Healthcare Transformation an the role of EHR: Views from government
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- Anthony Gardner
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1 Healthcare Transformation an the role of EHR: Views from government Dipl.-Ing. Dr. Alexander Schanner Program-Manager A-1020 Vienna, Schiffamtsgasse 15
2 Agenda 1. Introduction 2. ELGA Architecture 3. ELGA Standards 4. ELGA Projects Page 2
3 Initial Situation Political target: Using IT for the establishment of integrated medical care Legal assignment: Agreement according to article 15a federal constitutional law Legal framework: data protection act health telematics act E-Government act Laws on hospitals Technical requirements: e-card Present HIS-systems present intramural and extramural networking Page 3
4 Government Program 2007 Chapter 7 Health 2 Unterstützung integrierter Versorgungsformen durch ausgeweitete Anwendungen der e-card und der Elektronischen Gesundheitsakte unter Wahrung der PatientInnenrechte und des Datenschutzes. Die Finanzierung der ELGA ist sicherzustellen. Agreement according to article 15a federal constitutional law article 7, paragraph 3 In diesem Zusammenhang bekennen sich die Vertragsparteien prioritär zur Konzeption und Einführung der elektronischen Gesundheitsakte (ELGA) sowie der elektronischen Arzneimittelverschreibung und -verrechnung (erezept). Der Bund verpflichtet sich, zur Planung und Akkordierung der Einführung der elektronischen Gesundheitsakte eine österreichweite Steuerungsgruppe unter umfassender Einbindung aller Betroffenen einzurichten. Die Länder verpflichten sich, an dieser Steuerungsgruppe teilzunehmen. Page 4
5 Agreement according to article 15a federal constitutional law (version ) article 7 (1) Main targets: 1. Qualitative Verbesserung der Versorgung, 2. Nutzung der ökonomischen Potenziale von Informations- und Kommunikationstechnologien, 3. Harmonisierung der nationalen Vorgangsweise mit Programmen und Aktivitäten auf europäischer Ebene und 4. Sicherstellung des Rechtes der Patientinnen und Patienten auf Zugang zu persönlichen und allgemeinen Gesundheitsdaten. (2) ICT is a tool for modernizing health care (3) Continuation of ELGA planning- and implementation tasks Page 5
6 Definition of ELGA 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 (costsaving) 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 Page 6
7 Primary goals Medical care Patients management Organisation of treatment processes Information for patients Page 7
8 Secondary goals Quality management Self-contained health related activities of the patient Financial and administrative processes Monitoring of healthcare system Science and research Target: avoid parallel structures! Page 8
9 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 Page 9
10 Task Force Electronic Health Record - Arge ELGA - Arbeitsgemeinschaft Elektronische Gesundheitsakte 1. Decision of Federal Health Commission from July 2006 concerning establishment of Arge ELGA and financial remuneration 2. Working basis of Arge ELGA is an agreement between 1. Federal Government 2. Provinces and 3. Social Insurance Institutions 3. Since September 2006 ARGE ELGA is acting operationally Location: A-1020 Vienna, Schiffamtsgasse Page 10
11 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 Page 11
12 Tasks of Arge ELGA according to Agreement Among others: 1. Assistance to the Federal Health Agency concerning controlling and coordinating activities; 2. Definition of strategic priorities for the establishment of ELGA and of the roadmap for its implementation; 3. Planning of detailed concepts and implementation of projects to introduce ELGA as well as the development of financing proposals; 4. Demand of necessary legal amendments and the binding use of approved standards; 5. Crisis and escalation management 6. Evaluation of project results Page 12
13 Implementation preliminary planning 2006: 2007: February to June 2006: Preparation of Arge ELGA (contract) 28. June 2006: Decision about contract Arge ELGA Summer/Autumn: Feasibility Study September 2006: Arge ELGA is operational January: Publication of Feasibility Study Dec 06 Feb 07: Architecture plan for the first implementation phase March / April: Consultation with Stakeholders BGK: Acceptance of architecture plan, standards and commissioning of first implementation phase Masterplan Page 13
14 Federal Health Commission (BGK) decision (1/4) Overview about decisions Architecture of Basic Components and Core Applications Standards Projects for planning and implementation Page 14
15 Agenda 1. Introduction 2. ELGA Architecture 3. ELGA Standards 4. ELGA Projects Page 15
16 Federal Health Commission (BGK) decision (2/4) Architecture Basis Components Master Patient Index Health Service Provider (HSP) Index Registry Authorization System Portal Core applications discharge Summary e-report - radiology e-report - laboratory e-medication Page 16
17 Overview of Basic Components and Core Applications Preconditions for ELGA ELGA Basic Components ELGA Core Applications First Implementation Phase ELGA Basics Citizen / Patient Storage and Filing Legal Measures Data Protection Consumers Acceptance Management Organisational Measures Master Patient Index nationwide compatible with EU Portal HSP Index roles Authorization System Access Protocols Network Standards Portal Health Information Current Topics HSP Information Health Promotion Portal Applications Document Registry centralized Document Repository decentralized Discharge Summary e-report (laboratories) e-report (radiology) e-medication (doctor, hospital, pharmacy) Page 17
18 Framework Architecture and Main Applications Data Sources A hyper-index with sophisticated search functions Doctor reading writing HSP Index Master Patient Index ELGA Authorization System Registry Portal Citizen Card with PIN Adaptor Adaptor Adaptor e-medication e-report (radiology, laboratories) Discharge Summary Adaptors: Interfaces which make existing applications compatible with ELGA Page 18
19 Hierarchical View on ELGA Authorization System HSP Index ELGA Visibility Master Patient Index Registry Central Storage of Data Signature, Entry in Registry HSP - Local Storage of Data Reports Laboratory X-ray Discharge Summaries Precise link to a document, URL Page 19
20 Authorization System ELGA View on Data HSP HSP Index Patient Master Patient Index Central Storage of Data Registry Radiology reports HSP - Local Storage of Data Laboratory reports Medication Discharged Summary Page 20
21 Overview System Architecture ELGA Context Audit System External Registries (base identification number,...) Pat - Index Autohorization System Document Registry HSP - Index HSP System HSP System Portal Consumer Source Repository Consumer Source Consumer Source Page 21
22 Agenda 1. Introduction 2. ELGA Architecture 3. ELGA Standards 4. ELGA Projects Page 22
23 Federal Health Commission (BGK) decision (3/4) International standards for ELGA 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) Page 23
24 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! Page 24
25 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. Page 25
26 Technical framework: IHE Profil XDS Page 26
27 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 Page 27
28 Document structure HL7 CDA 2.0 source: Page 28
29 International data exchange Request HSP authorization Public Insurance Public Insurance Request patient identifikation Request insurance status Request patient consent ELGA LSP Search med. documents Access / download med. documents HSP HSP Page 29
30 Agenda 1. Introduction 2. ELGA Architecture 3. ELGA Standards 4. ELGA Projects Page 30
31 Federal Health Commission (BGK) decision (4/4) Detailed planning and first piloting (2007 / 2008) Concretion Basis Components and Master Plan (IBM-Follow-Up Mission) Mai to August 2007 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 Page 31
32 Facts for Planning and Implementation a) Preliminary Planning Architecture Plan Standards Data Protection b) Detailed Planning and Piloting c) Implementation / Rollout Page 32
33 ELGA Projects first phase of implementation Page 33
34 Thank you for your Attention! Page 34
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