Healthcare Transformation an the role of EHR:
Views from government
Dipl.-Ing. Dr. Alexander Schanner
Program-Manager
22.10.2007
www.arge-elga.at
+43 1 212 70 50
A-1020 Vienna, Schiffamtsgasse 15
Agenda
1.
2.
3.
4.
Introduction
ELGA Architecture
ELGA Standards
ELGA Projects
22.10.200716.3.2007
Alexander Schanner
EHR in Austria
22.10.2007
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Initial Situation
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Political target:
Using IT for the establishment of integrated medical care
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Legal assignment:
Agreement according to article 15a federal constitutional law
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Legal framework:
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data protection act
health telematics act
E-Government act
Laws on hospitals
…
Technical requirements:
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e-card
Present HIS-systems
present intramural and extramural networking
Alexander Schanner
EHR in Austria
22.10.2007
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Government Program 2007
Chapter 7 – Health 2
“… Unterstützung integrierter Versorgungsformen durch ausgeweitete Anwendungen
der e-card und der ‚Elektronischen Gesundheitsakte‘ unter Wahrung der PatientInnenrechte und des Datenschutzes. Die Finanzierung der ELGA ist sicherzustellen. …“
Agreement according to article 15a federal
constitutional law
article 7, paragraph 3
„In diesem Zusammenhang bekennen sich die Vertragsparteien prioritär zur
Konzeption und Einführung der elektronischen Gesundheitsakte (ELGA) sowie der
elektronischen Arzneimittelverschreibung und -verrechnung (eRezept). Der Bund
verpflichtet sich, zur Planung und Akkordierung der Einführung der elektronischen
Gesundheitsakte eine österreichweite Steuerungsgruppe unter umfassender
Einbindung aller Betroffenen einzurichten. Die Länder verpflichten sich, an dieser
Steuerungsgruppe teilzunehmen.“
Alexander Schanner
EHR in Austria
22.10.2007
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Agreement according to article 15a federal
constitutional law (version 2008-2013)
article 7
(1) Main targets:
1.
2.
3.
4.
Qualitative Verbesserung der Versorgung,
Nutzung der ökonomischen Potenziale von Informations- und
Kommunikationstechnologien,
Harmonisierung der nationalen Vorgangsweise mit Programmen
und Aktivitäten auf europäischer Ebene und
Sicherstellung des Rechtes der Patientinnen und Patienten auf
Zugang zu persönlichen und allgemeinen
Gesundheitsdaten.
(2) ICT is a tool for modernizing health care
(3) Continuation of ELGA planning- and implementation tasks
Alexander Schanner
EHR in Austria
22.10.2007
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Definition of ELGA
ELGA (Elektronische Gesundheitsakte)
= Austrian’s EHR
 ELGA contains relevant multimedia-based and health related data
and information referring to a precisely identified person.
 Data und information originate from
 different health service providers and
 from the patient himself/herself
and are stored in one or several different information systems
(virtual health record).
 Data are available independently of place and time (costsaving) at the place of treatment for all authorized persons
according to the tasks and needs of these persons and in
compliance with data protection rules
Alexander Schanner
EHR in Austria
22.10.2007
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Primary goals
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Medical care
Patients‘ management
Organisation of treatment processes
Information for patients
Alexander Schanner
EHR in Austria
22.10.2007
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Secondary goals
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Quality management
Self-contained health related activities of the
patient
Financial and administrative processes
Monitoring of healthcare system
Science and research
Target: avoid parallel structures!
Alexander Schanner
EHR in Austria
22.10.2007
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Federal Health Commission – BGK Bundesgesundheitskommission
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Organ of the Federal Health Agency
Consists of 27 members
7 Federal Government, 1 for each province, 6 Main Association
of Austrian Social Security Institutions, 1 representing cities and 1
representing communities, 1 bishops’ conference together with
the Protestant’s, 1 patients’ ombud, 1 General Medical Council of
Austria

Commercial operated by Ministry of Health, Family
and Youth
Alexander Schanner
EHR in Austria
22.10.2007
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Task Force Electronic Health Record - Arge ELGA Arbeitsgemeinschaft Elektronische Gesundheitsakte
1. Decision of Federal Health Commission from July
2006 concerning establishment of Arge ELGA and
financial remuneration
2. Working basis of Arge ELGA is an agreement
between
1. Federal Government
2. Provinces and
3. Social Insurance Institutions
3. Since September 2006 ARGE ELGA is acting
operationally
Location: A-1020 Vienna, Schiffamtsgasse 15
22.10.200716.3.2007
Alexander Schanner
EHR in Austria
22.10.2007
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Object of Arge ELGA according to Agreement
The objective of the ELGA Task Force is to drive the connection of
existing and future electronic information and documentation systems
in the Austrian health care system within the scope of a multi-project
management.
The main target is the establishment of the so called „electronic
health record” (ELGA) in order to increase quality and efficiency of
the health care system.
22.10.200716.3.2007
Alexander Schanner
EHR in Austria
22.10.2007
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Tasks of Arge ELGA according to Agreement
Among others:
1. Assistance to the Federal Health Agency concerning
controlling and coordinating activities;
2. Definition of strategic priorities for the establishment of ELGA
and of the roadmap for its implementation;
3. Planning of detailed concepts and implementation of projects
to introduce ELGA as well as the development of financing
proposals;
4. Demand of necessary legal amendments and the binding use
of approved standards;
5. Crisis and escalation management
6. Evaluation of project results
22.10.200716.3.2007
Alexander Schanner
EHR in Austria
22.10.2007
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Implementation – preliminary planning
2006:
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2007:
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February to June 2006: Preparation of Arge ELGA (contract)
28. June 2006: Decision about contract Arge ELGA
Summer/Autumn: Feasibility Study
September 2006: Arge ELGA is operational
January: Publication of Feasibility Study
Dec 06 – Feb 07: Architecture plan for the first
implementation phase
 March / April: Consultation with Stakeholders
 4.5.2007 – BGK: Acceptance of architecture plan, standards
and commissioning of first implementation phase
 Masterplan
Alexander Schanner
EHR in Austria
22.10.2007
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Federal Health Commission (BGK) –
decision (1/4)
Overview about decisions
 Architecture of Basic Components and
Core Applications
 Standards
 Projects for planning and implementation
Alexander Schanner
EHR in Austria
22.10.2007
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Agenda
1.
2.
3.
4.
Introduction
ELGA Architecture
ELGA Standards
ELGA Projects
22.10.200716.3.2007
Alexander Schanner
EHR in Austria
22.10.2007
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Federal Health Commission (BGK) –
decision (2/4)
Architecture Basis Components
 Master Patient Index
 Health Service Provider (HSP) Index
 Registry
 Authorization System
 Portal
Core applications
 discharge Summary
 e-Report - radiology
 e-Report - laboratory
 e-Medication
Alexander Schanner
EHR in Austria
22.10.2007
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Overview of Basic Components and Core
Applications
ELGA Basic Components
Preconditions
for ELGA
First Implementation Phase
ELGA Basics
Master Patient
Index
Legal Measures
Data Protection
ELGA Core Applications
nationwide
compatible with EU
HSP Index
Citizen / Patient
Storage and
Filing
Portal
Document
Registry
Health Information
Current Topics
centralized
Discharge
Summary
Document
Repository
e-Report
(laboratories)
e-Report
(radiology)
roles
Consumers’
Acceptance
Management
HSP Information
Authorization
System
Health Promotion
Access Protocols
Portal
Applications
Network
e-Medication
(doctor, hospital,
pharmacy)
decentralized
Organisational
Measures
Standards
Portal
Alexander Schanner
EHR in Austria
22.10.2007
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Framework Architecture and
Main Applications
„A hyper-index with sophisticated search functions“
Doctor
Portal
ELGA
HSP Index
Citizen Card
with PIN
Authorization
System
Master Patient
Index
Registry
reading
Data Sources
writing
Adaptor
e-Medication
Adaptor
Adaptor
e-Report
Discharge
Summary
(radiology,
laboratories)
…
Adaptors: Interfaces which make existing applications compatible with ELGA
22.10.200716.3.2007
Alexander Schanner
EHR in Austria
22.10.2007
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Hierarchical View on ELGA
Authorization System
HSP Index
Master Patient Index
ELGA
Visibility
Central Storage of
Data
Registry
Signature,
Entry in Registry
HSP - Local
Storage of Data
Reports
Laboratory
X-ray
Discharge
Summaries
Precise link to a document, URL
Alexander Schanner
EHR in Austria
22.10.2007
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ELGA View on Data
HSP
Authorization System
Patient
HSP Index
Master Patient Index
Central Storage of
Data
Registry
HSP - Local
Storage of Data
Radiology reports
Laboratory reports
Medication
Discharged Summary
Alexander Schanner
EHR in Austria
22.10.2007
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Overview System Architecture
ELGA Context
Audit System
External
Registries
(base identification number,
...)
Pat - Index
Autohorization
System
Document
Registry
HSP - Index
HSP System
HSP System
Portal
Repository
Consumer
Source
Consumer
Alexander Schanner
EHR in Austria
Source
Consumer
Source
22.10.2007
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Agenda
1.
2.
3.
4.
Introduction
ELGA Architecture
ELGA Standards
ELGA Projects
Alexander Schanner
EHR in Austria
22.10.2007
Page 22
Federal Health Commission (BGK) –
decision (3/4)
International standards for ELGA in Austria:
 IHE Frame-Work with domain
 IT Infrastructure
 Patient Care Coordination
 Laboratory
 Radiology
 HL7 CDA 2.0 as document standard
 LOINC (area Laboratory data)
 DICOM 3.0 incl. WADO (area radiology)
 HL7 (in Version 3 with RIM as prospective data model)
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EHR in Austria
22.10.2007
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Interoperability –
Standards and Catalogs
 Technical (syntactical) interoperability
 Content wise (semantical) interoperability
Requirement:
Assortment of international standards
 Standards rise quality and reduce costs!
 Standards promote competition!
Alexander Schanner
EHR in Austria
22.10.2007
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International standards
Strategy:
established, international used standards
 Hospital Information System (HIS) Providers have to comply with
the international market, Austria‘s operating companies focus on
internationally widespread HIS
 HL7 RIM (Health Level 7 Reference Information Model) and CDA
(Clinical Document Architecture) are preferred candidates for data
model and document configuration
 IHE XDS (Cross Enterprise Document Sharing) including PCC
(Patient Care Coordination) for document exchange.
Alexander Schanner
EHR in Austria
22.10.2007
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Technical framework: IHE Profil XDS
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EHR in Austria
22.10.2007
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Project CDA documents
Content wise interoperability via
„Clinical Document Architecture“ from HL7
 Level 1
 Level 2
 Level 3
for
 discharge Summary
 e-Report - radiology
 e-Report - laboratory
 e-Medication
by Arge ELGA, members of standardization institute with different
medical associations
Alexander Schanner
EHR in Austria
22.10.2007
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Document structure HL7 CDA 2.0
source: www.ihe.net
Alexander Schanner
EHR in Austria
22.10.2007
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International data exchange
Public
Request HSP
authorization
Request patient
identifikation
Request insurance
status
Request patient
consent
Search med.
documents
Access / download
med. documents
Alexander Schanner
Insurance
Public
Insurance
ELGA
LSP
HSP
HSP
EHR in Austria
22.10.2007
Page 29
Agenda
1.
2.
3.
4.
Introduction
ELGA Architecture
ELGA Standards
ELGA Projects
Alexander Schanner
EHR in Austria
22.10.2007
Page 30
Federal Health Commission (BGK) –
decision (4/4)
Detailed planning and first piloting (2007 / 2008)
 Concretion Basis Components and Master Plan (IBM-Follow-Up
Mission) Mai to August 2007
 Project 1 – Master Patient Index
 Project 2 – HSP Index
 Project 3 – Document Registry
 Project 4 – Authorization System
 Project 5 – Portal
 Project 6 – Main Application first phase of implementation
 Project 7 – Acceptance Management
Acceptance of each project after the presentation of an organizational
and financial concept through BGK
Alexander Schanner
EHR in Austria
22.10.2007
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Facts for Planning and Implementation
a) Preliminary Planning

Architecture Plan
 Standards
 Data Protection
b) Detailed Planning and Piloting
c) Implementation / Rollout
Alexander Schanner
EHR in Austria
22.10.2007
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ELGA Projects
first phase of implementation
Alexander Schanner
EHR in Austria
22.10.2007
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Thank you for your Attention!
Alexander Schanner
EHR in Austria
22.10.2007
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