patientendossier - europäische konzepte · ehealth competence center university hospital...
TRANSCRIPT
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Patientendossier - europäische Konzepte
Bernd Blobel, PhD, FACMI, FACHI, FHL7
Head, eHealth Competence Center, University Hospital Regensburg, Germany Past-Chair HL7 Germany Past-Chair, IMIA Working Group “Standards in Health Care Informatics Chair, EFMI Working Groups “EHR” and “Security, Safety and Ethics Chair, CEN/ISSS eHealth Standardization Focus Group Chair, German Health Informatics Standards Committee Head of the German Delegation to ISO and CEN Past-Chair, GMDS Working Groups “Standards for Interoperability and EHR” Co-Chair ,GMDS Working Group “Data Protection in Health Information Systems” Chair, GDD Working Group “Security and Privacy in Health and Welfare”
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Interoperability Challenge
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Observation
Interpretation Action
Data
Information
Observation
Diagnosis Therapy
Knowledge
Consent
HP or HCE Action Patient
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Interoperability Level Instances
Technical interoperability Technical plug&play, signal- & protocol
compatibility
Structural interoperability Simple EDI, envelopes
Syntactic interoperability Messages, clinical documents, agreed
vocabulary
Semantic interoperability Advanced messaging, common
information models and terminology
Organizations/Service
interoperability Common business process
Interoperability Levels
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Requirements for Achieving Interoperability and Harmonization
• Openness, scalability, flexibility, portability
• Distribution at Internet level
• Standard conformance
• Service-oriented / semantic interoperability
• Consideration of timing aspects of data and information exchanged
• Lawfulness
• User acceptance
• Appropriate security and privacy services
Model-Driven Architecture
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Model
A model is a partial representation of reality. It is
restricted to attributes the modeller is interested
in. Defining the pragmatic aspect of a model, the
interest is depending on the addressed audience,
the reason and the purpose of modelling the
reality and using the resulting model for a certain
purpose and for a certain time instead of the
original. Therefore, the model as a result of an
interpretation must be interpreted itself.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Electronic Health Records
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Definitions (according to ISO TR 20514 Health
informatics - Electronic health record – Definition, scope and
context ) (1/2) EHR A repository of information regarding the health status of a subject of care, in computer processable form. An EHR provides the ability to share patient health information between authorized users of the EHR and the primary role of the EHR in supporting continuing, efficient and quality integrated health care. EHR system The set of components that form the mechanism by which electronic health records are created, used, stored, and retrieved. It includes people, data, rules and procedures, processing and storage devices, and communication and support facilities.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Definitions (according to ISO TR 20514 Health informatics -
Electronic health record – Definition, scope and context ) (2/2)
EHR architecture
A model of the generic features necessary in any electronic healthcare record in order that the record may be communicable, complete, a useful and effective ethico-legal record of care, and may retain integrity across systems, countries, and time.
In general, a system’s architecture defines its components, their
functionalities and relationships.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
EHR Types
• Organization-centric EHR
• Personally moderated EHR
• Personal Health Record (PHR)
• Legal EHR
• Centralized EHR
• Distributed EHR
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Requirements the EHR must meet: ISO 18308 after Kalra
The EHR shall preserve any explicitly
defined relationships between different
parts of the record, such as links between
treatments and subsequent complications
and outcomes. The EHR shall preserve the original data
values within an EHR entry including code
systems and measurement units used at
the time the data were originally
committed to an EHR system. The EHR shall be able to include the
values of reference ranges used to
interpret particular data values. The EHR shall be able to represent or
reference the calculations, and/or
formula(e) by which data have been
derived. The EHR architecture shall enable the
retrieval of part or all of the information in
the EHR that was present at any particular
historic date and time. The EHR shall enable the maintenance of
an audit trail of the creation of,
amendment of, and access to health
record entries.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Currently, three streams for specifying and implementing advanced EHR architectures, which partially have their roots in existing systems, in traditional thoughts and methodologies as well as in specific domain-languages and modelling languages:
Data approach (data representation)
Concept approach (concept/knowledge representation)
Process/service approach (business process / service representation)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
• An alternative structure of current approaches with analogue methodologies and modelling languages under implementation focus is: Communication focus (message) Document focus (clinical document) Business process focus (application)
• According to the time dimension, following structure can be proposed:
Episode focus (EHR extract) Life-long record focus (EHR service)
• Because of their rational roots and driving factors, all those approaches have
their right to exist at least temporarily. Therefore, they exist also practically in co-existence or concurrency. The three approaches develop continuously, thereby showing some convergence.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC16 August 2007 14
Direct vs. Indirect EHR Access Model
• “National (regional) switchpoint” – E.g. Netherlands, Greece – Requires central client (patient), provider, and organizational
registries – Query/response paradigm used to retrieve discrete data versus
• Central respository(ies) – E.g. (Canadian/UK/Finland) – Requires central registries as above – Discrete results uploaded to central/regional registries – Centralized legal record in Finland
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
EHR Approaches
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
EHR Approaches after HIMSS
Wales Germany England
The Netherlands Denmark
Canada
New Zealand
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
EHR Projects and Standards
• ISO TC 215 TS 18308, TR 20514
• CEN EN 12967 „Health Information System Architecture“
• CEN EN 13606 „EHR Communication“
• openEHR
• GEHR
• IHE RID: Retrieve Information for Display
• IHE XDS: Cross-enterprise Clinical Document Sharing
• G-CPR
• ASTM CCR
• HL7 RIM & CDA, EHR-S Functional Model, EHR-S Interoperability Model, CCD
• HARP
• DICOM SR: Structured Reporting
• WADO: Web Access to DICOM Persistent Objects
• EuroRec, ProRec Centers
• MML: The Medical Mark-up Language
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Archetype Object Model 1.5 (after Beale)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
ADL Archetype Structure (after Beale)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
CIMI Core Reference Model (after CIMI)
class CIMI Core Reference Model
COMPOSITION
+ category :CODED_TEXT
+ language :CODE_PHRASE
+ territory :CODE_PHRASE
CONTENT_ITEM
ENTRY
+ language :CODE_PHRASE
SECTION
ARCHETYPED
+ archetype_id :ARCHETYPE_ID
+ template_id :TEMPLATE_ID [0..1]
+ rm_version :String
LOCATABLE
+ name :TEXT
+ uid :UID_BASED_ID [0..1]
+ archetype_node_id :String
LINK
+ meaning :TEXT
+ target :EHR_URI
+ type :TEXT
ITEM
+ null_flavor :CODED_TEXT [0..1]
ELEMENTCLUSTER
+ structure_type :CODE_PHRASE [0..1]
DATA_VALUE
PARTICIPATION
+ function :TEXT
+ mode :CODED_TEXT
+ time :DATE_TIME [0..1]
PARTY_PROXY PARTY_SELF
PATHABLE
+value
0..1
+provider
0..1 +subject 1..1
+items
*..*+content
*..*
+composer
1..1
+data 1..*
1
+items
1..*
+other_participation
0..*
+performer
1..1
+archetype_details
0..1
+links
*..*
+participations *
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
CIMI Hierarchical Representation (after CIMI)
ELEMENT
Name: Problem Diagnosis Name
Meaning: 404684003|Clinical finding|
Parent-child-link: 246090004|Associated finding|
Value: ϵ ProbDiag_RefSet
CLUSTER
Name: Location Details
Meaning: 123037004|Body structure|
Parent-child-link: 363698007|Finding site|
ELEMENT
Name: Body Site
Meaning: 123037004|Body structure|
Parent-child-link: 363698007|Finding site|
Value: ϵ BodyStructure_RefSet
ELEMENT
Name: Laterality
Meaning: 182353008|Side|
Parent-child-link: 272741003|Laterality|
Value: ϵ Side_RefSet
ELEMENT
Name: Severity
Meaning: 272141004|Severities|
Parent-child-link: 246112005|Severity|
Value: ϵ Severity_RefSet
ELEMENT
Name: Finding Context
Meaning: 410514004|Finding context value|
Parent-child-link: 408729009|Finding context|
Value: ϵ FindingContext_RefSet
CLUSTER
Name: Problem Diagnosis
Meaning: 243796009|Situation with explicit context|
CLUSTER
Name: Associated Problem Diagnosis
Meaning: 404684003|Clinical finding|
Parent-child-link: 246090004|Associated finding|
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Header
Document Information
Encounter
Service Actors
Service Targets
Body
Structured (Narrrative) Text, Coded Entries
CDA Document
The CDA Header & Body (after Heitmann)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Medical Logic Modules (after HL7)
• General layout
maintenance: slotname: slotbody;; slotname: slotbody;; … library: slotname: slotbody;; … knowledge: slotname: slotbody;; … end:
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Overview on the CIMI Project (after CIMI)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
National EHR Approaches
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Strategy
• Some countries start with an infrastructure project (Germany, Austria, partially the Netherlands)
• Some countries focus on the record/repository (Austria)
• Some countries focus on a solutions architecture (Canada, Germany)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
National EHR Strategy Examples
England: National Programme for IT (NPfIT)
Australia: HealthConnect, NEHTA
Canada: Infoway, EHRS Blueprint
USA: National Health Information Infrastructure (NHII), EHRVA
Germany: bIT4health, eGK, eGA
Taiwan: National Health Information Exchange Platform
France: DMP (Dossier Medical Personnel)
The Netherlands: AORTA
Wales: IHR/LLR within the “Informing Healthcare Program” (IHC)
… and probably 60+ other countries
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
International Programs and Budgets Examples
• Health Infoway ( Canada)
• By 2007, the government of Canada had invested $1.6 billion CAD
in Infoway. By March, 2008, Infoway had committed nearly than
$1.5 billion CAD in co-investment within the jurisdictions. 50%
pop. have EMR
• Health Connect (Australia)
• NEHTA has received $160 AUD million in funding. All pts have
EMR anytime
• Ctr. for Interoperable EHR (Korea )
• 1.1 bill. USD by 2010 for universal EMR
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
International Programs and Budgets Examples
• National Program for IT ( UK)
• The National Programme for IT (NPfIT) was initiated in 2003 and was
originally budgeted to be £6.0 billion over 10 years, but the National Audit
Office estimates the figure to be £12.4bn over 10 years and other officials
have been recently quoted in papers as estimating the figure to be close to
£20.0 billion. Objective: IT infrastructure for safe and efficient health
information transfer
• National Health Information Infrastructure ( USA)
• 86.5 mill. USD 2005, 125mill. USD 2006 for universal EMR. Within ARRA,
more 40 billion US $ will be spent to provide a PHR to every American.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
ELGA Project (after Sauermann, changed)
Medical reports to be designed in CDA format:
– Discharge summary
– laboratory and radiology reports
– data segments for medication
CDA level 2, partly 3
First trials in 2008
International standards mandated
Approach:
Preparation of a process choreography, accompanying measures, preparation of test beds
„Picking up“ all involved parties for realizing a joint, coordinated
process
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
(after Hyppönen)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
(after Hyppönen)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC33
VISION
eHealth and eWelfare
space 2020 LPWR
Users
Primary users
Secondary users
- context
- purpose
Legislation
Regulations
Requirements (dynamic, context aware)
- Need to know
- Restrictions
- Rights
- Permissions
- Obligations
- Confidentiality
person
Use
control
Audit
- consent
- opt-out
- ….
after Pekka Ruotsaleinen
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC34
Granular
context, purpose,
security policy,
semantics
at time of creation
At granular
Granular context, purpose,
security policy,
semantics
at time of creation
Information source 1
Information source n
Subject of information
Dynamic context
aware permission
opt-out in this context
and for requested purpose
Personal security policy
E
T
H
I
C
S
R
E
G
U
L
A
Y
I
O
N
S
Primary requester
Environment,
context, need to
know,
permission to
access,
role
Request
Context, purpose,
objects to access
LPWR
Access and
Disclose mana-
gement
output
Event log
Secondary user
Environment,
context, need to
know,
permission to
access,
role
after Pekka Ruotsaleinen
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC35
Requirements
for the LPWR
Available general
models:
-Information models
-Inf. system models
Health care specific
models:
-Information models
-inf. system models
Model:
- Information model for the
LPWR
- Infrastructure model
- Model for trusted use
Requirements
for
infrastructure
after Pekka Ruotsaleinen
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
EHRS Blueprint Key Definitions: EHR Solution
36
The EHR Solution is a combination of people, organizational entities, business processes, systems, technology and standards that interact and exchange clinical data to provide high quality and effective healthcare.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
EHRS Blueprint Key Definitions: EHR Infostructure
37
The EHR Infostructure is a collection of common and reusable components in the support of a diverse set of health information management applications. It consists of software solutions for the EHR, data definitions for the EHR and messaging standards for the EHR.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Key EHRS Architecture Concepts
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer Point of Service
Application Point of Service
Application
EHRS
Locator
Longitudinal Record Services
Health Information Access Layer
Ancillary
Data &
Services
Health
Information
Data
Warehouse
EHR
Data &
Services
Registries
Data &
Services
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
EHR Infostructure: Conceptual Architecture
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data
& Services Registries Data
& Services
EHR Data
& Services
Data
Warehouse
Outbreak
Management
PHS
Reporting
Shared
Health Record
Drug
Information
Diagnostic
Imaging Laboratory
Health
Information
POINT OF SERVICE
Hospital, LTC,
CCC, EPR
Physician
Office EMR EHR Viewer
Physician/
Provider
Business
Rules
EHR
Index
Message
Structures
Normalization
Rules
Security Mgmt
Data Privacy Data Configuration
Physician/
Provider
Physician/
Provider
Lab System
(LIS)
Lab Clinician
Radiology
Center
PACS/RIS
Radiologist
Pharmacy
System
Pharmacist
Public Health
Services
Public Health
Provider
Longitudinal Record Services
HIAL Communication Bus
Common Services
Client
Registry
Provider
Registry
Location
Registry
Terminology
Registry
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
CROSS-JURISDICTIONAL INFOSTRUCTURE
EHR Infostructure: EHRS Locator Data
• EHRi Client ID (resolved ECID) • CR instance ID (OID root) • EHRi instance ID (which instance of an EHRi) • EHRi URI (the URI to access the HIAL) • Optimized for performance
– Information type (drug, lab, DI) (derived from HL7 act classes)
– First created date – Last updated date
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of
Service
Application
Point of
Service
Application
Ancillary
Data &
Services
Health
Information
Data
Warehouse
EHR
Data &
Services
Registries
Data &
Services
Longitudinal Record Services
Health Information Access Layer
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of
Service
Application
Point of
Service
Application
Ancillary
Data &
Services
Health
Information
Data
Warehouse
EHR
Data &
Services
Registries
Data &
Services
Longitudinal Record Services
Health Information Access Layer
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
EHRS
Locator
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
English EHR Architecture
• England’s EHR - the Spine - acts as a central Summary Record (CDA-based, ebXML) consists of the Spine Directory, Demographics Services, the Summary Care Record and adapters and is not an EHR. It contains only a small percentage of the information held in primary and secondary care systems.
• The English envisioned EHR contains a new network infrastructure as well as national applications that will utilize the EHR (e.g., electronic transfer of prescriptions, electronic outpatient scheduling).
• The EHR portion (the Care Record Service) includes three components:
– Personal Demographics Service (PDS),
– Summary Care Record (patient's clinical information, such as allergies and adverse reactions to medicine),
– Secondary Uses Service (SUS), which uses data from patient records to provide anonymised and pseudonymised business reports and statistics for research, planning and public health delivery.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
English EHR Architecture (after Department of Health)
• The NHS turns between detailed information models on the one hand and extended terminology to include information models.
• The result is the Logical Record Architecture (LRA) for Health and Social Care in England.
– A generic model designed to work with the SNOMED CT terminology
– Domain models, derived directly from the Generic Model and terminology, designed to meet specified uses
– A catalogue of the requirements/uses for data, whether for direct care of patients or secondary uses, including analysis
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
LRA Modelling (after Department of Health)
LRA
Repository
Technical Model Artefact
Development
Select existing or model new SNOMED CT
terminology bound ELEMENTs and (terminology
neutral) ENTRYs to satisfy Candidate Data
Element Definitions and Information Descriptions
ELEMENTS
ENTRYs
Output
Interface Artefact Model
Development
Select existing or create new Data Element
Definition and Refined Technical Model
constraints of ELEMENTs and ENTRYs; select
existing or create new Query Specifications.
Data Element
Definitions
Refined
Technical Model
Query
Specifications
Output
LRA Technical Modelling
Domain and Analysis Scoping
Review and Establish Requirements, Determine
Information and Process Concepts
Requirements
Catalogue
Stakeholder
Information View
Stakeholder
Business Model
Output
Logical Analysis
Modelling, Detailed Definitions, and Traceability
of Requirements, Pathways, and Information
Concepts
Information
Analysis Model
Use Case Model
Business
Process Model
Output
LRA Analysis
Identify Existing and/or New Requirements for
Data Element Definitions, Queries,
and Data Aggregation Models
Information
Descriptions
Query
Functionality
Candidate Data
Element Definitions
Output
LRA Knowledge Modelling
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
The record structure
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
LRA Core Components (after Department of Health)
• SNOMED CT terminology Description Logic
• BS/ISO/EN13606 Electronic Health Record for Communications object model
• HL7 Data Types (draft ISO)
• UCUM Units of Measure
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
The LRA Base Elements (after Department of Health)
Element
Observation Activity Relationship
Property
Finding
Investigation
Substance
Activity
General Activity
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Logical Care Record Model
The 5 Layers for Analysis of Care Records
Query (constraint ) Specifications
Classification / Grouping Rules (logic)
Human focused Business Rules
Business focused Requirements
Current Data Dictionary
Current Data Model
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Logical Record
Architecture
Pathways
Metrics Other dataset developments
Social care
LRA Requirements (after Department of Health)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
LRA Content Development (after Department of Health)
Use case
Elaboration
Design
Construction
Requirement
Elaboration
Design
Construction
Metadata
Registry
Purpose
& scope
Library
Imple
men
tation
cycle
Sta
ndard
s
Develo
pm
ent
cycle
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCCTerminology and archetypes Templates and forms
Use case
Elaboration
Design
Construction
Requirement
Elaboration
Design
Construction
Metadata
Registry
Purpose
& scope
Library
Local National
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
DMP: a French national eHealth record
DMP (Dossier Médical Personnel) will be:
a private medical file digitalised aimed at favouring coordination, quality and continuity of care;
a file shared by Healthcare professionals (HCP) but under the holder's control (i.e. The patient manages its access, the holder can hide documents...)
not a substitute for professional files of HCP in ambulatory care or in Hospital
accessed through :
• Web Portal for holder's
• Only through professional application for Healthcare professionals to maximize ergonomy and avoid time-consuming change of application
consisting of data (structured or not) signed by the author (at first only by the HCP)
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
DMP: A health record needing adequate protection
As a health record, the DMP needs to be:
• Available – Opens 7/24 – Availability 99,9% (total amount of interruption of 8 hours a year)
• Protective of data integrity and confidentiality
– Protected communications (SSL) – Restrictive access to a DMP (eSafe, HCP rights defined by law) – Separation of trusted services (authentication) and data housing
– Good level authentication
* Caisse des Dépôts et Consignations is a state-owned financial institution that performs public-interest missions on behalf of France’s central, regional and local governments.
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
DMP: A record used by numerous actors
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Dutch Design of the Architecture, Basic Infrastructure, for Healthcare after NICTIZ, 2002
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Dutch eHealth Activities Scheme after NICTIZ, 2004
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Turkey National EHR Approach
• Development of an Adaptor for automatically transforming National Health Information System (NHIS)of Turkey“Transmission Schema” instances to HL7 CDA R2 conformant EHRs
• Development of a Terminology Server based architecture enabling automatic mappingof the local coded terms that appear in the NHIS Transmission Schema instancesto international counterparts
• Development of an Adaptor for automatically transforming CDA conformant NHIS Transmission Schema instances to CEN EN 13606 conformant EHRs
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
The Architecture of the Transformation Environment for National Health Information System (NHIS) of
Turkey after Assuman, 2008
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Healthcare System Vison for Croatia after Blazona, 2007
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
German Approach
• There are two streams in the German EHR approach:
– An architecture-centric, intelligent, adaptive solution specifications based on international standards and partially borrowed from the Cnadian EHR-S Blueprint, launched by the Federal Ministry for Economy and realized by the eHCC
– An set of pilots more or less independent from international standards and international experiences, launched by the Federal Ministry for Health and realized by different hospital trusts, Fraunhofer Institutes and others
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
German EHR Architecture
Registries Common Services EHR System
Health Data Warehouse
Longitudinal Record Services
Communication Bus Common Services
Connector Connector Connector Connector
Application 1 Application 2 EHR Viewer
Resource Locator Service
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
eHealth Components (Logical View)
Policy
Services
Client
Services
Application
Services
Audit
Services
PMI EHR
Systeme
Dir./Reg.
Services
ID CA
Services
ACA
Services PKI
Terminology
Services
Gesundheitskarte
Name Zeile 1
Name Zeile 2
Name der Krankenkasse
123456789 A123456789
Kassennummer Versichertennummer
Knowledge
Services
Ontology
Services
Patientendossier - europäische Konzepte
Bernd Blobel
eHealth Competence Center
University Hospital Regensburg
Jahrestagung der HL7 Benutzergruppe Schweiz
18. Oktober 2012, Olten, Schweiz eHCC
Thank you for your attention!
Prof. Dr. rer. nat. habil Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center Franz-Josef-Strauss-Allee 11
D-93042 Regensburg, Germany
Email: [email protected]
Phone: +49-941-944 6769
Fax: +49-941-944 6766
http://www.ehealth-cc.de