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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 Page 2
Agenda
1. Introduction
2. ELGA Architecture
3. ELGA Standards
4. ELGA Projects
22.10.2007 Alexander Schanner EHR in Austria Page 3
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
22.10.2007 Alexander Schanner EHR in Austria Page 4
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.“
22.10.2007 Alexander Schanner EHR in Austria Page 5
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
22.10.2007 Alexander Schanner EHR in Austria Page 6
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
22.10.2007 Alexander Schanner EHR in Austria Page 7
Primary goals
Medical care Patients‘ management Organisation of treatment processes Information for patients
Page 7
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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!
Page 8
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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
22.10.200716.3.2007 1022.10.2007Alexander Schanner EHR in Austria Page 10
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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22.10.200716.3.2007 1122.10.2007Alexander Schanner EHR in Austria Page 11
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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22.10.200716.3.2007 1222.10.2007Alexander Schanner EHR in Austria Page 12
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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22.10.2007 Alexander Schanner EHR in Austria Page 13
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
Page 14
22.10.200716.3.2007 1522.10.2007Alexander Schanner EHR in Austria Page 15
Agenda
1. Introduction
2. ELGA Architecture
3. ELGA Standards
4. ELGA Projects
22.10.2007 Alexander Schanner EHR in Austria Page 16
Federal Health Commission (BGK) – decision (2/4)
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
Page 16
22.10.2007 Alexander Schanner EHR in Austria Page 17
Overview of Basic Components and Core Applications
Page 17
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 Page 1822.10.2007
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 19Page 19
HSP Index
Master Patient 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 20Page 20
HSP Index
Master Patient 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
22.10.2007 Alexander Schanner EHR in Austria Page 21
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
22.10.2007 Alexander Schanner EHR in Austria Page 22
Agenda
1. Introduction
2. ELGA Architecture
3. ELGA Standards
4. ELGA Projects
22.10.2007 Alexander Schanner EHR in Austria Page 23
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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Federal Health Commission (BGK) – decision (3/4)
22.10.2007 Alexander Schanner EHR in Austria Page 24
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!
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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.
22.10.2007 Alexander Schanner EHR in Austria Page 26
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
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 ConsumerDocument Consumer
Document RepositoryDocument Repository
Document ConsumerDocument ConsumerDocument RegistryDocument Registry
Patient IdentitySource
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
MAKE
Document SourceDocument Source
Document SourceDocument Source
Document RepositoryDocument Repository
1 Provide
STORE
MAKE
Page 26
22.10.2007 Alexander Schanner EHR in Austria Page 27
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
22.10.2007 Alexander Schanner EHR in Austria Page 28
source: www.ihe.net
Document structure HL7 CDA 2.0
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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
22.10.2007 Alexander Schanner EHR in Austria Page 30
Agenda
1. Introduction
2. ELGA Architecture
3. ELGA Standards
4. ELGA Projects
22.10.2007 Alexander Schanner EHR in Austria Page 31
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
Page 31
Federal Health Commission (BGK) – decision (4/4)
22.10.2007 Alexander Schanner EHR in Austria Page 32
Facts for Planning and Implementation
a) Preliminary Planning Architecture Plan Standards Data Protection
b) Detailed Planning and Piloting
c) Implementation / Rollout
Page 32
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ELGA Projects first phase of implementation
22.10.2007 Alexander Schanner EHR in Austria Page 34
Thank you for your Attention!
Page 34
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