Lower Austria regional eHealth Integrator Thomas Gitter, MD Product Manger Int. CC Health Services Rennweg Vienna, Austria Project Overview HIMSS06 San Diego Feb., 14th

1 “Lower Austria”….

2 Prerequisites Situation 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.

3 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. eHealth Existing regional examples

eHealth Aspects The 10 e's in “e-health” (Gunther Eysenbach)  Efficiency  Enhancing quality of care  Evidence based  Empowerment of consumers and patients  Encouragement of a new relationship patient and health professional  Education of physicians through online sources  Enabling information exchange and communication in a standardized way between health care establishments  Extending the scope of health care beyond its conventional boundaries  Ethics  Equity.

5 eHealth Integrator Features 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

6 Healthcare Record Approach: 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 base Oracle HTB® Coordination by T-Systems int. CC health Vienna

7 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 telematics General Goals

8 Lower Austria What we face 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 Landscape sites 22 organizational entities 18 owners 270 IT Systems by 70 providers

9 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 Asutrian Health and Welfare Fund

10 = Platform for Healthcare Additional to eCard = Patientindex Additional for local HIS Additional for Primary Care and family doctor´s Information Systems = = Patient Index Core Component

11 Clear/Unique Identity of the Patient M aster P atient I ndex (MPI) Medical History Index E lectronic P atient R ecord - I ndex (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*government EPR-I Historical record of all interactions in conjunction with healthecare AdmissionsOutpatient 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

12  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 Index Reasons

13 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

14 Document Consumer Document Repository Document Consumer Cross-Enterprise Clinical Documents Sharing (XDS) Document Source Document Registry Patient Identity Source MPI MPI Master Patient Index EPR-I EPR-I Elektronic Patient Record - Index Document Source Document Repository 1 Provide & Register 2 Register 3 Query 4 Retrieve STORE VIEW SEARCH MAKE IHE profile describes the “how-to”

15 Patient and Medical History Index. Overview – Data Management. … … Doc 1Doc n HIS 1HIS n Patient Master ID Copy of local data

16 NÖMED WAN. Patient and Medical History Index. Process Example: Index Query, Patient Data Transfer. Pat. & Findings Index KIS-Dialog Web Server Abfrage Index Msg Server Local Client Connector HIS: Patient Search Query Result HIS Extension

17 NÖMED WAN Patient and Medical History Index Process Example: Medical History Query. Pat. & Findings Index HIS Web Server Link MH Query Medical History, Browser Msg Server

18  Matching algorithm  Patient demography  Social insurance number  Remote ID`s kept in central index system  Reconciliation tool  Part of contract  Compliant with regional/national/international law (?)  Data security / privacy issues “Master Patient”

Projekt NÖMED WAN Timeline 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 WAN Technical Architecture

21 T-Systems Austria Thank You for Your attention! Dr.Thomas Gitter Product Management Int.cc Health Services Vienna

22 Backup….

23 NÖMED WAN the Healthcare-Network NÖMED WAN NÖMED WAN = Family of projects to establish a state-wide network across all Healthcare providers in 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)

24 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.