Standardisierung von Standardisierung von EPAs EPAs - - IHE IHE - - Andreas Kassner Andreas Kassner VHitG e.V. VHitG e.V. IHE IHE- Deutschland Deutschland „vendor vendor “ “ co co- chair chair Integrating Integrating the the Healthcare Enterprise Healthcare Enterprise Interoperabilität Interoperabilität – – ganz ganz einfach einfach
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Standardisierung von EPAs -IHE-services.informatik.hs-mannheim.de/~kis/lu/vortraege/Kassner... · Standardisierung von EPAs-IHE-Andreas Kassner VHitG e.V. IHE-Deutschland „vendor“
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Standardisierung von Standardisierung von EPAsEPAs--IHEIHE--
Andreas KassnerAndreas KassnerVHitG e.V.VHitG e.V.
Basierend auf HL7 CDA R1 (ANSI) ; HL7 CDA R2 (Draft) ; EHR ENV 13606 (CEN-Draft)
Patient IDService Start and Stop TimeDocument Creation TimeDocument Class Code and Display NamePractice Setting Code and Display NameHealthcare Facility Type Code and Display NameAvailable Status (Available, Deprecated)Document Unique ID...
Die komplette Liste enthält 33 Attribute, plus freie Definitionen
Cross Cross CommunityCommunity DiscoveryDiscoveryBuild an index of patient data locations
Several identifying communities
Controlled by attributes
RLS/PIX+
XDS Community B
XDS Registry
XDS Repository
Cross Community
Bridge
Cross Community
Bridge
PDQ Server
XDS Registry
Community Attribute Search Engine
Cross CommunitySearcher
(1)
(2)
(3)(4)
(8)
(5)
(6)
(7)
(1)
XDS Repository
Akteurmodell (Akteurmodell (eFAeFA v1.1)v1.1)
»Case«
IdentityManagement
Case Registry
PatientIdentity Feed
TokenService
Patient Care CoordinationPatient Care Coordination
Adressiert die Integration von Leistungserbringern überEinrichtungsgrenzen, klinische Fragestellung und Zeit
Berücksichtigt allgemeine und spezielle medizinischeAspekte, ebenso wie technische Infrastruktur
Bildet Workflow und Informationsaustausch ab in kooperativen Netzen
In 2005 begonnen, heute 5 Profile
PCC ProfilesPCC Profiles
Medical Summaries
ED Referral
ExchangingPHR
Content
AntenatalCare
Summary
EmergencyDepartment
Report
PreprocedureHistory and
Physical
BasicPatientPrivacyConsent
LabReport
CareAssessments
20052005--060620062006--070720072007--0808In
teg
rati
on
Co
nte
nt
Query for Dynamic Clinical Data
PCC TF as Library of TemplatesPCC TF as Library of Templates
LAB
Problems
Vitals
Result
Problem
Obs
SeverityReferral
Documents Sections Entries Parts
XPHR Vital
Emergency Department ReferralEmergency Department ReferralAbstractAbstract
Define a referral format for "heads-up" call
Supports Medical Summary Content
Special Needs of Emergency Department• Expected Time of Arrival
• Mode of Arrival
• Disposition/Orders
Emergency Department ReferralEmergency Department ReferralUse CaseUse Case
1. The patient undergoes assessments by a triage nurse, is assigned a triage category (i.e. emergent, urgent, non-urgent).
2. The patient is then registered and demographic data is obtained.
3. The patient undergoes additional assessments by a primary RN,
4. The patient is seen by an ED physician who performs a history and physical, orders various diagnostic tests, determines a course of therapy, orders medications to be administered in the ED and performs procedures on the patient.
5. Upon completion of ED care, the patient is either admitted to the hospital, discharged from the ED, or transferred to another facility.
Exchange of PHR ContentExchange of PHR ContentAbstractAbstract
Hilft beim Austausch von Dokumentenzwischen PHR und EHR Systemen
Indentifizierung von Policies unter denen ein DokumentAuthorisiert veröffentlicht werden soll
“Zwingt” zur Einhaltung des Datenschutzes und derPatientenzustimmung
AntepartumAntepartum SummarySummary
Pregnant diabetic patient is seen by obstetrician in office for initial visit.
Ultrasound performed to determine gestational age.
Patient sent for perinatology consult as a high risk patient.
Patient returns to perinatologist biweekly for blood testing andultrasounds when necessary in addition to regular ob visits.
Perinatologist reports back to obstetrician after each visit.
Patient arrives at labor and delivery at the hospital.
Obstetrician delivers by Cesarean Section after anesthesia.
Obstetrician provides postpartum care.
Functional Status AssessmentFunctional Status Assessment
The Institute of Medicine has determined that a high risk for errors occurs during the transfer of care.
The Functional Status Assessment Profile (FSA) supports the handoff of assessment information between practitioners during transfers of care, cross-enterprise or intra-enterprise.
Transfer of physician documentation provides medical assessment, diagnosis and treatment information.
Transfer of nursing documentation provides assessment and treatment of human response (psychosocial, physiologic, emotional and spiritual) of patient/family to changing conditions.
Key Technical PropertiesKey Technical Properties
Considerations for scales Scales chosen are evidence based with strong reliability and validity.
Widely accepted cross-enterprise or required/recommended by accrediting agencies
Content ScalesNumeric Rating Scale (NRS-11) for Pain
... ... demnächstdemnächst in IT Infrastructurein IT InfrastructureNext step 2007
XDS FederationPIX and PDQ using HL7 v3Web Services Transport for IHE TransactionsXUA – Cross-Enterprise User AuthenticationRisk Management Planning White Paper