The Liver Case
University Medicine Mannheim (UMM) is a big tertiary care hospital that is part of Heidelberg University with some 50,000 inpatients per year, roughly 5,500 employees and an annual turnover of around €340m. On the IT end, UMM has been following a best-of-breed healthcare IT strategy with various highly specialised IT systems that are linked or partially linked to a central based hospital information system. “This legacy IT landscape has slowly evolved over the last decade. It exists to help us get our processes done, but so far it certainly doesn’t put the patient in the middle,” said Dr Lennart Jahnke, Chief Digital Officer of UMM, in his contribution to the session ‘How connectivity and interoperability can drive patient-centric care’ at HIMSS Europe 18 in Sitges, Spain.
Connecting with referring doctors
Jahnke said that hospitals that want to establish patient-centric data flows to bridge the rifts between individual medical institutions have to address a number of challenges: “Hospitals are not IT-driven companies. IT departments are often not that strong. There are regulatory and many privacy and security issues that need to be addressed, and there is a severe shortage of qualified and talented IT professionals.” UMM nevertheless decided to accept the challenge: “We wanted to change the status quo and move towards a patient-centric digital infrastructure to be ready for the future. So we had to develop a broad strategy for connecting our hospital to partnering institutions.”
To start with, UMM chose to focus on patients with liver diseases, including liver transplant patients. Liver diseases are relatively common and, because they have a tendency to progress towards liver cirrhosis and liver cancer, their medical and economical relevance is high. Furthermore, patients move back and forth from in-patient care to out-patient care again and again, and hospital experts and ambulatory doctors need quick and reliable access to laboratory data, liver imaging, discharge letters, pathology results and other clinical information.
Once the decision was taken to establish a patient-centric IT platform, Jahnke and his colleagues made up their mind in choosing the best possible approach: “We talked to our colleagues at Heidelberg University who had established an IHE platform already, and we were soon convinced that this was the right way to go.” After scanning the market, UMM decided to enter into a partnership with Siemens Healthineers and use their IHE platform eHealth Solutions.
“Think big, and IHE is the only way”
To Jahnke, these solutions offer a number of advantages over other approaches to cross-institutional communication: “An important aspect is that it is scalable. We are connecting to only a small number of private practices at the moment. But we see this as the beginning of a much larger network that might in the future become part of a regional electronic patient record infrastructure in the metropolitan region Rhine-Neckar. So we are thinking big, and when you think big, the only way of doing that is via open standards. We don’t want to do the integration work again and again. This is why we think that an IHE solution is the way to go.”
Another advantage of an eHealth Solution based on IHE is that it makes it comparably easy to implement patient-centricity. For Jahnke, health information belongs to the patient, and not to the hospital or anyone else: “We need to be able to give patients access to their data. Providing data from an IHE platform is much easier than providing it from our proprietary information systems.” The liver patients might only be interested in looking at the documents and images. But other patients, for example cancer patients or orthopaedic patients, might want to use their data to get a second opinion before embarking on a suggested treatment path. “This is their legal right, and as a hospital, we have the obligation to make it possible,” said Jahnke.
Adding a patient portal to the IHE platform that is used in Mannheim will be not much of an issue, according to the UMM-CDO: “The Siemens Healthineers solution is also being used by most regions in Austria as a platform for the Austrian national electronic health record ELGA. That means that there is a patient portal available already that we will implement in our own network as soon as possible.” In the future, patient involvement via the IHE platform could well be extended beyond simply giving patients access to hospital documents: Including telehealth tools and video-conferencing are options for additional ways of contact between the hospital and its patients that UMM is actively considering.
Waiting in the wings for the natinal record
IHE platform projects for electronic patient records like the one at UMM are closely monitored in Germany at the moment. The country is currently undertaking a serious effort to establish a nation-wide network of electronic patient records. How this network will look like exactly, is still under debate, but it seems clear that it won’t be a state-controlled unified patient record. The German healthcare system rather strives for a market-model type of approach that will result in a network of competing, but interoperable regional or supra-regional electronic patient records established in a by different providers.
“Our IHE platform fits very good into this vision,” said Jahnke in Sitges. “Because it is compliant with IHE profiles, we become a little more independent from individual information system providers and can easier fulfill interoperability requirements.” Conversations are already underway to connect the Mannheim platform with a similar IHE platform that was established by the University of Heidelberg nearby. In the future, there could well be a regional electronic patient record offered by the Metropolitan Region Rhine-Neckar of which the UMM IHE platform can easily become part of: “We are prepared for whatever the digital patient might expect from us,” said Jahnke.