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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 Health Working Group MEDIS, Institute for Biological and Medical Imaging *) ProRec Germany STC2010 - Reykjavik, June 2010 Outline • ByMedConnect • Introduction of Standards o CCR (Continuity of Care Record) o ISO/CEN 13606 (EHR Communication) • Actual Developments ByMedConnect – Improving Communication by Linking Domains thus Fostering Integrated Healthcare in Bavaria • A project of Helmholtz Zentrum München in cooperation with the GO IN Health Network Ingolstadt • July 2009 – July 2012 • Funded by the Bavarian State Ministry of Environment and Public Health • Goals Communication of relevant patient data and information Improvement of continuity of care across institutional boundaries (seamless care) Application and evaluation of standards for health record communication Legacy systems as a basis Communication in ByMedConnect ICT in German Health Care • More than 200 different Physicians Office Management Systems • Big number of Hospital Information Systems Heterogenous information systems • Concurring solutions for online communication (e.g. D2D, eFA, vita-X) • National Health Telematics Platform (eGK, eGA) not yet available Status Quo: No common infrastructure for online exchange of health data Physicians Offfice Systems in GO IN Net M2 (Compu Med) 2% Med EDV PVS nach 2% Quincy Win mPI Medibit 2% 2% 2% Hersteller Easywin (Promedico) 2% Pata-Vital 2% Compu Group 2% Medistar 22% Kuno. Informed (apple) 2% M1 4% Compumed 4% Doc Expert (Comfort / Concept) 20% MCS (Isynet) 10% Turbomed 12% Albis 12% Nennungen n=51 Internetanschluss Electronic Communication: Access to Internet ISDN 20% keine Angabe 4% Keinen 5% DSL + ISDN 17% DSL 54% ICT in German Health Care – Example GO IN Regional Network Ingolstadt Communication of Doctor's Letters 8 8 by paper by email digitalised 46 GO IN Health Network • Regional Doctor‘s Network Ingolstadt (AUDI city), north of Munich • 520 GPs and Specialists • General emergency ambulance • Emergency ambulance for children State-of-the Art Documentation and Communicaton • Computer-based systems for accounting, letter writing and patient administration • The only data electronically communicated is remuneration, laboratory and radiological images • Doctor‘s letters and reports from external are collected in a paper-based patient record • The heterogeneous landscape of practice administration systems poses a challenge • A safe network for electronic exchange of health data has to be set up as the German Health Telematics Platform is not yet available • -> The physicians welcome electronic communication Study on needs and wishes Demands electronic communication Gegenüberstellung Inhalte - gemittelte Wertung 4 Dokumentiert Erhalten Erwünscht 4 = immer Erwünscht 3 = häufig 4 = ja 2 = selten 2,7 = eher ja 1 = einmalig 1,3 = eher nein 0 = nie 0 = nein 3 2 1 0 ByMedConnect study May 2010, first results (population 520, 60 answers so far) n=54 Data input Import BMC data POS HIS Viewing/Editing BMC data BMC-com Communication of BMC data Viewing/Controlling BMC data BMC-com Data adoption Data adoption 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) • • • • Patient health summary standard ASTM Provides a lean and application-oriented dataset Developed by US - physicians Well established and widely used by more than 100 system vendors for transferring patients health data in the US (Google Health, Microsoft Health Vault, Keas) Continuity of Care Record (CCR) • CCR standard sections or data objects include Insurers/Payers; Providers; Problems; Medications; Alerts; Vital Signs; Immunizations; Results; Procedures; Encounters; Family History; Social History; Functional Status; Support; Advance Directives; Medical Equipment; Plan of Care; Comments Detailed information at: www.ccrstandard.com • Used to define the medical content to be transferred in ByMedConnect • Adaptation to the requirements of the GO IN health network physicians expected ISO EN 13606 – Electronic Health Record Communication •The Europe based international standard specifies an „information architecture“ to deal with the heterogeneous medical data world •Reference model defines generic structures that form the „building-blocks“ of a health record •Archetype model is used for the design of information „patterns“ (medical concepts) that add „knowledge“ and thus enable semantic interoperability •-> Dual-model approach allows to separate systems engineering and content definition • More info at: www.en13606.org ISO EN 13606: LEGO Analogy Data elements © The LEGO Group Knowledge Benefits ISO EN 13606 • Archetypes empower the medical professionals to define the semantics of their own information systems • Archetypes are a formal model of real clinical concepts that are standarised and can be reused • The definition of archetypes is an important step towards semantic interoperable EHRs that are • portable (via institutional / regional boundaries) • precise (e.g. terminology binding) • accessible (individual queries + decision support) • durable (life-long health record) Status ByMedConnect • EHRflex – a generic archetype based medical record system o Import of archetypes o Data capturing and storage o Open source project at SourceForge • Archetype Definition o Enabling the use of the CCR within ISO EN 13606 based systems o Usage of LinkEHR a tool developed by Institute IBMI at “Universidad Politécnica de Valencia” • Survey on “communication needs” within the GO IN Health Network EHRflex View Patient Record EHRflex – Add New Entry Next Steps • Mapping of legacy data o Metadata of archetypes allow for a precise mapping that obeys the semantics of data o LinkEHR will be used • Development of a transformation module o Import of legacy data o Conversion to standardised format • Pilot implementation at GO IN Health Network in Ingolstadt Contact www.ByMedConnect.de [email protected]