Lower Austria regional eHealth Integrator Thomas Gitter, MD Product Manger Int. CC Health Services...

Lower Austria regionaleHealth Integrator

Thomas Gitter, MDProduct Manger Int. CC Health ServicesRennweg 97-99

1030 Vienna, Austria

[email protected]

Project Overview

HIMSS06

San Diego

Feb., 14th

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“Lower Austria”….

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PrerequisitesSituation of healthcare in Austria

Hospital and Primary Care landscape in Austria Primary Care doctors are independent, most of them having

conctracts with one or more insurances Hospitals are owned mostly by regional authorities or clerical;

few private High frequency out-patient clinics in most of the hospitals

Insurance and healthcare – finanzing „Dual“ financing: Different payors for in/out – patients Patient is at risk to get „ping-pong“ subject eCard: Recently rolled out for prove of eligibility

Patient identification No unique Identification of patients (nor inhabitants) Insurance – number good for search and matching

not necessarily unique not from birth.

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Addressed point-to-point delivery of discharge letters and reports Using kind of mail-box-systems Recipient known at time of delivery

Portals for admission Still only few, individual

Teleradiology Gains ground Point-to-point Images less problematic compared to reports.

eHealthExisting regional examples

eHealthAspects

The 10 e's in “e-health” (Gunther Eysenbach)

Efficiency

Enhancing quality of care

Evidence based

Empowerment of consumers and patients

Encouragement of a new relationship patient and health professional

Education of physicians through online sources

Enabling information exchange and communication in a standardized

way between health care establishments

Extending the scope of health care beyond its conventional

boundaries

Ethics Equity.

gheider

one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement.

gheider

increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers.

gheider

e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation. Much work still has to be done in this area.

gheider

by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice.

gheider

professional, towards a true partnership, where decisions are made in a shared manner.

gheider

This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceuticals.

gheider

e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues.

gheider

- to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the "haves" and "have-nots". People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases.

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eHealth IntegratorFeatures

Functional scope Patient Index Medical History Index (Admissions, visits, document registry) Integration interfaces for connecting participants Implemented business processes Web Application

Future Extensions Clinical Repository Increased collaborative processes between healthcare

facilities

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Healthcare RecordApproach: Product and Solution

Base technology • Database• Application Server

eHealth Integrator• Patient Index• Medical History Index

Middleware: Health Transaction Base (HTB®)• Health Data Repository• Integration Platform <

Base technology• Integration:

SeeBeyond eGate®

Solution specifics• NÖMED WAN

Cu

stom

er sp

ecifi

c solu

tion

Product baseOracle HTB®

Coordination by T-Systemsint. CC health Vienna

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Network across all Healthcare Service providers Hospitals General Practitioners Specialists Nursing Services Emergency Units Pharmacies etc.

Availability of all kind of data with medical relevance Anywhere At any time For everybody authorized At required Scope

EU – Target !

eHealth and telematicsGeneral Goals

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Lower AustriaWhat we face

Mistelbach

Hainburg

Hollabrunn

St. Pölten

Lilienfeld

Amstetten

Waidhofen an der Thaya

Gmünd

Krems

Tulln Korneuburg

Stockerau

Melk

ScheibbsWaidhofen an der Ybbs

Zwettl

Horn

Eggenburg

Allentsteig

Gugging

MauerMödling

Baden

Hochegg

Wiener Neustadt

Neunkirchen

Klosterneuburg

Landscape 2003

•27 sites•22 organizational entities•18 owners

270 IT Systems

by

70 providers

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Duties: (some) Steering of healthcare providing Investments Structural improvements Defining of guidelines for economical behavior of hospitals Ongoing improvement of service-oriented finanzing Setting up appropriate acute-care capacities Extension of alternative care-institutions Coordination and planning of structures of care Balancing of service offerings between hospitals

The Customer:NÖGUS (transltd) Lower Asutrian Health and Welfare Fund

http://www.noegus.at/

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= Platformfor Healthcare

Additional to eCard=

Patientindex

Additional for local HIS

Additional for Primary Care and family doctor´s Information Systems

=

=

Patient IndexCore Component

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Clear/Unique Identity of the PatientMaster Patient Index (MPI)

Medical History IndexElectronic Patient Record - Index

(EPR-I)

MPI• Establishment of a unique identity and linking it to already existing

local (Lower Austrian) records (based on master records) yielding at international applicability

• Linking-up with index systems of other regions /countries …..

• Linking up with e*government

EPR-I• Historical record of all interactions in conjunction with healthecare

Admissions Outpatient treatments Visits with physicians

• With the vision of being a key to the relevant documentsMedical summary Medical reports X-Ray images Drug applications

Master Patient Index

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Avoiding redundancies of examinations Awareness of and utilization of already existing, recent

findings e.g. from medical laboratory or preceding examinations

Data should accompany the patient; e.g.:

Electronic referral by the local practitioner

Automatic reception of data at the hospital and forwarding to the relevant ward (outpatients)

Results and findings always reach the practitioner or the ward ahead of the patient – they are already waiting for him/her

Master Patient IndexReasons

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A distributed lifetime electronic medical history

requires a strict Separation of:

• MAKE = Creation of Documents

• STORE = Archiving of Documents

• SEARCH = Looking for Documents resp.dedicated content

• VIEW = Presentation of documents

Medical Documentation

This VISION has been empowered by the DICOM Standards in the area of radiology and today is reality-proven there

and has become REALITY by the IHE model for the entire healthcare segment.

Editor

User

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Document Consumer

Document Repository Document

Consumer

Cross-Enterprise Clinical Documents Sharing (XDS)

Document Source

Document Registry

Patient Identity SourceMPIMPI

Master Patient Index

EPR-IEPR-IElektronic Patient Record - Index

Document Source

Document Repository

Document Repository

1 Provide & Register

2 Register

3 Query

4 Retrieve

STORE

VIEW

SEARCH

MAKE

IHE profile describes the “how-to”

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Patient and Medical History Index.Overview – Data Management.

……Doc 1 Doc n

HIS 1 HIS n

Patient Master ID

Copy of local data

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NÖMED WAN. Patient and Medical History Index.Process Example: Index Query, Patient Data Transfer.

Pat. & FindingsIndex

KIS-Dialog

Web Server

Abfrage Index

MsgServer

Local Client

Connector

HIS: Patient Search

Query

Resu

ltHIS Extension

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NÖMED WAN Patient and Medical History IndexProcess Example: Medical History Query.

Pat. & FindingsIndex

HIS

Web Server

Link

MH Query

Medical History, Browser

Msg Server

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Matching algorithm Patient demography Social insurance number Remote ID`s kept in central index system

Reconciliation tool Part of contract Compliant with regional/national/international law (?)

Data security / privacy issues

“Master Patient”

Projekt NÖMED WANTimeline

Step 1 – Patient Index Index went live January 2006 Initial Load of patient data (demography) from pilot - hospitals Integration with SAP Patient Management/ i.s.h.med at ZK

St.Pölten

Step 2 – Patient History Enrichment of Index by: Admissions, Document-MetaData: June 06 Initial Load from pilot hospitals Integration with SAP Patient Management/ i.s.h.med at ZK

St.Pölten

Future Scope Connection with decentralizd Document repositories Direct Document retrival from respective archive.

Projekt NÖMED WANTechnical Architecture

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T-Systems Austria

Thank You for Your attention!

Dr.Thomas GitterProduct Management Int.cc Health Services Vienna

[email protected]

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Backup….

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NÖMED WAN the Healthcare-Network

NÖMED WANNÖMED WAN = Family of projects to establish a state-wide

network across all Healthcare providersin Lower Austria

General Conditions:

Countrywide Applicability (Austria) Conformity with International Standards Consideration of National Healthcare reform-programs

• Healthcare Agency / Platform

• Regional Concepts

• Electronic Healthcare Record (ELGA) Consideration of the e-Health Europe action plan

(EU-Target) Consideration of chip-card for Healthcare Services (e-card)

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Global Aims

Global aims

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.

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