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TheeDLmobileapp
Improvingcommunica5onbetweenhospitals,pa5entsandcommunityphysicians
Dr.LeonardoLezcano,UAH,SpainDr.HendrikDrachsler,OUNL,Netherlands
Heerlen,October25th,2012
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DischargeLeerexchangescenarios
Specialist Paent
Paent GP
GPA GPB
Communicaonbetweenhospitals
andlocalmedicalofficersandGPs.
Summarydatawhichclinicalcoders
relyuponforclinicalclassificaon.
Medico-legalpurposes,financialand
administravefuncons.
Theycontain:administraveinfo,
follow-upappointments,clinicalinfo,
problemsonadmission,diagnosis,
proceduresperformed,medicaons
ondischarge
Supportconnuityofcare.
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Sample1BalmainHospital,
Sidney,Australia
(2005)
DischargeLeer
Handwrien(legibility) Freetext,narrave
(accuracy)
Unstandardized Errors,omissions Slowprep.(boleneck) Terminologybindings Difficultintegraonin
EHRsystems
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DischargeLeer
Sample2
Patersonetal.
(1999),Discharge
SummaryStudyGroup,Canada
Terminologybindings Handwrien(legibility) Freetext,narrave
(accuracy)
Unstandardized Errors,omissions Slowprep.(boleneck) Difficultintegraonin
EHRsystems
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Sample3
Patersonetal.,
Dalhousie
UniversityCanada(2002)
Terminologybindings Semi-Structured Controlled
Vocabularies
Fasterprep. Unstandardized Errors Difficultintegraonin
EHRsystems
eDischargeLeer
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eDischargeLeer
Sample4
Bludauetal.
DepartmentofInternal
Medicine,UniversityofHeidelberg,Germany
(2003)
Terminologybindings Structured ControlledVocabularies Fasterprep. EHRstandards Seamlessintegraonin
EHRsystems
Limitedtotheboundariesofhealthcaresystems
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RemainingproblemsofeDL
Itisnotnecessarilythecasethatelectronic
summariesareofhigherqualitythanhandwri?enones[]electronicsummariesmay
containmoredeficienciesthanhandwri?en
summaries(Callenetal.,2007)
WeneedawidelyadoptedstandardforDLs:
Candidateterminologies:ICD,SNOMED,MeSH,UMLS,MEDCIN)
EHRstandards:HL7-CDA,openEHR,EN13606
Inspiteofbeingverysimilar,therearesyntaccal,structuralandsemancdifferencesthatmustbesolved.
Naonale-HealthTransionAuthority(Australia)&CLAS
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PrivacyandSecurityIssues(II)
somehealthcareproviderswereapprehensiveaboutthe
electronictransferofdocuments,andfourGPsrefusedtoreceiveelectronicdocumentsatallonehospitalspsychiatricward
declinedelectronictransmissionoftheirdischargesummaries
becauseofthehighlysensivenatureofthedatacontained
therein(Schabetsbergeretal.(2006)
signaturefuncJonalitymustbeintegratedintotheworkflow
surroundingdocumentcreaJon,ideallybyusingPublicKey
Infrastructure(PKI).(Brandneretal.(2002)
somecountrieshaveprivacylegislaonthatprohibitstheelectronictransferofdischargesummaries.(NaonalE-Health
TransionAuthority,2006)
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TheeDLmobileapp(I)
Specialist Paent
Paent GP
GPA GPB
TechnicalBenefits Nointernetconnecon
required
Nosenguprequiredforthetransfer.
Nopairingrequired. Maximumdistance4cm
(securityandprivacy).
MobiledevicessupporngNFCtechnologyaregrowinginpopularity
E.g.GoogleWalletisbasedonNFC.
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TheeDLmobileapp(II)
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TheeDLmobileapp(III)
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Bridgingthegapbetweenprimaryandsecondarycare. Fullystructuringandsemancallydescribingdata. ImprovinglegibilitywhencomparedtohandwrienDLs. EasingpreparaonofDLs&workpraccesofhospital
clinicians. AssessingGPpreferencesinordertoreachasuitableDL
standard.Detecngadverseeventsanderrorrates.
Providingsupportacrossheterogeneoussystems(e.g.crosscountry)
ImprovingthesecurityofferedbypaperbasedDLs(electronicsignature)
PreservingtheprivacyofferedbypaperbasedDLs.
Benefitsforboththehealthcareproviderandthepaent
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Paentempowerment Incontrastwithcentralizedsoluons,thepaentisthecarrieroftheinformaon
Medicaonsnoficaons Followupandappointmentmanagement Reducinghandlingoperaonsandpapersaving.
Ulmately,increasingpaentsafetyandqualityofcare.
Derivedbenefitsforthepaent
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appdemo
