Introduksjon til del 2 · Endo-base. Endus. O. O. O. A. A. DocuLive. Ullevål. DocuLive. RH. DL Pat. Ullevål. DL Pat. Aker/RH. D. D. D. R. R. R. R. R. ... (medisinsk biokjemi, immunologi,

Sept. 8th 2011 1

1. Introductions2. ICT in Norwegian healthcare (Margunn

Aanestad)3. The projects and deliverables (Ole Hanseth)4. Grouping

Agenda

2

A brief overview

INF 5210, September 2011

ICT in Norwegian healthcare

The big picture – in brief

• Administrative structure of the sector• Specialist healthcare: regional health enterprises• Primary healthcare: municipal responsibility

• IT systems in use in the sector• Hospitals, general practitioners, nursing homes,

pharmacies, private sector specialists• Communications between institutions

• Status, projects

3

4

Helse NORD IKTHelse Nord IKT (DIPS)

Helse Midt-NorgeHEMIT AS (DocuLive)

Helse VestHelse Vest IKT (DIPS)

Helse Sør-Øst(Mainly DIPS. Doculive at OUS, IMX at Telemark)

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EPR in Norway (2003)

EPR in Norway (2011)

US Nord-Norge

Helse Bergen

Voss S

Odda SStord S

Haugesund SHaugesund san.f.rev.S

Stavanger

Egersund

SeS i Rogaland

Odda S

Aker USLovisenberg S

Bærum

Radiumhospitalet

LillehammerLilleh.san.rev.S

ElverumHamar

Gjøvik

Sykehuset Innlandet

StensbyKongsvingerAUS

Sande-fjord

AskimSki

S ØstfoldFredrikstad

Halden

HortenTønsberg

S i Vestfold

Larvik

Moss

SaaS

HønefossDrammen

Central IT systems in hospitals

• EPR: Electronic Patient Record Systems• Implemented between 1993 - 2008

• PAS: Patient Administrative Systems • also called ADT – Admisission, Discharge, Transfer• Implemented typically in the 1970s as first IT system

• RIS (Radiological Information Systems, textual information) and PACS (Picture Archiving and Communication Systems, digital images)

• Laboratory systems (multiple)• Other systems (many!).

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8

Supply Chain

Health Information Management

Pharmacy/Medication Safety Physician Clinical Practice

Care Management

Departmental/Support Services

Clinical Decision Support

Clinical Documentation

Enterprise Patient Access

Core Information Management Components

MedicationOrder Entry

OutpatientPrescriptions

MAR

FormularyManagement

DosingManagement

Substitution/Cost

Management

PhysicianOrder Entry

ResultsReview

Order Sets Rules andAlerts

ProviderDocumentation

Task Lists/Workflow

Tools

Patient History/ Problem Lists

Patient Locator/ Patient Lists

AmbulatoryPractice

Management

RoundingTools

Pathways Protocols

User Interface/Portal

Data Aggregation and Reporting Tools

DataWarehouse

ComparativeDatabaseAccess

SeverityAdjustment

OutcomesMeasurement

Report Writer

ResourceUtilization

ProviderProfiling

Credentialing

Admission/Registration

EnterpriseScheduling

EligibilityVerification

Request forAuthorization

ConsumerPortal

TechnicalDenial

Management

PatientAssessment

I & OVital Signs Flowsheets

Care Plans

Solution ComponentsSolution Sets

RobotInterface

PositivePatient

Identification

DrugInteractions

Access toDrug

Databases

Kardex

TransitionPlanning

Critical CareDocumentation

Task Lists

Non-MDOrders

Interfacesto Monitors

SpecialtyDocumentation

PatientEducation

PatientSupplyCharges

Tracking &Reconciliation

Support forProduct

Standards

Interface toERP System

PrecertificationAuthorization

PayorCommunication

and Notes

SocialServicesSupport

Initial &Concurrent

Review

InterQualSupport for

LOC

Post AcutePlacement

DischargePlanning

Work Lists

ReadmitAlerts

ClinicalDenial

Management

Pathways

DiseaseManagement

ChartManagement(Deficiencies)

Transcription/Dictation

DocumentImaging

CodingSupport

ElectronicSignature

MRNManagementand Merge

Release ofInformation CDMP (?)

WorkflowTools

Master PersonIndex (MPI)

Clinical Data

Repository

ResearchRepository

CommonMedical

Vocabularies

OrderEntry

DecisionSupport

Repository

RulesEngine

SecurityTools

IntegrationTools

ConsumerContent

PDASupport

StandardCDM

Lab

Pathology

Blood Bank

Radiology/PACS

EmergencyDepartment

OtherDepartmental

Systems

Cardiology

Surgery

Kilde: John Quinn, Ernst & Young, 2002

•

9

O riginal vis ion Later vis ion Current vis ion

PAS

LabS ystem

LabS ystem ...

LocalEPR

LocalS ystem

LocalEPR

LocalS ystem

DocuLive ”U m bre lla” PAS

LabS ystem

LabS ystem

...

LocalEPR

LocalEPR

LocalS ystem

LocalS ystem

DocuLive ”U m bre lla”

A ll systems integrated with in D ocuL ive Some S ystems integrated(loose ly or t ightly)

PAS

LabS ystem

LabS ystem ...

LocalEPR

LocalS ystem

LocalEPR

New Porta l ”U mbre lla ”

DocuLive

Variab le levels of integrationunder the New Portal

From: Hanseth, Jacucci, Grison and Aanestad: Reflexive Standardization. Side-effects And Complexity In Standard-making. MIS Quarterly Vol. 30, Special Issue on Standardization Aug. 2006, pp. 563-581.

10

Service layer

Presentation layer

Integration layer

Legacy systems

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12

Oslo Universitetssykehus

PAS

Klin.dok.

Kurve

RIS/ PACS

LAB

PAT

Spes.

Aker UUS RH Radium

DIPS

(Meta- Vision)

Care-stream

Flexlab

Saphire, m.fl.

PasDoc

DocuLive

MetaVision

Siemens

Swisslab

DocuLive PAT

Prosang,Cardas,

Endus, m.fl.

DocuLive

MetaVision

Sectra

UniLab

DocuLive PAT

Well multimedia, Nyrebase,

Albert, Vmax, m.fl

Agfa

DocuLive PAT

Oncentra, CytoDose, m.fl.

EPJ ved OUS pr. 01.01.2011

DocuLive PAT

UniLab

Flexlab

Swisslab

AgfaRIS

SectraRIS

SiemensRISCare-

streamRIS

Carddas

ProsangSapphire

Endo-base

Endus

O

O

OA

A

DocuLiveUllevål

DocuLiveRH

DL PatUllevål

DL PatAker/RH

D

D

D

R

R

R

R

R

Miclis

R

R

R

R

R

A

Concerto/Rhapsody/

CDR/ BizTalk

R

R

R

R

Kliniskportal

PasDoc

DIPS

SectraPACS

AgfaPACS

SiemensPACS

CarestreamPACS

PACSViewer/

Repository

To pasientadministrative systemer sender informasjon om pasientkontakter

P

P

P

P

Elektronisk bestilling (Orders)Svarrapporter (Results)PAS-info (ADT and Patients)Dokumentmetadata og PDF’erPACS-bilder

O

AD

R

P

Org.enhetKortkodeKortkodeFRESHFRESH-

LegeIDHPRHPRHPRHPR-

Sender melding til Viser innhold i

UniLab

Flexlab

Swisslab

AgfaRIS

SectraRIS

SiemensRISCare-

streamRIS

Carddas

ProsangSapphire

Endo-base

Endus

O

O

OA

A

DocuLiveUllevål

DocuLiveRH

DL PatUllevål

DL PatAker/RH

D

D

D

R

R

R

R

R

Miclis

R

R

R

R

R

A

Concerto/Rhapsody/

CDR/ BizTalk

R

R

R

R

Kliniskportal

PasDoc

DIPS

SectraPACS

AgfaPACS

SiemensPACS

CarestreamPACS

PACSViewer/

Repository

Tre kliniske dokumentasjonssystemer formidler journaldokumenter

P

P

P

P

Elektronisk bestilling (Orders)Svarrapporter (Results)PAS-info (ADT and Patients)Dokumentmetadata og PDF’erPACS-bilder

O

AD

R

P

Org.enhetKortkodeKortkodeFRESHFRESH-

LegeIDHPRHPRHPRHPR-

Sender melding til Viser innhold i

UniLab

Flexlab

Swisslab

AgfaRIS

SectraRIS

SiemensRISCare-

streamRIS

Carddas

ProsangSapphire

Endo-base

Endus

O

O

OA

A

DocuLiveUllevål

DocuLiveRH

DL PatUllevål

DL PatAker/RH

D

D

D

R

R

R

R

R

Miclis

R

R

R

R

R

A

Concerto/Rhapsody/

CDR/ BizTalk

R

R

R

R

Kliniskportal

PasDoc

DIPS

SectraPACS

AgfaPACS

SiemensPACS

CarestreamPACS

PACSViewer/

Repository

Femten RIS/lab-systemer formidler svarrapporter

P

P

P

P

Elektronisk bestilling (Orders)Svarrapporter (Results)PAS-info (ADT and Patients)Dokumentmetadata og PDF’erPACS-bilder

O

AD

R

P

Org.enhetKortkodeKortkodeFRESHFRESH-

LegeIDHPRHPRHPRHPR-

Sender melding til Viser innhold i

UniLab

Flexlab

Swisslab

AgfaRIS

SectraRIS

SiemensRISCare-

streamRIS

Carddas

ProsangSapphire

Endo-base

Endus

O

O

OA

A

DocuLiveUllevål

DocuLiveRH

DL PatUllevål

DL PatAker/RH

D

D

D

R

R

R

R

R

Miclis

R

R

R

R

R

A

Concerto/Rhapsody/

CDR/ BizTalk

R

R

R

R

Kliniskportal

PasDoc

DIPS

SectraPACS

AgfaPACS

SiemensPACS

CarestreamPACS

PACSViewer/

Repository

En PACS-viewer viser innhold fra fire PACS

P

P

P

P

Elektronisk bestilling (Orders)Svarrapporter (Results)PAS-info (ADT and Patients)Dokumentmetadata og PDF’erPACS-bilder

O

AD

R

P

Org.enhetKortkodeKortkodeFRESHFRESH-

LegeIDHPRHPRHPRHPR-

Sender melding til Viser innhold i

Oversikt data ved RH (eks)

Unilab (medisinsk biokjemi, immunologi, mikrobiologi)

Pasientjournalen

DocuLive Patologi

2000 2005

SkannetElektronisk

Papir

Sectra RIS (RAD)

Klinisk portal(svarrapporter)

DocuLive (tekstlige journaldokumenter)

Agfa RIS (RAD)

1995 2010

Miclis (mikrobiologi)

DocuLive (andre journaldokumenter, skjema, svarrapporter fra ikke-integrerte systemer)

Mars 2006

EPR outside hospitals

• General practioners: 100% coverage• 4 products (other than hospitals); Profdoc Vision,

Profdoc Winmed, System X, Infodoc Plenario.

• Municipal nursing homes/home care:• Not fully computerized, or installed EPR not fully

utilized• Other products (Gerica, Cosdoc etc)

• Private specialists:• Specific EPR systems

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Communication between actors

• Slow uptake of electronic communication• Initial alignment with CEN standardization

(EDIFACT/X.400-based, now ebXML).• Norwegian Health Network established 2003/4

• Closed, secure, broadband network for health sector• Largest volumes: laboratory result messages,

increasing also other types:• http://www.kith.no/templates/kith_WebPage____2932

.aspx• Largest utilization in Region Nord• Statistics: http://ehelsestat.nhn.no/ 20

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22

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Projects

• ELIN (Elektronisk informasjonsutveksling)• Suite of different projects (for GPs, for nursing

homes/home care, etc)• Standardizing messages, formats, patterns of usage

• eResept (ePrescription)

• Meldingsløftet (the Message Boost project)• National + regional initiatives to speed up

implementation of digital messages

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25

Core actors on national level

• The Directorate of Health• The Ministry of Health and Care• ”Nasjonal IKT” (ICT forum for the RHE’s)• Norwegian Health Network• KITH (Competency center for IT in health)• HELFO (Rikstrygdeverket, NAV)• Norwegian Centre for EPR • National Center for Telemedicine

• … etc. …

26

National strategies• ”Mer helse for hver bIT” (1997-2000)

• ”Si @!” (2001-2003)

• ”S@mspill 2007” (2004 – 2007)

• ”Samspill 2.0” (2008-2013)• Achievement-focused: • The Message Boost, • ePresecription, • include primary care

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Sentrale helseregistre• Det er etablert sju sentrale helseregistre i henhold til

helseregisterloven:• 1. Dødsårsaksregisteret

2. Kreftregisteret 3. Medisinsk fødselsregister (MFR) 4. Meldesystemet for infeksjonssystemer (MSIS) 5. Det sentrale tuberkuloseregisteret 6. System for vaksinasjonskontroll (SYSVAK) 7. Reseptbasert legemiddelregister

• Med unntak av Kreftregisteret har Nasjonalt folkehelseinstitutt databehandlingsansvar for alle disse registrene.

• www.fhi.no

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Medisinske kvalitetsregistre• Mange spesialiserte fagmiljøer har utviklet egne

kvalitetsregistre som verktøy for kvalitetsforbedring av pasientbehandlingen.

• Pr 2006: ca 60 regionale/nasjonale registre• Måler resultat av behandling, prosedyrer og tiltak.

• Oftest er registrering separat (ikke del av rutine- dokumentasjon i de vanlige kliniske systemene)

• Bidrar til kunnskapsbasert praksis• www.shdir.no/kvalitetsforbedring

Projects

• Meldingsløftet• North• Mid• West• South/East• National

• eResept• E LIN-K• Kjernejournal• Telemed• OUS 30