ehealth in Austria -- National Strategy and Regional Approches Dr. Thomas Schabetsberger Masterclass, 23-Jul-2007 UMIT, Hall in Tyrol

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1 ehealth in Austria -- National Strategy and Regional Approches Dr. Thomas Schabetsberger Masterclass, 23-Jul-2007 UMIT, Hall in Tyrol

2 Agenda Introduction in the Austrian health care system and ehealth key facts Vision and scenario 2014 Technical solution architecture Data protection and security aspects Discussion

3 Austrian Health Care System / 1 Key data: 8,23 Mio citizens 264 hospitals (63000 beds) ~15000 GPs (and resident specialists) ~2000 pharmacies Relation: Germany = x 10 National health-insurance system as part of the comprehensive social security system Costs: 10,2 % of GNP (state: 7,2% ; private: 3%)

4 Austrian Health Care System / 2 Increasing... Live expectancy and multi-morbidity Amount of information Specialisation in medicine Costs Needed modern ict-tools to better support/enable cooperation and integrated care... already commonly used by health care providers... networking between health care provideers logically the next step

5 Austrian Health Care System / 3 Germany Vorarlberg Salzburg Italy citizens, ~12 hospitals, ~1500 GPs

6 Definition of ehealth ehealth is an emerging field in the intersection of medical informatics, public health and business, referring to health services an information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care worldwide by using information and communication technology Eysenbach,2001

7 ehealth in Austria e-card introduced all over the country in Provides also physical network infrastructure to health care providers. Austrian ehealth Initiative finalised a strategy for networking the institutions of the health care system in Feasability study analysed existing projects, standards, activities in 2006 and developed organisational and technical scenarios for EHR. National ehealth coordination office established in Coordinated decisions: Architecture based on IHE-XDS, CDA In Tyrol and NOEMED-WAN in Lower Austria are precursers for EHR in Austria.

8 key facts Research project since 2002, realises prototypes with the general AIM of the Electronic Health Record. Coordination at CEMIT and UMIT. Cooperation with industrial partners, other universities and international research institutions. Cooperation with the Austrian Medical Association, state health insurance and other occupation groups of the health care system. Team of about 10 members.

9 objectives creation of a cross-institutional health care network (Shared Electronic Patient/Health Record) secure communication between health care actors (hospitals, laboratories, pharmacies, etc) electronic transmission of medical results communication plattform between inpatient and outpatient domain access to medical data by citizens/patients

10 Vision: customer centered communication between health care provider change of this provider-oriented, directional transmission of reports and findings towards a more customer-centered provision of reports and findings would support cross-institutional information-processing, and would therefore also improve the quality and efficiency of the health system and increase the safety of medical treatment and compliance Ball, 2002

11 Solution: virtual cross-institutional Electronic Patient Record distributed customer centered model (vs. provider oriented) information resides at producing health care institution, but is shared with other actors high potential for quality improvement and financial savings socio-technical integration of all actors necessary

12 visions & scenarios 2014 Citizens expect guarantee of the highest possible degree of data privacy protection and security access to one s own health record and control over access rights medical contents should be adapted for patients possibility to add personal entries and to keep medical diaries

13 visions & scenarios 2014 Doctors expect prompt access to treatment relevant information (medical history) adapted visualization of information and emergency data set (i.e. list of medication and latest diagnoses) emergency access without explicit consent of the patient (but with documentation in his medical file - the patient must later be notified of this) electronic transfer of charges to the health insurers electronic prescriptions and confirmation whether a medication was picked up or not

14 overall requirements guarantee of highest possible data security, high scalability / extensibility and high availability, avoidance of a single point of failure or a single point of attack consideration/integration of existing infrastructure and request of distributed data storage, cost-saving operation (no additional data processing centers) avoidance of information flood for medical professionals rebutting doubts regarding the transparent patient or also the transparent doctor strong request for an Open Source solution

15 challenges non-existence of a common patient-index non-existence of well-established and accepted standards

16 Process of a cross-institutional comm. Through fully- or partially automated sequential step-by-step-handling of these four levels a cross-institutional medical inquiry can be realised, under preservation of data protection regulations.

17 System architecture / main services basic concept for document sharing provider manages his own document repository and document index in case of search for patient data: automatic search in all relevant indices index gives description and link to document (independent of physical location) realization of basic concept based on IHE-XDS usage of open source components web service technology, IHE XDS framework access by open interfaces

18 Security concept Check if requesting user is allowed to call this service SERVICE Certificate Secured WS Call Secured WS Response Check service roles USER Certificate REQ RESP Check user roles WS Call XDS Actor Components configured through XACML, WS-PL Check if requesting service is allowed to call this service Configured by XACML, WS-PL Basis: role based access control (RBAC)

19 Networking solutions (local node) For institutions without an own repository or registry (such as GPs, etc.). For institutions with an already existing repository (archive), or institutions who would like to provide the registry functionality. For institutions who would like to stay fully independent and host its own repository and registry (such as big hospitals). connectathon approved

20 Networking solutions (community node) For regions or countries to network 1..n local nodes or XDS actors. Provides also a master patient index. For regions which would also like act as a XDS affinity domain and communicate with other affinity domains (regional / national / international)

21 Networking solutions (portals)

22 Vision: Networked Health Care System in Tyrol XDS Affinity Domain Tyrol

23 security summarisation Only indices in SEHR (no patient demographic data) Medical information stored at producer site NO central component Encrypted communication, based on certificates

24 current state Several Prototypes finished (shows and legal technical feasability) First node currently established at Innsbruck University Hospital, other nodes will follow this year conform with Austrian ehealth strategy (EHI) and law based on existing and approved web service technology usage of secure e-card / e-government infrastructure scaleable up to a nation wide (Europe wide?) secure healthcare network

25 discussion realization of Shared Electronic Patient (Health) Records likely within next few years tight cooperation between stakeholders necessary stepwise strategy was useful for gaining knowledge and receiving quick results IHE-XDS provides a realistic and approved way for networking health care facilities. Standardised interfaces ensure vendor-independent interoperability. Broad discussions with patients and stake holders, legal adoptions and semantic standarisations are needed before nation wide rollout is precursor in Austria, has ambitions for Nation / Europe wide model project Similar networking approaches in several countries all over the world (Spain, France, Scandinavia, US, Canada, Australia, South Africa,...

26 Thank you for your attention! Dr. Thomas Schabetsberger

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