Cooperation of HRB with Healthcare Providers and Communication with their Operational Information Systems

Reinhold Haux

Maik Plischke

Markus Wagner

et al.

WCIT 2014, September 30, 2014 Guadalajara, Mexico

Cooperation of HRB with healthcare providers and communication with their operational information

systems

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

Lower Saxony Bank of Health

on PLRI

Prof. Reichertz 1930 - 1987

1969 P.L. Reichertz became professor at MHH (Development of the MSH)

1974 Foundation of the Institute for Medical Informatics at MHH

1975-1988 Minor subject medicine at computer science program of TU Braunschweig, organized by Prof. Reichertz

Prof. Pretschner 1938 - 2007

1986 D.P. Pretschner became professor at Univ. of Hildesheim

1996 Foundation of the Institute for Medical Informatics at TU Braunschweig

1997 Prof. D.P. Pretschner moved to TU Braunschweig

2007 Foundation of PLRI

2004 Retirement of Prof. D.P. Pretschner

40 years medical informa1cs

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

PLRI – Peter L. Reichertz Institute for Med. Informatics












?

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

PLRI – Peter L. Reichertz Institute for Med. Informatics












?

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


on PLRI

Standort TU Braunschweig

loca1on TU Braunschweig loca1on TU MH Hannover

health-enabling technologies

health information systems and management

other research directions, ...

research

educa1on

≥ 25 faculty, 3 (full/assoc.) professorships

computer science

business information technol.

computer and comm. eng.

dentistry

medicine

medical informatics

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

The eHealth.Braunschweig project Se

cond

ary

proc

ess

Pri

mar

y pr

oces

s

Transinstitutional information system

(Home) care General practitioner outpatient inpatient Rehabilitation At home

Information management

Marketing

Quality management

Patient-oriented regional health care network Funded by the European Union Duration: 2009-2012 Follow-up funding: 2013-2014

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


Lessons learned …

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


The Lower Saxony Bank of Health (LSBH) was founded in 2011 basing on results of the eHealth.Braunschweig project.

Motivation: Establishment of a standard compliant solution for intersectoral communication in health care

As independent and neutral organization (act as trustee) the LSBH will undertake legal and organizational tasks and provide central technical services, with which actors of the health care are able to network in a better way.

LSBH is (to our knowledge) the first initiative of this kind in Germany.

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

Organizational structure of the LSBH

Participants of the network form the groups of:

•  Customers • Health Care and Technical

Experts Committee

Hospital A

Hospital B

Resident doctors

…


Advisory Board

Rehabilitation facility

Technical Experts Health Care Experts Committee Commitee

Academic: •  Peter L. Reichertz Institute for Medical Informatics

Participants – Care Providers: •  Braunschweig Medical Center •  Association of Statutory Health Insurance Physicians

Lower Saxony Governmental:

•  Ministry of Economy •  Braunschweig City Council

Other: •  OFFIS e.V. •  LINEAS Systeme GmbH

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

Basic principles of the LSBH (excerpt) Data storage

•  Medical data of individuals should still remain stored at HCPs

different to central data storage idea of IHRB. Why?

Reasons for decision (patients & HCP):

•  Achieve high acceptance and trust from patients ( permits data provision for and by LSBH)

▶  Minimize patient’s fear of data misuse Concerns of illegal data analysis or transfer to unknown third parties higher for central storage

▶  Keep doctor-patient confidentiality Legal privacy protection for medical documents expires in Germany if they are stored by a “non-HCP”/IHRB

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


•  Medical data of individuals should still remain stored at HCPs

Reasons for decision (patients & HCP):

•  Achieve good commitment from HCPs ( provide many documents)

▶  Voluntary provision of electronic documents

▶  Patient has the right to get insight in the original EMR of a HCP

▶  Patient has the right to get a (paper based) copy of the original EMR (but has to pay the efforts)

▶  No explicit legal regulation for electronic copies yet

▶  Many HCPs want to keep “their” documents in their range of influence different opinions of data ownership

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


Chosen Architecture – IHE XDS Affinity Domain

Advantage using IHE: base for future national network solutions and cross-border communication of medical data (e.g. the epSOS project in Europe)

Registry / Repository Profiles PIX/PDQ, XDS, XCA ATNA, XUA …

Local node doc. source, doc. consumer doc. repository

Doctor‘s office



Care home Hospital

Web / portal application


Administration system

Patient Record

Drug / medication DB Communication server

Clinical information system


Depart. X Electronic Patient Record and archive

Depart. Y

Nursing documentation and recording system


Regional node (LSBH) ●  On independent regional level ●  Master Patient Index (MPI) and

Document Registry Local node (HCP): ●  Encapsulation of IHE acteurs

LSBH

Copy of attested document

Benefit from already successful routine installations (e.g. Austria) and progress in standardization.

Personal EHR Directed communication

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


Central storage as separate hosting service for HCP



Doctor‘s office



Care home Hospital




Patient Record





Depart. Y



LSBH

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


Complete central data storage technically possible but not intended



Doctor‘s office



Care home Hospital




Patient Record





Depart. Y



LSBH

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

Basic principles of the LSBH (excerpt) Patient control

•  Only individuals respectively by his/her authorized HCPs should be able to access their medical data.

•  The will of the individual has to be taken into account.

According to German data protection law undirected communication of medical data requires an informed consent of the patient (Opt-In).

Two-stage consent procedure chosen for communication platform:

1.  Registration consent: Patient allows his/her current HCP the registration of documents of the actual treatment context.

2.  Retrieval consent: Patient allows his/her current HCP the retrieval of already registered documents.

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

Basic principles of the LSBH (excerpt) Data usage

•  All services of the LSBH are known to the respective individuals and HCPs.

•  As a rule the data is used by a HCP for the health care of an affected individual.

The LSBH will not offer or allow a usage of the data by third parties, which is not known by the affected individual or the affected HCP.

In first phase of the LSBH no data is provided for clinical research.

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

Perspective: Services of the LSBH

Functional ▶  Referral / Discharge documents ▶  Transition care ▶  Transition MRSA ▶  Lab communication ▶  Image communication TNW Administrative ▶  MPI patient identification ▶  HP identification / authentication ▶  XDS referencing ▶  Clearing ▶  ATNA logging ▶  XCA gateway to other domains Technical ▶  Long-term archiving, backups ▶  Monitoring, support and maintenance etc.

Functional services

Referral / Discharge

management MRSA …

Administrative services

MPI XDS XCA MPI …

Technical services

Source: PhD thesis Dr. Nathalie Gusew, 30.01.2012

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

Current status

Stage 3: „Prototype 1.0“ Connecting further hospitals and resident doctors

Stage 2: Connecting Braunschweig Medical Center and migrate existing directed communication to IHE infrastructure

Stage 1: Setup of central components of the communication infrastructure

Stage 4: further extension

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


References …

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


References …

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


References …

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen


Important milestone work and publications …

© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen



© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen



© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen



© G

esun

dhei

tsda

tenb

ank

für N

iede

rsac

hsen

Further information:

www.gd-bank.de (in German)

www.IMIA.org IMIA Working Group on Health Record Banking

www.plri.de Peter L. Reichertz Ins1tute for Medical Informa1cs University of Braunschweig and Hannover Medical School www.plri.de

Cooperation of HRB with Healthcare Providers and Communication with their Operational Information Systems

Healthcare

reichertz institute

customers health care

central storage

health careas independent

hcp patient

decision patients hcp

minor subjectmedicine

central technicalservices