National Electronic Health Record in Austria based on ihe challenges & Opportunities for dicom in Telemedicine

National Electronic Health Record in Austria based on IHE Challenges & Opportunities for DICOM in Telemedicine

• Alexander SCHANNER

• Program-Manager Arge ELGA

• Task Force Electronic Health Record

Introduction

• Introduction

• ELGA Architecture

• ELGA Standards

• ELGA Projects

• Summary

Initial Situation

• Political target:

• Using IT for the establishment of integrated medical care

• Legal assignment:

• Agreement according to article 15a federal constitutional law, Government Program 2007 (Chapter 7 – Health)

• Legal framework:

• data protection-, health telematics-, e-Government act, Laws on hospitals, ...

• Technical preconditions:

• e-card
• Present HIS-systems
• present intramural and extramural networking

Agreement according to article 15a federal constitutional law (version 2008-2013)

• Article 7:

• Main targets:

• I. qualitative improvement of supply
• II. use of economic potential of information- and communication-technologies
• III. harmonization of national approach with programs and activities on European level
• IV. securing patients’ rights to have access to personal and general health data

• ICT is a tool for modernizing health care

• Continuation of ELGA planning- and implementation tasks

Definition of ELGA (Elektronische Gesundheitsakte) = Austrian’s EHR

• ELGA contains relevant multimedia-based and health related data and information referring to a precisely identified person.

• Data und information originate from

• different health service providers and
• from the patient himself/herself

• and are stored in one or several different information systems (virtual health record).

• Data are available independently of place and time (cost-saving) at the place of treatment for all authorized persons according to the tasks and needs of these persons and in compliance with data protection rules.

Federal Health Commission (BGK –Bundesgesundheitskommission)

• Organ of the Federal Health Agency

• Consists of 27 members

• 7 Federal Government, 1 for each province, 6 Main Association of Austrian Social Security Institutions, 1 representing cities and 1 representing communities, 1 bishops’ conference together with the Protestant’s, 1 patients’ ombud, 1 General Medical Council of Austria

• Commercial operated by Ministry of Health, Family and Youth

Task Force Electronic Health Record Arbeitsgemeinschaft Elektronische Gesundheitsakte

• Decision of Federal Health Commission from July 2006 concerning establishment of Arge ELGA and financial remuneration

• Working basis of Arge ELGA is an agreement between

• Federal Government
• Provinces and
• Social Insurance Institutions

• Since September 2006 ARGE ELGA is acting operationally Location: A-1020 Vienna, Schiffamtsgasse 15

Object of Arge ELGA according to Agreement

• The objective of the ELGA Task Force is to drive the connection of existing and future electronic information and documentation systems in the Austrian health care system within the scope of a multi-project management.

• The main target is the establishment of the so called „electronic health record” (ELGA) in order to increase quality and efficiency of the health care system.

Tasks of Arge ELGA according to Agreement

• Among others:

• Assistance to the Federal Health Agency concerning controlling and coordinating activities;
• Definition of strategic priorities for the establishment of ELGA and of the roadmap for its implementation;
• Planning of detailed concepts and implementation of projects to introduce ELGA as well as the development of financing proposals;
• Demand of necessary legal amendments and the binding use of approved standards;
• Crisis and escalation management
• Evaluation of project results

Implementation preliminary planning (1/2)

• 2006:

• February to June: Preparation of Arge ELGA (contract)
• 28. June: Decision about contract Arge ELGA
• May to November: Feasibility Study
• September: Arge ELGA is operational

• 2007:

• January: Publication of Feasibility Study ELGA
• Dec06 – Feb07: Architecture plan for the first phase of implementation
• March and April: Consultation with Stakeholders
• 4.5.2007 – BGK: Acceptance of architecture plan, standards and commissioning of first phase of implementation
• May to August: Concretion Basic Components, Master Plan and Roadmap

Implementation preliminary planning (2/2)

• 2007:

• May to Sept: Detailed planning of individual projects
• Sept to Oct: Agreement according to article 15a federal constitutional law (2008-2013)
• ELGA cost-benefit-analysis
• ELGA association
• Establishment of IHE Austria

• 2008:

• January: Start of cost-benefit-analysis
• June: Federal Health Commission decides (based on results of cost-benefit-analyses and detailed planings) about the implementation of ELGA

Federal Health Agency (BGK) – decision (1/3)

• Architecture Basic Components

• Master Patient Index
• Health Service Provider Index
• Document Registry
• Authorization System
• Portal

• Core applications

• discharge Summary
• e-Report - radiology
• e-Report - laboratory
• e-Medication

Federal Health Agency (BGK) – decision (2/3)

• International standards for EHR in Austria:

• IHE Frame-Work with domain

• IT Infrastructure
• Patient Care Coordination
• Laboratory
• Radiology

• HL7 CDA 2.0 as document standard

• LOINC (area laboratory data)

• DICOM 3.0 incl. WADO (area radiology)

• HL7 (in Version 3 with RIM as prospective data model)

Federal Health Agency (BGK) – decision (3/3)

• Detailed planning and first piloting (2007 / 2008)

• Concretion Basic Components and Master Plan –

• Project 1 – Master Patient Index

• Project 2 – HSP Index

• Project 3 – Document Registry

• Project 4 – Authorization System

• Project 5 – Portal

• Project 6 – Main Application first phase of implementation

• Project 7 – Acceptance Management

• Acceptance of each project after the presentation
• of an organizational and financial
• concept through BGK

Introduction

• Introduction

• ELGA Architecture

• ELGA Standards

• ELGA Projects

• Summary

Overview System Architecture

Hierarchical View on ELGA

ELGA View on Data

Introduction

• Introduction

• ELGA Architecture

• ELGA Standards

• ELGA Projects

• Summary

Interoperability – Standards and Catalogs

• Technical (syntactical) interoperability

• Content wise (semantical) interoperability

• Requirement:

• Assortment of international standards

• Standards rise quality and reduce costs!
• Standards promote competition!

International standards

• Strategy:

• established, international used standards

• Hospital Information System (HIS) Providers have to comply with the international market, Austria‘s operating companies focus on internationally widespread HIS

• HL7 RIM (Health Level 7 Reference Information Model) and CDA (Clinical Document Architecture) are preferred candidates for data model and document configuration

• IHE XDS (Cross Enterprise Document Sharing) including PCC (Patient Care Coordination) for document exchange.

Why Standards ?

Technical framework: IHE XDS Profile

Federated System Architecture

Introduction

• Introduction

• ELGA Architecture

• ELGA Standards

• ELGA Projects

• Summary

Facts for Planning and Implementation

• Preliminary Planning
• Architecture Plan
• Standards
• Data Protection
• Detailed Planning and Piloting
• Implementation / Rollout

ELGA Projects first phase of implementation

Project CDA documents

• Content wise interoperability via

• „Clinical Document Architecture“ from HL7

• Level 1
• Level 2
• Level 3
• for
• discharge Summary
• e-Report - radiology
• e-Report - laboratory
• e-Medication
• by Arge ELGA, members of standardization institute with different medical associations

Lower Austria

Starting Point Hospitals in Lower Austria

Global Aims of NÖGUS

• Creation of a central and integrative information and communication platform to meet the patient-related requirements of healthcare and welfare in Lower Austria.

• To make all relevant medical data of a patient available at any location and at any time for authorized persons or organizations to the extent required, thus providing quicker and more efficient medical assistance.

• Synergy and cost efficiency in the acquirement and operation of IT systems.

NÖMED WAN Solution

• Patient Demographics
• PDQ embedded in HIS
• Document Consumer
• embedded in HIS
• Via Web-Application

IHE Profiles in Lower Austria

IHE, global standards-based profiles adopted by several national & regional projects

Introduction

• Introduction

• ELGA Architecture

• ELGA Standards

• ELGA Projects

• Summary

Request HSP authorization

• Request HSP authorization

• Request patient identifikation

• Request insurance status

• Request patient consent

• Search med. documents

• Access / download med. documents

Participation in the making of ELGA

• Working groups for the Masterplan included doctors as well as external experts for privacy law and data security

• Talks with patient self help groups have started

• Permanent communication with private groups of stakeholders as well as with institutions

Data protection is an indispensable precondition for the success of ELGA

• Data protection is an indispensable precondition for the success of ELGA

• Close cooperation with all groups of society

• Legal implementation along technical implementation – legal acts to be amended and newly enacted

• Roles and authorization system

• Gapless logging of retrievals

Main communication targets

• Reduce fear

• Raise curiosity

• Create confidence

Thank you for your Attention!

• Thank you for your Attention!