Transcript Slide 1

Electronic Health Records (EHR) in PROMED platform
in accordance with the Romanian legislative
framework
Roxana ANTOHIa, Cristina OGESCUa, Daniel BISTRICEANU a
Livia STEFANb, Silviu DUMITRUb
a -The Company for Research, Development, Engineering and
Manufacturing for Automation Equipment and Systems -IPA SA,
Bucharest Romania
b - Institute for Computers- ITC SA, Bucharest Romania
The project is financed by the CEEX - National Program in Romania
► PROMED platform is able to process unitary the information regarding
different kind of patient healthcare services, namely ambulatory treatment,
family doctor consultation, hospitalization in different hospitals.
►The existing informatics’ systems are accomplished for a specific hospital or
private patient clinics and therefore the patient who needs his Electronic
Patient Record has to collect his record from each hospital where he was
hospitalized or private patient clinic where he was in treatment.
► By using the PROMED platform the patients will be able to visualize their
healthcare evolution through a unitary Electronic Patient Record in a single
request. The patients can also present to their current physician the
Electronic Patient Records completed by other physicians. In this way the
diagnosis decision process of physicians can be shorter.
Hospital Emergency Room
Internet
Administrator
Physicians
Ministry of Public Health
Emergency
Health Assurance
The infrastructure of the Multifunctional Platform
The technical specifications of the application were established by means of
diagrams to point the main action for:
 Authentication;
 Security;
 Data Saving and Retrieving.
The diagnosis registered in the electronic patient medical record is compliant
with ICD-10-AM (CIM – the 10th OMS revision 2/2001VOL1). The procedures
for interventions in the health field are from ICD-10-AM (CIM 10–AM) revision
3/2002 edited by The National Centre for Classification in Health Sydney,
translated into Romanian.
∎ In the case of platform PROMED the data is stored on the server.
∎ There is a requirement that the entire database should be copied on to a
backup media.
∎ Oracle Recovery Manager (RMAN) has been recently enhanced to provide
sophisticated backup and recovery services for huge databases.
∎ These enhancements mean that storing volumes of medical data in an
ORACLE Database is now feasible.
The main purpose of an electronic health record
(EHR) is to support the multidisciplinary
communication, cooperation and decision-making
in the patients’ care process
The basic characteristics of an electronic health
record (patient-centered, longitudinal,
comprehensive and prospective) can be acquired
only in the context of an Integrated Care EHR in
accordance with the a healthcare data
management system
The general principles that need to be considered by a healthcare
data management system are:
• The responsibility of the Public Authorities for data collection,
stocking and analysis;
• To provide specifications of the information flows;
• To ensure protection of the fundamental rights of the persons;
• To ensure the data security;
• To provide definitions of the data processing domain and conditions;
• To provide access of the deciding persons to the existing data and
information;
• To ensure data confidentiality;
• To ensure access of the persons/patients to the general and
healthcare information.
The implementation of the Promed Platform took into consideration
these general principles
The PROMED multifunctional platform is implemented as a web
portal application being able to centralize the data from different
regions of the country from hospitals, ambulatories, private patient
clinics etc
The Public Authorities can use the PROMED Platform to easily
collect the data and view analysis by means of the “Medical
statistics and research” module integrated in the Platform
This module is intended to present synthetic information
regarding the health status of the entire population. Various
reports are designed to be used for medical research and
statistics and for healthcare providers reporting needs
Medical statistics and research
Public - Age group patient Rapport
Public - The average duration of the hospitalization Report
Public - Surgical cases number Report
Public - Patients ‘ Number with allergies Report
Public- Patients ‘ Number with chronic diseases Report
Public - Neoplasm diagnosed Patients number Report
Public - Birth Number Report
Confidential - The patients list of the physician
Age group patient Report
Surgical cases number Report
Patients ‘ Number with allergies Report
Patients ‘ Number with chronic diseases Report
Neoplasm diagnosed Patients number Report
In order to access the Promed Platform, the patient receives a “Patient
consent” form which must be completed by giving his name, surname, national
personal identification number and e-mail address.
Also, the patient must express his consent regarding the registration of his
health data in the platform.
The patient is the only person who can access the entire health record by giving
his user name and password, sent by e-mail by the platform’s administrator
following a the patient registration.
•The physician has access only to his patients’ data and to his patients’
treatments. The patient has the power to give the physician access to her/his
entire Electronic Patient Record only if he/she decides to.
The patients list of the physician
The PROMED platform is a useful tool at the patient’s disposal and also for
correct diagnosis in case of an emergency (life risk situation) when the
physician can access the platform through mobile devices (smart phone,
PDA) by introducing the national personal identification number. The
physician has access in this way to vital information regarding the health
status of the patient, namely the blood group, the Rhesus factor, chronic
diseases, allergies to drugs or other substances.
The “Primary Care Electronic Patient Record”
This module is intended to be used by primary care providers (family
doctors, ambulatory healthcare carers). This module manages all the data
referring to the patients reported into the ambulatory, allows to view and
modify various information from platforms database according to specific
right access.
The module has access to the following information:
• patient's administrative data and “patient’s anamnesis” section which
manages the medical history data as it is declared by the patient in
ambulatory;
• all the patient’s data restrictive to emergency information: the major
illnesses, allergies, etc. and the specific pathology (e.g. obstetrical
anamnesis for women
The module :
• manages the data regarding patient’s health status during the treatments;
• manages the patient’s data about the functional explorations prescription;
• manages the patient’s data about laboratory analysis prescriptions;
• manages the patient’s data about medication prescription during the treatments.
After accessing the platform’s site www.rommed.ro, the physicians enter on
the Physician page. The physician introduces the user name and the
password (given by the Administrator). If the physician wants to change the
password, he has this possibility by using the "Change Password" button. If
the physician wants to see his patients will use the “List Patient” button and a
list of patients will appear.
If a patient is present, the physician will introduce the national
personal identification number. If the patient is already in the database,
the minimal electronic patient record will be listed and the physician
can update the record.
After saving the patient‘s data, the physician will open the window
“Examination details“ . During the patient’s examination the
physician can update the patient‘s data and the patient’s anamnesis in
this window.
If all the introduced data is correct, the physician will use the “Save“
button and the patient is introduced in the “ Physicians examination
list“.
If the physician will take the patient in treatment, he has the
possibility to record the evolution of the patient in the “Evolution”
window, which appears when a patient is selected from the
“Physicians examination list“.
The physician can prescribe medication during the treatment
using the window “Medication“ and also can prescribe functional
explorations from CIM -1 AM ed 3 /2002
When the physician considers that he has all the data for the examination
finalization, he will use the ”Examination finalizing “button. The physician has
the possibility to modify the first diagnosis to introduce new data about the
patient, resulted from functional explorations.
If the physician considers that he correctly recorded all the data, he will
use the “Final Examination“ button. As a consequence, the patient will
disappear from the “Examination list“ and will appear in the “Patient
list“ of the physician and the data about the examination will appear in
the “Patient” page.
Conclusion
The PROMED platform supports all the medical specialties
The PROMED Platform ensures the confidentiality of the data
registration, the patient identification being made with the national
personal identification number. The patients’ registration in the database
is performed following a signed patient consent / agreement.
We consider that the PROMED healthcare information platform will
eliminate many current problems occuring in the national health
system, ranging from paper format healthcare records managing
problems to cooperation between healthcare providers. Currently, we
make experiments with PROMED platform in a pilot system with a
4G database. The PROMED Platform is presently tested by physicians
from two hospitals in Iassy and Bucharest, Romania
Thank you
ITC SA
IPA SA
Roxana Antohi - [email protected]
Livia Stefan – [email protected]
Cristina Ogescu – [email protected]
Silviu Dumitru [email protected]
Daniel Bistriceanu [email protected]