record. GP receives this information and refers Sonya to a specialist for consultation/ examination.

  • Diagnostic Card

    Instructions image

    During a visit to the doctor's office, for each examination, NHIS offers the doctor a list of mandatory and optional indicators, tests, and questions compiled in an electronic diagnostic card. Both the plan and each diagnostic card are created based on predefined health standard rules, as well as individual characteristics such as risk factors, family history, recent test results, and more. During a regular examination, based on predefined NHIS indicators and new health complaints – constant fatigue, skin rashes, and joint pain, the GP suspects Sonya may be suffering from a new disease.

    He begins the process of differential diagnosis and supplements the diagnostic card with an extended panel of tests, including glycated hemoglobin, 24-hour urine for microalbuminuria, and creatinine clearance. Doctor's goal is the speedy diagnosis of a potentially new disease during its early symptoms. When these tests’ results are registered in NHIS, system identifies deviations from the norm and marks them in her record. GP receives this information and refers Sonya to a specialist for consultation/ examination.

  • Monitoring

    Instructions image

    Upon making a record of the new disease, NHIS updates Sonya's personal health care plan. When there are overlaps between doctor visits and identical tests on nearby dates, the system optimizes the plan and consolidates overlapping events. The treatment prescribed by the specialist for systemic lupus is also registered in NHIS. However, upon analyzing the new data, system identifies a documented incompatibility between newly prescribed medication and one of the medications Sonya has been taking for her chronic diseases. NHIS sends an alert to both her and her GP of potential health risk. GP changes the hypertension treatment prescription to another compatible medication.

    Instructions image

    NHIS continues to monitor Sonya's personal treatment plan progress. It can alert her and her GP in case of an emerging treatment problem, new symptoms, detection of abnormal test results, or dangerously elevated indicators.

    Instructions image

    This is possible only thanks to medical specialists’ timely, accurate, and correct reporting of essential information to NHIS. As a result, Sonya's chances of managing the new disease increase significantly, risk of complications is reduced, and she is given the opportunity for a long and healthy life.

Download eZdrave to access your Preventive Care Calendar or visit my.his.bg

  • Electronic healthcare as a precondition for a long and healthy life

    Instructions image

    A future is possible where electronic healthcare can ensure quality, personalized care, and proactive assistance for citizens, thus enabling a long and healthy life. Making this future a reality is the goal of providing a 360-degree view of citizens' health status and 24/7 access to one’s NHIS electronic health record to both public users and their doctors.

    Here is a hypothetical success story of a patient from the future where healthcare has transitioned from analog to digital. *Text is based on excerpts from the "Transition to Digitalized Healthcare" keynote speech by Boris Kostadinov, Director of Software Integration at Information Services, during the 10th Annual "Innovations and Best Practices in Health Sector" Conference.

  • Health Record

    Instructions image

    Sonya, a 35-year old patient from the future, leads a sedentary lifestyle and works in an office. Due to lack of physical activity, unhealthy diet, and constant stress, she is overweight and suffers from two chronic diseases – high blood pressure and diabetes, for which she regularly takes medication. Her attending physician has entered her diagnosed diseases and prescribed treatment into her electronic health record.

    The electronic health record contains information about her complete medical history – preventive measures taken; past illnesses; current problems and diagnoses; use of medical devices and implants; performed procedures; and dispensary care. It also includes a brief summary of taken medication, vaccines, test results, and imaging diagnostics.

  • Personal Plan

    Instructions image

    NHIS uses the information registered in Sonya's electronic health record to create and maintain an up-to-date personal health care plan. This plan is the main mechanism for tracking both her diseases over time and the impact prescribed treatment has on them. The personal plan marks important events for the citizen – starting from mandatory child check-ups immediately after birth and continuing with regular preventive examinations, vaccinations, screening tests, and many others. Each of these events sends timely notifications to patient/parent and general practitioner, and allows for appointment scheduling through the relevant integrated system.

    In addition to standard events, Sonya's personal record includes additional regular examinations, specialized tests, and daily measurements of indicators critical to her condition. The personal plan and its implementation results are easily accessible to both Sonya and her physicians. She and her doctors can receive timely reminders for follow-up examinations, upcoming tests, and necessary prescriptions.

  • Diagnostic Card

    Instructions image

    During a visit to the doctor's office, for each examination, NHIS offers the doctor a list of mandatory and optional indicators, tests, and questions compiled in an electronic diagnostic card. Both the plan and each diagnostic card are created based on predefined health standard rules, as well as individual characteristics such as risk factors, family history, recent test results, and more. During a regular examination, based on predefined NHIS indicators and new health complaints – constant fatigue, skin rashes, and joint pain, the GP suspects Sonya may be suffering from a new disease.

    He begins the process of differential diagnosis and supplements the diagnostic card with an extended panel of tests, including glycated hemoglobin, 24-hour urine for microalbuminuria, and creatinine clearance. Doctor's goal is the speedy diagnosis of a potentially new disease during its early symptoms. When these tests’ results are registered in NHIS, system identifies deviations from the norm and marks them in her record. GP receives this information and refers Sonya to a specialist for consultation/ examination.

  • Diagnostic Card

    Instructions image

    During a visit to the doctor's office, for each examination, NHIS offers the doctor a list of mandatory and optional indicators, tests, and questions compiled in an electronic diagnostic card. Both the plan and each diagnostic card are created based on predefined health standard rules, as well as individual characteristics such as risk factors, family history, recent test results, and more. During a regular examination, based on predefined NHIS indicators and new health complaints – constant fatigue, skin rashes, and joint pain, the GP suspects Sonya may be suffering from a new disease.

    He begins the process of differential diagnosis and supplements the diagnostic card with an extended panel of tests, including glycated hemoglobin, 24-hour urine for microalbuminuria, and creatinine clearance. Doctor's goal is the speedy diagnosis of a potentially new disease during its early symptoms. When these tests’ results are registered in NHIS, system identifies deviations from the norm and marks them in her record. GP receives this information and refers Sonya to a specialist for consultation/ examination.

  • Monitoring

    Instructions image

    Upon making a record of the new disease, NHIS updates Sonya's personal health care plan. When there are overlaps between doctor visits and identical tests on nearby dates, the system optimizes the plan and consolidates overlapping events. The treatment prescribed by the specialist for systemic lupus is also registered in NHIS. However, upon analyzing the new data, system identifies a documented incompatibility between newly prescribed medication and one of the medications Sonya has been taking for her chronic diseases. NHIS sends an alert to both her and her GP of potential health risk. GP changes the hypertension treatment prescription to another compatible medication.

    Instructions image

    NHIS continues to monitor Sonya's personal treatment plan progress. It can alert her and her GP in case of an emerging treatment problem, new symptoms, detection of abnormal test results, or dangerously elevated indicators.

    Instructions image

    This is possible only thanks to medical specialists’ timely, accurate, and correct reporting of essential information to NHIS. As a result, Sonya's chances of managing the new disease increase significantly, risk of complications is reduced, and she is given the opportunity for a long and healthy life.

Key functionalities

The Prevention section of the module allows configuration of a National Preventive Care Calendar for all citizens. It includes mandatory preventive examinations, tests, and vaccinations, starting from birth through rest of life. Preventive Care Calendar is created in accordance with current regulations and in compliance with Ordinance 8 of the Health Act. Based on this calendar, module prepares a personal health care plan for each citizen, which contains a series of events with a start date and (optionally) an end date for completion. Most often, these events are examinations or immunizations. For each of these events, system sends timely notifications to patient/parent and GP.

Plan for each citizen is created at the moment of their first registration in NHIS. For newborns, this is the registration of birth through the Hospitalization module, and for other citizens, it is the creation of the first electronic document in the system. Upon plan’s creation, NHIS automatically schedules upcoming events for next 3 months according to the national Preventive Care Calendar and person’s specific age. For individuals over 18 years old at the time of module initiation, this includes the annual preventive examination and potentially DT (diphtheria-tetanus) revaccination. For newborns and minors, this includes all mandatory examinations according to the Child Health plan, as well as all mandatory and recommended vaccinations for respective age. Plan is updated every night based on latest data entered into each citizen's NHIS health record.

For each event (examination or immunization), NHIS prepares an electronic diagnostic card, which contains a list of measurements, tests, and questions for the citizen. List is created from predefined nomenclatures based on patient’s individual characteristics and context of relevant event. All information is accessible to patients on my.his.bg and on the eZdrave mobile application, as well as to GPs on doc.his.bg according to their patient lists.

This module monitors citizens' health status, keeping track of their most important information since birth. This includes mandatory prophylactics and vaccinations; past illnesses; use of medical devices and implants; performed procedures; dispensary care; test results; medication intake; current problems; diagnoses; and more. Collection of all this data enables long-term tracking of diseases, prescribed treatment’s effectiveness, and early diagnosis of potentially new diseases.
*Coming soon

Potential individual risk factors are identified after a doctor fills out a questionnaire for each patient. These can be related to age, family history, medication intake, previous illnesses, etc. System alerts medical specialists to existing risk factors; suggests additional tests; signals improper medication combinations; reminds of upcoming planned tests; and more.
*Coming soon

For each event in the module, there is reliable, easy-to-understand information explaining what is happening as well as basic guidelines pertaining to said condition. For each event related to vaccination, information is provided about which disease it protects against; time period in which it should be administered; and benefits of vaccine in question. In the Assisted Patient Pathway, additional information is provided about what is expected to happen and how citizens should react in certain situations related to long-term conditions, such as pregnancy and childbirth.
*Coming soon

Key functionalities

The Prevention section of the module allows configuration of a National Preventive Care Calendar for all citizens. It includes mandatory preventive examinations, tests, and vaccinations, starting from birth through rest of life. Preventive Care Calendar is created in accordance with current regulations and in compliance with Ordinance 8 of the Health Act. Based on this calendar, module prepares a personal health care plan for each citizen, which contains a series of events with a start date and (optionally) an end date for completion. Most often, these events are examinations or immunizations. For each of these events, system sends timely notifications to patient/parent and GP.

Plan for each citizen is created at the moment of their first registration in NHIS. For newborns, this is the registration of birth through the Hospitalization module, and for other citizens, it is the creation of the first electronic document in the system. Upon plan’s creation, NHIS automatically schedules upcoming events for next 3 months according to the national Preventive Care Calendar and person’s specific age. For individuals over 18 years old at the time of module initiation, this includes the annual preventive examination and potentially DT (diphtheria-tetanus) revaccination. For newborns and minors, this includes all mandatory examinations according to the Child Health plan, as well as all mandatory and recommended vaccinations for respective age. Plan is updated every night based on latest data entered into each citizen's NHIS health record.

For each event (examination or immunization), NHIS prepares an electronic diagnostic card, which contains a list of measurements, tests, and questions for the citizen. List is created from predefined nomenclatures based on patient’s individual characteristics and context of relevant event. All information is accessible to patients on my.his.bg and on the eZdrave mobile application, as well as to GPs on doc.his.bg according to their patient lists.

This module monitors citizens' health status, keeping track of their most important information since birth. This includes mandatory prophylactics and vaccinations; past illnesses; use of medical devices and implants; performed procedures; dispensary care; test results; medication intake; current problems; diagnoses; and more. Collection of all this data enables long-term tracking of diseases, prescribed treatment’s effectiveness, and early diagnosis of potentially new diseases.
*Coming soon

Potential individual risk factors are identified after a doctor fills out a questionnaire for each patient. These can be related to age, family history, medication intake, previous illnesses, etc. System alerts medical specialists to existing risk factors; suggests additional tests; signals improper medication combinations; reminds of upcoming planned tests; and more.
*Coming soon

For each event in the module, there is reliable, easy-to-understand information explaining what is happening as well as basic guidelines pertaining to said condition. For each event related to vaccination, information is provided about which disease it protects against; time period in which it should be administered; and benefits of vaccine in question. In the Assisted Patient Pathway, additional information is provided about what is expected to happen and how citizens should react in certain situations related to long-term conditions, such as pregnancy and childbirth.
*Coming soon

Management of the Personal Plan

Arrow timeline

  1. 1 Birth or initial registration in the system

  2. 2 System creates a personal plan and fills it with upcoming events for next 3 months

    The initially populated events are from the Preventive Care Calendar – mandatory examinations, immunizations, and tests. For newborns, these include all mandatory examinations according to the Child Health plan, as well as mandatory and recommended vaccinations. For individuals over 18 years old, these events include annual preventive examination and potentially DT (diphtheria-tetanus) re-vaccination.

  3. 3 System marks an upcoming event, creates a diagnostic card for it, and sends a notification to eZdrave

    Electronic diagnostic card is created based on predefined rules according to health standards, individual characteristics, risk factors, family history, recent test results, medications taken, administered vaccines, etc. Events whose deadlines have expired are locked. System adds the event to list of upcoming events in GP’s patient list.

  4. 4 Doctor's office visit for the relevant event (examination, immunization, etc.).

    Doctor downloads the electronic diagnostic card from NHIS, which contains a list of mandatory and optional indicators, tests, and questions. Doctor performs respective activity.

  5. 5 Doctor performs respective activity (examination, immunization, diagnostic activities).

    Doctor registers necessary documents in NHIS and fills in a required diagnostic card containing questions, measurements, tests, prescribed treatment, and scheduled additional examinations (if any). System sends a notification for completed actions.

  6. 6 System marks an event as completed and links it via the National Reference Number (NRN) to the registered electronic document.

  7. 7 System removes an event from upcoming schedule and updates the personal plan with next event on the list.

  8. If an event is missed and its deadline expires, it is marked as incomplete in citizen's medical history. System removes said event from upcoming schedule.

  1. 1 Birth or initial registration in the system

  2. 2 System creates a personal plan and fills it with upcoming events for next 3 months

    The initially populated events are from the Preventive Care Calendar – mandatory examinations, immunizations, and tests. For newborns, these include all mandatory examinations according to the Child Health plan, as well as mandatory and recommended vaccinations. For individuals over 18 years old, these events include annual preventive examination and potentially DT (diphtheria-tetanus) re-vaccination.

  3. 3 System marks an upcoming event, creates a diagnostic card for it, and sends a notification to eZdrave

    Electronic diagnostic card is created based on predefined rules according to health standards, individual characteristics, risk factors, family history, recent test results, medications taken, administered vaccines, etc. Events whose deadlines have expired are locked. System adds the event to list of upcoming events in GP’s patient list.

  4. 4 Doctor's office visit for the relevant event (examination, immunization, etc.).

    Doctor downloads the electronic diagnostic card from NHIS, which contains a list of mandatory and optional indicators, tests, and questions. Doctor performs respective activity.

  5. 5 Doctor performs respective activity (examination, immunization, diagnostic activities).

    Doctor registers necessary documents in NHIS and fills in a required diagnostic card containing questions, measurements, tests, prescribed treatment, and scheduled additional examinations (if any). System sends a notification for completed actions.

  6. 6 System marks an event as completed and links it via the National Reference Number (NRN) to the registered electronic document.

  7. 7 System removes an event from upcoming schedule and updates the personal plan with next event on the list.

  8. If an event is missed and its deadline expires, it is marked as incomplete in citizen's medical history. System removes said event from upcoming schedule.