Imaging and radiological information in Cross-institutional networks: s and concepts, implementation experiences Prof. Dr. med. Björn Bergh Chairman Dept. of Information Technology and Clinical Engineering Professor for Medical Information Systems IHE User Co-Chair Germany Dept. of Information Technology and Medical Engineering (ZIM) 186 staff members Plan, purchase, deploy + operate all IT infrastructure, all applications (incl. RIS, PACS, LIS...) all medical devices + furniture telephony, patient record archives Scientific unit (10 FTE) ehealth, systems integration, IT + engineering, standards, open source, digital signatures Prof. Dr. Björn Bergh 2 1
s 3 Integration with standards? Existing ehealth standards 4 2
Integration with standards? Existing ehealth standards Understandable and complete 5 Integration with standards? Existing ehealth standards Understandable and complete Industry accepted and Implemented (EHR) 6 3
Integration with standards? Existing ehealth standards Understandable and complete Industry accepted and Implemented (EHR) Industry accepted and Implemented (HIS-CIS) HL7 + DICOM => IHE 7 Integrating the Healthcare Enterprise (IHE) Definition of Integration Profiles (Actors and Transactions) Definition of Content Profiles J Transaction J Actor 1 Content Actor 2 4
IHE XDS-b Cross-enterprise document sharing Registry Stored Query [ITI-18] Patient Identity Source Patient Identity Feed [ITI-8] Document Registry (XDS.b) Document Consumer Register Document Set-b [ITI-42] Provide and Register Document Set-b [ITI-41] Document Repository (XDS.b) Retrieve Document Set [ITI-43] Document Source IHE XDS-I b (Imaging) Registry Stored Query [ITI-18] Patient Identity Source Patient Identity Feed [ITI-8] Document Registry (XDS.b) Document Consumer Register Document Set-b [ITI-42] Imaging Document Consumer Imaging Document Source Provide and Register Imaging Document Set MTOM/XOP [RAD-68] Document Repository (XDS.b) Retrieve Document Set [ITI-43] Retrieve Images [RAD-16 Retreive Key ImageNote[RAD-31]] WADO Retrieve [RAD-55] Retrieve Imaging document Set [RAD-69] 5
Patient Identity Source Imaging Document Source Document Registry Document Repository Imaging Document Consumer Patient Identity Feed [ITI-8] Provide and Register Imaging Document Set MTOM/XOP [RAD-68] Register Document Set-b [ITI-42] Registry Stored Query [ITI-18] Retrieve Reports [ITI-27] WADO Retrieve [RAD-55] Retrieve Imaging Document Set [RAD-68] Classes of standards related specifications (*) 300-500 30-50 500-800 (*) based on the ehealth-interop Report in response to EU Mandate/403-2007, Section 4.3, http://www.ehealth-interop.eu 6
Experiences in the Rhine- Neckar Region 13 Rhine-Neckar Region (2,6 Mio.) 7
Previous experiences in crossinstitutional communication = Telemedicine Teleradiology (10.000 p.a.) Teleneurology (320 p.a.) Tele-oncology (paediatric) Home Care Monitoring (35 patients). 15 Lessons Learned The usage of separate Telemedicine components is beneficial but: Information from all HIT-systems and Home Care belongs together!! Prof. Dr. Björn Bergh 8
2005 approach: a cross-institutional record but how? 17 Cross-institutional records Patient / citizen 9
PHR Personal Health Record PHR alone does not work Google Health discontinued 31.12.2011 ICW Life Sensor discontinued 31.05.2011 Microsoft Vault, no market entry in Central Europe Barmer health insurance: negative experiences Why? Document integration Care provider access Foreseeable 19 EHR 2 main considerations Data privacy Technology and standards 20 10
Data Privacy and EHR ehealth + EHRs are totally safe! Goya EHR data privacy Main approaches in use Global: opt-in / out Semi-automatic access rights management based on technical tools: users, roles, affiliation organisation, time, context The medical case 22 11
EHR Data privacy study - Results No concept fulfils all needs!! Bergh B, Bach N, Brandner A, Heinze O (2009) - EHR access rights and the role of the patient. World Congress on Medical Physics and Biomedical Engineering; 2009 : 316-19 Data Privacy and EHR ehealth + EHRs are totally safe! They most certainly are not! None of the present solutions is satisfying Goya Goya 12
Alternatives? Our approach: PEHR Personal Electronic Health Record To combine the advantages of PHR and EHR and exclude the disadvantages 26 13
Vision - PEHR Patient Decides - who sees what - sees all accesses - chooses provider Care providers Communicate only via the PEHR with each other Awards: TELEMED Award 2008 + 2010, Influencer of the Year 2010, Health Region of the future Technical concept 14
Patient allocation and document sharing MPI: Meier HIS 1= 1234 HIS 2= 4711 Hospital 1 (P)EHR Hospital 2 HIS 1 HL7 ADT Patient data HL7 MDM documents MPI Record Module HL7 ADT Patient data HL7 MDM documents HIS 2 viewing Web viewing EPR: Meier OP-Report HIS 1 Discharge Letter HIS 2 Technical concept - Imaging 15
Patient allocation, document sharing and integration of PACS Hospital 1 (P)EHR Hospital 2 HIS 1 HL7 ADT Patient data HL7 MDM documents MPI Record Module HL7 Patient data HL7 MDM documents HIS 2 viewing image-ref. Web viewing viewing Web Web image-ref. Web PACS 1 images WADO image-request PACS 2 Sequence diagramm HIS/CIS RIS PACS WADO+ (P)EHR HL7 ADT A01 / A31 (PID, Consent, etc.) HL7 ORR (PID, Accession #, Visit, Requesting OU) DICOM Q/R HL7 MDM T01 DICOM Q/R Prop. Display ADT: Admission, Discharge, Transfer (Administrative Patientendaten) A01: Admission A31: Patient Update ORR: General Order Response Message MDM: Medical Document Management T01: Original document notification without content 16
IHE XDS-I Regional implementation Registry Stored Query [ITI-18] DICOM Viewer Patient Identity Source Patient Identity Feed [ITI-8] Document Registry (XDS.b) Document Consumer PEHR (MPI) PEHR Register Document Set-b [ITI-42] Imaging Document Consumer Imaging Document Source Provide and Register Imaging Document Set MTOM/XOP [RAD-68] Document Repository (XDS.b) PEHR Retrieve Document Set [ITI-43] RIS/PACS Retrieve Images [RAD-16 Retreive Key ImageNote[RAD-31]] WADO Retrieve [RAD-55] Retrieve Imaging document Set [RAD-69] PEHR Partners Phase 1 University Hospital Heidelberg (2300 beds) Maximum medical care 75.000 inpatients/a 420.000 outpatients/a Rhine-Neckar Health Centers (GRN ggmbh) 4 Hospitals (1000 beds) InterComponentWare AG Walldorf Product: Professional Exchange Server (PXS) MPI and Record Module (EHR) Lifesensor (PHR) CHILI GmbH WADO-Gateway + DICOM-Webserver 17
Summary Implementation with HL7/DICOM is ok ORR is an issue XDS-I appears feasible It requires regional adaptation Parts are lacking: consent management, provider and organisation registry/repositor (we developped both as OSS, Open ehealth foundation) Caching (hybrid architecture) requires 2 doc. sources (updating not foreseen in Rad-68) 35 Thank you for your attention! University Hospital Heidelberg Dept. of Information Technology and Medical Engineering (ZIM) Speyerer Str. 4 69115 Heidelberg Germany Prof. Dr. med. Björn Bergh (Chairman) Mail bjoern.bergh@med.uni-heidelberg.de Fon +49 6221 56 2000 18