Wien, Schiffamtsgasse 15 eHealth: from promise to sustainability eHealth – sharing of experiences and lessons learned EHR in Austria – regional and nationwide Dipl.-Ing. Dr. Alexander SCHANNER Program-Manager

Alexander SCHANNER Open Days Seite 2 Agenda Overview: points to be addressed; Introduction: personal and organisational information; Background: region, programme or project to be presented; Major issues: lessons learned, requirements and future outlook; Conclusions: final remarks.

Alexander SCHANNER Open Days Seite 3 Points to be addressed Lower Austria: Local EHR project Nömed WAN Austria: National EHR program ELGA Interoperability Advantages of international Standards

Alexander SCHANNER Open Days Seite 4 Agenda Overview: points to be addressed; Introduction: personal and organisational information; Background: region, programme or project to be presented; Major issues: lessons learned, requirements and future outlook; Conclusions: final remarks.

Alexander SCHANNER Open Days Seite 5 NÖGUS ( Lower Austrian health and welfare fund Project-Manager NÖ Landeskliniken-Holding ( Personal and organisational information Arbeitsgemeinschaft Elektronische Gesundheitsakte ( Program-Managerwww.arge-elga.at Since 2006 Dr. Alexander SCHANNER

Alexander SCHANNER Open Days Seite 6 Task Force Electronic Health Record Decision of Federal Health Commission (BGK) from July 2006 concerning establishment of Arge ELGA and financial remuneration Working basis of Arge ELGA is an agreement between Federal Government Federal states / Provinces and Social Insurance Institutions Since September 2006 ARGE ELGA is acting operationally ArgeELGA =Arbeitsgemeinschaft Elektronische Gesundheitsakte Arge ELGA Steering Committee Program-Management BGK

Alexander SCHANNER Open Days Seite 7 Federal Health Commission (BGK –Bundesgesundheitskommission) Consists of 27 members 7 Federal Government, 9 for provinces (1 for each federal state), 6 Main Association of Austrian Social Security Institutions, 1 representing cities and 1 representing communities, 1 bishops conference together with the Protestants, 1 patients ombud, 1 General Medical Council of Austria Chair: Minister of Health, Family and Youth

Alexander SCHANNER Open Days Seite 8 Agenda Overview: points to be addressed; Introduction: personal and organisational information; Background: region, programme or project to be presented; Major issues: lessons learned, requirements and future outlook; Conclusions: final remarks.

Seite Alexander SCHANNER Open Days Regional EHR-Solution in Lower Austria Started 2004, in operation since 2006 approx. 1.6 million inhabitants 27 hospitals approx beds approx general practitioners 270 IT Systems supplied by 70 Manufacturers Project: Patienten-Index Mistelbach Hainburg Hollabrunn St. Pölten Lilienfeld Amstetten Waidhofen an der Thaya Gmünd Krems Tulln Korneuburg Stockerau Melk Scheibbs Waidhofen an der Ybbs Zwettl Horn Eggenburg Allentsteig Gugging Mauer Mödling Baden Hochegg Wiener Neustadt Neunkirchen Klosterneuburg

Seite Alexander SCHANNER Open Days ELGA the EHR-Solution in Austria ~ 8.3 million inhabitants ~270 hospitals ~700 institutes ~ 1200 Pharmacies ~ general practitioners & specialists Core applications discharge Summary e-Report – radiology e-Report – laboratory e-Medication

Seite Alexander SCHANNER Open Days 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 (HSP) 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. ELGA (Elektronische Gesundheitsakte) = Austrian EHR

Seite Alexander SCHANNER Open Days ELGA Steps of progress ELGA Feasibility Study 2006 Architectureplan, 1 th Phase of Implementation Masterplan BGK Decision Architecture Standards Detailed planning projects 2008Cost-Benefit Study Requirements document BGK Decision Autumn 2008

Seite Alexander SCHANNER Open Days ELGA basic supply domain ELGA domain 1..N Central Patientindex + RLS HSP Index Role based Access Service Portal Local Patientenindex Document- Registry Authori- zation System ConsumerSource HSP-System ConsumerSource Gateway HSP-System ConsumerSource Document- Repository Local Patientindex HSP-System ConsumerSource Provider Document- Repository Audit System Information Authori- zation System Audit System Audit System (Aggregation) virtual Registry Document- Registry Gateway ELGA-Architecture

Seite Alexander SCHANNER Open Days Agenda Overview: points to be addressed; Introduction: personal and organisational information; Background: region, programme or project to be presented; Major issues: lessons learned, requirements and future outlook; Conclusions: final remarks.

Seite Alexander SCHANNER Open Days Requirements Technical (syntactical) interoperability Content wise (semantical) interoperability Requirement: Assortment of international standards Standards raise quality and reduce costs! Standards promote competition! Legal interoperability?? Financial interoperability??

Seite Alexander SCHANNER Open Days Why Standards ? HIS Patient Identify Source Registry Consumer Repository Source IHE conform: easy to replace Vendors not IHE conform: no replacement of Vendors possible HIS Patient Identify Source Registry Consumer Repository Source Standard Non Standard

Seite Alexander SCHANNER Open Days Example for 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 SWG eHealth

Seite Alexander SCHANNER Open Days Austria & epSOS European Patients Smart Open Services – Open eHealth Initiative for a European Large Scale Pilot of Patient Summary and Electronic Prescription Arge ELGA is Austrians national Competence Center, Austria is the leader in the Working Package 3.6 Identity Management ELGA Connex e-Prescription (ELGA-eMedication) Patient Summary (~ELGA-Discharge summary)

Seite Alexander SCHANNER Open Days Agenda Overview: points to be addressed; Introduction: personal and organisational information; Background: region, programme or project to be presented; Major issues: lessons learned, requirements and future outlook; Conclusions: final remarks.

Seite Alexander SCHANNER Open Days Key success factors Patients are in the Center Involvement of all Health Service Providers and Stakeholders in planning and implementation phase Considerations concerning the federated healthcare structures in Austria

Seite Alexander SCHANNER Open Days Recommendations Identify balance between centralized and decentralized solutions Recommend a step by step migration from existing, proprietary local systems to a compatible distributed and shared eHealth infrastructure Require the separation between IT-Infrastructure Applications Data

Seite Alexander SCHANNER Open Days Recommendations Dont think about point to point communication n*(n-1)/2 27 EU-Members 351 Interfaces Dont reinvent the wheel Look for best practices Think big and global, act small and local

Seite Alexander SCHANNER Open Days Thank you for your Attention!