Healthcare Network Tirol GesundheitsNetz Tirol (GNT)

Transcription

1 Healthcare Network Tirol GesundheitsNetz Tirol (GNT) Trondheim, Norway Christian Stark Department for Information Technology Clinical Information Systems Tiroler Landeskrankenanstalten GmbH (TILAK) Innsbruck, Austria TILAK Tiroler Landeskrankenanstalten GmbH: Management Holding owned 100% by the Government of Tirol TILAK manages 4 Hospital Sites (+1) with ~ beds and ~ staff (FTE s) + 4 affiliate companies ca. 580 Mio. annual budget, ca. 50 Mio. investment p.a. (c) TILAK 2010 Dr. I. Wilhelmy MMag. Ch. Stark 1

2 Landeskrankenhaus University Medical Center Innsbruck (c) TILAK 2010 Dr. I. Wilhelmy MMag. Ch. Stark Location Munich Vienna Innsbruck 2

3 TILAK managed Hospital Sites in Tirol Tirol ~ Einwohner km 2 Landes-KH Hochzirl 200 Beds 275 Staff Inpatients p.a. Landes-KH Natters 164 Beds 211 Staff Inpatients p.a. University Medical Center Innsbruck 1604 Beds Staff Inpatients p.a. LKH Hall ~ 537 Beds ~ 700 Staff Nursing Hospital Hall 116 Beds 93 Staff Dr. I. Wilhelmy MMag. Ch. Stark Some Impressions from Innsbruck (c) TILAK

4 IT-Strategy and IT-Systems at Tilak Tilak IT Strategy 4

5 Strategic IT-Goals Integrated intramural multimedial EPR / EMR Consistent IT-Suppprt for all major Processes Standardization of clinical and administrative Processes Extramural Communication / ehealth Edifact-based Communication sense based GNT First steps towards ELGA (ELektronische GesundheitsAkte) Involvement of Patients into Electronic Communication Supporting Management, QM and scientific Research Major IT-Systems at Tilak Historically grown there exists a heterogeneous interconnected IT landscape of about 200 systems at Tilak, supporting clinical and administrative processes. ERP / Management SAP R/3 Patient Administration SAP-IS-H Clinical Information System (CIS) Cerner Millennium, Cerner Corp., USA clinical workplace one EMR across all Tilak Hospitals RIS GE Centricity PACS Agfa IMPAX Radio-Therapy-System Nexus Medfolio LIS (Central Lab, Bloodbank, Serology, etc) pg-softline OP-Resource Planning System RPS Multimedia Archive + Repository for IHE communication syngo.share Infrastructure for IHE-based extramural communication sense... Dr. I. Wilhelmy MMag. Ch. Stark 5

6 Software Vendor Main Application Area Users Cerner Millennium Siemens syngo.share Cerner Corp. Kansas City, USA ITH-icoserve GmbH (a Siemens Company) Clinical Information System ~ Digital Multimedia Archie Digital Chart Archive Backup-System IHE-Repository (GNT) ~ SAP-IS-H SAP AG Patient Administration & Billing ~ SAP R/3 SAP AG ERP ~ 500 Dr. I. Wilhelmy MMag. Ch. Stark Lab SAP-R/3 ERP SAP-IS-H Patienten- Admin- System Cerner Millennium Cloverleaf Blodbank Radiology Medical Auxiliary Systems PACS + syngo.share Digital Multimedia Archive Standard Software / / Intranet / Internet Dr. I. Wilhelmy MMag. Ch. Stark 6

7 Tilak HL7 Communication Dr. I. Wilhelmy MMag. Ch. Stark Clinical Information System Cerner Millennium 7

8 Implemented Millennium Functions Scheduling for booking ~ patient appointments per month TILAK wide Multimedia-EPR and the Clinical Workplace Electronic transcription & validation for discharge letters Structured Documentation with over 650 Electronic Forms Integration of TILAK s Multimedia Archive Siemens syngo.share Electronic Nursing Planning and Nursing Documentation Computerized Physician Order Entry (CPOE) FirstNet Tracking Board for Trauma-, ED- and other outpatient units PathNet-AP for Pathology SurgiNet OP Documentation Diagnosis- and Procedure Coding Interfacing Departmental Systems Extramural Communication / ehealth via sense modules Currently working on Fever Curve & Medication Key Application Data Parameter Value Departments 38 Registered Users ~ Concurrent Users at peak times ~ Installed PC Clients ~ Documents written in CERNER Millennium (per month) ~ Radiology findings fed into the system (per month) ~ Scheduled Appointments (per month) ~

9 Integration of Tilak s Multimedia Archive syngo.share into Cerner Millennium Integration of Siemens syngo.share into Cerner Millennium Siemens Syngo.share = Tilak s Multimedia Archive consisting ~ 180 TB Archive Volume, Management Software (DB Size ~ 2TB) and a viewer At Tilak all DICOM images (e.g. from radiology) and all other images and imagelike data, such as pdf-documents from other contributor systems, are stored in Siemens syngo.share Siemens Syngo.share sends a HL7-Reference Pointer to Millennium, whenever a new image-object is being stored Image objects, such as DICOM images, pdf documents, video sequences, etc. can be accessed from a patient s chart by clicking on the syngo.share - Reference pointer entry viewer will be opened and it will show the requested object. 9

10 Integration of Siemens syngo.share into Cerner Millennium s EMR Dicom PACS Dicom Tilak s Multimedia Archive syngo.share containis image objects (DICOM-images, video sequences, pdf-docs, etc.) from different clinical image sources (e.g. RAD Modalities, digital cameras, video, subsystems, etc.) Via the syngo.share Dicom viewer the user has access to the Muldimedia Archive from all clincal workplaces. pdf Document Pdf-Documents via HL7 (c) TILAK 2010 Integration of Siemens syngo.share into Cerner Millennium DICOM DICOM syngo. HL7 Image PACS Image share Reference Pointer Millennium DICOM-Image, directly invoked from the patient s EPR Reference Pointer Millennium syngo.share 10

11 Integration of Siemens syngo.share into Cerner Millennium Examples of image objects that can be directly accessed via PowerChart ECGs in pdf Format Bacteriology Results in pdf Format Radiology Images Endoscopy Images (c) TILAK 2010 The Austrian ehealth Strategy 11

12 Core Elements of Austria s ehealth Strategy ELGA (ELektronische GesundheitsAkte) Austria s concept for a lifelong, patient-centered EHR Online access to validated Health Information IT Support of cross-institutional processes emedication / eprescription ereferral Implementation of Decision Support Systems Telemedicine Services Tools for Health Data Analysis Privacy / Data Security Non-ELGA Scenario Specialist Institute Pharmacy Specialist GP Patient Acute Care for Inpatients Nursing Homes After Care Source: Arge ELGA In a fragmented non-elga = non-ehr patient care scenario patient data exist in different unrelated information silos 12

13 Integrated Patient Care via ELGA External Institute Pharmacy Specialist GP Patient Acute Care for Inpatients Nursing Homes After Care Extramural Care other extramural Providers Identification Information Documentation Security-Architecture Patient Index Health Care Provider Index Document Registry WebPortal Relevant Standards for ELGA The Austrian Ministry of Health and the Federal Health Commission propose the following standards as base for ELGA Integrating the Healthcare Enterprise (IHE) Technical Framework IHE-Profiles HL7 Reference Information Model (RIM) Clinical Document Architecture (CDA) LOINC (Logical Observation Identifiers Names and Codes) Coding Standard for Lab-Parameters, etc. DICOM including workflow and data management 13

14 GesundheitsNetz Tirol GNT Health Network Tirol Cross Enterprise Document Sharing and emedication via sense as first ELGA Implementations in Tirol GNT Project History GNT Project started in 2007 GNT Project Goals Implementation of a Tirol-wide IHE Affinity Domain + EHR to support shared care Decentralized Repositories Exchange of CDA Level 1 and 2 Documents via XDS Profile Integration of GNT Interface into localized EMR-Systems Current GNT Partners Tilak and 3 Regional Hospitals in Tirol, representing 4500 beds Further expansion planned (other hospitals, nursing homes, GPs etc.) Documents registered from until now official Go-Live: October 2009 GNT-Core Technology developed by ITH-icoserve ITH-icoserve is a Tilak subsidiary (70% Siemens, 30% Tilak) Technology is IHE approved and ELGA compatible 14

15 GesundheitsNetz Tirol GNT HealthNetwork Tirol GNT Project Full XDS affinity domain > 4 Mio documents online Live since 01/2009 Basic sense Infrastructure Community Node: Provides central IHE- Registry, ATNA Profile and the Affinity Domainwide Patient Index (PIX) Local Node: Each GNT participant needs a sense-local Node providing the interface to local CIS and EHR Repository. Registration also runs via Local Node. 15

16 sense Components and Communication Workflow Siemens sense is connectathon approved ATNA, BPPC, CT, NAV, ODS, PDQ (v2/v3), PIX (v2/v3), SVS, XCA, XCA-I, XCPD, XDM, XDR, XDS.b, XDS-I.b, XDS-MS, XDS-SD, XUA/XUA++.. with all actors. Certified by EuroRec. 16

17 ELGA Projects in Austria From EMR to EHR Integration of sense and its IHE XDS Mechanism into Millennium 17

18 GNT Access from a Patient s Chart After the consent form has been printed and signed the physician confirms its existence by activating a checkbox then he can continue. Adjusting Filters for GNT Query Starting Search for encounters and documents 18

19 Fetching a Document and saving it in our own HIS Integration of emedication Accessing a Patient s emedication List via GNT 19

20 ELGA Pilot Project emedication Initiated by the Austrian Ministery of Health, Austrian Social Insurance, ELGA GmbH, Federal States 3 Pilot Regions (Vienna, Upper Austria, Western Tirol) Objectives gaining experience with emedication centralized registration of all prescriptions made by GPs centralized registration of all medication delivered to patients by pharmacies increasing patient safety avoiding Adverse Drug Events (ADEs) avoiding double prescriptions Key indicators for emedication Pilot in Tirol 40 GPs 13 Pharmacies 2 Hospitals (one of them: University Medical Center Innsbruck) Queries during Pilot Phase (June to December 2011) Project Evaluation by UMIT and the University of Vienna Informing Physicians about an emedication Patient Physician opens the EMR of a patient participating in emedication Popup will inform about the possibility to access the patient s medication list 20

21 Accessing emedication List via Tab e-medication from EMR Check-Box to confirm that patient has given verbal consent for accessing emedication List Button to fetch emedication List Importing emedication List into Siemens syngo.share and the EMR Activating Button in Akte übernehmen will import the current emedication List into Siemens syngo.share and the patient s EMR 21

22 GNT Future Steps Enriching GNT Content Content currently available Discharge Letters (inpatient + outpatient) Radiology Reports Dermato-Histology Endoscopy-Findings (reports including images) Content expansion planned by Lab Results Pathology Results Reports from specialized departments Images Nursing Documentation WebPortal for GNT Access for GPs, Nursing Homes, etc. Supporting information exchange for CDA Level 2 and 3 Supporting complex interdisciplinary workflows / shared care Stroke Treatment Oncology Treatment Processes for chronically ill patients, such as diabetes patients, etc. Enabling GNT Access for Patients Thank you very much! 22