Presentation Agenda. TILAK Clinical Information system CERNER Millennium. Introduction on Tilak. TILAK Hospitals

Transcription

1 Presentation Agenda TILAK Tiroler Landeskrankenanstalten G.m.b.H. Introduction of Tilak Tilak s Millennium Project Examples of implemented Millennium Functions Project Management Folie: 2 TILAK Clinical Information system CERNER Millennium Immanuel Wilhelmy Introduction on Tilak Department for Information Management Clinical Information System s Group Tiroler Landeskrankenanstalten GmbH Innsbruck Austria Folie: 3 TILAK Tiroler Landeskrankenanstalten GmbH: Management Holding, owned 100% by the Government of Tirol TILAK Hospitals Tyrol: population: area: km 2 TILAK is responsible for 5 Hospital Sites, including the Medical University Center Innsbruck, with about ~ beds and ~ employees. With the Hospital in Schwaz TILAK is having a Management Cooperation to run the Hospital. Folie: 8 LKH Hochzirl 200 beds 270 empl inpatients 18.1 avg LOS CERNER Millennium LKH Natters 164 beds 206 empl inpatients 5.6 avg LOS INNSBRUCK UNIVERSITY MEDICAL CENTER 1600 beds empl inpatients 5.0 avg LOS PKH Hall 275 beds 314 empl inpatients 16.4 avg LOS LPK Hall 110 beds 92 empl days of stay Folie: 9 1

2 Site View of the Medical University Innsbruck University Hospital Innsbruck 23 Univ.-Clinics 62 Operation Theaters ~ Surgeries p.a. ~ Beds ~ Staff (1.000 Physicians) Inpatients p.a. 5.1 Days avg. LOS Outpatients p.a. Folie: 10 Folie: 11 University Hospital Innsbruck - Patient Care - Research - Teaching (400 new medical students p.a.) IT Strategy Folie: 12 Clinical Information System: Expectations Management: a tool for strategic controlling, quality management costs IT Department: get a lean system environment, avoid sub-systems long-term: a reduction of software license and service costs, avoid scattering of system know-how Clinical Information System: Expectations Physician: high availability of reliable information, better overview (inter-departmental), reduction of administrative tasks, support of medical documentation, more time for the patient, support of scientific work Nurses: facilitation of administrative tasks, high availability of reliable information, support of care planning / outcome Folie: 14 Folie: 15 2

3 Clinical Information System: Expectations Patient: no duplicate questioning no duplicate examinations historic information (quickly) available optimum treatment IT-Systems TILAK [Lechleitner03] EIS Resource Management Systems Advanced Applications Operational Systems Datawarehouse (SAP-BW) / OLAP SAP-HR Other Resource Planing Systems SAP SAP IS-H Accounting PAS Simulation/ Reconstruction CERNER Icoserve-AIM EPR, Clinical Image Information System Management Operational Departmental Systems Lab Facility Management Surgery- Management RIS/ SIS/ NIS PACS Radiodiagnostics Office Software Internet / Intranet / Office / Folie: 16 Folie: 17 Strategic IT-Systems at TILAK Laboratory SAP Accounting. Controlling Human Res. SAP IS-H PAS Billing CERNER Millennium Clinical Information System Bloodbank Radiology Image Management + PACS Tilak s Millennium Project OP-Theatre andere other Med. Spezialsysteme medical Subsystems Administrative Systems Clinical Systems Folie: 18 Base -System at TILAK Integration with MPI SAP IS-H: 1.3 million patients, encounter, real-time sync 'real-time'-patient lists (outpatient/inpatient) Organisational structure, cost center structure Inbound interfaces: labs (ZL, MHL, Hem, BB, MC), radiology1 (MEDORA), radiology2 (MagicSAS), anatomic pathology, nuclear medicine,hygiene (serology),... Security concept (based on role, organization, relation), shielded psychiatric departments (inpatient) diagnosis and procedures coding System Integration Strategic aspects all validated patient data within enterprise are stored in Millennium EPR one single access to the enterprise wide EPR prerequisites: sending system meets HL7 standard (minimal set) Technical view on the flow of data system integration systems exchange ADT, ORU, ORM, DFT and BAR messages to support clinical flow of information and workflow Folie: 20 Folie: 21 3

4 simplified view IT Topology at Tilak TILAK Millennium Project History TILAK Millennium Project started in 1999 Achievements of the Primary Project -1 ( ): TILAK wide implementation of Scheduling TILAK wide availability of PowerChart TILAK wide accessible EPR Implementing DTS Transcriptionist as report writing tool Supporting Physician and Nursing Documentation with now more than 200 Forms Integration of TILAK s Advanced Image Management System AIM Extramural communication via Austrian Medical Networks Piloting PathWays for nursing Folie: 22 Folie: 23 Implementation Status Functions 1/3 Target: develop metrics to monitor IT-coverage in TILAK hospitals catalogue of IT-functions covering all (clinical) mid term needs assess all departments for their current coverage rating: availability of functions usage of provided functions Folie: 24 Patient Administration Outpatient Management Scheduling Lab Ordering Rad Ordering Inpatient Procedure Coding Outpatient Procedure Coding Register patient, patient lists Patient tracking, results workflow, task lists Appointment books E-Orders to central Lab E-Orders to Rad- Dept s ICD-10, MEL (for billing) Regional cat. (for billing) SAP IS-H SAP IS-H, Folie: 25 Functions 2/3 Functions 3/3 Inpatient Nursing Documentation Outpatient Nursing Documentation Discharge Letters, Results Special Documentation Results Viewing Surgery planning and documentation Clinical Pathways Incl. nursing plans (Powerplan) Nursing anamnesis, status Powerforms, Genviews Powerchart Interdisciplinary ICP SAP IS-H Folie: 26 Scanning Multimedia Patient Record Digital Transmission of Results Vital Parameters Medication (inpatient) Medication (outpatient) Jpeg, wav, mpg Replacing conventional mail Temp, blood pressure, medical device interfaces fever chart Prescriptions AIM, AIM,, PDMS Folie: 27 4

5 Coverage - Rating Implementation Depth - coded in colours Usage Availability Folie: 28 Folie: 29 Interpretation Vertically: green: rollout completed red: function (currently) not implemented/available Horizontally: green: department has high overall usage of IT ( early adaptor ) red: maybe organisational problem Implementation Highlights Trauma Surgery (FirstNet) workflow, ordering, Physical Therapy pre-admit, ordering, task lists, documentation, outpatient procedure documentation Emergency Centre MZA Structured Physician Doku Neurology Scheduling (since 1999), Transcription (since 2000) Office MedText centralized transcription service Nuclear Medicine PowerPlan, LabOrdering, PowerForms, Tasklists Dept of general and transplant surgery Firstnet: full usage of patient tracking and e-ordering (Rad and Lab) Folie: 30 Folie: 31 Functions rolled out Scheduling Discharge Letters, Findings (Transcription) Diagnosis and Procedure Coding Results Viewing Interfaces Lab, Rad, Bacteriology, Hygiene, Pathology (PathNet) Integration with Patient Administration System on line patient lists PACS-Integration Extramural communication (discharge letters) Nursing Documentation, Powerplan Scanning New Functions Planned / under Development Medication risks: medication catalogue, workflow and emar (data presentation) Fever Chart interactive summary of orders, medication, vital parameters; supporting different views (morning round) and workflows e-health integration IHE-compliant extramural communication from push to pull first step in direction of national EHR Folie: 32 Folie: 33 5

6 Implementation Strategy Key Data of Millennium Usage at Tilak Functional Depth PILOT... reporting order management struct. documentation Multimedia-Integration diag&procedure coding scheduling information system documentation (dts-transcriptionist)) ROLL OUT Parameter Value Departments 36 Registered Users ~ Concurrent Users at peak times ~ 450 Installed PC Clients ~ Documents written in CERNER Millennium (per month) ~ Radiology findings fed into the system (per month) ~ Scheduled Appointments (per month) ~ rolling out functionalities Folie: 34 Folie: 35 Partners in TILAK s Millennium Project Cerner Corporation Information Technology for Healthcare (ITH) Computing Center ARZ Examples of Millennium Functions implemented at Tilak Icoserve University of Health Informatics And Technology Tyrol Folie: 36 Folie: 39 Scheduling Scheduling was one of the first Millennium applications used Tilak-wide used by almost all Tilak clinics approximately patient appointments are being booked per month cross booking saves time (no unnecessary phone calls) complex appointment structures can be booked via protocols Reason why we started with the Scheduling Application: to gain acceptance right from the beginning by rolling out a functionality that immediately created benefits for the users Scheduling Folie: 40 Folie: 41 6

7 Outpatient Scheduling PowerChart Physician Outpatient unit appointments Check-In/-Out browsing Ward Checkup appointment browsing Checkup appointments waiting list browsing Direct entry (quota) Service Provider PowerChart: Millennium s core application integrating the Electronic Patient Record (EPR) and the Clinical Workplace for physicians and nurses PowerChart covers different medical information and workflow demands patient s demographic and encounter information clinical result display (flowsheet) electronic ordering (ordering tab) electronic forms for structured documentation special functions, such as FirstNet for tracking emergency patients etc. Folie: 42 Folie: 43 A Virtual Tour... The EPR at TILAK - a Virtual Tour Starting Point: the online patient list at ward Folie: 45 A Virtual Tour... Starting Point: the online patient list at ward Patient search (if patient is not on list) Folie: 46 Folie: 47 7

8 A Virtual Tour... Starting Point: the online patient list at ward Patient search (if patient is not on list) Results overview Folie: 48 Folie: 49 PowerChart Electronic Patient Record Folie: 50 Folie: 51 Patient Information Diagnosen Folie: 52 Folie: 55 8

9 Leistungen Folie: 56 Folie: 59 Pilotierung: Onkologiezentrum Folie: 60 Folie: 61 Folie: 62 Folie: 63 9

10 Structured Documentation via PowerForms Special Overview for Outpatient Units Folie: 64 Folie: 65 Free Text Documentation Text documentation (findings and discharge letters) MS Word-integration Automatic integration of stored data in documents,» e.g. surgery-reports, emergency reports. Authentication workflow Security concept / Publish-Level Results and Arztbrief Different types of workflows central responsible physician (e.g. head of outpatient department) documents are authenticated by head of department pool of transcriptionists (proxy, common task list)... To be defined: at which step is doc finalized no changes possible, ready to be mailed? who is authorized to authenticate a document? Folie: 66 Folie: 67 Results and Arztbrief Workflow: Results / Arztbrief Experiences types of workflows have to be discussed thoroughly with clinicians and the well defined. Main problem: communication of chosen workflow (who is really authorized to authenticate document) Acceptance: work is tightened to PC communication of desired / made changes is difficult (no means within system) additional efforts BUT: good availability of trusted documents is a striking feature Folie: 68 Junior Doctor Not OK OK Secretary Senior Doctor Not OK OK Printing Mailing Filing into Paper Chart Folie: 69 10

11 DTS-Transcription Entry Word Integration Electronic Validation of transcribed Documents via In- Box Folie: 70 Folie: 71 Medical Documentation: Security Model Dokumente in KIS Enterprise - Wide EPR (Findings, Discharge Letters, Diagnoses, Problems,...) Pub.Doc. Int. Doc. Pub.Doc. Int. Doc. Pub.Doc. Int. Doc.... Pub.Doc. Int. Doc. Dept A Dept B Dept C Dept.. Internal Documents only visible within Department, e.g. Decursus, internal remarks,... Folie: 72 Generating Letters from Forms Emergency Report Structured form for entering data Document template draws in all information from form inserts units etc. builds readable sentences if defined Folie: 75 Folie: 76 11

12 ICD-10 and MEL-Coding via HCC Folie: 77 Folie: 78 FirstNet Millennium s Solution for Emergency Departments and Patient Tracking PowerChart: FirstNet Integration for Emergency Units Frisch, Liegend Folie: 79 Folie: 80 Ordering X-Ray or Cast from Tracking List Frisch, Liegend Workflow Control via Tracking List Frisch, Liegend Folie: 81 Folie: 82 12

13 Workflow Control via Tracking List Symbol in Tracking List shows clinicians, that x-ray is ready for reporting Frisch, Liegend Frisch, Liegend Frisch, Liegend Frisch, Liegend Frisch, Liegend Folie: 83 Folie: 84 Advanced Image Management System Multimedia Patient Record Integration of Tilak s Advanced Image Management System AIM and Millennium Dicom PACS Dicom Icoframe Framegrabber Solution AIM contains image objects (DICOM - images, video sequences, pdf-docs, etc.) from all possible clinical image sources (e.g. RAD-Modalities, digital cameras, video, subsystems, etc.) Via the viewing tool icoview the user has access to AIM from all clincal workplaces. pdf pdf Document Document Pdf-Documents via HL7 Folie: 87 Integration of Tilak s Advanced Image Management System AIM into Millennium DICOM DICOM HL7 Image PACS Image AIM Reference Pointer Millennium DICOM-Image, directly invoked from the patient s EPR Reference Pointer Millennium AIM Integration of Tilak s Advanced Image Management System AIM into Millennium Examples of image objects that can be directly accessed via PowerChart ECGs in pdf Format Bacteriology Results in pdf Format Folie: 89 Radiology Images Endoscopy Images Folie: 90 13

14 e-health in TILAK Motivation for Extramural Electronic Communication Extramural Communication The Conventional Way Intramural (TILAK) Extramural (e.g. referring Physician)? Millennium Clinical Clinical Document Document Folie: 102 Extramural Communication Conventional vs. Electronic Conventional paper-mail: most referring physicians do have office systems and prefer electronic communication communication via conventional paper-mail is cumbersome handling clinical results received cannot be imported directly into the patients EHR in the referring physician s office system speed is always an issue Extramural Communication Conventional vs. Electronic Electronic extramural communication text based communication (like discharge letters) transmission of images (e.g. DICOM), video sequences, etc. Electronic communication in healthcare is a central focus of the Austrian Government ( ehealth initiative) and within the EU Savings in operative costs less paper minimum handling costs no postal fees Folie: 103 Folie: 104 TILAK s Electronic Extramural Communication Channels Because of the advantages of electronic communication in healthcare TILAK currently supports 2 channels for transferring clinical results to extramural physicians, other hospitals etc. 1. via Austrian Reporting Networks 2. via TILAK s webportal health@net Millennium medikom Gateway EDIFACT-Format Advanced Image Management System Austrian Austrian Medical Medical Reporting Reporting Networks Networks e.g. referring physician s office system Extramural Reporting Networks Extramural Medical Networks Interfacing Millennium to Extramural Networks Sending Reports to GPs via Extramural Networks Workflow Aspects intramural (TILAK) extramural Folie:

15 Integration of Extramural Reporting Networks In Austria there are several Medical Networks to transfer clinical information from etc. Clinical Results (e.g. reports, lab results) can be transferred from one medical network participant (e.g. hospital) to another (e.g. a GP) Transport Format = EDIFACT (Electronic Data Interchange for Administration Commerce and Transport), an international UN-driven standard originally designed for international trade. Folie: 107 Integration of Extramural Reporting Networks original document EDIFACT transferred document Folie: 108 The electronic addresses of external GPs that can be reached via network, is an alias in the Personnel Alias Table. Integration of Extramural Reporting Networks Millennium Intramural (TILAK) Clinical Document written, using Millennium s Transcripton Entry Application EDIFACT EDIFACT Gateway Extramural (GP) GP s Medical Office System EDIFACT EDIFACT Austrian Medical Networks (e.g. DaMe, Medical Net) Folie: 109 Provider Database evga elektronisches Verzeichnis der Gesundheitsdiensteanbieter electronic directory of health care providers LDAP access daily synchronized into database Folie: 111 List of recipients that the currently written document should receive Indicates an electronically reachable external doctor Folie: 112 Folie:

16 Sign off of a completed document is the trigger event for conversion into EDIFACT- Format and for the transfer via extramural networks to GPs. Integration of Extramural Reporting Networks Integration of Extramural Reporting Networks Update of GPs that can be reached via network Central LDAP Server A Millennium OPs-Job runs every 10min Millennium Clinical Report in EDIFACT-Format, containing the receiving GP s MEnumber as mail address looking for documents ready to be sent. ftp-transfer Mail address and encryption certificate of the receiving GP Gateway Server Message will be signed with the sender s certificate. Then it will be encrypted and sent. Central LDAP 1) server, containing relevant data of all Austrian GPs, run by the Medical Doctor s Chamber of Austria S M I M E Austrian Medical Network Providers medical net DaMe Gateway medcom GP A GP B GP C GP 1 GP 2 GP 3 GP X GP Y GP Z Local LDAP lokaler lokaler ldap Local ldap LDAP? Local LDAP GP U Folie: 114 C. Stark GNV Gateway GP V Local Autor GP W: Dr. I. Wilhelmy LDAP Folie: 115 Advantages of sending medical documents directly from Millennium to GPs Speed Cost Reduction Seamlessly integrated into authentication workflow GP can import the electronically received results directly into the Patient s Medical Record High Transmission Security Clinical Results will be encrypted when being sent to GPs Logging TILAK s Webportal for Extramural Communication (Push-Portal) Folie: 116 TILAK s Webportal Webportal for extramural communication of medical reports and image data. Via health@net GP s, hospitals, insurances, etc. can access patient related information (medical reports, images) without having to be a customer of existing Austrian medical networks. Each health@net user can only access patient related information that has been released explicitly for her/him (e.g. because she/he is the patient s referring physician) health@net has been designed by UMIT, icoserve, ITH and TILAK. Folie: 118 Millennium EDIFACT, RTF Clinical Information (e.g. a report) in HL7, that has been validated for a health@net user (e.g. a referring physician) LDAP Query Release Notification Message via HL7 Advanced Image Management System (AIM) Austrian Directory of Healthcare Providers (EVGA) Reports Images Overview Notification new result at health@net health@net Web-Server Extramural health@net User TILAK s Web-Portal Autor health@net : Dr. I. Wilhelmy Folie:

17 Role of AIM in Extramural Communication via Dicom PACS Dicom As AIM already contains image objects (DICOM -images, video sequences, pdf-docs, etc.) from all possible clinical sources (e.g. RAD- Modalities, digital cameras, video, subsystems, etc.) it serves as backend repository for Secure Connection via https-protocol (URL = Icoframe Framegrabber Solution pdf pdf Document Pdf-Documents from subsystems Document Release Notification Message sent to make a document or an image available for a health@net user Login to health@net portal Millennium Clinical Document (e.g. medical report) to be provided for a health@net user Folie: 121 Folie: 122 Medical Report as EDIFACT Double clicking a patient on the patient list will show the patient s reports / images available for viewing or downloading. Folie: 123 Folie: 124 Medical Report as EDIFACT Medical Report as PDF Folie: 125 Folie:

18 TILAK s Webportal Ex Post Release for health@net Clinical documents that are transcribed using Millennium s Transcriptionist and for which one or several recipients are health@net users transferred to AIM (together with the HL7-Release Notification Message) immediately after sign-off. Medical Report in PDF-Format Releasing documents or images ex post for health@net directly from PowerChart. Folie: 127 Folie: 128 Summary and Advantages of health@net health@net ( is TILAK s webportal for electronic extramural communication of clinical reports and images Extramural communication partners can apply for a free of charge health@net account Whenever a new clinical result (report, image) is available for a health@net user, he will receive a notification Summary and Advantages of health@net Health@net s main advantages are Speed Cost Reduction (no postal fees for TILAK, usage is free of charge for health@net users) Seamlessly integrated into authentication workflow health@net can provide medical documents as well as medical images GP can import the results received electronically directly into his Patient s medical record High Transmission Security Secure communication via https-protocol Logging health@net can also be used for communication with scientific partners Folie: 129 Folie: 130 ELGA Next Steps Towards an Shared Electronic Health Record Elektronische Gesundheitsakte Electronic Health Record National architecture and infrastructure to access well defined health data Status: Architecture concepts are being developed Project is government driven! Folie:

19 ELGA-Architecture Status Next step: implementation of regional (Innsbruck) web portal for querying documents (proof of concept based on IHE profiles) local ELGA test phase (Dr. A. Schanner, 2007) Folie: 133 Folie: