www.arge-elga.at+43 1 212 70 50 a-1020 vienna, schiffamtsgasse 15 healthcare transformation an the...

www.arge-elga.at +43 1 212 70 50 A-1020 Vienna, Schiffamtsgasse 15

Healthcare Transformation an the role of EHR:Views from government

Dipl.-Ing. Dr. Alexander SchannerProgram-Manager

22.10.2007

22.10.200716.3.2007 222.10.2007Alexander Schanner EHR in Austria

Agenda

1. Introduction

2. ELGA Architecture

3. ELGA Standards

4. ELGA Projects

22.10.2007 Alexander Schanner EHR in Austria

Initial Situation

Political target: Using IT for the establishment of integrated medical care

Legal assignment:Agreement according to article 15a federal constitutional law

Legal framework: data protection act health telematics act E-Government act Laws on hospitals …

Technical requirements: e-card Present HIS-systems present intramural and extramural networking


Government Program 2007Chapter 7 – Health 2

“… Unterstützung integrierter Versorgungsformen durch ausgeweitete Anwendungen der e-card und der ‚Elektronischen Gesundheitsakte‘ unter Wahrung der PatientInnen-rechte und des Datenschutzes. Die Finanzierung der ELGA ist sicherzustellen. …“

Agreement according to article 15a federal constitutional law article 7, paragraph 3

„In diesem Zusammenhang bekennen sich die Vertragsparteien prioritär zur Konzeption und Einführung der elektronischen Gesundheitsakte (ELGA) sowie der elektronischen Arzneimittelverschreibung und -verrechnung (eRezept). Der Bund verpflichtet sich, zur Planung und Akkordierung der Einführung der elektronischen Gesundheitsakte eine österreichweite Steuerungsgruppe unter umfassender Einbindung aller Betroffenen einzurichten. Die Länder verpflichten sich, an dieser Steuerungsgruppe teilzunehmen.“


Agreement according to article 15a federal constitutional law (version 2008-2013)

article 7

(1) Main targets:1. Qualitative Verbesserung der Versorgung,2. Nutzung der ökonomischen Potenziale von Informations- und

Kommunikationstechnologien,3. Harmonisierung der nationalen Vorgangsweise mit Programmen

und Aktivitäten auf europäischer Ebene und4. Sicherstellung des Rechtes der Patientinnen und Patienten auf

Zugang zu persönlichen und allgemeinen Gesundheitsdaten.

(2) ICT is a tool for modernizing health care(3) Continuation of ELGA planning- and implementation tasks


Definition of ELGA

ELGA contains relevant multimedia-based and health related data and information referring to a precisely identified person. Data und information originate from

different health service providers and from the patient himself/herself

and are stored in one or several different information systems (virtual health record). Data are available independently of place and time (cost-saving) at the place of treatment for all authorized persons according

to the tasks and needs of these persons and in compliance with data protection rules

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ELGA (Elektronische Gesundheitsakte)= Austrian’s EHR

ELGA (Elektronische Gesundheitsakte)= Austrian’s EHR


Primary goals

Medical care Patients‘ management Organisation of treatment processes Information for patients

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Secondary goals

Quality management Self-contained health related activities of the

patient Financial and administrative processes Monitoring of healthcare system Science and research

Target: avoid parallel structures!

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Federal Health Commission – BGK -Bundesgesundheitskommission

Organ of the Federal Health Agency Consists of 27 members

7 Federal Government, 1 for each province, 6 Main Association of Austrian Social Security Institutions, 1 representing cities and 1 representing communities, 1 bishops’ conference together with the Protestant’s, 1 patients’ ombud, 1 General Medical Council of Austria

Commercial operated by Ministry of Health, Family and Youth


Task Force Electronic Health Record - Arge ELGA - Arbeitsgemeinschaft Elektronische Gesundheitsakte

1. Decision of Federal Health Commission from July 2006 concerning establishment of Arge ELGA and financial remuneration

2. Working basis of Arge ELGA is an agreement between 1. Federal Government2. Provinces and3. Social Insurance Institutions

3. Since September 2006 ARGE ELGA is acting operationallyLocation: A-1020 Vienna, Schiffamtsgasse 15

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Object of Arge ELGA according to Agreement

The objective of the ELGA Task Force is to drive the connection of

existing and future electronic information and documentation systems

in the Austrian health care system within the scope of a multi-project

management.

The main target is the establishment of the so called „electronic

health record” (ELGA) in order to increase quality and efficiency of

the health care system.

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Tasks of Arge ELGA according to Agreement

Among others:1. Assistance to the Federal Health Agency concerning

controlling and coordinating activities;2. Definition of strategic priorities for the establishment of ELGA

and of the roadmap for its implementation;3. Planning of detailed concepts and implementation of projects

to introduce ELGA as well as the development of financing proposals;

4. Demand of necessary legal amendments and the binding use of approved standards;

5. Crisis and escalation management6. Evaluation of project results

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Implementation – preliminary planning2006:

February to June 2006: Preparation of Arge ELGA (contract) 28. June 2006: Decision about contract Arge ELGA Summer/Autumn: Feasibility Study September 2006: Arge ELGA is operational

2007: January: Publication of Feasibility Study Dec 06 – Feb 07: Architecture plan for the first implementation

phase March / April: Consultation with Stakeholders 4.5.2007 – BGK: Acceptance of architecture plan, standards

and commissioning of first implementation phase Masterplan

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Federal Health Commission (BGK) – decision (1/4)

Overview about decisions

Architecture of Basic Components and Core Applications

Standards Projects for planning and implementation

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Agenda

1. Introduction


3. ELGA Standards

4. ELGA Projects



Architecture Basis Components Master Patient Index Health Service Provider (HSP) Index Registry Authorization System Portal

Core applications discharge Summary e-Report - radiology e-Report - laboratory e-Medication

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Overview of Basic Components and Core Applications

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Preconditions for ELGA

Storage and Filing

Citizen / Patient

Document Repository

decentralized

Portal

ELGA Basics

Legal MeasuresData Protection

Consumers’ Acceptance

Management

OrganisationalMeasures

Master Patient Index

nationwidecompatible with EU

Network

ELGA Core Applications

First Implementation Phase

DocumentRegistry

centralized

e-Medication

(doctor, hospital,pharmacy)

e-Report(laboratories)

e-Report (radiology)

Discharge Summary

Portal

Health InformationCurrent Topics

HSP Information

Health Promotion

Portal Applications

Standards

ELGA Basic Components

HSP Indexroles

AuthorizationSystem

Access Protocols

22.10.200716.3.2007 18Alexander Schanner EHR in Austria 22.10.2007

Framework Architecture and Main Applications

„A hyper-index with sophisticated search functions“

Master PatientIndex

Adaptors: Interfaces which make existing applications compatible with ELGA

HSP Index

RegistryAuthorizationSystem

e-Report(radiology,

laboratories)

Adaptor

Discharge Summary

Adaptor

…e-Medication

Adaptor

Doctor

Da

ta S

ou

rce

s

PortalELGA

reading

writing

Citizen Card with PIN

22.10.2007 Alexander Schanner EHR in Austria Page 19

HSP Index


Registry

ReportsLaboratory X-ray Discharge

Summaries

Authorization System

Hierarchical View on ELGA

Signature,Entry in Registry

ELGAVisibility

HSP - LocalStorage of Data

Central Storage ofData

Precise link to a document, URL

22.10.2007 Alexander Schanner EHR in Austria Page 20

HSP Index


RegistryA

uth

ori

zati

on

Sys

tem

ELGA View on Data

HSP

HSP - LocalStorage of Data

Central Storage ofData

Patient

Radiology reports

Laboratory reports

Medication

Discharged Summary


Overview System Architecture

PortalHSP System HSP System

Consumer

Consumer Consumer SourceSource

Source

Pat - Index

Repository

HSP - Index

AutohorizationSystem

Document Registry

Audit System

External Registries

(base identifi-cation number,

...)

ELGA Context


Agenda

1. Introduction


3. ELGA Standards

4. ELGA Projects


International standards for ELGA in Austria:

IHE Frame-Work with domain IT Infrastructure Patient Care Coordination Laboratory Radiology

HL7 CDA 2.0 as document standard LOINC (area Laboratory data) DICOM 3.0 incl. WADO (area radiology) HL7 (in Version 3 with RIM as prospective data model)

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Interoperability – Standards and Catalogs

Technical (syntactical) interoperability Content wise (semantical) interoperability

Requirement:

Assortment of international standards

Standards rise quality and reduce costs! Standards promote competition!


International standards

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Strategy: established, international used standards

Hospital Information System (HIS) Providers have to comply with the international market, Austria‘s operating companies focus on internationally widespread HIS

HL7 RIM (Health Level 7 Reference Information Model) and CDA (Clinical Document Architecture) are preferred candidates for data model and document configuration

IHE XDS (Cross Enterprise Document Sharing) including PCC (Patient Care Coordination) for document exchange.


Technical framework: IHE Profil XDS

Document Consumer

Document Repository

Document ConsumerDocument Registry

Patient IdentitySource

MPIMPIMaster Patient Index

EPAEPA--IIElektronischer Patienten Akte - Index

2 Register

3 Query

4 Retrieve

VIEW

SEARCH

Document Source

Document Source

Document Repository

1 Provide

STORE

MAKEDocument Consumer

Document Repository

Document ConsumerDocument Registry




2 Register

3 Query

4 Retrieve

VIEW

SEARCH

Document Source

Document Source

Document Repository

1 Provide

STORE

MAKEDocument ConsumerDocument Consumer

Document RepositoryDocument Repository

Document ConsumerDocument ConsumerDocument RegistryDocument Registry





2 Register

3 Query

4 Retrieve

VIEW

SEARCH

Document Source

Document Source

Document Repository

1 Provide

STORE

MAKE

Document SourceDocument Source

Document SourceDocument Source

Document RepositoryDocument Repository

1 Provide

STORE

MAKE

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Project CDA documents

Content wise interoperability via

„Clinical Document Architecture“ from HL7 Level 1 Level 2 Level 3

for discharge Summary e-Report - radiology e-Report - laboratory e-Medicationby Arge ELGA, members of standardization institute with different

medical associations


source: www.ihe.net

Document structure HL7 CDA 2.0


International data exchange

Request HSP authorization

Request patient identifikation

Request insurance status

Request patient consent

Search med. documents

Access / download med. documents

Public

HSP

ELGA

Insurance Public

HSP

LSP

Insurance


Agenda

1. Introduction


3. ELGA Standards

4. ELGA Projects


Detailed planning and first piloting (2007 / 2008)

Concretion Basis Components and Master Plan (IBM-Follow-Up Mission) Mai to August 2007

Project 1 – Master Patient Index Project 2 – HSP Index Project 3 – Document Registry Project 4 – Authorization System Project 5 – Portal Project 6 – Main Application first phase of implementation Project 7 – Acceptance Management

Acceptance of each project after the presentation of an organizational and financial concept through BGK

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Facts for Planning and Implementation

a) Preliminary Planning Architecture Plan Standards Data Protection

b) Detailed Planning and Piloting

c) Implementation / Rollout

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ELGA Projects first phase of implementation


Thank you for your Attention!

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www.arge-elga.at+43 1 212 70 50 a-1020 vienna, schiffamtsgasse 15 healthcare transformation an the...

Documents

alexander schannerehr

elga projects slide

and implementation tasks

elga standards

elga architecture

finanzierung der elga

continuation of elga

networking slide