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Alexander SCHANNER Program-Manager Arge ELGA Task Force Electronic Health Record

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. Agenda. Introduction ELGA Architecture ELGA Standards ELGA Projects Summary.

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Alexander SCHANNER Program-Manager Arge ELGA Task Force Electronic Health Record

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  1. National Electronic Health Recordin Austria based on IHEChallenges & Opportunities for DICOM in Telemedicine Alexander SCHANNER Program-Manager Arge ELGA Task Force Electronic Health Record

  2. Agenda Introduction ELGA Architecture ELGA Standards ELGA Projects Summary Alexander Schanner 2008-04-10

  3. 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 Alexander Schanner 2008-04-10

  4. 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 Alexander Schanner 2008-04-10

  5. 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. Alexander Schanner 2008-04-10

  6. 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 Alexander Schanner 2008-04-10

  7. Task Force Electronic Health RecordArbeitsgemeinschaft 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 operationallyLocation: A-1020 Vienna, Schiffamtsgasse 15 Alexander Schanner 2008-04-10

  8. 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. Alexander Schanner 2008-04-10

  9. 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 Alexander Schanner 2008-04-10

  10. Implementationpreliminary 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 Alexander Schanner 2008-04-10

  11. Implementationpreliminary 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 Alexander Schanner 2008-04-10

  12. 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 Alexander Schanner 2008-04-10

  13. 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) Alexander Schanner 2008-04-10

  14. 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 Alexander Schanner 2008-04-10

  15. Agenda Introduction ELGA Architecture ELGA Standards ELGA Projects Summary Alexander Schanner 2008-04-10

  16. ELGA Context Audit System External Registries (base identifi- cation number, ...) Autohorization System Document Registry Pat - Index HSP - Index HSP System HSP System Portal Repository Consumer Source Consumer Source Consumer Source Overview System Architecture Alexander Schanner 2008-04-10

  17. Hierarchical View on ELGA Authorization System HSP Index Master Patient Index Central Storage of Data ELGA Visibility Registry Signature, Entry in Registry HSP - Local Storage of Data Reports Laboratory Discharge Summaries X-ray Precise link to a document, URL Alexander Schanner 2008-04-10

  18. ELGA View on Data HSP HSP Index Patient Central Storage of Data Master Patient Index Registry Authorization System HSP - Local Storage of Data Radiology reports Laboratory reports Medication Discharge Summary Alexander Schanner 2008-04-10

  19. Agenda Introduction ELGA Architecture ELGA Standards ELGA Projects Summary Alexander Schanner 2008-04-10

  20. 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! Alexander Schanner 2008-04-10

  21. 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. Alexander Schanner 2008-04-10

  22. Why Standards ? Standard Non Standard HIS Patient Identify Source Patient Identify Source HIS Consumer Consumer Registry Registry Source Source Repository Repository IHE conform: easy to replace Vendors not IHE conform: no replacement of Vendors possible Alexander Schanner 2008-04-10

  23. Technical framework: IHE XDS Profile Alexander Schanner 2008-04-10

  24. Audit System Portal XCA XDS Autohorization System Document Registry Pat - Index Information HSP - Index Consumer Audit System Audit System Autohorization System Autohorization System Source PIX PIX Document Registry Document Registry Federated System Architecture ELGA Context RLS Cross Community Bridge (CCB) CCB CCB HSP System Service-Provider HSP System Repository Repository Consumer Source Consumer Source Alexander Schanner 2008-04-10

  25. Agenda Introduction ELGA Architecture ELGA Standards ELGA Projects Summary Alexander Schanner 2008-04-10

  26. Facts for Planning and Implementation • Preliminary Planning • Architecture Plan • Standards • Data Protection • Detailed Planning and Piloting • Implementation / Rollout Alexander Schanner 2008-04-10

  27. ELGA Projects first phase of implementation Alexander Schanner 2008-04-10

  28. 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 Alexander Schanner 2008-04-10

  29. Project Patienten-Index XDS in Lower Austria NÖGUS (www.noegus.at) Lower Austrian health and welfare fund NÖ Landeskliniken-Holding (www.lknoe.at) going there …… Alexander Schanner 2008-04-10

  30. Lower Austria • Federal stateofLower Austria • approx. 1.6 million inhabitants • 27 hospitals • approx. 8000 beds • approx. 3000 general practitioners Vienna Alexander Schanner 2008-04-10

  31. Waidhofen an der Thaya Gmünd Allentsteig Horn Eggenburg Zwettl Hollabrunn Mistelbach Krems Stockerau Tulln Korneuburg Klosterneuburg St. Pölten Melk Gugging Hainburg Amstetten Mauer Mödling Lilienfeld Scheibbs Baden Waidhofen an der Ybbs Wiener Neustadt Neunkirchen Hochegg Starting PointHospitals in Lower Austria Situation 2004 • 27 Locations • 22 Organizational Units • 18 Different Owners • 270 IT Systems • supplied by • 70 Manufacturers Alexander Schanner 2008-04-10

  32. 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. Alexander Schanner 2008-04-10

  33. NÖMED WAN Solution • Patient Demographics • PDQ embedded in HIS • Document Consumer • embedded in HIS • Via Web-Application Alexander Schanner 2008-04-10

  34. IHE Profiles in Lower Austria Already used • PIX • PDQ • EUA • ATNA • PWP • XDS.a • XDS.b planned • XDS-I • RFD • BPPC • XUA • XCA Alexander Schanner 2008-04-10

  35. Lower Austria Austria IHE, global standards-based profiles adopted by several national & regional projects Netherland Amsterdam Italy (Conto Corrente Salute) UK CfH (Radiology WF) Denmark (Funen) Italy (Veneto) Spain (Aragon) FranceDMP Quebec, Toronto,Alberta, British ColumbiaCanada Infoway VITL-Vermont Boston Medical Center - MA Philadelphia HIE CPHIC – Pennsylvania CareSpark – TN & VA South Africa THINC- New York NCHICA – N. Carolina Malaysia CHINA-MoH Lab results sharing JAPAN-Nagoya Imaging Info Sharing CHINA-Shanghai Imaging Info Sharing Alexander Schanner 2008-04-10 Parisot, Vienna, WoHIT 2007

  36. Agenda Introduction ELGA Architecture ELGA Standards ELGA Projects Summary Alexander Schanner 2008-04-10

  37. International data exchange Public Public Insurance Insurance ELGA LSP HSP HSP Alexander Schanner 2008-04-10 Request HSP authorization Request patient identifikation Request insurance status Request patient consent Search med. documents Access / download med. documents

  38. 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 Alexander Schanner 2008-04-10

  39. Data Protection and Data Security 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 Alexander Schanner 2008-04-10

  40. Main communication targets • Reduce fear • Raise curiosity • Create confidence Alexander Schanner 2008-04-10

  41. Alexander Schanner 2008-04-10 Thank you for your Attention!

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