TRANSFORMATION GATEWAY

The EMC Collaborative Healthcare Solution at Saint-Pierre University Hospital, Brussels, Belgium

Agenda

• Introducing Saint-Pierre University Hospital

• I.T. Strategy and Landscape

• Electronic Health Record and Clinical Documents

• Collaborative Healthcare Medical Image Sharing and Management Project in Saint-Pierre

• (Preliminary) conclusions

Saint-Pierre University Hospital, Brussels

• 600-beds University Hospital

• 1,700 employees

• Member of the IRIS public hospitals network of the Brussels Region

• 20+ medical specialties

Saint-Pierre’s I.T. Strategy

• Long term partnership with suppliers

• Integration – Intra-muros – Ensemble middleware – within IRIS network – dbMotion platform – within Brussels regional healthcare network

• Virtualization – Storage layer – Server layer – Client layer – Patient layer

Current I.T. Landscape

• Mostly vertical applications, in many functional domains

– Patient administration, scheduling, billing

– Medico-Technical departments : lab, medical imaging, … – Real-time support : intensive care, surgery – Computerized patient records, global and per specialty – Logistics : pharmacy, transportation, catering, ...

• Multiple platforms – Operating systems : Windows, Solaris, Linux – Databases : Oracle, Informix, Microsoft SQLServer

• 200+ Servers

Medical Data aggregation in Saint-Pierre

Unified Patient Information Aggregation

Middleware

Business Intelligence

Digitalized documents

General Clinical Data.

Specific Clinical data

Medical Imaging

Analogical Data

Web Pages

Clinical Biology & Anapath

Other Med-Tech

Application Modules

Medical Data aggregation (cont’d)

Admin. Archives

Clinical Data

Depart-mental data

Imaging Analogical Data

Web Pages

Labs data

Other M/T

Clinical Data Repository

LOCAL NODE

LOCAL NODE

CDR

Aggregation Layer

Middleware Ensemble

Applicative Layer Data consultation platform

Production Servers Independent

storage

LOCAL NODE

LOCAL NODE

DCR CDR

Document Cache Repository: Medical document collector

Structured clinical data : medications, diagnosis, immunizations, allergies

Clinical Documents Indexes

Images indexes

Patients demographic data & encounters

Content of local node

Admin. Archives

Clinical Data

Depart-mental data

Imaging Analogical Data

Web Pages

Labs data

Other M/T

Clinical Data Repository

LOCAL NODE

LOCAL NODE

CDR

Aggregation Layer

Middleware Ensemble

Applicative Layer Data consultation platform

Production Servers Independent

storage

LOCAL NODE

LOCAL NODE

DCR CDR

Document Cache Repository: Medical document collector Content of cache

Medical Data aggregation (cont’d)

All documents stored in a repository (oracle database) and converted in PDF. A WebService allows retrieval and display of documents when requested by the user

Data aggregation in the IRIS network

Integration in the ABruMeT Brussels Healthcare Network and in the Belgian’s eHealth HUB-METAHUB Network

ABruMeT

RSW

Flanders

dbMotion

IRIS Network

kmehr DCR

APPLIC RELAIS

CoCoeur

CoSite

MetaHub e-Health

Topology of the eHealth HUB-MetaHUB Project

Electronic Health Record

“The electronic health record is a repository of information regarding the health status of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorised users. It has a standardised or commonly agreed logical information model which is independent of EHR systems. Its primary purpose is the support of continuing, efficient and quality integrated health care and it contains information which is retrospective, concurrent, and prospective”

ISO/TR 20514

Key capabilities of an EHR Institute of Medecine, 2003

Health information and data Immediate access to key information improve ability to make sound clinical decision

Result management Access to new and past results by all caregivers […] improve patient safety and effectiveness of care

Order management […] enhance legibility, reduce duplication, and improve the speed with which orders are executed

Decision support […] improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions […]

Electronic communication and connectivity

[…] improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events

Patient support […] improve control of chronic conditions

Administrative processes […] improve hospitals' and clinics' efficiency […]

Reporting […] enable health care organizations to respond more quickly to federal, state, and private reporting requirements […]

Content of the Electronic Health Record

• Demographic Data – Patient ID, name, birthdate, gender – Address(es), contact persons, … – Health insurances, …

• Orders, Results, Observations – Biometric data, vital signs, clinical biology, … – Treatments : pharmacy, physiotherapy, … – Technical procedures and imaging : ECG, EEG, X-Ray, NMR, … – Progress notes

• Problem lists, alerts, allergy, risk factors,

• Documents – Results, discharge letters, …

Documents in the EHR

• Documents are mostly snapshot s of a (small) subset of the EHR, for communication and/or archiving purposes

• Legal status

• Generaly NOT structured

• Emerging standards like CDA and KMEHR

• Multiple formats : TIFF (…), PDF, Microsoft Word, …

• Basic part of minimalistic integration pattern for 3rd-party software :

– Get patient ID and demographics from Master Patient Index – Get patient contacts from ADT system – Put examination report

• Metadata for indexing/classification purposes

Documents Registry and the Virtual Patient Record

Documents Registry

Saint-Pierre’s documents repositories

• Multiple sources, but mostly – Digitalization of hand-written notes, reports, documents from external

institutions, … in the medical archives facility – Electronic reports

• Huge and rapidly growing number – 10+ Mio clinical reports (TIFF, PDF, Word, …) - 2 Tb – 60+ Mio DICOM images from the PACS - 20 Tb

• Multiple storage – Proprietary – Oracle DB – PACS

→ Looking for a strong partnership and for an all-in-one, hospital-wide archiving solution with DICOM integration

EMC Proposal

EMC Collaborative Healthcare - Medical Image Sharing and Management Solution

• Including EPA suite from DocByte

• Medical archive integrated into patient information system

• Vendor-neutral PACS archive

• Clinical information lifecycle management

• Cost-effective virtualized infrastructure

• J4Care zero-footprint DICOM viewer on Medical Image Sharing archive device

Medical Image Sharing and Management Project at Saint-Pierre: Architecture before starting the project:

PACS XX.x

DCR

PACS Viewer

CD-Import

Application layer

Medical Image Sharing and Management Project at Saint-Pierre Proof of Concept • DCR – Documentum interface

– Define metadata – Store PDF – Retrieve PDF

• PACS – Document interface – Via HealthCare Connector (HCC) – Store all patient series for small subset of patients – Store large mammography images

Medical Image Sharing and Management at Saint-Pierre Proof of Concept

HCC (Health Care Connector)

DCR

EMC² Documentum

J4Care

PACS XX.x

PACS Viewer

CD-Import

Application layer

Target architecture at Saint-Pierre

PACS HCC (Health Care

Connector)

Radiology

DCR

EMC² Documentum

J4Care

Archive retrieval (store&remember)

CD-Import DBMOTION

Medical Image Sharing and Management at Saint-Pierre A view of tomorrow

Other Doc E-Mail

EMC² Documentum

Multi Media

PACS

HCC (Health Care Connector)

Radiology DCR

EPR

Hospital A

J4Care

CD-Import

Preliminary Conclusions

• Achieve robust enterprise storage & archive – Enterprise documents – Enterprise DICOM images

• Move away from vendor lock-in

• Avoid long and custom migrations in the future

• Healthcare-oriented Content Management platform – Standards-based (Clinical Document Architecture, XDS

profiles, …) – Full-text indexing

THANK YOU THANK YOU This presentation is also available at

www.momentumeurope.com password: spree