Health IT Presentation... · •eHealth, systems integration, IT + engineering, radiological...

Health IT

Status and perspectives

Prof. Dr. med. Björn BerghChairman – Dept. of Information Technology and Clinical Engineering

Professor for Medical Information Systems

Heidelberg

2

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

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 signaturesProf. 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

SSID: 1QoS

SSID: 2

SSID: 3

SSID: 4

SSL Web VPNServer

2,4 Ghz

5 Ghz

SSID: 5

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

11

Major Applications - Technology

Finances

Materials

Controlling

HR

FM

…

ERP

Patient index

Registration

Coding

Billing

….

HIS

Digital Record

Reports

CPOE

Scheduling

OR

Charting

…

CIS

Images

Multimedia

objects

PACS

Enterprise

resource

planning

HIS=Hospital Information system

PAS=Patient administration system

CIS=Clinical information system

EPR, EMR= Electronic Patient (Medical)

record

Technology - Products

ERP + HIS: OK

CIS

• Completeness

• Robustness

• Performance

• Flexibility

• Usability

PACS: OK

Architecture and standards

12




Resources


• 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

GatewayLabLIS

HIS

Gases

PoCT – Application Integration

PDMS

Sugar

BAR Code

ECG

MegaCareArchiv

ADT-ProxyLinux/Dräger

SAPIS-H* med

Druckserver

EliLinkImport-Service

WEB-Service

MegaCare System / Dienste

SiFor

Mortara EKG

XMLEKG

Worklist

File-ServiceExport EKG-PDF

pull/transfer

ADT

unso

licite

dm

essa

ges

MegaCare ClientInternetExplorer

mind. Sun Java 1.4.x

Infinity Network

HL7 Interface

Infinity GW

Hausnetz

Systemkonzept Infinity MegaCare UKL HeidelbergRenatus Beck, Dräger medical GmbH, A.Buchauer 4.8.2008

Heik04eGate

Leistungs-übermittlung

Query ADT Data

ADT

Orders

Url-Call

ImportEKG

Print service

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

IT systemsHIS/CIS

TMC systemGP system

Pharmacy systemSensor Platform

Shared Care Record

EHRPHR

Record of TMC

PHR NodeCommunication ModulePhone, Video Conf.

Sensors

Patient + Family HC Professional

Consideration - Vision 1

Prof. Dr. B. Bergh - ZIM

Record type Characteristics Main Advantages Main Disadv.

EMR

Electronic

Medical Record

All clinical data of a patient

to document, monitor and

manage care delivery in

one institution

Case-based accessible within

the care delivery organisation

(CDO)

Not accessible for

other doctors or

the patient

EHR

Electronic

Health Record

Subsets of each CDO‘s EMR

presently assumed to include

summaries (CCR, etc.)

Longitudinal access across

multiple institutions

Viewing in other

CDOs possilbe

Easier data import

from professional

systems (high quality

and completeness)

No patient

involvement for

viewing and

access

management

PHR

Personal Health

Record

Contains patient input (home

care devices, diet, sports).

Acess for multiple institutions is

managed by the patient

Fully controled by

the empowered

patient

No automated

data import from

other systems

EMR, EHR and PHR

Two main issues anticipated

with EHR

Architecture and systems integration

with standards

Ensure patient’s right for data privacy

24

EHR - Integration with standards?

25

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Existing eHealth standards


26


Understandable and

complete

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard


27


Industry accepted and

Implemented (EHR)

Understandable and

complete

27

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard

Standard


28



Implemented (EHR)


Implemented (HIS-CIS)

Understandable and

complete

2828

Standard

Standard

Do it yourself

HL7 + DICOM

=> IHE

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!!

Goya

Data Privacy and EHR

eHealth + EHRs

are totally safe!

They most certainly

are not!

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 - PEHRPatient

Decides- who sees what- sees all accesses- chooses provider

Care providersCommunicate only via the

PEHR with each other

TELEMED Award 2008

Core aspects

Technology

• Products and solutions

• Architecture

• Standards




Resources


• Staff

36

What is required?

Prof. Dr. Björn Bergh

Raffaello Santi

Unite the Know-How

- Create cooperation

- Reports (Good eHealth Report)

- more: structured, pitfalls, technology

- Disseminate

Give CIOs and citizens voice

Edvard Munch

- EHTEL

- e-HITS (European Health IT Society)

- ICMCC (International Council on

Medical & Care Compunetics)

- Patient organisations

- Journals…

-…

Pablo Picasso

Unique ID (Europe?)

- Citizens

- HCP (Index)

Piet Mondrian

Reference architectures

- Not so many alternatives

- EHR

- PEHR

- central vs. decentral

- PHR…

- cards

One standard

Wassily Kandinsky

- 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…)

Legal + regulatory

43Hans Holbein

- Who owns cross-institutional

information?

- Who ensures data privacy?

- How are data privacy

violations punished?

Organisational - Socio-psychiological

44

And who is

taking care of

us?

The citizen? – a heterogeneous group

How to support patients/citizens best?

How to involve them best?

How to empower them best?

Goscinny, Uderzo

Fra Angelico

eHealth can be a blessing or

The European eHealth landscape?

Pieter Brueghel

a curse, it is in our hands!!!

Claude Monet – Impression soleil levant

Prof. Dr. B. Bergh - ZIM - UK Heidelberg

Health IT Presentation... · •eHealth, systems integration, IT + engineering, radiological...

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