1. DICOM INTERNATIONAL DICOM INTERNATIONAL CONFERENCE & SEMINAR April 8-10, 2008 Chengdu, China National Electronic Health Record in Austria based on IHE Challenges & Opportunities for DICOM in Telemedicine Alexander SCHANNER Program-Manager Arge ELGA Task Force Electronic Health Record

2. Page 2 Alexander Schanner2008-04-10 Agenda 1.Introduction 2.ELGA Architecture 3.ELGA Standards 4.ELGA Projects 5.Summary

3. Page 3 Alexander Schanner2008-04-10 Initial Situation Political target: –Using IT for the establishment of integrated medical care Legal assignment: –Agreement according to article 15a federal constitutional law, Government Program 2007 (Chapter 7 – Health) Legal framework: –data protection-, health telematics-, e-Government act, Laws on hospitals,... Technical preconditions: –e-card –Present HIS-systems –present intramural and extramural networking

4. Page 4 Alexander Schanner2008-04-10 Agreement according to article 15a federal constitutional law (version 2008-2013) Article 7: Main targets: –I. qualitative improvement of supply –II. use of economic potential of information- and communication-technologies –III. harmonization of national approach with programs and activities on European level –IV. securing patients’ rights to have access to personal and general health data ICT is a tool for modernizing health care Continuation of ELGA planning- and implementation tasks

5. Page 5 Alexander Schanner2008-04-10 Definition of ELGA (Elektronische Gesundheitsakte) = Austrian’s EHR 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.

6. Page 6 Alexander Schanner2008-04-10 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

7. Page 7 Alexander Schanner2008-04-10 Task Force Electronic Health Record Arbeitsgemeinschaft Elektronische Gesundheitsakte Decision of Federal Health Commission from July 2006 concerning establishment of Arge ELGA and financial remuneration Working basis of Arge ELGA is an agreement between –Federal Government –Provinces and –Social Insurance Institutions Since September 2006 ARGE ELGA is acting operationally Location: A-1020 Vienna, Schiffamtsgasse 15

8. Page 8 Alexander Schanner2008-04-10 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.

9. Page 9 Alexander Schanner2008-04-10 Tasks of Arge ELGA according to Agreement Among others: –Assistance to the Federal Health Agency concerning controlling and coordinating activities; –Definition of strategic priorities for the establishment of ELGA and of the roadmap for its implementation; –Planning of detailed concepts and implementation of projects to introduce ELGA as well as the development of financing proposals; –Demand of necessary legal amendments and the binding use of approved standards; –Crisis and escalation management –Evaluation of project results

10. Page 10 Alexander Schanner2008-04-10 Implementation preliminary planning (1/2) 2006: February to June: Preparation of Arge ELGA (contract) 28. June: Decision about contract Arge ELGA May to November: Feasibility Study September: Arge ELGA is operational 2007: January: Publication of Feasibility Study ELGA Dec06 – Feb07: Architecture plan for the first phase of implementation March and April: Consultation with Stakeholders 4.5.2007 – BGK: Acceptance of architecture plan, standards and commissioning of first phase of implementation May to August: Concretion Basic Components, Master Plan and Roadmap

11. Page 11 Alexander Schanner2008-04-10 Implementation preliminary planning (2/2) 2007: May to Sept: Detailed planning of individual projects Sept to Oct: Agreement according to article 15a federal constitutional law (2008-2013)  ELGA cost-benefit-analysis  ELGA association Establishment of IHE Austria 2008: January: Start of cost-benefit-analysis  June: Federal Health Commission decides (based on results of cost-benefit-analyses and detailed planings) about the implementation of ELGA

12. Page 12 Alexander Schanner2008-04-10 Federal Health Agency (BGK) – decision (1/3) Architecture Basic Components -Master Patient Index -Health Service Provider Index -Document Registry -Authorization System -Portal Core applications -discharge Summary -e-Report - radiology -e-Report - laboratory -e-Medication

13. Page 13 Alexander Schanner2008-04-10 Federal Health Agency (BGK) – decision (2/3) International standards for EHR 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)

14. Page 14 Alexander Schanner2008-04-10 Federal Health Agency (BGK) – decision (3/3) Detailed planning and first piloting (2007 / 2008) -Concretion Basic Components and Master Plan – -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

15. Page 15 Alexander Schanner2008-04-10 Agenda 1.Introduction 2.ELGA Architecture 3.ELGA Standards 4.ELGA Projects 5.Summary

16. Page 16 Alexander Schanner2008-04-10 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

17. Page 17 Alexander Schanner2008-04-10 Hierarchical View on ELGA HSP Index Master Patient Index Registry Reports Laboratory X-ray Discharge Summaries Authorization System Signature, Entry in Registry ELGA Visibility HSP - Local Storage of Data Central Storage of Data Precise link to a document, URL

18. Page 18 Alexander Schanner2008-04-10 ELGA View on Data HSP Index Master Patient Index Registry Authorization System HSP HSP - Local Storage of Data Central Storage of Data Patient Radiology reports Laboratory reports Medication Discharge Summary

19. Page 19 Alexander Schanner2008-04-10 Agenda 1.Introduction 2.ELGA Architecture 3.ELGA Standards 4.ELGA Projects 5.Summary

20. Page 20 Alexander Schanner2008-04-10 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!

21. Page 21 Alexander Schanner2008-04-10 International standards 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.

22. Page 22 Alexander Schanner2008-04-10 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

23. Page 23 Alexander Schanner2008-04-10 Technical framework: IHE XDS Profile

24. Page 24 Alexander Schanner2008-04-10 Federated System Architecture Pat - Index HSP - Index Autohorization System Document Registry Audit System HSP System ConsumerSource HSP System ConsumerSource Repository ELGA Context Service-Provider Repository Portal Consumer Source Information Audit System Autohorization System PIX Document Registry XDSXCA CCB Audit System Autohorization System PIX Document Registry CCB Cross Community Bridge (CCB) RLS

25. Page 25 Alexander Schanner2008-04-10 Agenda 1.Introduction 2.ELGA Architecture 3.ELGA Standards 4.ELGA Projects 5.Summary

26. Page 26 Alexander Schanner2008-04-10 Facts for Planning and Implementation Preliminary Planning –Architecture Plan –Standards –Data Protection Detailed Planning and Piloting Implementation / Rollout

27. Page 27 Alexander Schanner2008-04-10 ELGA Projects first phase of implementation

28. Page 28 Alexander Schanner2008-04-10 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

29. Page 29 Alexander Schanner2008-04-10 NÖGUS (www.noegus.at) Lower Austrian health and welfare fund NÖ Landeskliniken-Holding (www.lknoe.at) going there …… Project Patienten-Index XDS in Lower Austria

30. Page 30 Alexander Schanner2008-04-10 Lower Austria Federal state of Lower Austria  approx. 1.6 million inhabitants  27 hospitals  approx. 8000 beds  approx. 3000 general practitioners Vienna

31. Page 31 Alexander Schanner2008-04-10 Starting Point Hospitals in Lower Austria 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 Situation 2004 27 Locations 22 Organizational Units 18 Different Owners 270 IT Systems supplied by 70 Manufacturers

32. Page 32 Alexander Schanner2008-04-10 Global Aims of NÖGUS 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.

33. Page 33 Alexander Schanner2008-04-10 NÖMED WAN Solution Patient Demographics –PDQ embedded in HIS Document Consumer –embedded in HIS –Via Web-Application

34. Page 34 Alexander Schanner2008-04-10 Already used PIX PDQ EUA ATNA PWP XDS.a XDS.b XDS-I RFD BPPC XUA XCA IHE Profiles in Lower Austria planned

35. Page 35 Alexander Schanner2008-04-10 IHE, global standards-based profiles adopted by several national & regional projects Quebec, Toronto, Alberta, British Columbia Canada Infoway Denmark (Funen) Italy (Veneto) Spain (Aragon) THINC- New York NCHICA – N. Carolina Italy (Conto Corrente Salute) Boston Medical Center - MA France DMP UK CfH (Radiology WF) Philadelphia HIE CHINA-MoH Lab results sharing CPHIC – Pennsylvania CHINA-Shanghai Imaging Info Sharing JAPAN-Nagoya Imaging Info Sharing South Africa Malaysia VITL-Vermont CareSpark – TN & VA Netherland Amsterdam Lower Austria Parisot, Vienna, WoHIT 2007 Austria

36. Page 36 Alexander Schanner2008-04-10 Agenda 1.Introduction 2.ELGA Architecture 3.ELGA Standards 4.ELGA Projects 5.Summary

37. Page 37 Alexander Schanner2008-04-10 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

38. Page 38 Alexander Schanner2008-04-10 Participation in the making of ELGA Working groups for the Masterplan included doctors as well as external experts for privacy law and data security Talks with patient self help groups have started Permanent communication with private groups of stakeholders as well as with institutions

39. Page 39 Alexander Schanner2008-04-10 Data Protection and Data Security Data protection is an indispensable precondition for the success of ELGA Close cooperation with all groups of society Legal implementation along technical implementation – legal acts to be amended and newly enacted Roles and authorization system Gapless logging of retrievals

40. Page 40 Alexander Schanner2008-04-10 Main communication targets Reduce fear Raise curiosity Create confidence

41. Page 41 Alexander Schanner2008-04-10 Thank you for your Attention!