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 STC Reykjavik, June 2010

Copyright © 2008 ASTM International and American Academy of Family Physicians Outline Outline ByMedConnect ByMedConnect Introduction of Standards Introduction of Standards oCCR (Continuity of Care Record) oISO/CEN (EHR Communication) Actual Developments Actual Developments

Copyright © 2008 ASTM International and American Academy of Family Physicians 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 A project of Helmholtz Zentrum München in cooperation with the GO IN Health Network Ingolstadt July 2009 – July 2012 July 2009 – July 2012 Funded by the Bavarian State Ministry of Environment and Public Health Funded by the Bavarian State Ministry of Environment and Public Health Goals 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

Copyright © 2008 ASTM International and American Academy of Family Physicians Communication in ByMedConnect Communication in ByMedConnect

Copyright © 2008 ASTM International and American Academy of Family Physicians ICT in German Health Care ICT in German Health Care More than 200 different Physicians Office Management Systems More than 200 different Physicians Office Management Systems Big number of Hospital Information Systems Big number of Hospital Information Systems  Heterogenous information systems Concurring solutions for online communication (e.g. D2D, eFA, vita-X) Concurring solutions for online communication (e.g. D2D, eFA, vita-X) National Health Telematics Platform (eGK, eGA) not yet available National Health Telematics Platform (eGK, eGA) not yet available Status Quo: No common infrastructure for online exchange of health data

Copyright © 2008 ASTM International and American Academy of Family Physicians Physicians Offfice Systems in GO IN Net

Copyright © 2008 ASTM International and American Academy of Family Physicians Electronic Communication: Access to Internet

Copyright © 2008 ASTM International and American Academy of Family Physicians ICT in German Health Care – Example GO IN Regional Network Ingolstadt ICT in German Health Care – Example GO IN Regional Network Ingolstadt

Copyright © 2008 ASTM International and American Academy of Family Physicians GO IN Health Network GO IN Health Network Regional Doctor‘s Network Ingolstadt (AUDI city), north of Munich Regional Doctor‘s Network Ingolstadt (AUDI city), north of Munich 520 GPs and Specialists 520 GPs and Specialists General emergency ambulance General emergency ambulance Emergency ambulance for children Emergency ambulance for children

Copyright © 2008 ASTM International and American Academy of Family Physicians State-of-the Art Documentation and Communicaton State-of-the Art Documentation and Communicaton Computer-based systems for accounting, letter writing and patient administration Computer-based systems for accounting, letter writing and patient administration The only data electronically communicated is remuneration, laboratory and radiological images 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 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 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 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 -> The physicians welcome electronic communication

Copyright © 2008 ASTM International and American Academy of Family Physicians Study on needs and wishes

Copyright © 2008 ASTM International and American Academy of Family Physicians Demands electronic communication ByMedConnect study May 2010, first results (population 520, 60 answers so far)

Copyright © 2008 ASTM International and American Academy of Family Physicians POS BMC-com Data input Viewing/Controlling BMC data BMC-com Viewing/Editing BMC data Communication of BMC data HIS Import BMC data Data adoption Communication Scenario ByMedConnect (BMC) Communication Scenario ByMedConnect (BMC)

Copyright © 2008 ASTM International and American Academy of Family Physicians ByMedConnect - Communication Network Secured network Transmission of standardised data packages according to ISO EN  Separation of meta and patient data Communication module in each institution  Visualization of data  Interaction (Selection, Edition)  Data Exchange  Integration of legacy systems

Copyright © 2008 ASTM International and American Academy of Family Physicians Continuity of Care Record (CCR) Continuity of Care Record (CCR) Patient health summary standard ASTM Patient health summary standard ASTM Provides a lean and application-oriented dataset Provides a lean and application-oriented dataset Developed by US - physicians 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) 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)

Copyright © 2008 ASTM International and American Academy of Family Physicians Continuity of Care Record (CCR) Continuity of Care Record (CCR) CCR standard sections or data objects include 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: Used to define the medical content to be transferred in ByMedConnect Used to define the medical content to be transferred in ByMedConnect Adaptation to the requirements of the GO IN health network physicians expected Adaptation to the requirements of the GO IN health network physicians expected

Copyright © 2008 ASTM International and American Academy of Family Physicians ISO EN – Electronic Health Record Communication The Europe based international standard specifies an „information architecture“ to deal with the heterogeneous medical data world 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 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 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 -> Dual-model approach allows to separate systems engineering and content definition More info at: More info at:

Copyright © 2008 ASTM International and American Academy of Family Physicians Knowledge Data elements ISO EN 13606: LEGO Analogy © The LEGO Group

Copyright © 2008 ASTM International and American Academy of Family Physicians Benefits ISO EN Benefits ISO EN Archetypes empower the medical professionals to define the semantics of their own information systems 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 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 The definition of archetypes is an important step towards semantic interoperable EHRs that are portable (via institutional / regional boundaries) ‏ portable (via institutional / regional boundaries) ‏ precise (e.g. terminology binding) ‏ precise (e.g. terminology binding) ‏ accessible (individual queries + decision support) ‏ accessible (individual queries + decision support) ‏ durable (life-long health record) durable (life-long health record)

Copyright © 2008 ASTM International and American Academy of Family Physicians Status ByMedConnect Status ByMedConnect EHRflex – a generic archetype based medical record system EHRflex – a generic archetype based medical record system oImport of archetypes oData capturing and storage oOpen source project at SourceForge Archetype Definition Archetype Definition oEnabling the use of the CCR within ISO EN based systems oUsage of LinkEHR a tool developed by Institute IBMI at “Universidad Politécnica de Valencia” Survey on “communication needs” within the GO IN Health Network Survey on “communication needs” within the GO IN Health Network

Copyright © 2008 ASTM International and American Academy of Family Physicians EHRflex - View Patient Record

Copyright © 2008 ASTM International and American Academy of Family Physicians EHRflex – Add New Entry EHRflex – Add New Entry

Copyright © 2008 ASTM International and American Academy of Family Physicians Next Steps Next Steps Mapping of legacy data Mapping of legacy data oMetadata of archetypes allow for a precise mapping that obeys the semantics of data oLinkEHR will be used Development of a transformation module Development of a transformation module oImport of legacy data oConversion to standardised format Pilot implementation at GO IN Health Network in Ingolstadt Pilot implementation at GO IN Health Network in Ingolstadt

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