Lower Austria regionaleHealth Integrator

Thomas Gitter, MDProduct Manger Int. CC Health ServicesRennweg 97-991030 Vienna, Austriathomas.gitter@t-systems.at

Project OverviewHIMSS06

San DiegoFeb., 14th

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“Lower Austria”….

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PrerequisitesSituation of healthcare in Austria

Hospital and Primary Care landscape in Austria Primary Care doctors are independent, most of them having

conctracts with one or more insurances Hospitals are owned mostly by regional authorities or clerical;

few private High frequency out-patient clinics in most of the hospitals

Insurance and healthcare – finanzing „Dual“ financing: Different payors for in/out – patients Patient is at risk to get „ping-pong“ subject eCard: Recently rolled out for prove of eligibility

Patient identification No unique Identification of patients (nor inhabitants) Insurance – number good for search and matching

not necessarily unique not from birth.

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Addressed point-to-point delivery of discharge letters and reports Using kind of mail-box-systems Recipient known at time of delivery

Portals for admission Still only few, individual

Teleradiology Gains ground Point-to-point Images less problematic compared to reports.

eHealthExisting regional examples

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eHealth IntegratorFeatures

Functional scope Patient Index Medical History Index (Admissions, visits, document registry) Integration interfaces for connecting participants Implemented business processes Web Application

Future Extensions Clinical Repository Increased collaborative processes between healthcare

facilities

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Healthcare RecordApproach: Product and Solution

Base technology • Database• Application Server

eHealth Integrator• Patient Index• Medical History Index

Middleware: Health Transaction Base (HTB®)• Health Data Repository• Integration Platform <

Base technology• Integration:

SeeBeyond eGate®

Solution specifics• NÖMED WAN

Customer specific solution

Product baseOracle HTB®

Coordination by T-Systemsint. CC health Vienna

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Network across all Healthcare Service providers Hospitals General Practitioners Specialists Nursing Services Emergency Units Pharmacies etc.

Availability of all kind of data with medical relevance Anywhere At any time For everybody authorized At required Scope

EU – Target !

eHealth and telematicsGeneral Goals

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Lower AustriaWhat we face

Mistelbach

Hainburg

Hollabrunn

St. Pölten

Lilienfeld

Amstetten

Waidhofen an der Thaya

Gmünd

Krems

Tulln Korneuburg

Stockerau

Melk

ScheibbsWaidhofen an der Ybbs

Zwettl

Horn

Eggenburg

Allentsteig

Gugging

Mauer Mödling

Baden

Hochegg

Wiener Neustadt

Neunkirchen

Klosterneuburg

Landscape 2003

•27 sites•22 organizational entities•18 owners

270 IT Systemsby

70 providers

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Duties: (some) Steering of healthcare providing Investments Structural improvements Defining of guidelines for economical behavior of hospitals Ongoing improvement of service-oriented finanzing Setting up appropriate acute-care capacities Extension of alternative care-institutions Coordination and planning of structures of care Balancing of service offerings between hospitals

The Customer:NÖGUS (transltd) Lower Austrian Health and Welfare Fundhttp://www.noegus.at/

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= Platformfor Healthcare

Additional to eCard=

Patientindex

Additional for local HIS

Additional for Primary Care and family doctor´s Information Systems

=

=

Patient IndexCore Component

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Clear/Unique Identity of the PatientMaster Patient Index (MPI)

Medical History IndexElectronic Patient Record - Index

(EPR-I)MPI

• Establishment of a unique identity and linking it to already existing local (Lower Austrian) records (based on master records) yielding at international applicability

• Linking-up with index systems of other regions /countries …..

• Linking up with e*governmentEPR-I

• Historical record of all interactions in conjunction with healthecareAdmissions Outpatient treatments Visits with

physicians• With the vision of being a key to the relevant documents

Medical summary Medical reports X-Ray images Drug applications

Master Patient Index

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Avoiding redundancies of examinations Awareness of and utilization of already existing, recent

findings e.g. from medical laboratory or preceding examinations

Data should accompany the patient; e.g.:

Electronic referral by the local practitioner

Automatic reception of data at the hospital and forwarding to the relevant ward (outpatients)

Results and findings always reach the practitioner or the ward ahead of the patient – they are already waiting for him/her

Master Patient IndexReasons

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Lower Austria eHealth Integrator Phase 1… …is a solution tailored to customer-specific needs …has been developed in parallelism to developmet of PIX

and PDQ and follows these IHE profiles to a high degree …eHI has as product “as it is” not been Connectathon-

proven jet

T-Systems and Partner PIX and XDS (XDS-I, XDS-MS) - Implementations passed Connectathon in Chicago recently.

XDS Document registry - according to customer – strictly follows

the IHE profiles, applicable; (Phase 2 of project, this year)

Customer specificity will still remain (additional objects to cover)

Master Patient IndexIHE and Product Perspectives

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A distributed lifetime electronic medical history

requires a strict Separation of:

• MAKE = Creation of Documents

• STORE = Archiving of Documents

• SEARCH = Looking for Documents resp.dedicated content

• VIEW = Presentation of documents

Medical Documentation

This VISION has been empowered by the DICOM Standards in the area of radiology and today is reality-proven there

and has become REALITY by the IHE model for the entire healthcare segment.

Editor

User

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Document Consumer

Document Repository Document

Consumer

Cross-Enterprise Clinical Documents Sharing (XDS)

Document Source

Document Registry

Patient Identity SourceMPIMPI

Master Patient Index

EPR-IEPR-IElektronic Patient Record - Index

Document Source

Document Repository

Document Repository

1 Provide & Register

2 Register

3 Query

4 Retrieve

STORE

VIEW

SEARCH

MAKE

IHE profile describes the “how-to”

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Patient and Medical History Index.Overview – Data Management.

……Doc 1 Doc n

HIS 1 HIS n

Patient Master ID

Copy of local data

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NÖMED WAN. Patient and Medical History Index.Process Example: Index Query, Patient Data Transfer.

Pat. & FindingsIndex

KIS-Dialog

Web Server

Abfrage Index

MsgServer

Local Client

Connector

HIS: Patient Search

Quer

y ResultHIS Extension

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NÖMED WAN Patient and Medical History IndexProcess Example: Medical History Query.

Pat. & FindingsIndex

HIS

Web Server

Link

MH Query

Medical History, Browser

Msg Server

Projekt NÖMED WANTimeline

Step 1 – Patient Index Index went live January 2006 Initial Load of patient data (demography) from pilot -

hospitals Integration with SAP Patient Management/ i.s.h.med at ZK

St.Pölten

Step 2 – Patient History Enrichment of Index by: Admissions, Document-MetaData:

June 06 Initial Load from pilot hospitals Integration with SAP Patient Management/ i.s.h.med at ZK

St.Pölten

Future Scope Connection with decentralizd Document repositories Direct Document retrival from respective archive.

Projekt NÖMED WANTechnical Architecture

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T-Systems Austria

Thank You for Your attention!

Dr.Thomas GitterProduct Management Int.cc Health Services Viennathomas.gitter@t-systems.at

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Backup….

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NÖMED WAN the Healthcare-Network

NÖMED WANNÖMED WAN = Family of projects to establish a state-widenetwork across all Healthcare providersin Lower Austria

General Conditions: Countrywide Applicability (Austria) Conformity with International Standards Consideration of National Healthcare reform-programs

• Healthcare Agency / Platform• Regional Concepts• Electronic Healthcare Record (ELGA)

Consideration of the e-Health Europe action plan(EU-Target)

Consideration of chip-card for Healthcare Services (e-card)

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Global Aims

Global aims

Creation of a central and integrative information and communication platform to meet the patient-related requirements of healthcare and welfare in Lower Austria.

To make all relevant medical data of a patient available at any location and at any time for authorized persons or organizations to the extent required, thus providing quicker and more efficient medical assistance.

Synergy and cost efficiency in the acquirement and operation of IT systems.