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Improvement of Cross-Sector Communication for an Integrated Health Environment
Hans Demski, Anton Brass, Claudia Hildebrand, Rolf Engelbrecht*
Helmholtz Zentrum München - German Research Center for Environmental HealthWorking Group MEDIS, Institute for Biological and Medical Imaging*) ProRec Germany
STC2010 - Reykjavik, June 2010
OutlineOutline
• ByMedConnectByMedConnect
• Introduction of StandardsIntroduction of Standards
o CCR (Continuity of Care Record)CCR (Continuity of Care Record)
o ISO/CEN 13606 (EHR Communication)ISO/CEN 13606 (EHR Communication)
• Actual DevelopmentsActual Developments
ByMedConnect – ByMedConnect – Improving Communication by Linking Domains thus Improving Communication by Linking Domains thus Fostering Integrated Healthcare in BavariaFostering Integrated Healthcare in Bavaria
• A project of Helmholtz Zentrum München in A project of Helmholtz Zentrum München in cooperation with the GO IN Health Network cooperation with the GO IN Health Network IngolstadtIngolstadt
• July 2009 – July 2012July 2009 – July 2012
• Funded by the Bavarian State Ministry of Funded by the Bavarian State Ministry of Environment and Public HealthEnvironment and Public Health
• GoalsGoals Communication of relevant patient data and informationCommunication of relevant patient data and information Improvement of continuity of care across institutional Improvement of continuity of care across institutional
boundaries (seamless care)boundaries (seamless care) Application and evaluation of standards for health record Application and evaluation of standards for health record
communicationcommunication Legacy systems as a basis Legacy systems as a basis
Communication in ByMedConnectCommunication in ByMedConnect
ICT in German Health CareICT in German Health Care
• More than More than 200 different Physicians Office Management 200 different Physicians Office Management SystemsSystems
• Big number of Hospital Information SystemsBig number of Hospital Information Systems
Heterogenous information systems
• Concurring solutions for online communication Concurring solutions for online communication (e.g. D2D, eFA, vita-X)(e.g. D2D, eFA, vita-X)
• National Health Telematics Platform (eGK, eGA) National Health Telematics Platform (eGK, eGA) not yet availablenot yet available
Status Quo: No common infrastructure for online exchange of health data
Physicians Offfice Systems in GO IN NetPhysicians Offfice Systems in GO IN Net
Electronic Communication: Access to InternetElectronic Communication: Access to Internet
ICT in German Health Care – ICT in German Health Care – Example GO IN Regional Network IngolstadtExample GO IN Regional Network Ingolstadt
Communication of Doctor's Letters
46
8
8
by paper
by email
digitalised
GO IN Health NetworkGO IN Health Network
• Regional Doctor‘s Network Ingolstadt Regional Doctor‘s Network Ingolstadt (AUDI city), north of Munich(AUDI city), north of Munich
• 520 GPs and Specialists520 GPs and Specialists
• General emergency ambulanceGeneral emergency ambulance
• Emergency ambulance for childrenEmergency ambulance for children
State-of-the Art State-of-the Art Documentation and Communicaton Documentation and Communicaton
• Computer-based systems for accounting, letter writing Computer-based systems for accounting, letter writing and patient administrationand patient administration
• The only data electronically communicated is The only data electronically communicated is remuneration, laboratory and radiological imagesremuneration, laboratory and radiological images
• Doctor‘s letters and reports from external are collected Doctor‘s letters and reports from external are collected in a paper-based patient record in a paper-based patient record
• The heterogeneous landscape of practice administration The heterogeneous landscape of practice administration systems poses a challengesystems poses a challenge
• A safe network for electronic exchange of health data A safe network for electronic exchange of health data has to be set up as the German Health Telematics has to be set up as the German Health Telematics Platform is not yet availablePlatform is not yet available
• -> The physicians welcome electronic communication -> The physicians welcome electronic communication
Study on needs and wishesStudy on needs and wishes
Demands electronic communicationDemands electronic communication
ByMedConnect study May 2010, first results (population 520, 60 answers so far)
POS
BMC-com
Data input
Viewing/ControllingBMC data
BMC-com
Viewing/EditingBMC data
Communication of BMC data
HIS
Import BMC data
Dat
a ad
optio
n
Data adoption
Communication Scenario ByMedConnect (BMC)Communication Scenario ByMedConnect (BMC)
ByMedConnect - Communication Network
• Secured network
• Transmission of standardised data packages according to ISO EN 13606
Separation of meta and patient
data
• Communication module in each institution
Visualization of data
Interaction (Selection, Edition)
Data Exchange
Integration of legacy systems
Continuity of Care Record (CCR)Continuity of Care Record (CCR)
• Patient health summary standard ASTMPatient health summary standard ASTM
• Provides a lean and application-oriented Provides a lean and application-oriented datasetdataset
• Developed by US - physicians Developed by US - physicians
• Well established and widely used by more than Well established and widely used by more than 100 system vendors for transferring patients 100 system vendors for transferring patients health data in the US (health data in the US (Google Health, Microsoft Google Health, Microsoft Health Vault, Keas)Health Vault, Keas)
Continuity of Care Record (CCR)Continuity of Care Record (CCR)
• CCR standard sections or data objects includeCCR standard sections or data objects include Insurers/Payers; Providers; Problems; Medications; Insurers/Payers; Providers; Problems; Medications;
Alerts; Vital Signs; Immunizations; Results; Procedures; Alerts; Vital Signs; Immunizations; Results; Procedures; Encounters; Family History; Social History; Functional Encounters; Family History; Social History; Functional Status; Support; Advance Directives; Medical Status; Support; Advance Directives; Medical Equipment; Plan of Care; CommentsEquipment; Plan of Care; Comments Detailed information at: Detailed information at: www.ccrstandard.comwww.ccrstandard.com
• Used to define the medical content to be Used to define the medical content to be transferred in ByMedConnect transferred in ByMedConnect
• AAdaptation to the requirements of the GO IN daptation to the requirements of the GO IN health network physicians expectedhealth network physicians expected
ISO EN 13606 – ISO EN 13606 – Electronic Health Record Electronic Health Record CommunicationCommunication
•The Europe based international standard specifies anThe Europe based international standard specifies an „information architecture“ to deal with the „information architecture“ to deal with the heterogeneous medical data worldheterogeneous medical data world•Reference model defines generic structures that form Reference model defines generic structures that form the „building-blocks“ of a health recordthe „building-blocks“ of a health record•Archetype model is used for the design of information Archetype model is used for the design of information „patterns“ (medical concepts) that add „knowledge“ „patterns“ (medical concepts) that add „knowledge“ and thus enable semantic interoperabilityand thus enable semantic interoperability•->-> Dual-model approach allows to separate systems Dual-model approach allows to separate systems engineering and content definitionengineering and content definition
• More info at:More info at: www.en13606.orgwww.en13606.org
Knowledge
Data elements
ISO EN 13606: LEGO Analogy
© The LEGO Group
Benefits ISO EN 13606Benefits ISO EN 13606
• Archetypes Archetypes empower the medical professionalsempower the medical professionals to to define the semantics of their own information define the semantics of their own information systems systems
• ArchetypesArchetypes are a formal model of real clinical are a formal model of real clinical concepts that are standarised and concepts that are standarised and can be reusedcan be reused
• The definition of archetypes is an important step The definition of archetypes is an important step towards towards semantic interoperable EHRssemantic interoperable EHRs that are that are
• portable (via institutional / regional boundaries)portable (via institutional / regional boundaries)
• precise (e.g. terminology binding)precise (e.g. terminology binding)
• accessible (individual queries + decision support)accessible (individual queries + decision support)
• durable (life-long health record)durable (life-long health record)
Status ByMedConnectStatus ByMedConnect
• EHRflex – a EHRflex – a generic archetype based medical generic archetype based medical record system record system o Import of archetypesImport of archetypes
o Data capturing and storageData capturing and storage
o Open source project at SourceForgeOpen source project at SourceForge
• Archetype DefinitionArchetype Definitiono Enabling the use of the CCR within ISO EN 13606 based Enabling the use of the CCR within ISO EN 13606 based
systemssystems
o Usage of LinkEHR a tool developed by Institute IBMI at Usage of LinkEHR a tool developed by Institute IBMI at “Universidad Politécnica de Valencia”“Universidad Politécnica de Valencia”
• Survey on “communication needs” within the GO Survey on “communication needs” within the GO IN Health NetworkIN Health Network
EHRflex -EHRflex -ViewViewPatientPatientRecordRecord
EHRflex – Add New EntryEHRflex – Add New Entry
Next StepsNext Steps
• Mapping of legacy dataMapping of legacy datao Metadata of archetypes allow for a precise Metadata of archetypes allow for a precise
mapping that obeys the semantics of datamapping that obeys the semantics of data
o LinkEHR will be usedLinkEHR will be used• Development of a transformation moduleDevelopment of a transformation module
o Import of legacy dataImport of legacy data
o Conversion to standardised formatConversion to standardised format
• Pilot implementation at GO IN Health Pilot implementation at GO IN Health Network in IngolstadtNetwork in Ingolstadt
