Health IT Status and perspectives Prof. Dr. med. Bjrn Bergh - PowerPoint PPT Presentation

Health IT Status and perspectives Prof. Dr. med. Björn Bergh Chairman – Dept. of Information Technology and Clinical Engineering Professor for Medical Information Systems

Heidelberg Castle Hospital + Med. Faculty Age 800 years 723 years (1386) Visitors 1.000.000 pa 1.300.000 pa Av. length of stay 90 min. 1200 min. Ranking in Germany 9 1 (16 worldwide) Employees 57 8500 Beds (in use) - 1650 + (350) ~2000 2

Centre of Information Technology and Medical Engineering (ZIM)  175 staff members  Plan, purchase, deploy + operate • all IT infrastructure, applications (incl. RIS, PACS, LIS. . .) • all medical devices + furniture • telephony, patient record archives…  Scientific unit • eHealth, systems integration, IT + engineering, radiological informatics, digital signatures Prof. Dr. Björn Bergh 3

The status  Which industries come to your mind completely supporting their main processes by IT?  Not Healthcare?  Why is that the case? 4

Core aspects  Technology • Products and solutions • Architecture • Standards  Acceptance/Usefulness • Perceived (Benefits) • Documented (Evidence, cost-benefit analysis)  Resources • Financial / Reimbursement • Staff 5

Intra-institutional  Infrastructure 6

Networking and mobility  Technology • Highspeed LAN + wired VOIP • WLAN + wireless VOIP • Mobile devices (Tablet, Laptop, PDA) • Apps for mobile devices  Resources (often in infrastructure)  Acceptance 7

WLAN and services 2,4 Ghz QoS SSID: 1 SSID: 2 SSID: 3 5 Ghz SSID: 4 SSID: 5 SSL Web VPN Server

Future  WLAN as the global platform unifying services • Wireless VOIP (Professionals and patients) • Positioning (staff, devices) • Alarm (nurse call), call stratification, sensors • Monitoring • Entertainment • Something like the iphone?  Integration of medical devices!! • Safety + security 9

Intra-institutional  Applications 10

Major Applications - Technology ERP HIS CIS PACS Digital Record Patient index Reports Finances Registration Images CPOE Materials Coding Scheduling Controlling Billing Multimedia OR HR …. objects Charting FM … … Enterprise HIS=Hospital Information system resource PAS=Patient administration system planning CIS=Clinical information system EPR, EMR= Electronic Patient (Medical) record 11

Technology - Products  ERP + HIS: OK  CIS • Completeness • Robustness • Performance • Flexibility • Usability  PACS: OK  Architecture and standards 12

 Acceptance/Usefulness • Perceived (Benefits) • Documented (Evidence, cost-benefit analysis)  Resources • Financial / Reimbursement • Staff (bypass product deficits!) 13

The future  Patient safety  Integration of medical devices  Integration of knowledge (decision support systems)  Integration of clinical trials / data mining  Integration of biomolecular data 14

POCT Network  Point Of Care Testing  Decentral lab test (Gases, sugar…)  Devices standardised • ca. 130 sugar (Roche) • 35 Gas (Bayer)  ca. 800-1000 POCT-orders/d  G-VLAN integration (vendor neutral): • HL7: ADT + orders, results back • Security: partial

PoCT – Application Integration HIS PDMS BAR Code Sugar Gases Lab Gateway LIS

ECG MegaCare Client InternetExplorer mind. Sun Java 1.4.x SAP Url-Call IS-H* med Druckserver MegaCare System / Dienste ADT Mortara EKG Orders WEB-Service Print service Leistungs- Heik04 übermittlung XML eGate EKG ADT unsolicited messages Worklist HL7 Interface Import EKG EliLink Import-Service pull/transfer File-Service Export EKG-PDF SiFor Archiv MegaCare Hausnetz Query ADT Data Infinity GW Infinity Network ADT-Proxy Linux/Dräger Systemkonzept Infinity MegaCare UKL Heidelberg Renatus Beck, Dräger medical GmbH, A.Buchauer 4.8.2008

Cross-institutional 18

Applications  Telemedicine + Home monitoring  Portals  Records (EHR, PHR, PEHR)  Ambient assisted living 19

Experiences with eHealth  Teleradiology  Teleneurology  Tele-oncology (pediatric)  Home Care Monitoring  ….  The usage of separate Telemedicine components is beneficial but:  Information from all HIT-systems and Home Care belongs together!! 20

Solution: a cross-institutional record 21

Consideration - Vision 1 Patient + Family HC Professional Communication Module PHR Node Phone, Video Conf. Sensors IT systems Shared Care Record HIS/CIS EHR TMC system PHR GP system Record of TMC Pharmacy system Sensor Platform Prof. Dr. B. Bergh - ZIM

EMR, EHR and PHR Record type Characteristics Main Advantages Main Disadv. EMR All clinical data of a patient Not accessible for other doctors or to document, monitor and Electronic the patient manage care delivery in Medical Record one institution Case-based accessible within the care delivery organisation (CDO) Subsets of each CDO‘s EMR EHR Viewing in other No patient presently assumed to include CDOs possilbe involvement for Electronic summaries (CCR, etc.) viewing and Easier data import Health Record access Longitudinal access across from professional management multiple institutions systems (high quality and completeness) PHR Contains patient input (home Fully controled by No automated care devices, diet, sports). the empowered data import from Personal Health Acess for multiple institutions is patient other systems Record managed by the patient

Two main issues anticipated with EHR  Architecture and systems integration with standards  Ensure patient’s right for data privacy 24

EHR - Integration with standards? Standard Standard Standard Existing eHealth standards Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard 25

EHR - Integration with standards? Standard Standard Standard Existing eHealth standards Standard Standard Standard Understandable and complete Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard 26

EHR - Integration with standards? Standard Standard Existing eHealth standards Standard Understandable and complete Standard Standard Industry accepted and Implemented (EHR) Standard Standard Standard Standard Standard Standard Standard 27 27

EHR - Integration with standards? Standard Existing eHealth standards Understandable and Do it yourself complete HL7 + DICOM Industry accepted and => IHE Implemented (EHR) Industry accepted and Implemented (HIS-CIS) Standard 28 28 28

Data Privacy and EHR eHealth + EHRs are absolutely safe! Goya

EHR Data privacy study - Methods  Requirements analysis • Patients • Physicians • Data privacy officers • Review federal and state regulations => High level requirements  Technical capabilities • Access concepts HIS-CIS systems • Access concepts EHR projects and vendors  Matching requirements and capabilities 30

EHR Data privacy study - Results No concept fulfils all needs!!

Data Privacy and EHR eHealth + EHRs are totally safe! They most certainly are not! Goya Goya

Solutions?  Full access for all HC professionals and logging (patient surveilance)  Give the power to the citizens/patients 33

Our decision: Focus on the citizen/patient Grant Wood

Vision 2 - PEHR Decides Patient - who sees what - sees all accesses - chooses provider Care providers Communicate only via the PEHR with each other TELEMED Award 2008

Core aspects  Technology • Products and solutions • Architecture • Standards  Acceptance/Usefulness • Perceived (Benefits) • Documented (Evidence, cost-benefit analysis)  Resources • Financial / Reimbursement • Staff 36

What is required? Prof. Dr. Björn Bergh

Unite the Know-How - Create cooperation - Reports (Good eHealth Report) - more: structured, pitfalls, technology - Disseminate Raffaello Santi

Give CIOs and citizens voice - EHTEL - e-HITS (European Health IT Society) - ICMCC (International Council on Medical & Care Compunetics) - Patient organisations - Journals… - … Edvard Munch

Unique ID (Europe?) - Citizens - HCP (Index) Pablo Picasso

Reference architectures - Not so many alternatives - EHR - PEHR - central vs. decentral - PHR… - cards Piet Mondrian

One standard - Communication first - Then semantics - Not against the market but with - Industry accepted - Get CIOs involved in standardisation - Gov. organizations have to help - Connectivity = Open source SW (OSS) - IHE profiles need refinement/bundling (XDS, BPPC, XPHR, PIX…) Wassily Kandinsky

Legal + regulatory - Who owns cross-institutional information? - Who ensures data privacy? - How are data privacy violations punished? Hans Holbein 43

Organisational - Socio-psychiological And who is taking care of us? Goscinny, Uderzo The citizen? – a heterogeneous group How to support patients/citizens best? How to involve them best? How to empower them best? 44

eHealth can be a blessing or Fra Angelico