karl p. pfeiffer department of medical statistics, informatics and health economics

© 2005 ADV * e-Health-Initiative * http://ehi.adv.at

Karl P. PfeifferDepartment of Medical Statistics, Informatics and Health

EconomicsInnsbruck Medical University, Austria

Chairman of the WP 1: National eHealth Strategy

[email protected]

eHealth in Austria

Establishing a high level coordination committee for implementing the eHealth strategy

2© 2005 ADV * e-Health-Initiative * http://ehi.adv.at

Content

• The Austrian eHealth Initiative (EHI)– Aims of the Austrian EHI– Current situation– Strategic goals– First results from the working parties

• Expected benefits from e Health

• Discussion


The Austrian eHealth Initiative• Established in April 2005• >100 members from

– IT-companies– Hospital organisations– Social and private insurance companies– Chamber of doctors– Chamber of pharmacists– Universities– Ministry of health and woman– eGovernment


Working Parties in the eHealth Initiative

• AK1: National eHealth strategy– The results of AK2 – AK7 will be summarized in AK1 to a national

eHealth strategy

• AK2: Interoperability – standardisation• AK3: Patient identification and archiving• AK4: Network of the health care and social system,

infrastructure• AK5: Customer related information systems• AK6: Health care system related information

systems• AK7: Telemedicine


eHealth Mission

• eHealth is a service for the citizen for continuous improvement of the Austrian health care system


eHealth Vision• An ubiquitous management of health by

supporting the processes of all health care professionals by using information technology with special attention to privacy and data safety

• In some years all necessary data are available electronically for the person who has the right to access to this data– Independent of time and location


eHealth Topics

Strategy

Business Processes

Applications

Technology

Feas

ibilit

yEvaluation


Current Situation of eHealth in Austria• Health Telematics Law

– MAGDA-LENA– Guideline for secure digital communication in the health care sector

• eCard– Introduction in 2005

• EDIVKA– Standardized communication for reimbursement

• eVGA– Registry of doctors and pharmacies

• Austrian DRG system for inpatient financing since 1997– Standardized Minimum Basic Data Set

• Diagnoses, procedures

• ELGA – Elektronischer Gesundheitsakt– Electronic Health Care Record– Feasibility study is ongoing

• Many (different) hospital and physician information systems


Strategic goals of eHealth• Improvement of the quality of health care

– by streamlining processes– by integrating processes

• Improvement of the efficiency, effectiveness, safety, timeliness, …

• Access to patient centred data for an optimal treatment and better patient management

• Access to best medical knowledge – For citizen– For professionals

• Access to data for a better management of health care institutions

• Data for planning, quality assurance


Content of eHealth• Patient centred electronic health care record

– ELGA … Elektronischer Gesundheitsakt – Includes an active participation of the citizen

• Health information networks– Presentation of medical knowledge

• Telemedicine services• Mobile equipment

– Especially monitoring systems

• Decision support systems• Tools for processing of data for planning, management


Scope of the eHealth Strategy /1• Documentation

– Structured– Standardized nomenclature– Standard architecture for documents– Standardized document header or envelope

• Communication– Based on standards

• SOAP (XML, UTF8, MIME)– E.g. Letters for names of foreign citizen

• IHE• HL 7 (V3)• DICOM• Recommendations from CEN TC 251

– Secure and save– Hardware specifications for mobile equipment

• ISO / IEEE 11073


Scope of the eHealth Strategy /2• Archiving and identification management

• Key card– Role concept for access

• Usability of a 4 step model?– Long term availability– Fast access– Registries and archives are organized by a trusted party– “A document should exist only once!”– Protocols of access

• Processing– Decision support– Implementation of clinical pathways

– Analysis for planning, quality assurance, management, financing, …– Scientific use


Participants in the eHealth Strategy• Citizen

– Passive: patient– Active: diary of health care activities, sending data from mobile equipment

• Actors, providers– Hospitals, ambulatories, doctors, pharmacies, dentists, nurses, …

• Financiers– Social insurance companies– Private health insurance companies– National and provincial health care agencies

• Science– Health economics, epidemiology

• Politics– Planning

• Public– Information about quality– Information about capacities– Medical knowledge


Key Elements of the eHealth Strategy

• Unique person and patient identifier• Unique identifier of all health care providers

– Registry with up to date data

• Unique nomenclature for diagnoses, procedures, products, implants, …

• Technical standards• Standardized architecture of key documents


Infrastructure for eHealth• Management of patient identification

– eCard• Management of an up-to date registry of providers

– Professional card• Pseudonymisation of data sets for data analysis• Master Patient Index• Archives

– Centralized– Distributed environment

• RHIO … Regional Health Information Organization

• Meta data– Standardized terminology– Medical knowledge

• Network infrastructure– Performance, security


Expected Benefits of eHealth /1• Efficiency

– Case and disease management– No doubled examinations– Data are available just in time

• Decision can be made earlier

• Effectiveness– Treatment according to newest medical

knowledge– Seamless clinical pathways– Better admission and discharge management

• Safety– Warning for drug interaction– Warning for allergies

Quality

Cost


Expected Benefits of eHealth /2• Patient centred

– Basic data for anamnesis are available– Automatic reminder e.g. for vaccination– Interactive patient education

• Timeliness– Identification of critical trends

• E.g. electronic diabetes diary– Identification of patients at risk

• Equality– Use of telemedicine services– Access to centres of excellence

• Cost reduction

Quality Koste

n


Discussion• Development of a road map• Identification of the most promising projects

– Demonstration of • Benefit, utility, feasibility, cost

– eMedication, eLab, eScheduling, eDischarge letter, eDiary, ePrevention, eEmpowerment, e…

– Reminder for vaccination– Mother and child booklet– Disease management

• Quality assured patient information• Quality assured information for professionals

– Responsibility for the content

• Setting up a legal framework for eHealth– Prohibition of non-care related misuse


Road Map• Select use cases

– Fitting in the global framework of eHealth

• Identify the processes and the participants in this processes

• Define the technology– Which standards are available?– Guarantee interoperability

• Start with pilot projects– Coordinate with EU projects

Goal

Start


Main Challanges Expected• Resistance to reorganisation

– Change Management– Usability of the software– Structuring and standardization of documents

• Responsibility for the infrastructure• Are the current technical standards the

standards of the future? • Acceptance by the citizen


Conclusion• eHealth is the key for modernization of the

health care systems– It is a long term, well organized process– It needs new legal regulations

• We have to start now!– Otherwise the IT-systems are to heterogeneous– IT-investments should be in accordance with

technical standards • We have to set up coordinated pilot projects

under a European perspective• The benefits are evident!

karl p. pfeiffer department of medical statistics, informatics and health economics

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