Transcript 2010 06 03 ByMedConnect EFMI STCl Engelbrecht

Improvement of Cross-Sector
Communication for an Integrated Health
Environment
Hans Demski, Anton Brass, Claudia Hildebrand,
Rolf Engelbrecht*
Helmholtz Zentrum München - German Research Center for Environmental Health
Working Group MEDIS, Institute for Biological and Medical Imaging
*) ProRec Germany
STC2010 - Reykjavik, June 2010
Outline
• ByMedConnect
• Introduction of Standards
o CCR (Continuity of Care Record)
o ISO/CEN 13606 (EHR Communication)
• Actual Developments
ByMedConnect –
Improving Communication by Linking Domains thus
Fostering Integrated Healthcare in Bavaria
• A project of Helmholtz Zentrum München in
cooperation with the GO IN Health Network
Ingolstadt
• July 2009 – July 2012
• Funded by the Bavarian State Ministry of
Environment and Public Health
• Goals
 Communication of relevant patient data and information
 Improvement of continuity of care across institutional
boundaries (seamless care)
 Application and evaluation of standards for health
record communication
 Legacy systems as a basis
Communication in ByMedConnect
ICT in German Health Care
• More than 200 different Physicians Office Management
Systems
• Big number of Hospital Information Systems
Heterogenous information systems
• Concurring solutions for online communication
(e.g. D2D, eFA, vita-X)
• National Health Telematics Platform (eGK, eGA)
not yet available
Status Quo:
No common infrastructure for online exchange
of health data
Physicians Offfice Systems in GO IN Net
M2 (Compu Med)
2%
Med EDV
PVS nach
2%
Quincy Win
mPI Medibit
2%
2%
2%
Hersteller
Easywin
(Promedico)
2%
Pata-Vital
2%
Compu Group
2%
Medistar
22%
Kuno. Informed (apple)
2%
M1
4%
Compumed
4%
Doc Expert (Comfort /
Concept)
20%
MCS (Isynet)
10%
Turbomed
12%
Albis
12%
Nennungen n=51
Internetanschluss
Electronic Communication:
Access to Internet
ISDN
20%
keine Angabe
4%
Keinen
5%
DSL + ISDN
17%
DSL
54%
ICT in German Health Care –
Example GO IN Regional Network Ingolstadt
Communication of Doctor's Letters
8
8
by paper
by email
digitalised
46
GO IN Health Network
• Regional Doctor‘s Network Ingolstadt
(AUDI city), north of Munich
• 520 GPs and Specialists
• General emergency ambulance
• Emergency ambulance for children
State-of-the Art
Documentation and Communicaton
• Computer-based systems for accounting, letter writing
and patient administration
• The only data electronically communicated is
remuneration, laboratory and radiological images
• Doctor‘s letters and reports from external are collected
in a paper-based patient record
• The heterogeneous landscape of practice administration
systems poses a challenge
• A safe network for electronic exchange of health data
has to be set up as the German Health Telematics
Platform is not yet available
• -> The physicians welcome electronic communication
Study on needs and wishes
Demands electronic communication
Gegenüberstellung Inhalte - gemittelte Wertung
4
Dokumentiert
Erhalten
Erwünscht
4 = immer
Erwünscht
3 = häufig
4 = ja
2 = selten
2,7 = eher ja
1 = einmalig
1,3 = eher nein
0 = nie
0 = nein
3
2
1
0
ByMedConnect study May 2010, first results (population 520, 60 answers so far)
n=54
Data input
Import
BMC data
POS
HIS
Viewing/Editing
BMC data
BMC-com
Communication of
BMC data
Viewing/Controlling
BMC data
BMC-com
Data adoption
Data adoption
Communication Scenario ByMedConnect (BMC)
ByMedConnect - Communication Network
• Secured network
• Transmission of standardised data
packages according to ISO EN 13606
 Separation of meta and patient
data
• Communication module in each
institution
 Visualization of data
 Interaction (Selection, Edition)
 Data Exchange
 Integration of legacy systems
Continuity of Care Record (CCR)
•
•
•
•
Patient health summary standard ASTM
Provides a lean and application-oriented dataset
Developed by US - physicians
Well established and widely used by more than
100 system vendors for transferring patients
health data in the US (Google Health, Microsoft
Health Vault, Keas)
Continuity of Care Record (CCR)
• CCR standard sections or data objects include
 Insurers/Payers; Providers; Problems; Medications;
Alerts; Vital Signs; Immunizations; Results;
Procedures; Encounters; Family History; Social History;
Functional Status; Support; Advance Directives;
Medical Equipment; Plan of Care; Comments
Detailed information at: www.ccrstandard.com
• Used to define the medical content to be
transferred in ByMedConnect
• Adaptation to the requirements of the GO IN
health network physicians expected
ISO EN 13606 – Electronic Health Record
Communication
•The Europe based international standard specifies an
„information architecture“ to deal with the
heterogeneous medical data world
•Reference model defines generic structures that form
the „building-blocks“ of a health record
•Archetype model is used for the design of information
„patterns“ (medical concepts) that add „knowledge“
and thus enable semantic interoperability
•-> Dual-model approach allows to separate systems
engineering and content definition
•
More info at: www.en13606.org
ISO EN 13606: LEGO
Analogy
Data elements
© The LEGO Group
Knowledge
Benefits ISO EN 13606
• Archetypes empower the medical professionals to
define the semantics of their own information
systems
• Archetypes are a formal model of real clinical
concepts that are standarised and can be reused
• The definition of archetypes is an important step
towards semantic interoperable EHRs that are
• portable (via institutional / regional boundaries)
• precise (e.g. terminology binding)
• accessible (individual queries + decision support)
• durable (life-long health record)
Status ByMedConnect
• EHRflex – a generic archetype based medical
record system
o Import of archetypes
o Data capturing and storage
o Open source project at SourceForge
• Archetype Definition
o Enabling the use of the CCR within ISO EN 13606 based
systems
o Usage of LinkEHR a tool developed by Institute IBMI at
“Universidad Politécnica de Valencia”
• Survey on “communication needs” within the GO
IN Health Network
EHRflex View
Patient
Record
EHRflex – Add New Entry
Next Steps
• Mapping of legacy data
o Metadata of archetypes allow for a precise
mapping that obeys the semantics of data
o LinkEHR will be used
• Development of a transformation module
o Import of legacy data
o Conversion to standardised format
• Pilot implementation at GO IN Health
Network in Ingolstadt
Contact
www.ByMedConnect.de
[email protected]