Continuity of Care Record (CCR) in Germany? PROREC activities on the way to EHR interoperability
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1 Herzlich Willkommen! EHTEL Telemed ehealth IOP Satellite Heidelberg, 12 June 2008 Continuity of Care Record (CCR) in Germany? PROREC activities on the way to EHR interoperability Sebastian Claudius Semler -ViceChairPROREC-DE Wissenschaftlicher Geschäftsführer, Telematikplattform für Medizinische Forschungsnetze e.v., (TMF), Berlin Telematikplattform für Medizinische Forschungsnetze (TMF) e.v.
2 PROREC-DE founded in Dec German association (e.v.) private and institutional memberships national EUROREC centre (member of EUROREC) PROREC intentions: foster implementation and pervasiveness of EHR / EPR contribute to standardisation of EHR / EPR dissemination of EHR / EPR benefits Chairmen PROREC-DE: Horst Strüter ( ) Bernd Blobel ( ) Rolf Engelbrecht (2007- ) Participant in EU project QREC 2002 association with VHitG; 2006 first new industrial members workshop acitivites; 2007/08: CCR workshops S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 2
3 PROREC-DE Website S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 3
4 EuroRec - Institute «European Institute for Health Records» non-profit organisation established 16 April 2003 goal: promotion of applications and systems based on Electronic Health Record systems (EHRs) in Europe Support of national ProRec centres in Europe EUROREC repository & tools EU Funding periods PROREC ( ) WIDENET ( ) Q-REC( ) Participation in EU projects Q-REC RIDE EHR-Implement S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 4
5 ProRec Centres Zentren Belgium Bulgaria Danmark Germany France Ireland Italy Rumania Serbia Slovakia Slovenia Spain Antragsteller Greece Great-Britain Netherlands Norway Poland Portugal Sweden Turkey Hungaria Cyprus Differences in Language, Culture und Health Care System S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 5
6 EU Projects Q-REC European Quality Labelling and Certification of Electronic Health Record systems (EHRs) Duration: Contract No: IST SSA Coordinator: Prof. Georges De Moor EHR-Implement National policies for EHR implementation in the European area: social and organizational issues Duration: Contract No: IST SSA Coordinator: Dr. Laurence Esterle RIDE A Roadmap for Interoperability of ehealth Systems in Support of COM 356 with Special Emphasis on Semantic Interoperability Duration: Contract No: IST Coordinator: Prof. Asuman Dogac S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 6
7 Q-REC Project Goals: Methods and Processes for Quality labelling and Certification of EHR systems in Europe Establishing of a central EUROREC repository for quality and certification criteria, suitable for testing, benchmarking etc. Harmonisation via national PROREC centres 12 Partner and 2 subcontractors EuroRec Institute = coordinating partner 30 months ( ) S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 7
8 Repository Workflow S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 8
9 Continuity of Care Record (CCR) developed by ASTM (American Society for Testing and Material) ASTM E Standard Specification for the Continuity of Care Record (CCR) ASTM Committee E31 on Healthcare Informatics SUBCOMMITTEE E31.28 on ELECTRONIC HEALTH RECORDS / CCR Initiative (c/o Claudia Tessier) supported by > 12 clinical associations and institutions (US), representing MDs e.g. American Academy of Family Physicians (AAFP), American Academy of Pediatrics basic idea: CCR = core data set as (patient) summary of all the key current and historical data that defines that patient s current clinical status exchange of core data set, not of complete EHRs SW vendors support CCR in USA (incl. Google, MS) S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 9
10 Technical Design of the CCR (Source: ASTM CCR) Comprehensive Security, Confidentiality, and Privacy Support for compete dis-identification of data from patient and provider(s). Support for static encryption and encryption in transport (IETF/W3C Compliant). Support for blinded patient, provider, and data identifiers. XML IETF/W3C Compliant - all content tagged, all formatting supported through external.xslt(s). Maximized for parsing efficiency and system scalability. Language (tag and content) independence. Human readability. Ease of implementation. Data Model XML-based object-relational data model. De-normalized for processing (processor) efficiency. UML object data model representation. Implementation Support Designed to map seamlessly with PHR and EHR architectures. Support for 100% open-source implementation if desired. Implemented using widely supported machine-readable (XML) and display/print output (PDF/H) formats. S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 10
11 Continuity of Care Record (CCR) Structure XML-based, flexible data representation, scalable CCR Header CCR Identification Patient Identification CCR Body Payers Advance Directives Functional Status, Problems (incl. Diagnoses) Family & Social History, Alerts Medication Vital Signs, Results (incl. Lab) Procedures, Plan of Care, Addresses CCR Footer Actors, Signatures S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 11
12 CCR Specification S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 12
13 Continuity of Care Record (CCR) Problems Problem: to identify & extract the key clinical data needed from the patient and the medical record to make clinical decisions need to have interoperable data models need to have data access (export & import) to EHR systems complementary to HL7 CDA exchange of data sets vs. electronic documents de-normalized vs. redundant flexible vs. not binding / not mandatory no (obligate) controlled terminology existing model convenient to US MDs, not fully compatible with German conditions S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 13
14 Continuity of Care Record (CCR) in Germany? EHR situation in Germany: no central mission and national institution to push nation-wide EHRs (no masterplan ) Gematik? will 291a EPR ever come? secondary use scenarios restricted by law Technical, organizational and financial resources are bound to implementation project of the health card and the gematik telematics infrastructure. local and regional approaches and projects with different business models with different standards frustration and declination of IT / EPR projects by the German MDs ( Ulmer Ärztetag ) S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 14
15 Continuity of Care Record (CCR) in Germany? PROREC-DE: 3rd Workshop: CCR-DE a medical data set supporting continuity of care Munich, April 2008 Topics: Basis Experiences from CCRimplementations in US (ASTM CCR) EHR-COM international standard (EN 13606) Goals Development of a concept for CCR-DE Implementation considerations S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 15
16 Continuity of Care Record (CCR) in Germany? PROREC Project Idea Project Idea: Evaluation of CCR data set with German MDs (is CCR suitable for the German routine?) Evaluation of CCR data sets concerning usability for clinical / epidemiological research, public health German translation of CCR specification and field definitions conceptual integration of archetypes (EN openehr) conceptual integration of well-defined nomenclature elements (controlled terminology) conceptual integration of gematik security architecture pilot implementation with German practitioners using medication export data sets for gematik eprescription Showcase: bringing back benefits of structured data exchange to the German MDs! (no CCR vs. CDA project!) Support: Bavaria Min. Health, Baymatik / Go-In (egk-testregion), industrial partners, ASTM-CCR, S.C.Semler Continuity of Care Record (CCR) in Germany?, EHTEL Telemed IOp Satellite, Heidelberg, Seite 16
17 Thank you for your attention! Contact data + more information: [email protected] Telematikplattform für Medizinische Forschungsnetze (TMF) e.v.
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