A-1020 Vienna, Schiffamtsgasse 15 Healthcare Transformation an the role of EHR: Views from government Dipl.-Ing. Dr. Alexander Schanner Program-Manager

Alexander SchannerEHR in AustriaPage Agenda 1.Introduction 2.ELGA Architecture 3.ELGA Standards 4.ELGA Projects

Alexander SchannerEHR in AustriaPage 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

Alexander SchannerEHR in AustriaPage 4 Government Program 2007 Chapter 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.“

Alexander SchannerEHR in AustriaPage 5 Agreement according to article 15a federal constitutional law (version ) 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 und 4.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

Alexander SchannerEHR in AustriaPage 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 Page 6 ELGA (Elektronische Gesundheitsakte) = Austrian’s EHR

Alexander SchannerEHR in AustriaPage 7 Primary goals  Medical care  Patients‘ management  Organisation of treatment processes  Information for patients Page 7

Alexander SchannerEHR in AustriaPage 8 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

Alexander SchannerEHR in AustriaPage 9 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

Alexander SchannerEHR in AustriaPage 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 Government 2.Provinces and 3.Social Insurance Institutions 3.Since September 2006 ARGE ELGA is acting operationally Location: A-1020 Vienna, Schiffamtsgasse 15 Page 10

Alexander SchannerEHR in AustriaPage 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. Page 11

Alexander SchannerEHR in AustriaPage 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 management 6.Evaluation of project results Page 12

Alexander SchannerEHR in AustriaPage 13 Implementation – preliminary planning 2006: 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 – BGK: Acceptance of architecture plan, standards and commissioning of first implementation phase Masterplan Page 13

Alexander SchannerEHR in AustriaPage 14 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

Alexander SchannerEHR in AustriaPage Agenda 1.Introduction 2.ELGA Architecture 3.ELGA Standards 4.ELGA Projects

Alexander SchannerEHR in AustriaPage 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

Alexander SchannerEHR in AustriaPage 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 Measures Data Protection Consumers’ Acceptance Management Organisational Measures Master Patient Index nationwide compatible with EU Network ELGA Core Applications First Implementation Phase Document Registry centralized e-Medication (doctor, hospital, pharmacy) e-Report (laboratories) e-Report (radiology) Discharge Summary Portal Health Information Current Topics HSP Information Health Promotion Portal Applications Standards ELGA Basic Components HSP Index roles Authorization System Access Protocols

Alexander SchannerEHR in AustriaPage Framework Architecture and Main Applications „A hyper-index with sophisticated search functions“ Master Patient Index Adaptors: Interfaces which make existing applications compatible with ELGA HSP Index Registry Authorization System e-Report (radiology, laboratories) Adaptor Discharge Summary Adaptor … e-Medication Adaptor Doctor Data Sources Portal ELGA reading writing Citizen Card with PIN

Alexander SchannerEHR in AustriaPage 19 HSP Index Master Patient Index Registry Reports Laboratory X-ray Discharge Summaries Authorization System Hierarchical View on ELGA Signature, Entry in Registry ELGA Visibility HSP - Local Storage of Data Central Storage of Data Precise link to a document, URL

Alexander SchannerEHR in AustriaPage 20 HSP Index Master Patient Index Registry Authorization System ELGA View on Data HSP HSP - Local Storage of Data Central Storage of Data Patient Radiology reports Laboratory reports Medication Discharged Summary

Alexander SchannerEHR in AustriaPage 21 Overview System Architecture Portal HSP System Consumer Source Pat - Index Repository HSP - Index Autohorization System Document Registry Audit System External Registries (base identifi- cation number,...) ELGA Context

Alexander SchannerEHR in AustriaPage 22 Agenda 1.Introduction 2.ELGA Architecture 3.ELGA Standards 4.ELGA Projects

Alexander SchannerEHR in AustriaPage 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) Page 23 Federal Health Commission (BGK) – decision (3/4)

Alexander SchannerEHR in AustriaPage 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!

Alexander SchannerEHR in AustriaPage 25 International standards Page 25 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.

Alexander SchannerEHR in AustriaPage 26 Technical framework: IHE Profil XDS Page 26

Alexander SchannerEHR in AustriaPage 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-Medication by Arge ELGA, members of standardization institute with different medical associations

Alexander SchannerEHR in AustriaPage 28 source: Document structure HL7 CDA 2.0

Alexander SchannerEHR in AustriaPage 29 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 InsurancePublic HSP LSP Insurance

Alexander SchannerEHR in AustriaPage 30 Agenda 1.Introduction 2.ELGA Architecture 3.ELGA Standards 4.ELGA Projects

Alexander SchannerEHR in AustriaPage 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)

Alexander SchannerEHR in AustriaPage 32 Facts for Planning and Implementation a) Preliminary Planning  Architecture Plan  Standards  Data Protection b) Detailed Planning and Piloting c) Implementation / Rollout Page 32

Alexander SchannerEHR in AustriaPage 33 ELGA Projects first phase of implementation

Alexander SchannerEHR in AustriaPage 34 Thank you for your Attention! Page 34