Experiences with Personal Electronic Health Records in the Rhine-Neckar-

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1 Experiences with Personal Electronic Health Records in the Rhine-Neckar- Region Prof. Dr. med. Björn Bergh Chairman Dept. of Information Technology and Clinical Engineering Professor for Medical Information Systems Oliver HEINZE, Antje BRANDNER

2 Once upon a time... Our story 2

3 Previous experiences in Telemedicine Teleradiology Teleneurology Tele-oncology (pediatric) Home Care Monitoring. 3

4 Learned The usage of separate Telemedicine components is beneficial but: Information from all HIT-systems and Home Care belongs together!! Prof. Dr. Björn Bergh

5 Solution: a cross-institutional record 5

6 Patient + Family Vision i 1 Communication PHR Node i Module Phone, Video Conf. HC Professional Sens sors Sensor Platform Shared Care Record EHR PHR Record of TMC IT systems HIS/CIS TMC system GP system Pharmacy system Prof. Dr. B. Bergh - ZIM

7 EMR, EHR and PHR Record type Characteristics Main Advantages Main Disadv. BB4 EMR Electronic Medical Record All clinical data of a patient to document, monitor and manage care delivery in one institution Case-based accessible within the care delivery organisation (CDO) Not accessible for other doctors or the patient EHR Electronic Health Record Subsets of each CDO s EMR presently assumed to include summaries (CCR, etc.) Longitudinal access across multiple institutions Viewing in other CDOs possilbe Easier data import from professional systems (high quality and completeness) No patient involvement for viewing and access management PHR Personal Health Record Contains patient input (home care devices, diet, sports). Acess for multiple institutions is managed by the patient Fully controled by the empowered patient No automated data import from other systems

8 Slide 7 BB4 user/target groups Prof. Dr. Björn Bergh; г.

9 Two main issues anticipated Architecture and systems integration with standards Ensure patient s right for data privacy 8

10 Integration with standards? Existing ehealth standards 9

11 Integration with standards? Existing ehealth standards Understandable and complete 10

12 Integration with standards? Existing ehealth standards Understandable and complete Industry accepted and Implemented (EHR) 11

13 Integration with standards? Existing ehealth standards Understandable and complete Industry accepted and Implemented (EHR) Industry accepted and Implemented (HIS-CIS) HL7 + DICOM => IHE 12

14 Data Privacy and EHR ehealth + EHRs are totally safe! Goya Goya

15 EHR Data privacy study - Methods Requirements analysis Patients Physicians Data privacy officers Review federal and state regulations => High level requirements Technical capabilities Access concepts HIS-CIS systems Access concepts EHR projects and vendors Matching requirements and capabilities 14

16 EHR Data privacy study - Results No concept fulfils all needs!!

17 Data Privacy and EHR ehealth + EHRs are totally safe! They most certainly are not! Goya Goya

18 Solutions? Open access and logging (patient controls) Give the power to the citizens/patients 17

19 Our decision: Focus on the citizen/patient Grant Wood

20 Vision i 2 - PEHR Patient Decides -who sees what - sees all accesses - chooses provider Care providers Communicate only via the PEHR with each other TELEMED Award 2008

21 How did do it?

22 Partner InterComponentWare AG Walldorf Product: Professional Exchange Server (PXS) MPI and Record Module (EHR) Lifesensor (PHR) CHILI GmbH WADO+ Gateway + DICOM Webserver Rhine-Neckar Health Centers (GRN ggmbh): 4 Hospitals (1000 beds) Specialist practices (2 oncology) University Hospital Heidelberg (2000 beds) Maximum medical care inpatients/a outpatients/a

23 PEHR Scope Rhine-Neckar Region about 2,4 Mio. inhabitants 1 Phase: EHR 2 Phase: EHR more practices and hospitals 3 Phase: PEHR

24 Technical concept

25 Patient allocation and document sharing MPI: Meier HIS 1= 1234 HIS 2= 4711 Hospital 1 ISIS/PXS Hospital 2 Patient data MPI Patient data HIS 1 encounter, diagnoses, documents EPR encounter, diagnoses, document-ref. HIS 2 viewing Web viewing EPR: Meier OP-Report HIS 1 Discharge Letter HIS 2

26 Interfaces - MDM IS-H / i.s.h.med File system MDM-Builder (Auf ISI05) push /sap/med/isis/ pull 1. x.hl7 2. x.doc 3. x.ok push PEHR push Enterprise Service Bus (Auf ISI05) pull File system (ISI05 ESB HD-intern) /ISIS/MDM/ x.mdm Message and Document Flow

27 Patient allocation, document sharing and integration of PACS Hospital 1 ISIS/PXS Hospital 2 Patient data MPI Patient data HIS 1 encounter, diagnoses, documents EPR encounter, diagnoses, document-ref. HIS 2 viewing image-ref. Web viewing viewing Web Web image-ref. Web PACS 1 images PACS image-request PACS 2

28 Summary HIS / CIS Interfaces: feasible but complex RIS/PACS Interface: feasible, complex too, but not sufficient Implementation ti of consent management: decentralized d works fine but several disadvantages, centralized feasible, but has to be implemented yet Connection with GPs: until now unsatisfactory Data security: No problem: SSL encryption, certificates Privacy: Highly complex but acceptable, preliminary acceptance of data security officer Access rights: feasible but complex with restrictions: pro PEHR New processes inside units have to be implemented (sending trigger, consent) : problem of acceptance, sometimes top-down approaches required

29 Thank you! University Hospital Heidelberg Center of Information Technology and Medical Engineering (ZIM) Tiergartenstr Heidelberg Germany Oliver Heinze (M. Sc. in Medical Informatics) Mail Fon Antje Brandner (M. Sc. in Medical Informatics) Mail Fon Prof. Dr. med. Björn Bergh (Director ZIM) Mail Fon

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