Health IT Status and perspectives Prof. Dr. med. Bjrn Bergh - - PowerPoint PPT Presentation

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Health IT Status and perspectives Prof. Dr. med. Bjrn Bergh - - PowerPoint PPT Presentation

Sep 23, 2022 463 likes •959 views

Health IT Status and perspectives Prof. Dr. med. Bjrn Bergh Chairman Dept. of Information Technology and Clinical Engineering Professor for Medical Information Systems Heidelberg Castle Hospital + Med. Faculty Age 800 years 723 years

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Health IT Status and perspectives

  • Prof. Dr. med. Björn Bergh

Chairman – Dept. of Information Technology and Clinical Engineering Professor for Medical Information Systems

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Heidelberg

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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
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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 signatures

  • Prof. Dr. Björn Bergh

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The status

  • Which industries come to your mind

completely supporting their main processes by IT?

  • Not Healthcare?
  • Why is that the case?

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Core aspects

  • Technology
  • Products and solutions
  • Architecture
  • Standards
  • Acceptance/Usefulness
  • Perceived (Benefits)
  • Documented (Evidence, cost-benefit analysis)
  • Resources
  • Financial / Reimbursement
  • Staff

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Intra-institutional

  • Infrastructure

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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

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WLAN and services

SSID: 1 QoS SSID: 2 SSID: 3 SSID: 4 SSL Web VPN Server 2,4 Ghz

5 Ghz

SSID: 5

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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

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Intra-institutional

  • Applications

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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

  • bjects

PACS

Enterprise resource planning HIS=Hospital Information system PAS=Patient administration system CIS=Clinical information system EPR, EMR= Electronic Patient (Medical) record

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Technology - Products

  • ERP + HIS: OK
  • CIS
  • Completeness
  • Robustness
  • Performance
  • Flexibility
  • Usability
  • PACS: OK
  • Architecture and standards

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  • Acceptance/Usefulness
  • Perceived (Benefits)
  • Documented (Evidence, cost-benefit analysis)
  • Resources
  • Financial / Reimbursement
  • Staff (bypass product deficits!)

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The future

  • Patient safety
  • Integration of medical devices
  • Integration of knowledge (decision support

systems)

  • Integration of clinical trials / data mining
  • Integration of biomolecular data

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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
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Gateway

Lab LIS HIS

Gases

PoCT – Application Integration

PDMS

Sugar

BAR Code

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ECG

MegaCare Archiv ADT-Proxy Linux/Dräger SAP IS-H* med

Druckserver

EliLink Import-Service WEB-Service MegaCare System / Dienste

SiFor

Mortara EKG

XML EKG Worklist

File-Service Export EKG-PDF pull/transfer ADT unsolicited messages MegaCare Client InternetExplorer

  • mind. Sun Java 1.4.x

Infinity Network HL7 Interface

Infinity GW

Hausnetz Systemkonzept Infinity MegaCare UKL Heidelberg

Renatus Beck, Dräger medical GmbH, A.Buchauer 4.8.2008

Heik04 eGate

Leistungs- übermittlung Query ADT Data ADT Orders Url-Call

Import EKG

Print service

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Cross-institutional

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Applications

  • Telemedicine + Home monitoring
  • Portals
  • Records (EHR, PHR, PEHR)
  • Ambient assisted living

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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!!

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Solution: a cross-institutional record

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IT systems

HIS/CIS TMC system GP system Pharmacy system

Sensor Platform

Shared Care Record

EHR PHR Record of TMC

PHR Node

Communication Module Phone, Video Conf.

Sensors Patient + Family HC Professional

Consideration - Vision 1

  • Prof. Dr. B. Bergh - ZIM
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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

  • ne institution

Case-based accessible within the care delivery organisation (CDO) Not accessible for

  • ther 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

  • ther systems

EMR, EHR and PHR

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Two main issues anticipated with EHR

  • Architecture and systems integration

with standards

  • Ensure patient’s right for data privacy

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EHR - Integration with standards?

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Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard

Existing eHealth standards

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EHR - Integration with standards?

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Existing eHealth standards Understandable and complete

Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard

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EHR - Integration with standards?

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Existing eHealth standards Industry accepted and Implemented (EHR) Understandable and complete

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Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard Standard

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EHR - Integration with standards?

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Existing eHealth standards Industry accepted and Implemented (EHR) Industry accepted and Implemented (HIS-CIS) Understandable and complete

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Standard Standard

Do it yourself HL7 + DICOM => IHE

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Data Privacy and EHR

eHealth + EHRs are absolutely safe!

Goya

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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

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EHR Data privacy study - Results

No concept fulfils all needs!!

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Goya

Data Privacy and EHR

eHealth + EHRs are totally safe! They most certainly are not!

Goya

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Solutions?

  • Full access for all HC professionals

and logging (patient surveilance)

  • Give the power to the

citizens/patients

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Our decision: Focus on the citizen/patient

Grant Wood

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Vision 2 - PEHR

Patient

Decides

  • who sees what
  • sees all accesses
  • chooses provider

Care providers Communicate only via the PEHR with each other

TELEMED Award 2008

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Core aspects

  • Technology
  • Products and solutions
  • Architecture
  • Standards
  • Acceptance/Usefulness
  • Perceived (Benefits)
  • Documented (Evidence, cost-benefit analysis)
  • Resources
  • Financial / Reimbursement
  • Staff

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What is required?

  • Prof. Dr. Björn Bergh
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Raffaello Santi

Unite the Know-How

  • Create cooperation
  • Reports (Good eHealth Report)
  • more: structured, pitfalls, technology
  • Disseminate
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Give CIOs and citizens voice

Edvard Munch

  • EHTEL
  • e-HITS (European Health IT Society)
  • ICMCC (International Council on

Medical & Care Compunetics)

  • Patient organisations
  • Journals…
  • …
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Pablo Picasso

Unique ID (Europe?)

  • Citizens
  • HCP (Index)
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Piet Mondrian

Reference architectures

  • Not so many alternatives
  • EHR
  • PEHR
  • central vs. decentral
  • PHR…
  • cards
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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…)

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Legal + regulatory

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Hans Holbein

  • Who owns cross-institutional

information?

  • Who ensures data privacy?
  • How are data privacy

violations punished?

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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

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Fra Angelico

eHealth can be a blessing or

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The European eHealth landscape?

Pieter Brueghel

a curse, it is in our hands!!!

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Claude Monet – Impression soleil levant

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