1 User oriented development of electronic communication between electronic patient records Vision:...
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• User oriented development of electronic communication between electronic patient records
• Vision:– Relevant and necessary information when needed for patient care
The ELIN projects
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The ELIN project is a project on a national basis to implement standards of interfaces and medical content in electronic communication in the Norwegian health care system.
Less paper!
More health!
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Electronic interchange of health information
The project is from the small medical offices point of view.
(Both GP’s and specialists)
What does ELIN mean?
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•Background:
•Agreement on the need of electronic co-operation in health care based upon functional requirements from physicians.
•Somebody has to represent the small medical offices
•Departmental initiative, recommended in report
•Gains:
•Development and testing of several new solutions on electronic communication based upon national standards
•Finances
•The Directorate of Health (ShDir)
•The National Industry Fond (Innovation Norway)
•The Norwegian Medical Association (Dnlf)
•National committee of hospital IT-solutions (NIKT)
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Some aspects taken in account in the project
• Continuity in health care– The patient must experience a chain of continuity in health care
• The secondary care physician must know the patient history from primary care• The GP must know the history from hospital treatment when taking further care• The level and content of information must be adequate
• Quality in health care– Establishment of best praxis
– Avoidance of unintentional events
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The project runs through 3 phases
• Phase 1– Until December 2004
• Discharge letters and lab.results with application message receipt excluding the simultaneous sending of paper. Some Internet patient service. Public Key Infrastructure.
• Phase 2– Until July 2006
• Referrals and requisition. Communication with the patient. Internet booking of appointments.
• Phase 3– Until December 2007
• “The good referral” and “The good discharge report”. Dialogue message. From Edifact to XML for all solutions. National encrypted enveloping (ebXML). Refinements of the solutions
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The functional requirements• Part 1 - Generals from all parts
– National standards and security. General requirements.
• Part 2 - Requisition and answers– Decision support system included in some solutions
• Part 3 - Referrals and discharge letters– Some demands on content and presentation
• Part 4 - Medical certificates and reports of disability– Electronic management at the National Insurance Administration
• (Part 5 - Prescription)– Separate national project. Common pharmaceutical lists of medicaments. Signature.
Management of a central part of the national ePrescription project. Separate requirements.
• Part 6 - Communication with the patient – Automatic documentation in EPR, integrated solution. Direct booking of appointments
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The ELIN method of developing functional requirements• An expert group of physicians define work processes and develop functional
requirements that ultimately can be tested.– Validation against law and regulations. – Validation against national standards of EPR and health communication
• Close cooperation with national standardisation authorities
– Validation against response groups• Physicians with no special IT interest or knowledge• Programmers of EPR systems
– Validation against functional testing• Development of test procedures
– Approval of the expert group– Integrated in the vendor development agreements– Updated after each development iteration– Final approval of expert group
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The ELIN method of testingfunctional requirements
Approved message standards
EPR GPs
Test-hospital
EPR others
Testserver
Seamless Communication
Test LabFunctional
requirements
PilotB-test
Testscenarios
Functional test of EPR communication
SeamlessCommunication
FATFactory Acceptance Test
SATSite Acceptance Test
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ebXML - framework (enveloping, addresses, transport receipt,
encrypting, authentication, cooperation certificate)
Standards of content (health information)
Message header (administrative information)
Application receipt
personal signature
Norwegian Health net
MailboxAddress catalogue
PKI-catalogue
Internet
Seamless communication requires an architecture of electronic interoperability
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Norwegian Health Net
Internet
Mailbox
Applicationreceipt
Content standard(health information)
Message header
Personal signature
ebXMLPKI-
catalogue
Address-catalogue
ELIN
Test and approval
•Use of XML•Data types•Attachments•FAQ•Help functions•Concepts
Relevantdocuments
EPR systems (EPJ, PAS, Lab, PACS/RIS, ..)
Health units in the communities
Coding lists
Health registers Pharmacies
National Insurance Office
Code register
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Laws and regulationsNational health plans
Development and testsMethods and coordination
Nationalstandards
User groups
Hospitals Community care
EP
R Functional
requirements
ELIN-kELIN-s ELIN(-a)
Functional
requirements
Functional
requirements
User groups
User groups
Functionalrequirements
Gen. practitionersProjects Projects Projects
Functionaltests and approval
Seamless communication
International standards
Preliminary project will start in 2007
Planning of several main projects
Patient summary project
ELIN stops end of 2007
ELIN-a follow up from 2008 may be realised
ELIN-k in community care
Phase 1 in 2007
EP
R
EP
R
Suggestion of an organisation that put user requirements in front
ELIN-o