Karl P. Pfeiffer Department of Medical Statistics, Informatics and Health Economics

1. eHealth in AustriaEstablishing a high level coordination committee for implementing the eHealth strategy Karl P. Pfeiffer Department of Medical Statistics, Informatics and Health Economics Innsbruck Medical University, Austria Chairman of the WP 1: National eHealth Strategy karl-peter.pfeiffer@uibk.ac.at

2. Content • The Austrian eHealth Initiative (EHI) • Aims of the Austrian EHI • Current situation • Strategic goals • First results from the working parties • Expected benefits from e Health • Discussion

3. The Austrian eHealth Initiative • Established in April 2005 • >100 members from • IT-companies • Hospital organisations • Social and private insurance companies • Chamber of doctors • Chamber of pharmacists • Universities • Ministry of health and woman • eGovernment

4. Working Parties in the eHealth Initiative • AK1: National eHealth strategy • The results of AK2 – AK7 will be summarized in AK1 to a national eHealth strategy • AK2: Interoperability – standardisation • AK3: Patient identification and archiving • AK4: Network of the health care and social system, infrastructure • AK5: Customer related information systems • AK6: Health care system related information systems • AK7: Telemedicine

5. eHealth Mission • eHealth is a service for the citizen for continuous improvement of the Austrian health care system eHealth is a service for the citizen!

6. eHealth Vision • An ubiquitous management of health by supporting the processes of all health care professionals by using information technology with special attention to privacy and data safety • In some years all necessary data are available electronically for the person who has the right to access to this data • Independent of time and location

7. eHealth Topics Strategy Evaluation Feasibility Business Processes Applications Technology

8. Current Situation of eHealth in Austria • Health Telematics Law • MAGDA-LENA • Guideline for secure digital communication in the health care sector • eCard • Introduction in 2005 • EDIVKA • Standardized communication for reimbursement • eVGA • Registry of doctors and pharmacies • Austrian DRG system for inpatient financing since 1997 • Standardized Minimum Basic Data Set • Diagnoses, procedures • ELGA – Elektronischer Gesundheitsakt • Electronic Health Care Record • Feasibility study is ongoing • Many (different) hospital and physician information systems

9. The problem of the health care system is not medicine, it´s the organisation of health care!

10. Strategic goals of eHealth • Improvement of the quality of health care • by streamlining processes • by integrating processes • Improvement of the efficiency, effectiveness, safety, timeliness, … • Access to patient centred data for an optimal treatment and better patient management • Access to best medical knowledge • For citizen • For professionals • Access to data for a better management of health care institutions • Data for planning, quality assurance Integrated health care

11. Content of eHealth • Patient centred electronic health care record • ELGA … Elektronischer Gesundheitsakt • Includes an active participation of the citizen • Health information networks • Presentation of medical knowledge • Telemedicine services • Mobile equipment • Especially monitoring systems • Decision support systems • Tools for processing of data for planning, management

12. Scope of the eHealth Strategy /1 • Documentation • Structured • Standardized nomenclature • Standard architecture for documents • Standardized document header or envelope • Communication • Based on standards • SOAP (XML, UTF8, MIME) • E.g. Letters for names of foreign citizen • IHE • HL 7 (V3) • DICOM • Recommendations from CEN TC 251 • Secure and save • Hardware specifications for mobile equipment • ISO / IEEE 11073 Information autonomy of the citizen!?

13. Scope of the eHealth Strategy /2 • Archiving and identification management • Key card • Role concept for access • Usability of a 4 step model? • Long term availability • Fast access • Registries and archives are organized by a trusted party • “A document should exist only once!” • Protocols of access • Processing • Decision support • Implementation of clinical pathways • Analysis for planning, quality assurance, management, financing, … • Scientific use

14. Participants in the eHealth Strategy • Citizen • Passive: patient • Active: diary of health care activities, sending data from mobile equipment • Actors, providers • Hospitals, ambulatories, doctors, pharmacies, dentists, nurses, … • Financiers • Social insurance companies • Private health insurance companies • National and provincial health care agencies • Science • Health economics, epidemiology • Politics • Planning • Public • Information about quality • Information about capacities • Medical knowledge

15. Key Elements of the eHealth Strategy • Unique person and patient identifier • Unique identifier of all health care providers • Registry with up to date data • Unique nomenclature for diagnoses, procedures, products, implants, … • Technical standards • Standardized architecture of key documents According to European standards!

16. Infrastructure for eHealth • Management of patient identification • eCard • Management of an up-to date registry of providers • Professional card • Pseudonymisation of data sets for data analysis • Master Patient Index • Archives • Centralized • Distributed environment • RHIO … Regional Health Information Organization • Meta data • Standardized terminology • Medical knowledge • Network infrastructure • Performance, security Interoperability

17. Expected Benefits of eHealth /1 • Efficiency • Case and disease management • No doubled examinations • Data are available just in time • Decision can be made earlier • Effectiveness • Treatment according to newest medical knowledge • Seamless clinical pathways • Better admission and discharge management • Safety • Warning for drug interaction • Warning for allergies Quality Cost

18. Expected Benefits of eHealth /2 • Patient centred • Basic data for anamnesis are available • Automatic reminder e.g. for vaccination • Interactive patient education • Timeliness • Identification of critical trends • E.g. electronic diabetes diary • Identification of patients at risk • Equality • Use of telemedicine services • Access to centres of excellence • Cost reduction Quality Kosten

19. Discussion • Development of a road map • Identification of the most promising projects • Demonstration of • Benefit, utility, feasibility, cost • eMedication, eLab, eScheduling, eDischarge letter, eDiary, ePrevention, eEmpowerment, e… • Reminder for vaccination • Mother and child booklet • Disease management • Quality assured patient information • Quality assured information for professionals • Responsibility for the content • Setting up a legal framework for eHealth • Prohibition of non-care related misuse

20. Road Map Goal • Select use cases • Fitting in the global framework of eHealth • Identify the processes and the participants in this processes • Define the technology • Which standards are available? • Guarantee interoperability • Start with pilot projects • Coordinate with EU projects Start

21. Main Challanges Expected • Resistance to reorganisation • Change Management • Usability of the software • Structuring and standardization of documents • Responsibility for the infrastructure • Are the current technical standards the standards of the future? • Acceptance by the citizen

22. Conclusion • eHealth is the key for modernization of the health care systems • It is a long term, well organized process • It needs new legal regulations • We have to start now! • Otherwise the IT-systems are to heterogeneous • IT-investments should be in accordance with technical standards • We have to set up coordinated pilot projects under a European perspective • The benefits are evident!

23. Thank you!