Medical Datasets and Communication in Germany

Transcription

1 Medical Datasets and Communication in Germany Hans Demski Helmholtz Zentrum München IBMI - MEDIS Neuherberg, April 28, 2008

2 Communication in Medicine Old Way Face to Face Letter ( Snail Mail ) First Innovations Telephone FAX-machine Online World Messaging Tele-Medicine (-Consultation, -Monitoring, -XXX) Electronic Health Record -> paradigm shift

3 A Typical Scenario

4 Overview Datasets in Germany xdt family at general practicioners ADT for reimbursement LDT for lab-communication BDT for DMP HL7 within hospitals HL7-SCIPHOX Initiative tries to bridge the two sectors edmp as a new generation dataset for DMP VhitG Arztbrief a general purpose doctors letter egk German Health Card NFD emergency data eprescription data AMDOK medication history... amongst a lot of others

5 Comparision by Content egk NFD (emergency) Patient ID Relevant Diagnoses,Operations, Procedures Medication Allergies Treating Physician Contact Person Other Remarks edmp Patient ID Anamnesis / Findings Relevant Events Medication Education Care Plan Sending Physician VhitG Doctors Letter Patient Details Author Details Problem Anamnesis Findings Diagnosis Special Remarks Care Plan Notes Epicrisis Appendices

6 Comparision by Used Formats egk NFD Proprietary XML Schema Weak Typing edmp Based on HL7-CDA flavour Strict Typing Fixed Codesets VhitG Doctors Letter SCIPHOX / HL7-CDA Strict Typing Use of different Codesets possible Optional use of CDA Levels 2 and 3 Generic Approach allows variants e.g. Discharge Summary, Progress note,ct report, Visit note limited specialised set limited specialised set flexible and dynamic set for doctors letters

7 Different Datasets for Different Applications egk NFD Support of Emercency Cases edmp Support of various DMPs Diabetes, Coronary Heart Disease, COPD, Asthma, Breast Cancer VhitG Doctors Letter Support of reporting between health professionals For Storage on Health Card For Quality Assurance Measures For Communication at certain Events

8 Example Diabetes Specific Discharge Letter Used within ByMedCard Projekt at the hospital Haunstetten in Augsburg

9 Medizinische Basisdokumentation a counterpart to CCR? Requirements for a Basic Medical Dataset according to Haas: Complete and continuous recording of the primary medical information of a patient Represents a special view to the more complex entire patient record within in a medical information system Automated extraction from the legacy medical record National minimum basic dataset should be obligatory The definition should be based on the potential benefits for the actual care, with regards to the patients and health professionals acceptance Prof. Peter Haas Medizinische Basisdokumentation und egesundheitskarte in MDI 2/2004

10 Overview Communication in Germany Promoted by physician chambers Doctors Practice Management focus Doctors letter, edmp, Reimbursement, Laboratory Promoted by HIS providers (Specs released QI-2008) Ambitious case based approach egk German Health Card Obligatory (in Testing phase Rollout 2009?) Phase 1 has limited coverage Administrative Data, Emergeny Data and Medication History

11 Where are we going to? Shared Care and Patient Centered Care are demanding a holistic solution unifing data from the various sectors We are moving from limited local networks ( closed shops ) to global networks on national and european scale. EHIC is a proof even though limited to the administrative part - that the european level can be reached CEN Electronic Health Record Communication proposes an architecture to deal with the heterogenous medical data world OpenEHR is aiming to provide the tools needed for real implementations