Presentation on theme: "University Hospital Brussels"— Presentation transcript:
1 University Hospital Brussels 1 december 2005Project “ABRUMET”Proposal for a Regional Medical NetworkR. Van de VeldeUniversity Hospital BrusselsAZ VUBVrije Universiteit Brussel
2 About Abrumet : Organisation for Telemedicine in Brussels MembersGP FAMGB, BHAKHospitals AZ-VUB, CHIREC, Clinique de l’Europe, Erasme, C. de Paepe, Sanatia, Saint Jean, Saint Luc IRIS (hospitals – CTO)ObjectivesTo foster availability, accessibility and portability of patient records by means of Health Information Networks (HIN)Collaboration: ability to share medical information between authorized HC workersTo stimulate confidence of general Practitioners and increased investment in CPRBilingualTo encourage patients to take a more important role in managing their health records .
4 What if a physician requests a patient record? May I please have the Patient Record?
5 x Hospitals : Do not share information The Answer is Yes, but …xDo not share informationH1H2H3Hospitals :Have distinct security approachesAZ-VUBAMISUZLLISA. . .Lock up data in proprietary formatsPerceive competition
6 Even when information is electronically available The Answer is Yes, but …Even when information is electronically availablein an electronic medical recordin a pharmacy systemin a digital radiology system….The patient is generally given at personal inconvenience, a hard copyNo “export” function available !
7 What if we gave GPs a tool to request their records electronically? xxH1H2H3AbrumetFirst Phase:
8 Finding Records: Manual Approach Laboratory ResultsSpecialist RecordHospital RecordRecordsSentThe challenge: Finding and accessing easily documents from other care providers in the community.Clinical EncounterClinical IT System
9 Finding Records: The Abrumet Way Laboratory ResultsSpecialist RecordHospital Record3-RecordsReturnedTemporary Aggregate Patient History3-Patient data presented to PhysicianClinical EncounterClinical IT SystemIndex of patients records(Document-level)2-Referenceto Records for Inquiry1-Patient Authorized Inquiry
12 The Patient “Longitudinal” Record General PractitionerClinical BOther Specialized CareClinical ATypically, a patient goes through a sequence of encounters in different Care Settings
13 Requirements (1/2)Foundation for a federated Health IT Infrastructure: Focussing on a shared Electronic Health Record, in a community, regionDistributed: A “federated” system composed of distinct, distributed, disparate, decentralized systems defined as “data keepers”. Each Health Care organization “publishes” clinical information for authorized users. Information that remains in the original location of creation.Document Centric: Published clinical data is organized into “clinical documents” based on agreed standard document typesSharing of documents between General Practioners, clinics, pharmacists, … with different medical IT systemsConsistent graphical user interface: Care providers are offered means to query and retrieve clinical documents of interest in the same consistent way independent of the source of information
14 The Master (Community) Patient Index 14355L-716MMaster Patient IndexDocument RegistryPatient RegistryDocument RepositoryLaboratoryClinical BAbrumetPortalClinical ASubmission of Patient & Doc ReferencesRetrieval of selected Documents
15 Requirements (2/2)Cross-Enterprise: A Master Patient (Community) Index provides an index for published information to authorized HealthcarePatient maintains control and can grant access to selected portions of his/her medical record (ACL) for authorized users specific to their rolePhysicians can be granted access to the record or portions of it to read or write. Should the patient choose they may be locked out at a future time. Collaboration is optimisedStandardized Queries: Are based on Web Services and KMehr standardEasy access based on Single Sign On (SSON) without installation of specific software at the user site with the same tokens/cardsInterconnectivity: The system enables links to other related networks such as CareNet, Be Health, Social Security, RIZIN-INAMI, ...
19 SUMEHR (Summarized Electronic Health Record) Patient IdentificationIdPatient PresentationNameForenamesSexBirth dateUsual languageContact personAuthorHealth care practitioner IdGMD relationshipRisksAllergiesAdverse drug reactionsSocial factorsOther factorsRelevant personal antecedents[ICPC2, ICD10, Other Code, Begin date, End date, text, links]Actual problems list[ICPC2, ICD10, Other Code, Begin date, text, links]Actual medications[CNK or other Id, Various administration informations, Begin date, text, links]Vaccination statusAdministrated [CNK or other Id, Date]To be administrated [CNK or other Id, Date]Contextual comment
22 The Architecture (1/3) Network S Med S S Med Med A Med Nw S Med Med S HospitalsST. PIERREUniversitairZiekenhuis VUBPharmacyData KeepersSMedSMedSMedNetworkAMedAbrumetDoctorsNwMedSMedSMedSécurité SocialeLaboSpecialistA Med = Access MediatorS Med = Service Mediator
23 The Architecture (2/3) A Med S Med S Nw Med Med Prescription Documents Dr. XDr. YDr. ZAMedAbrumetClients/UsersSMedPharmacyPrescriptionSMedHospitalsSt. PierreUniversitairZiekenhuis VUBAbrumetDocumentsSécurité SocialeNwMedLink
24 The Architecture (3/3) Access Mediator Network Service Mediators MPI 2Auth1tunnelNetworkMessages674JournalAccessHTTPSImportMsgWeb PortalVPNVisualisationSécurité SocialeJournalAccesst= 1 monthACLAuth.5
25 ACL (Access Control List) Scenario: ExampleLogicDo Not release the record of the dermatology specialist(SOAP)Do Not release 1 specific documentEverything what is treated by the department of PsychiatryDo Not release 1 type of documentEverything what is entered by a specific physicianDo Not release all documents related to one physicianKeep everything protected during a specific periodTime constraints
27 Ongoing Work : Project Life Cycle Public Tender:Hardware-LevelServers, Location: to be determinedSoftware-leveltool, Mediators, Portal-site (consisting), Authorization Server, Web ServicesHealth Information NetworkTelecom: Security & Access (Tokens) between points of care (with broadband connectivity)Member Fees- Quid?Helpdesk
28 When ? Study Group « Preparation Public Tender » 09-2006 06-2006 200520072006Study Group« Preparation Public Tender »Vendor SelectionPublic Tender« Publication »« Closure »First« Prototype »TestProduction