E-Record - access to all Public Health Records

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1 E-Record - access to all Public Health Records Greek ehealth ecosystem meeting Senior Consultant Jens Rahbek Nørgaard

2 Healthcare - Denmark 5 Hospital regions Hospitals Funding of Private GP s Private specialists 98 Municipalities Homecare, Training and Prevention Private Pharmacies Private Hospitals (only 1-2%)

3 EHR-vendors - Denmark Goals: Every Region has a consolidated EHR-system ultimo Single sign-on to all systems. North: CSC Clinical Suite Middle: Systematic Columna (MidtEHR) South: CGI-Gambio-Cosmic Seeland: CSC Opus Capital Region: CSC Opus Seeland:/Capital Region: Tender: Epic (like Kayser Permanente)

4 Danish digital infrastructure Health insurance Card: Civil Registration Number (CRN): = Public identifier. ddmmyy-xxxx (modulus check) All public data is based on CRN. All Hospitals/dept s have a unique number for registration, Hospitals uses ICD10 and GP s ICPC for diagnosing. NemID = Easy ID CRN Password - Code Access to Homebanking Patientdata Easy (public) mail All authorities (and private companys) From November 2014 all Citizens have to Communicate digitally with authorities.

5 Danish Health Portal: Access for both: Citizens & Physicians Danish Health Portal: Yellow pages Health Access to: E-Record Lab-portal Medicationcard Donation Living Will Apps: Yellow pages Doctors handbook Patients handbook

6 Citizens GP/Spec. Hospitals G H MyLog Sundhed.dk Health Net E-Record GP-Record E-Record Browser GP-Record E-Record Database Database From 2013 DAK-E QA EHR HIS GP/Spec. Medicine RIS/PACS Biochem. Mikrobio.

7 Delivery of data to E-Record E-Journal Content Diagnosis ICD10 X X Procedures X X Notes X X Medicine Labresults X X GP-Record: Approximately 82 % of all GP s is delivering data.

8 12 clinical types of incidents 6 additional types for next generation of EHR Simple Data-model Person Patient Personal information CAVE Episode 1 Episode 2 Incident 1 Incident 2 Incident 3

9 Hospitals Clinical Types of Incidents Type of Incident Description 100 % Period of Contact Start and end of period of hospital treatment or ambulatory visit 33 % Ordination of Medicine Ordination of Medicine and Anaesthesia 33 % Lab-result Laboratory results, Description of Radiology and Clinical Physiology examinations 100 % Diagnosis Diagnosis ICD % Medication Dose of Medicine or Infusion (including Anaesthesia). Only for the last two days 100 % Procedures Procedures done not Medication (Nordic Classification) General Ordination Requisition Ordinations not Medicine Requisition of a procedure or a lab-test Observation/ Findings Observation or Findings made by Physicians. (Ex pulse, blood pressure and temperature). 100 % Notes Description of treatment in ordinary text. (Ex discharge letter, Ambulatory notation, ward round notation) Administrative Information Administrative relations. (Ex GP (and code) Municipality (and code))

10 Single Sign On from EHR Link (context) parameters: userid, name, dept., role, hospital, CRN EHR Region Y X - City Hospital CRN number: Name: : Nancy Berggren Department: Th o rax - K irurgisk A fdeling Ø Hospital: X - Købing Regionshospital Date: 21/ kl 18:50 Diagnose: DI209 Angina pectoris Notes Lab. Procedures Food e - record Tuesday 28 th of January 2014 User : X - TKA - XYZ

11 Access for GP s since 2007 GP s allowed to lookup his own patients

12 Dear Jens Jensen Citizens letter The reason for this letter is sent to you is that the DPA has demanded that citizens be informed by. letter by posting in e-journal from other than their own doctor. The letter sent to ensure that your health information has only been seen by those who have been allowed to see your information. Your own doctor will have the opportunity to see your hospital records on the Internet - also called e-journal. Via e-journal has your own physician access to information about you, which is recorded in the hospitals' electronic health records (EHR). The advantage of e-journal is that your doctor here can see more information about your treatment at hospitals than it is customarily found in a discharge letter from the hospitals. In the period October March 2012, there have been one or more posts to your e-journal by persons other than your own doctor. It is probably a doctor or a vacation replacement for your regular doctor, who has used e-journal in connection with your treatment. The doctor may only see your information with your consent - ie. You must have given them permission to look in your e-journal. The following notice on your e-journal is made by anyone other than your own doctor: Date Doctor GP Adress 14/9-11 GP XX Doctors af Lowstreet Copenhagen 16/1-12 GP YY Doctors af Highstreet Odense As I said to call because you've used a different doctor than your own, and that you have given this doctor allowed to beat up on your information in the e-journal. If so, you do not do anything further. But if you do not know why the notice, or if you otherwise have questions about it, feel free to contact the patient counselors in your region. You have the opportunity to go in with your NemID or your digital signature on and see more about the individual posters and on the e-records solution. You can order a free NemID from the front of if you do not already have one. If you have questions about this letter or e-journal in general, please feel free to contact Hans Hansen in Danish Regions on telephone or Sincerely Hans Hansen Danish Regions (Google translation)

13 Access for Citizens since 2007 All information is delayed for 2 weeks

14 To be delivered to patients both at hospitals and in GP-offices Go Cards

15 Security/Audit Every six months a common regional audit workshop is organized. All lookups from one day are reviewed by staff from all 5 regions. Newspaper 12. Jan 2013 In MyLog, all citizens can see which Physician have been looking their record-data. Letters are sent to citizens if GP s have looked up record-data without a legal relation of treatment.

16 Hospital, Citizen og GP s lookups Number of lookups Hospitals: 60 % Citizens: 39 % GP s: 1 % Number of lookups - GP s

17 Monitoring results ,7 % (or patients) of Danish population have used E-Record in 2013 (2011: 5,4 % and 2013: 5,6 %) 10,2 % (or patients) of Danish population have physicians looked-up in 2013 (2011: 4,9 % og 2012: 8,2 %) 40 % (or ) of all patients who have used E- Record, has also been looked-up by physicians at hospitals. This group is basically empowered Physicians have used E-Record in % (eller 2300) of all GP s have used E-Record on patients in 2013

18 Physicians Access 2013 ( ) Females Mænd 50% % Males Kvinder 50 50% % Aldersgruppe

19 Citizens Access 2013 ( ) Females Mænd 42 59% % Males Kvinder 58 41% % Aldersgruppe

20 Weekly use 25,00% 20,00% Working days use 90 % Weekend use 10 % 15,00% 10,00% 5,00% 0,00% Monday Tuesday Wednesday Thursday Friday Saturday Sunday

21 Daily use 14,00% 12,00% 10,00% 8,00% 6,00% 4,00% 2,00% 0,00% Working hours 75 %

22 Main Benefits from E-Record 1 Hospitals can look up information from other Hospitals without involving them Saving staff resources (and fax) Improved Patient Safety More information and improved quality Improved Decision making Citizens do not ask for copy of Health Records. They look up data in E-Record. Saving staff resources Better patient empowerment Better understanding of own situation More active involvement Patients support is not a hot issue

23 Main Benefits from E-Record 2 E-Record is a unique repository for Epidemiologic research Datamining-based research (Big Data) Decisionsupport innovation Monitoring data is the basis of focusing dissemination and improved use E-Record is an archiving container for EHRsystems that is phased out. E-Record transmits health records to National Archives of history. Data can be used for purposes that we could not imaging from the beginning

24 Acute-ward Seeland Region E-Record ICD-10 IMATIS SnomedCT Anatomic context Visuel Presentation

25 E-Record future challenges We need more evaluation both for clinicians and citizens. Today citizens experience at delay of 14 days. Is it possible to avoid that for special groups or special situations. Admission for parent to se record-data for their own children. Admission for related persons to the patients. I.e. elderly and week persons/relatives. Citizens cannot understand the doctor language. They demand explanations to get a better understanding. We have patients in 2013, who has been empowered. How can we use these patients in questioning about expectations to further empowering activities?

26 E-Record Questions? Comments Greek ehealth ecosystem meeting Senior Consultant Jens Rahbek Nørgaard

27 E-Record list of episodes

28 E-Record Timeline

29 GP-Record

30 E-Record AUDIT Autorizationregister GP? Local Patient GP-Pt register Citizen Local patient Other patient Sundhed.dk MYLOG 1 % sample 10 % sample Audit E-Record Ordinary Letters for Citizens Date, GP

31 Security-infrastructure EasyId Citizen Local EHR Pt.relation / user / CRN Physician 14 days delay Deny Citizen Access Closed Department Deny Physician Access Closed Department Deny Access to all E-Record GP-Record Break Glass Deny Access to all E-Record GP-Record Access to Hospitals and GP s EHR-information

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