HEALTHCARE QUALITY ANALYSIS HEALTHCARE QUALITY ANALYSIS AND IMPROVED INFORMATION AND IMPROVED INFORMATION SYSTEM MODEL - BASED ON SYSTEM MODEL - BASED ON

PORTABLE PATIENT RECORDS”PORTABLE PATIENT RECORDS”the project started in August 2001

Project consortium members:• Department of Control Engineering and Information

Technology Budapest University of Technology and Economics as project consortium leader

• Bull Hungary Ltd.• Healthcare Network of the Hungarian Railway Co.

More information: lovanyi@iit.bme.hu

Goal: Multidisciplinary e - Health Services

The general goal of our project is to conceive and implement UnifiedInformation System Services, based on multimedia applications,including portable record structures, shared/virtual workstations,creating a multidisciplinary e-health services space providing secureglobal access to medical information. Application cases are beingidentified concerning shared workspaces, security, database and

imageengineering. Our project deals with an important segment of the esociety: HealthCare Information System, but all ICT results might beused in other application areas too. These tasks generate

subprojects,aiming to fulfil the general requirements of the global strategy.

General challenges in the General challenges in the Hungarian Healthcare Information Hungarian Healthcare Information

SystemsSystems

• To improve the public health• To enhance the efficiency of the healthcare

financial subsystem• To eliminate the regional differences in the

quality of services

Developing a new concept of an Integrated Medical Information

System

Our main development considerations

• Using standard solutions• Portable record structures / virtual workplaces• Electronic document management• Secure web-based multimedia database accessed via

Internet• Development of real-time image analysis algorithms• Implementation with real-time hardware-software• SmartCard technology increases data security,

confidentiality and portability• Multi-level security and access (GP, patient,

administrative staff, etc.)• Extensive use of networked imaging tools• Suitable mathematical interpretation of clinical

objectives

Healthcare Information

What kind of data is demanded?

Standard data types:

•Patient acceptance / release

•Diagnostics

•Treatment

•Information for patient

•Quality Improvement

•Management

•etc.

Where the information is asked from?•System Models

•Conventional

•Extended

•System Description Devices

•Etc.

• Processes

•Patient administration

•Diagnostics

•Therapy

•Economical aspects

•Analysis

•Etc.

Virtual workplaces

Data level compatibility

A B C

Data

Data acquisition systems

Interoperability

A

message

Data1

B

Data2

Systems has to be capable to use data coming from other systems - in accordance to their own specific functionalities

Portability

Patient Record stored in a given Source Information System is considered to be portable only if it can be transported to another Target Information System preserving integrity, and it can be indexed and processed in a similar way, compared with other records generated in the Target Information System itself.

NOT

Limitation 1.

Man - Machine - Machine - Man

BUT

Machine - Machine

Limitation 2.

We do NOT deal withthe multilanguage problem

Limitation 3.

Portability is NOT a data security problem

Limitation 4.

NOT „everybody with everybody” type communication

“State of art”

CENTC251

ISOTC215

HL7

Health Level 7

OSI Reference model

HL7≠P&P

Aiming to interpret a HL7 message, a lot of agreements are neededamong sender and receiver type parties. E.g.:

•technical type•work-flow type

HL7 Local conventions

Existing systems

A further step

The Completeness Criteria:

„Every standard message has to contain (or at least has to refer to )all information necessary for receiver information system aiming to use the message in accordance with it’s specific system functionalities

Health Directory Service

HDS

Service External sources

Technical layer

Service

Code Systemlistsquery

HealthCare

Information

<?xml version='1.0'?><!DOCTYPE HDS SYSTEM "HDS.dtd"><HDS><SERVER TYPE='primary' NAME='mav.hu' VERSION='0.1'><OBJECT TYPE='provider' NAME='kozpont.mav.hu'><SERVICE ADDRESS='Central.laboratory' TYPE='lab'><!-- other possible address format Central.laboratoy@kozpont.mav.hu--><REQUEST PID='taj@oep.hu' PORTFOLIO='oeno@gyogyinfok.hu' SAMPLE='barcode@kozpont.mav.hu'

REQUESTER='intezmeny@antsz.hu'> <PORTFOLIO TYPE='include'>23011, 23100, 25000-25999</PORTFOLIO><PORTFOLIO TYPE='exclude'>25998</PORTFOLIO><ADDRESS><TCPIP HOST='kplab.khz.mav.hu' PORT='ftp'/><SNAILMAIL ADDR='1062 Budapest, Podmaniczky u. 111' MEDIA='1.44FD'/><SNAILMAIL ADDR='1062 Budapest, Podmaniczky u. 111' MEDIA='CDROM'/></ADDRESS><PROTOCOL NAME='HL7' VERSION='2.3' RESOURCE='labor1@hl7.hu'/><PROTOCOL NAME='CEN.ENV1613:1995' VERSION='1' RESOURCE='1613@TC251.CEN'/></REQUEST><REPLY><ADDRESS><TCPIP HOST='kplab.khz.mav.hu' PORT='http'/></ADDRESS><PROTOCOL NAME='HL7' VERSION='2.3' RESOURCE='labor1@hl7.hu'/><CERTIFICATE RESOURCE='digiatalsignature@PKI.hu'/></REPLY></SERVICE></OBJECT></SERVER></HDS>

The HDS zone file

The communication scenario

HDSServer

BA

1. Question

2. HDS query

3. HDS Response

4. QUERY

5. Reaction

6. Reply

7. Reply

New trends in Medical InformaticsNew trends in Medical Informatics

• The advent of unified healthcare information systems and portability of medical records increases the need for security

• The use of the new tools in medical diagnosis multiplies the role of the image type data

Protection principles of healthcare Protection principles of healthcare datadata

According to the law in Hungary the owner of the medical data is the patient

It is not allowed to collect sensitive medical data in a central medical database

Image without personal data is not sensitive anymore but still useful: we may use them for diagnostical, educational, scientific and statistical purposes.

Doctors generally demand the original lossless image.

Conventional vs. IT-based image management

• Film- / paper based • Non-standard, Hospital or Department - specific protocoles• Manual generation of patient identifier (exchange of name, wrong

data entry, etc. possible)--------------------------------------------------------------------------• Hierarchical access• Time stamp, audit trail• Data grouping• Backup and archiving• Automatic generation of unique global patient identifier• Interoperability• Data integrity• Information retrieval and compression• Platform / vendor independent image representation• General protocol for image-related data

Relevant standards

• HISA – Healthcare Information System Architecture• DICOM - Digital Imaging and Communications in Medicine• NEMA - National Electrical Manufacturers Association PS 3.1 – PS 3.12• HL7 – Health Level Seven, an Application Protocol for Electronic Data

Exchange in Healthcare Environment• CEN TC251 – Comite Europeen de Normalisation, Technical Committee

251• PACS - Picture Archiving and Communication Systems• HIPAA - Health Insurance Portability and Accountability Act• Dig35 – Metadata standards• The Dublin Core Metadata Initiative

Problems with standards

• Overlapping or missing parts in standards created for networked imaging

• No general archiving or indexing solutions are offered • Conformity with standards doesn’t mean interoperability! • At least there is no language – specific problem!• Security, image integrity

Medical image has almost no value without related data

Related data types:• Patient data• Context of image acquisition• Parameters of image acquisition• Primary evaluation of image• Parameters of visualisation• Administrative data• etc.

What might be an appropriate „electronic clip” to connect visual and related textual data?

Image integrity verification

• A new watermark-based scenario is proposed• Brief unique digest is extracted from image and related

data• Trusted Third Party is involved• Time stamping• Global identifier• Even most sophisticated attacks can be detected

Implementation - design considerations

• Portability increases the need for security• The importance of medical images exponentially

increases in diagnosis and therapy!• IT adaptation and implementation of results

achieved in the previous phases• Use of up-to-date platforms (XML, UML, RDB,…) for

portable patient record structure modelling• Adaptable, example - like system design

Implementation - current status

– Buildup of the pilot project’s technical background

– Realization of the portable record structure• data model• communication protokol• data transfer and storage

– Implementation of different security solutions

Implementation - next steps

In the frame of pilot applications:– Modul tests– Integration tests– Functional tests

Conclusion: Current Status of the Conclusion: Current Status of the projectproject

Completed tasks

• Survey of the current situation in Hungarian Healthcare Informatics

• Process analysis of healthcare IT workplaces • Analysis of services of existing healthcare IT platforms • Analysis of the current data archiving and security techniques• New concept of portable patient record structures• New concept of Virtual workplaces• IT-based image management