Staying intelligent. Staying open. Focus: Healthcare IT Standardization. Dutch hospitals are well connected with JiveX.

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1 No International 12 Dutch hospitals are well connected with JiveX Risk and change management JiveX around the world Focus: Healthcare IT Standardization Staying intelligent. Staying open.

2 Editorial»The users have come to understand the disadvantages of silo approaches in their IT strategy.«hans Willi Lohrke Sales Director International, VISUS Imagine our life without standardization a complicated mess when you are never sure whether your flat screen cable will fit in your PC s port or the nozzle at the gas station will fit in your car s fuel tank. Without standardization life would not only be more chaos it would also be more expensive since we could not benefit from all products being offered. In healthcare IT this painful state of affairs has continued for a long time and even today there are providers who stubbornly refuse to work with internationally recognized standards. The users on the other hand have come to understand the disadvantages of silo approaches in their IT strategy and when considering new systems they demand a high degree of interoperability. There is a perfect illustration of the benefits of standardization on digitization, professional healthcare delivery and overall hospital success: the Netherlands. Eleven out of 80 hospitals reached Stage 6 from 7 in the EMRAM (Electronic Medical Record Adoption Model) Scoring of HIMSS Analytics Europe. An impressive result! For this issue of VISUS VIEW we talked to Dutch hospitals and asked why exactly they consider standards such as IHE crucial and how they use these standards. And we show how VISUS contributes to the implementation of standardization strategies. Why does VISUS have anything relevant to say on this issue? Because we are proud to report four out the eleven Stage 6 facilities use the same hospital-wide solution for the management of medical data outside and sometimes also within radiology: JiveX. VISUS and the Dutch clients, that s a textbook case of cross-fertilization: we as a company benefit from the pioneering spirit of the Dutch users whose ideas have contributed immensely to the development of PACS-II and Medical Archive. And the uses appreciate the direct access to us via our Dutch partner Alphatron and they encourage our strict compliance with IFE profiles which ensures highly flexibility and deep system integration. Enjoy browsing through this issue of our international VISUS VIEW. Best regards Hans Willi Lohrke 2

3 Contents 18 Standardization of healthcare IT Successful hospitals are willing to invest and prepared to integrate VIEW News 4 Innovative image and diagnostic data management: Advanced Medical Systems adds JiveX to its portfolio 6 Dräger and VISUS live presentation at Medica Rest ECG moves to the Medical Archive 6 Breast imaging & PACS Clinique Grangettes opts for VISUS 8 Digitized ECG data are available campus-wide 8 Same procedure as every year Connecthaton Well connected worldwide Monika Rimmele joins international team VIEW Focus: Standardization 10 Standardization of healthcare IT Successful hospitals are willing to invest and prepared to integrate 12 In the forefront of digitization Dutch hospitals are well connected with JiveX 16 The US-American Meaningful Use Program Technology is the tool, not the goal 22 Risk and change management What if...? OverVIEW 18 JiveX ECG The little hospital revolution 22 Risk and change management What if...? VIEW Report 24 Fit for the e-health future Merian Iselin Hospital in Basle consolidates data in JiveX Medical Archive 26 JiveX in the South African Netcare Blaauwberg Hospital Top medicine requires top technology 28 Amphia Ziekenhuis Breda Radiology: the next player on the JiveX team VIEW Insights 30 Certified VISUS partners JiveX around the world 30 Certified VISUS partners JiveX around the world 32 JiveX 4.7 Individual diagnoses common archive KLAUS KLEBER S Straight Talk 34 Standardization of medical data Pre-consolidation consolidation 3

4 VIEW News Innovative image and diagnostic data management Advanced Medical Systems adds JiveX to its portfolio Singapore Advanced Medical Systems Pte Ltd (AMS), a leading expert for high-end medical devices systems and services in the Asia/ Pacific region, has added the innovative solutions of the JiveX product family to its portfolio. JiveX is a market-leading solution for hospital-wide display, management and archiving of medical image and diagnostic data in Germany. The cooperation between AMS and JiveX manufacturer VISUS will enable healthcare providers in the Asia/Pacific region to benefit from quality made in Germany. AMS will distribute the JiveX products in Singapore, India, Malaysia, Australia and New Zealand. As a certified VISUS partner AMS can draw on the necessary product knowledge to provide high-quality service and support to its customers. AMS is the only organization of its kind to offer a complete range of services required for successful operation of specialized turnkey healthcare facilities. AMS engagement can be right from facility inception, best-in-class equipment procurement, systems integration, project handling and supervision, clinical-user training, engineering maintenance to project financing. International standards for global and flexible IT solutions One of VISUS outstanding marks of quality is the application of international standards which allow flexible and vendor-neutral use of IT solutions. All systems are highly compatible and can be integrated seamlessly into existing IT infrastructures. Based on the users requirements JiveX is split into three product categories: JiveX Enterprise PACS Radiological image management from distribution through digital reading to revision-proof long-term archiving JiveX Integrated Imaging (PACS-II) Integration of non-radiology imaging and diagnostic data in DICOM and non-dicom formats (videos, biosignals, ECGs) JiveX Medical Archive Consolidation of the patient s complete set of medical data in one system for display on a single viewer Our customers are particularly interested in the option to consolidate all medical data in the Medical Archive since decentralized storage and archiving is a costly approach, both in terms of time and money. The JiveX Medical Archive offers the possibility to put all these data into a single system and make them available for display on a single viewer, says Rahul Kaul, Director, Product Management Asia Pacific at AMS. JiveX Mammography will be another focus at AMS. This highly specialized solution allows the presentation of mammography and tomosynthesis images. In Germany, it is used inter alia in the national breast cancer screening program. When we select a partner we look above all for know-how, reliability and service orientation. Thus we are convinced that AMS is the perfect match for the Asia/Pacific region. The Singapore-headquartered company has been an renowned player for more than 25 years and with its offices in Australia, Malaysia and India it has the necessary resources in place to service the customers locally, says Hans-Willi Lohrke, Sales Director International at VISUS. 4

5 is also available online! You can look forward to exciting and exclusive topics! You have missed an issue of the magazine? No problem, you can download all issues as a PDF file on our website.

6 VIEW News Dräger and VISUS live presentation at Medica Rest ECG moves to the Medical Archive JiveX at the Dräger booth Medica 2014 Exactly one year after the medical technology manufacturer Dräger and IT service provider VISUS announced their partnership aiming to integrate intensive care data in JiveX at Medica 2013 the first tangible results are here: at Medica 2014 ( , Düsseldorf) the companies presented the integration of 12-lead rest ECG data into the VISUS JiveX Medical Archive. The 12-lead rest ECG reports generated by the Dräger Infinity Monitoring systems are automatically transmitted to the VISUS JiveX Medical Archive. This approach has several advantages: JiveX Medical Archive, the VISUS management system for displaying and archiving medical data, provides a platform for patient-related data display on the JiveX Viewer. Transfer of data to other vendors image data management systems is possible and moreover the signal data are automatically routed to the HIS or the long-term archive. Integration of the 12-lead rest ECGs is the first step in a process. Further data will follow suit, said Herbert Schmidt, Marketing Manager Monitoring & IT, Europe Central at Dräger. A further step towards data consolidation For VISUS this cooperation is an important milestone on the road towards a unified and patient-centered archive solution. Already today we can store different clinical data in JiveX Medical Archive, be it ECGs, video signals, documents or image data in any format. With the integration of Dräger Infinity Monitoring we have even more options to process signal data from ICUs, explained Peter Rosiepen, Head of Business Development at VISUS in Bochum. Dr. Daniel Geue, Product Manager at VISUS, added: We are convinced that in 2015 we will be able to present more exciting news on the integration of vital signs from intensive care. Breast imaging & PACS Clinique Grangettes opts for VISUS Tomosynthesis has become an integral part of breast cancer diagnosis. Thus, there is an increasing need for solutions to manage and store the large data sets efficiently and pool them with other patient images and data. JiveX Tomosynthesis meets this demand by allowing management of both 2D mammograms and 3D tomosynthesis data in a single system. This practical feature convinced physicians and IT specialists at Clinique Grangettes in Geneva, Switzerland: they recently ordered two JiveX Tomosynthesis workstations and additionally JiveX Enterprise PACS via Medicor, the Swiss VISUS partner for women s health. Clinique Grangettes Geneva, Switzerland 6

7 VIEW News Our Sales Team will be glad to help you get acquainted with JiveX 4.7, its main functions and its practical use and value. Moreover, we will be there to answer your questions, discuss various topics which may interest you, and tell you more about our PACS solutions. We look forward to meeting you in person at our booth! Location: Vienna, Austria MAR Location: Utrecht, Netherlands MAR Connecting Healthcare IT April 2015 Location: Berlin, Germany Location: Basel, Suisse APR JUN Location: Düsseldorf, Germany NOV Location: Paris, France NOV Location: Chicago, USA NOV/ DEC Location: Dubai, UAE JAN Scan the QR code to find out more about our events. 7

8 VIEW News Digitized ECG data are available campus-wide Both IT service providers such as VISUS and medical technology manufacturers aim to make therapy-relevant data electronically available across the entire hospital campus. At MEDICA, which took place from 12 to 15 November last year in Düsseldorf, the Swiss medical technology manufacturer SCHILLER and VISUS demonstrated how a constructive technology partnership can achieve this goal. For some time the two companies have been cooperating on the enhanced integration and display of ECG data in image data management systems. Thus, SCHILLER provides its data in the internationally recognized DICOM format. The consistent use of this standard allows specific ECG system to be queried and the results to be automatically transferred to a DICOM archive. VISUS on the other hand has been expanding its image data management system JiveX to a comprehensive medical data archiving solution the JiveX Medical Archive. The physician can now call up all medical data with a single push of a button and review them on a unified viewer. In order to offer a real added value at both ends, however, bidirectional communication between the two systems is required. Thus the SCHILLER devices not only send their data to JiveX, they also generate their orders from a DICOM Modality Worklist provided by JiveX. The users and the companies themselves benefit from a close cooperation between IT service providers and medical technology manufacturers. We at VISUS for example learnt a lot from the partnership with SCHILLER with regard to the display of ECG data in a way that makes them really useful for the physician and offers many processing options, explained Dr. Daniel Geue, Product Manager at VISUS. Medica visitors had the opportunity to experience the practical benefits of this cooperation at the SCHILLER booth. Together with VISUS we set up a complete diagnostic workflow and showed how digital ECG data can be used across the hospital from order entry to the integration into the EMR down to copying the data onto a patient CD, said Johan Sandberg, Business Development Manager at SCHILLER. JiveX at the Schiller booth Medica 2014 Same procedure as every year Connecthaton 2015 From 20 to 24 April 2015 software developers of all renowned healthcare IT providers will meet in Luxembourg to test their systems for IHE profiles and inter-system compatibility. Just like last year, the test focus in 2015 will be on IHE XDS (Cross Document Sharing). This profile allows cross-institutional exchange of medical data a crucial issue in the further development of JiveX Medical Archive. The new trial implementation profile Digital Breast Tomosynthesis (DBT) will undergo initial tests in It complements the Mammography Image (MAMMO) profile, which was successfully tested last year, by offering display and processing of breast tomosynthesis images. Connecthaton Developer Conference Istanbul, Turkey 8

9 VIEW News Well connected worldwide Monika Rimmele joins international team Europe, Africa, Asia/Pacific the JiveX product family is already at home in all corners of the world. In order to strengthen this global presence and to be able to respond in an even more targeted way to the requirements of our customers in the individual countries and regions VISUS got expert support: since January of this year Monika Rimmele, based at the Bochum headquarter, has been in charge of Policy, international strategy and market development. The 30-year-old Monika Rimmele will analyze national markets and healthcare systems with the aim to identify needs, establish contacts to ministries and authorities and develop market access strategies. This newly created function is a clear commitment by VISUS to position the company internationally as a strong partner for modern and future-safe e-health solutions. We are fully aware that we need to understand the structures and idiosyncrasies of the individual markets before we can offer tailor-made solutions. Thus, one of the major tasks of Monika Rimmele will be to establish pre-sales contacts to the relevant stakeholders in politics, medical care and research in the different countries, explains VISUS General Manager Guido Bötticher. Monika Rimmele is perfectly suited to fill this new position: Before joining VISUS she was consultant for politics, strategic networking and government contacts at the German Association of Healthcare IT Vendors (bvitg e. V.) where she represented the association and the members interests in the political and institutional arena on national and international levels. Ms Rimmele is excellently connected both nationally and internationally and has in-depth experience of bilateral project development. As consultant with the German Ministry of Health she developed, coordinated and followed up on health policy projects in France, Mongolia, Russia and Ukraine. Monika Rimmele Manager Governmental & International Affairs, VISUS IT as a tool to master global challenges National healthcare systems may differ widely, nevertheless they all face similar challenges: demographic change, skyrocketing costs caused by advanced and expensive medical technology, an ageing and increasingly multi-morbid population and a looming shortage of care staff and facilities in remote areas. IT is the crucial tool to solve these problems in the long run and to make healthcare systems future-safe, Monika Rimmele says. A dedicated healthcare IT professional, she is convinced that products such as JiveX Medical Archive, which consolidates medical patient data in a single system, will become increasingly important: In order to tackle the healthcare system issues the stakeholders have to create tightly woven networks. The strategy to consolidate medical data and to promote standards-based data exchange will lead healthcare facilities into the future. And VISUS will help shape this future. 9

10 VIEW Focus: Healthcare IT Standardization Staying intelligent. Staying open. This is how VISUS defines standardization without a doubt the gateway to the future of healthcare. But what exactly does standardization mean and how can hospitals implement it? For the focus topic of our current issue we talked to experts as well as users to find out what standardization in healthcare means to them and what they expect from it. Standardization of healthcare IT Successful hospitals are willing to invest and prepared to integrate Standardization reduces process costs while across industries this is the most frequently heard argument to drive standardization, the healthcare sector looks at a second important objective: improving the quality of care. No matter which industry, standardization is inextricably linked to digitalization. This is the point of departure of EMRAM, the Electronic Medical Record Adoption Model by HIMSS Analytics: EMRAM measures the extent of digitalization in hospitals and the concomitant patient benefit thus providing insights on countries which are successfully optimizing their processes. HIMSS Analytics voluntary benchmarking process reviews institutional IT systems and their interactions and ranks the results on a scale from 0 to 7. While the parameters and the algorithms to measure the parameters are identical for all European hospitals, the results achieved across countries differ widely. Netherlands: Stage 6 In addition to the Northern European countries and such long shots as Spain, the Netherlands populate the top spots on the EMRAM leader board. In the Netherlands the market is split: on the one hand roughly 40 percent of all hospitals reached stage 2, 45 percent reached stage 5 and 13 percent reached stage 6. In absolute numbers 11 out of 80 surveyed hospitals reached stage 6 the second-best rank which requires the interaction of clinical documents with a full-fledged Clinical Decision Support System and a closed medication management system. That is an extremely high degree of digitalization and networking and thus standardization, explains Uwe Buddrus, Senior Consultant for HIMSS Europe GmbH. And in Germany? 50 percent of all hospitals idle at stage 0, close to 35 percent reached stage 3 and only 9 percent reached stage 5 or higher. For Uwe Buddrus these results reflect the different IT budgets of the individual hospitals: While in Germany, France or Italy 21 to 23 Euro per capita are allocated for IT investments and operating costs, in the Netherlands it s 64 Euro, in the US even 87 Euro. 10

11 VIEW Focus: Healthcare IT Standardization In addition the Dutch healthcare system is characterized by the willingness to invest and to establish even entirely new hospital information systems (HIS). Over the past seven years the HIS in all eight Dutch university hospitals were fully replaced. Such a change is an enormous project for the hospitals, entailing a lot and long-term stress. In order to drive standardization of processes you need not only money but also courage and perseverance, the HIMSS expert knows. Success factor: High degree of integration Systems that are flexible, open for integration and which offer a platform for the consolidation of medical data are the best predictors for high scores. These systems take data from various sub-systems and thus provide an overview of the complete data pool. The pool, unlike dispersed data of several silos, can be easily migrated to lead systems such as the HIS to provide a structured and consolidated view on the clinically relevant data. Integration of a plethora of sub-systems into the HIS for consolidation purposes however can be a veritable structural and financial nightmare for the IT team, says Uwe Buddrus: A lot of money has to be spent on interfaces and is thus no longer available in other areas. In addition, systems integration requires human resources. In the Netherlands, therefore, calls for tender often stipulate integrated and integrating solutions. This in turn requires the use of internationally recognized standards, such as IHE profiles, to ensure seamless integration into an existing IT infrastructure. Focus on internationally recognized standards The regions with above-average scores share one more important characteristic: they demand systems standards. In Spain, for example, the IT strategies are developed for entire regions and interfaces are considered extremely important as to enable communication across campus borders. In the Netherlands the hospitals are autonomous but communication is also considered important and consequently the implementation of widely accepted standards is actively promoted. In all facilities that score high on EMRAM we generally see a high degree of awareness with regard to standards, such as IHE, and compliance is requested in the tender documents. Such standards play a very important role on the road to fully electronic patient records and that s why we currently work with IHE Europe to align IHE profiles with EMRAM, says Uwe Buddrus. Structural differences are frequently said to account for the wide differences in scores. Mr. Buddrus has little patience with such an argument: In order to rank high on EMRAM it is entirely irrelevant whether the hospital has its own pharmacy or lab or whether these services are out-sourced. What s important is whether the data are available in digital form in an electronic patient record and can be easily accessed to inform therapy decisions. This is the only way to generate benefit for the patient and to sustainably improve the quality of care. Uwe Buddrus Managing Director HIMSS Analytics Europe

12 VIEW Focus: Healthcare IT Standardization In the forefront of digitization Dutch hospitals are well connected with JiveX Pioneers of technological progress often enough find themselves at the top of their industry. This holds true for Dutch hospitals which were among the first to implement a PACS structure outside the radiology departments. The rationale was to allow all departments generating medical diagnostic images to benefit from the advantages a widely accepted standard such as DICOM offers. Thus, hospitals addressed vendors such as VISUS represented by Alphatron in the Netherlands to develop suitable solutions. The outcomes were, from a clinical point of view, more than satisfactory: JiveX Integrated Imaging (PACS-II) and JiveX Medical Archive. Recently, 12 Dutch hospitals reached stage 6 (from 7) of the EMRAM (Electronic Medical Record Adoption Model) Scoring, four of them being longstanding JiveX users. Reason enough to have a glimpse behind the scenes and learn how and why IT solutions such as JiveX support hospitals on their way to digitization with the ultimate aim to improve the delivery of healthcare services for all patients. Standards paved the way The first striking insight when having a closer look at the institutions with a high EMRAM score is their unwavering focus on standards: Early on, Dutch hospitals recognized standards as DICOM or IHE profiles to be the basis of a successful IT strategy for the entire hospital. This is by no means a coincidence but a result of the constant and intensive efforts of the Dutch IHE organization. Evert Sanders, Chairman of the IHE user group: Ten years ago nobody knew about IHE and today even the Dutch government is looking towards IHE as a solution for interoperability in healthcare. This success is inconceivable without keen marketing, PR and lobbying. One difference to other countries is the fact that we demand a yearly fee from our members and use the money to promote IHE issues countrywide, Evert Sanders adds. Over the years the Dutch IHE organized workshops, meetings and worked hard to identify the right target groups and get them on board. In the beginning, IHE directed their activities exclusively towards IT staff, but, as the IHE expert stressed, those who must be convinced of the importance of standards such as IHE are the CEOs as well as the decision-makers in politics. Obviously the efforts paid off. Another point of contact for IHE was Nictiz, the Dutch center of expertise for standardization and ehealth, funded by the government. Nictiz, being extremely well versed in national and international healthcare IT standards, assist stakeholders in the healthcare sector to develop and implement information standards. In collaboration with Nictiz we created the position of a Technical Manager with the objective to take IHE knowledge into that organization and into the hospitals. At that time the 12

13 VIEW Focus: Healthcare IT Standardization government adopted a policy to establish a regional digital infrastructure for the cross-hospital exchange of patient data. Thus hospitals needed to make up their minds how to implement the policy. Nictiz was a trusted consultant for the regions which is why today IHE is well known within the regions and the government as well, Evert Sanders explains. Obviously the efforts bore fruit, because all JiveX hospitals which reached EMRAM stage 6, besides focusing on technological innovation, will only consider systems that are based on standards such as DICOM and IHE. Or the other way round: the strict IHE compliance VISUS supports JiveX is compatible with so many IHE profiles that it can completely standardize all medical objects makes the system a very attractive product for Dutch hospitals. 13

14 VIEW Focus: Healthcare IT Standardization Ziekenhuis Twente Ziekenhuis Twente, an 800-bed hospital, opted for JiveX Integrated Imaging to manage all data outside the radiology department such as photo files from dermatology, ultrasound images from gynecology, videos and voice chords from ENT or brain graphs and reports from neurology. Moreover, PACS-II is used to manage images that are submitted by external radiologists. With such a wide range of data types, formats and vendors, a high degree of interoperability is a must. But JiveX is not a one-way street, just collecting and storing data, but a system which is highly integrated into the workflows, as Bastiaan de Vries, responsible for JiveX in Twente, underlines: We use it as a general solution for storing and distributing images. Patient appointments are registered in the HIS. JiveX uses these appointments to generate a worklist. The ultrasound technician uses this worklist to access the patient data and starts the exam. During the exam he or she sends the images to JiveX for storage. The medical specialist can then review the images with the JiveX viewer for diagnostic and reporting purposes. We were able to reach EMRAM stage 6 only due to this deep integration with the entire hospital, which is based on the good communication between the systems in combination with our closed loop medication. Ziekenhuis Twente Twente Maasstad Ziekenhuis Last year, Maasstad Ziekenhuis in Rotterdam reached EMRAM Stage 6. In healthcare, mature information and communication technology is the Alpha and Omega for the delivery of best services, says Simon Vermeer, Information and Communication Technology Manager at Maasstad Ziekenhuis, and adds, Our investments in our electronic patient record over the last few years are now paying off. The hospital, ChipSoft, provider of the HIS Ezis, and Alphatron Medical, Dutch sales partner of VISUS, closely cooperate in order to be able to link diagnostic, lab and imaging data and reports in the most efficient way. The aim is to make all data available in a complete and integrated format and for everybody who is involved in the care chain in order to further increase patient safety. In their report HIMSS Analytics Europe were particularly impressed by the outstanding integration of all image data into the electronic patient record. Images and their corresponding data are inseparably linked; good and complete integration is a conditio sine qua non of any intelligent EPR, concludes Simon Vermeer. 14

15 VIEW Focus: Healthcare IT Standardization Amphia Ziekenhuis At Amphia Ziekenhuis in the Dutch town of Breda JiveX Integrated Imaging has become a mainstay of data management and handles all data outside of radiology. In the context of a new HIS and in order to meet the internal standardization targets however the hospital will implement JiveX Enterprise PACS in the radiology department (see report on page 28). The decision to use JiveX products within and without radiology seemed natural in view of two important facts: firstly, they integrate well with the HIS by Epic, a provider who also sets great store by the use of IHE standards; secondly, they facilitate safe image data exchange with external partners throughout the region. Cross-sector data exchange requires the use of standards by all parties involved: the HIS, the external party and VISUS. JiveX simply is widely applicable as an enterprise archive. It provides numerous types of access possibilities via review client and webclient that can be integrated into the workflow in combi- nation with the EMR (Electronic Medical Record). Ordering and DICOM worklist, thus the complete workflow will be driven by the Epic EMR. This is already the case in nuclear medicine, dental surgery, cardio echo and will soon be implemented in radiology and ophtamology. In short: JiveX is really flexible and adaptable to the workflows, says E. Scheepers, Medical Physicist, and adds: It is a modular product with a wide range of modules for the entire hospital. It provides a flexible viewing platform: Two applications, generic and specific, for the entire hospital. Moreover, JiveX offers several tools to connect non-dicom sources and workflows to the platform in DICOM: print2pacs, import2pacs, scan- 2pacs, AMG, DICOM. At Amphia Ziekenhuis, it was the design of the Epic EMR supported by JiveX s streamlining of workflows throughout the entire hospital which made HIMSS stage 6 possible. Ziekenhuis Maasstad Rotterdam

16 VIEW Focus: Healthcare IT Standardization The US-American Meaningful Use Program Technology is the tool, not the goal In 2009 the Obama administration earmarked US$29 billion to speed up nationwide implementation of IT in the healthcare sector. The aim was to improve quality and sustainability in healthcare. The program for is based on incentives: Hospitals and physicians who took part from the beginning on receive up to US$44,000 during a five year period if they fulfill the requirements of the so-called Meaningful Use Program. One of the architects of this huge program is Dr. Doug Fridsma whom we met in Berlin at a symposium organized by bvitg. Doug Fridsma was Chief Science Officer and Director of the Office of Science and Technology of the Office of the National Coordinator for Health Information Technologies (ONC); he is currently CEO and President of the American Medical Informatics Association (AMIA). VISUS VIEW: Dr. Fridsma, Stage 1 of the Meaningful Use Program started in 2011 and was about data capture and sharing. What did you achieve in that stage and what were the pre-conditions with regard to the electronic health record? If I were to characterize Stages 1, 2 and 3 of the Meaningful Use Program I would say that all of them have got something to do with data capture. What was most important in Stage 1, though, was the adoption of the electronic health record. The focus was on getting people to think about how they can transit their work processes and information systems from paper records to electronic records. Stage 2 is much more about exchange for example about prescriptions being sent electronically or caregivers who provide a mechanism for a patient to obtain a copy of the record in an electronic format. When we started the program, the general practitioners were particularly slow to adopt it; the hospitals had a higher rate of adoption. During Stage 1 we moved from about 17 percent to now 65 percent electronic adoption. With Meaningful Use it is important to know that we focus on very clear objectives. Meaningful Use was never intended to provide comprehensive specifications for every function an electronic health record might be able to do. We focused on a very specific matrix and we tested the electronic health record for those specific functions, for example capturing specific health information or information that is useful to measure the quality. VISUS VIEW: Did you involve the users before you defined your requirements? We had a lot of input in setting up the criteria. We had two committees and almost a year of bi-monthly public hearings. Every month we would have a hearing and discussion in the public about the requirements, the policy objectives and the standards. We got a lot of input from the public. It was important for the certification program to be aligned with 16

17 VIEW Focus: Healthcare IT Standardization VISUS VIEW: What else did you do to get such a good response from users? One of the fundamental principles of Meaningful Use is that technology is a means to improve clinical outcomes, not an end in itself. Meaningful Use demonstrates that you use technology to calculate clinical outcome or to improve efficiency by exchanging information electronically. Our task at ONC was to ensure that the software can meet those clinical objectives. Therefore many certification programs focused on making sure that very specific functionalities were present. VISUS VIEW: Recapitulating the first stage: Which trends became visible, best of breed or monolithic systems? It is difficult for a single solution to solve all of the problems in such a diverse environment like the US healthcare system. Thus, in order to make sure that we provide the best solutions we focused on certain building blocks such as a certain vocabulary, certain kinds of standards for the structures and privacy and security concerns. Now, if a company has a really good approach to writing electronic prescriptions but is not interested in managing laboratory tests, it can get certified for this smaller component. Thus we provide the opportunity for smaller or niche companies to contribute a certified product in a larger set-up. Some vendors would actually create a comprehensive electronic health record that had all the functions that you needed to fulfill MU, a kind of a complete EHR. But the certification program allowed for both approaches: full and partial system certification. electronic version of the document to integrate in their electronic record. The third objective is to make sure that patients are empowered. In some countries you are not allowed to share information, in others it is very common. We are convinced if you have a common standard for a care summary, with a vocabulary that is small and that can be translated easily, you provide the opportunity for a patient to be part of disease management. VISUS VIEW: When you look at your work is there any advice you can give other countries working on the implementation of an electronic health record? Don t be afraid of getting things out that are not perfect solutions. Take small steps because you learn a lot from the first experiences that you can apply to the second and the third steps. the requirements of the technical specifications in meaningful use. Most electronic health records provide much greater functionality but we focused on those which were important for quality assessment, for public health and for exchange and access for patients and other caregivers. VISUS VIEW: You are not only involved in the US developments but also meet regularly with your EU colleagues. Is there a common ground for the US and the EU? There are three main goals we are trying to achieve. The first is to look at the vocabularies and the nomenclatures we use to standardize meaning and to see if we can identify an international subset. If there is a smaller subset that represents the most common diagnoses, it makes it easier for countries to translate those. The second area we look at is identifying either a collection of different things that would help us describe a care summary and which could serve as a focus point for an international care summary standard. So if you have a health emergency in Germany and then return to the US, the US facility can obtain an Dr. Doug Fridsma former Chief Science Officer and Director des Office of Science and Technology of the Office of the National Coordinator for Health Information Technologies (ONC), is current CEO and President of the American Medical Informatics Association (AMIA). More information on Meaningful Use Program: 17

18 OverVIEW JiveX ECG The little hospital revolution Nobody has ever counted the number of trees that were felled to produce ECG paper. Quite a lot, obviously, since the ECG is next to pulse or blood pressure measurements the most frequently performed examination in any hospital. While in the past years many processes that produce hard copy were digitized, the paper-based ECG has remained the physicians most faithful companion. High time to get rid of this antiquated procedure thought the developers at VISUS and came up with JiveX ECG. This module takes ECG data, transmits them to the PACS, offers digital post-processing tools and makes the ECG available on mobile devices across the entire hospital. In short: JiveX ECG allows ECGs to be handled as comfortably as digital x-ray images and ECG paper may face a similar fate as the lightbox in radiology: obsolescence. And similar to digital x-ray and PACS, which revolutionized the radiology workflow, the integration of ECG into the PACS is something of another small revolution. That s at least what the users say who work with JiveX ECG. Integration into the archive structure Modern ECG systems, to be sure, do offer the option to view the electrocardiogram right on the ECG monitor. Albeit in real clinical life stationary ECG reading is extremely awkward since this is one of the tasks most physicians do on the run at the desk or during a consultation. Moreover, as an ECG that was generated in the emergency department has to be made available to the cardiologist a printout was well-nigh indispensable. By integrating the ECG systems into the PACS archive structure we can do without the hard copy since all PACS data are available across the hospital. Another advantage: the ECGs are displayed on the same viewer as all the other data generated by systems and modalities that are linked to the PACS. Thus data that belong together can now be viewed together, says Michael Ziller, Head of IT at Bethanien Hospital, Moers, Germany. Two years, ago, the facility decided to implement JiveX Integrated Imaging (PACS-II) to manage and archive all data outside of radiology. Next to the integration of endoscopy, sonography and the cardiac cath lab the integration of the ECG data had top priority. Round-trip: to HIS and back Since the implementation of PACS-II all relevant diagnostic data are consolidated in one system and can be easily accessed and viewed a fact which immensely facilitates and speeds up the diagnostic process. And via a HL7 interface the data can even be sent to the HIS. Such a deep integration requires data to be in the internationally recognized DICOM format and indeed many renowned ECG system manufacturers 18

19 OverVIEW 19

20 OverVIEW» No more double entry of patient data when an ECG is needed. This saves time and increases patient safety since another source of errors is eliminated.«have migrated their devices from XML to DICOM. With older models, JiveX ECG simply converts XML data to DICOM. Deep integration with the HIS not only enables smooth export to HIS but also smooth import from HIS. This bidirectional communication significantly optimizes the clinical workflows as ECG requests can be generated right in the HIS, Michael Ziller is pleased to report. ECG readings can also be entered directly in the HIS and are available across the entire facility by mouse click when the physician s letter or discharge report has to be prepared. The team at St. Lucas Andreas Ziekenhuis in Amsterdam also uses JiveX as PACS-II and is equally pleased with the optimized workflows. When new DICOM-enabled ECG systems were purchased their integration into JiveX was a veritable piece of cake. When we got the new ECG systems we reviewed all our processes and changed them to match the digital archive structure, explains Thiemo Steen, ICT consultant at St. Lucas Andreas Ziekenhuis. Ever since, ECG requests are generated in the HIS by the clinical assistants and sent to the JiveX worklist. The ECGs call up the requests from the worklists and send the results back to the HIS. This procedure ensures that ECG and patient data always match and that all ECG data are forwarded to the electronic patient record. Be it in cardiology, internal medicine or the emergency department everybody needs ECGs. Right away! With JiveX we can quickly process the requests and can even assign priorities, adds Sabine Dorland, ICT project manager at St. Lucas Andreas Ziekenhuis. 20

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