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

Cooperation of HRB with healthcare providers and
communication with their operational information
systems
WCIT 2014, September 30, 2014
Guadalajara, Mexico
Reinhold Haux
Maik Plischke
Markus Wagner
et al.

© Gesundheitsdatenbank für Niedersachsen
Lower Saxony Bank of Health
on PLRI
Prof. Reichertz
1930 - 1987
1974
Foundation of
the Institute
for Medical
Informatics at
MHH
1969
P.L. Reichertz
became professor
at MHH
(Development of
the MSH)
40
years
medical
informa1cs
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
1997
Prof. D.P.
Pretschner
moved to TU
Braunschweig
1996
Foundation of
the Institute for
Medical
Informatics at
TU
Braunschweig
2007
Foundation
of PLRI
2004
Retirement of
Prof. D.P.
Pretschner

PLRI – Peter L. Reichertz Institute for Med. Informatics
Prof. Reichertz
1930 - 1987
?
1974
Foundation of
the Institute for
Medical
Informatics at
MHH
1969
P.L. Reichertz
became professor at
MHH
(Development of the
MSH)
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
1997
Prof. D.P.
Pretschner
moved to TU
Braunschweig
1996
Foundation of the
Institute for
Medical
Informatics at TU
Braunschweig
2007
Foundation
of PLRI
2004
Retirement of
Prof. D.P.
Pretschner
40
years
medical
informa1cs

on PLRI
loca1on
TU
Braunschweig
loca1on
TU
MH
Hannover
health-enabling technologies
Standort
TU
Braunschweig
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.
medicine
dentistry
medical informatics

The eHealth.Braunschweig project
Secondary
process
Primary
process
Patient-oriented regional health care network
Funded by the European Union
Duration: 2009-2012
Follow-up funding: 2013-2014
Information management
Marketing
Quality management
At home General practitioner outpatient inpatient Rehabilitation (Home) care
Transinstitutional information system

Lessons learned …

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.

Organizational structure of the LSBH
Technical Experts Health Care Experts
Committee Commitee
Experts Committee Hospital A
Participants of the network form
the groups of:
• Customers
• Health Care and Technical
Hospital B
Resident doctors
…
Advisory Board
Rehabilitation
facility
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

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

Data storage
• 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

Data storage
Chosen Architecture – IHE XDS Affinity Domain
Registry / Repository
Profiles
PIX/PDQ, XDS,
XCA
ATNA, XUA …
Local node
doc. source, doc. consumer
doc. repository
Patient Record
Depart. X
Drug /
medication DB Communication server
Regional node (LSBH)
● On independent regional level
● Master Patient Index (MPI) and
Document Registry
Local node (HCP):
● Encapsulation of IHE acteurs
Advantage using IHE: base for future national network solutions and cross-border communication of
medical data (e.g. the epSOS project in Europe)
Doctor‘s office
Local node
doc. repository
Local node
doc. repository
Care
Hospital home
Web /
portal
application
Web / portal
application
Administration
system
Clinical
information
system
Administration system
Electronic
Patient
Record
and
archive
Depart. Y
Nursing
documentation
and recording
system
Administration
system
LSBH
Copy of
attested
document
Benefit from already successful
routine installations (e.g. Austria)
and progress in standardization.
 Personal EHR
 Directed communication

Data storage
Central storage as separate hosting service for HCP
Profiles
PIX/PDQ, XDS,
XCA
ATNA, XUA …
Local node
doc. repository
Depart. X
Drug /
Doctor‘s office
Local node
doc. repository
Local node
doc. repository
Care
Hospital home
Web /
portal
application
Web / portal
application
Patient Record
Administration
system
Clinical
information
system
Electronic
Patient
Record
and
archive
Depart. Y
Nursing
documentation
and recording
system
Administration
system
LSBH

Data storage
Complete central data storage technically possible but not intended
Profiles
PIX/PDQ, XDS,
XCA
ATNA, XUA …
Local node
doc. repository
Depart. X
Drug /
Doctor‘s office
Local node
doc. repository
Local node
doc. repository
Care
Hospital home
Web /
portal
application
Web / portal
application
Patient Record
Administration
system
Clinical
information
system
Electronic
Patient
Record
and
archive
Depart. Y
Nursing
documentation
and recording
system
Administration
system
LSBH

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.

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.

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

Current status
Stage 4: further extension
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

References …

Important milestone work and publications …

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

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