Implementation of the cross-institutional Electronic Health Record ELGA in Austria

Implementation of the cross-institutional Electronic
        Health Record ELGA in Austria

         Swiss eHealth Summit, 14. / 15.09.2015, Bern

                             Christian Stark
                             IT-Projektleiter
                    Klinische Informationssysteme
                          Tirol Kliniken GmbH
                         Innsbruck, Österreich
                    Christian.Stark@tirol-kliniken.at
                          www.tirol-kliniken.at

•   Name: Christian Stark
•   Ausbildung:
     –   HTL Innsbruck, Nachrichtentechnik und Elektronik
     –   Diplomstudium Wirtschaft & Management, Management Center Innsbruck
     –   Masterstudiengang Medizininformatik / Informationsmanagement, Universität für
         Gesundheitswissenschaften, Medizinische Informatik und Technik, Hall in Tirol
•   Aktuelle Position: Projektleiter, Klinische Informationssysteme, Tirol-Kliniken
•   Lehrveranstaltungen an HTL, FH und Univ.
     –   Projektmanagement
     –   Medical Information Systems & eHealth

                                           Christian Stark                               2

Agenda

• Introduction of Tirol Kliniken
• ELGA Basics
• GNT2ELGA Project
• Project Status
• Next Steps

                             Christian Stark   3

Introduction of Tirol Kliniken

Some Impressions from Innsbruck …

                          Christian Stark      4

Tirol Kliniken is …

… a Management Holding owned a 100% by the Federal State of Tirol

        Tirol Kliniken manage 4 Hospital Sites in and around Innsbruck

                               Christian Stark                       5

Tirol Kliniken Key Figures

Number of Beds            2.461
Inpatients p.a.         119.000
Outpatient Visits p.a. 1.907.000
Staff                     7.120 FTEs
Operating Budget p.a.       595 Mio €

                                   Christian Stark     6

Tirol Kliniken Hospital Sites I

State Hospital Hall and Long
                                  State Hospital Innsbruck – University Medical Center
Term Nursing Home Hall

                                                                                         District Hospital Schwaz

                      State Hospital Hochzirl - Natters

                                                     Christian Stark                                                7

Tirol Klinken Hospital Sites II

                                  Tirol
              H
      H   H   H
                                  ~750 000 population
                                   12.647 km2
          H

              Christian Stark                    8

State Hospital – University Medical
                           Center Innsbruck

Total No. of Beds:      1.560
Intensive Care Beds:     127
Inpatients p.a.:       85.600
Staff :                5.480 FTEs

                                Christian Stark          9

University Medical Center Innsbruck

            Christian Stark           10

Major IT Systems

Clinical Information System – Cerner Millennium

Patientadministration and ERP – SAP

Intensive Care PDMS – GE Centricity Critical Care

Multimedia Archive – Siemens syngo.share

Surgery Documentation System - Carus MyMedis

Radiology - PACS Agfa Impax and RIS GE Centricity

                              Christian Stark       11

Tirol Kliniken IT-Strategy

Strategic IT Goals of Tirol Kliniken
– integrated comprehensive EMR
– consistent IT support for all major
  processes & process standardization
– IT support for QM and Research
– Cross institutional extramural electronic
  communication / eHealth

                              Christian Stark   12

„Classic“ Channels for Extramural
                                    Electronic Communication

Since 2003 Tirol Kliniken have been supporting two extramural electronic communication channels
     - Austrian Medical Networks (DaMe, Medicom, …)
     - Push-Portal health@net
                                                                                     Referring
                                                                   Austrian          Physician
                                      medikom                      Medical
                                      Gateway                      Reporting
                                                                   Networks
                             EDIFACT-Format
           Clinical
         Information
           System
                         pdf-A
                                   syngo.share

                                 intramural                        extramural
                                                 Christian Stark                                  13

https://www.healthnet.or.at
  Tirol Kliniken Push Portal

        Christian Stark        14

ELGA Basics

   Christian Stark   15

eHealth Definitions

EU Directorate Gerneral for Information Society and Media
e-Health means
   Internet-based applications
   Involvement of citizens / Empowerment

Health Information Management and Systems Society (HIMSS)
eHealth is “ ... the application of the Internet and other related technologies in the
healthcare industry to improve the access, efficiency, effectiveness, and quality of clinical
and business processes utilized by healthcare organizations, practitioners, patients, and
consumers to improve the health status of patients“.

Eysenbach
sees e-Health as“… an emerging field in the intersection of medical informatics, public
health and business, referring to health services and information delivered or enhanced
through the Internet and related technologies. In a broader sense, the term characterizes
not only a technical development, but also a state-of-mind, a way of thinking, an attitude,
and a commitment for networked, global thinking, to improve health care locally,
regionally, and worldwide by using information and communication technology”.

                                        Christian Stark                                         16

EU eHealth Strategy

eHealth is a major topic for EU’s Digital Agenda
  EU eHealth Action Plan of 2004
         covered everything from electronic prescriptions and health cards to new
         information systems that reduce waiting times and errors – to facilitate a more
         harmonious and complementary European approach to eHealth
         Member States should have developed tailored national and regional eHealth
         strategies derived from the EU eHealth Strategy
   eHealth was also a core part of the EU i2010 Strategy
   „eHealth Action Plan 2012 – 2020“ is a major bulding block of Europe‘s
   Digital Agenda / Initiative 2020
   https://ec.europa.eu/digital-agenda/en/news/ehealth-action-plan-2012-2020-innovative-
   healthcare-21st-century

                                       Christian Stark                                     17

Core of the Austrian eHealth
                                     Strategy

ELGA = Acronym for „ELektronische GesundheitsAkte“ („Electronic Health
Record“)
ELGA is an information system which enables all elegible users (citizens /
patients, physicians, nurses, pharmacists etc.) to gain access to healthcare
information.
     e-reports
     e-medikation
ELGA links data already available in different provider systems and gives access
to the care providers who have a current patient contact.
ELGA-Portal can be accessed via www.gesundheit.gv.at
From Dec. 2015 on Hospitals, Nursing Homes, GPs, Pharmacies will
successively be able to provide healthcare information for ELGA and access
information in ELGA in a step-by-step go-live-process. The first 2 Affinity
Domains that will go live are Wiener Krankenanstaltenverbund and KAGES
(Steiermark)
Go-Live Date for Tiroler Landesdomäne GNT-ELGA not determined yet
More information about ELGA: www.elga.gv.at
                                  Christian Stark                                  18

ELGA is mandatory!

ELGA GmbH, financed by the Republic
of Austria, all 9 Federal States and the
Social Insurance Group, was founded
in November 2009 to manage the
technical        and       organizational
implementation of ELGA.
www.elga.gv.at

                                            Christian Stark   19

Legal Framework for

BGBl. 111/2012: ELGA Law (ELGA-G)
ELGA Implementation Guideline of the Austrian Ministery of Health
(ELGA-VO)
Health Telematics Guidline 2013
Data Protection & Privacy Law 2000 (DSG 2000)
eGovernment Law
Patient Charta
Treaty for the Financing and Organisation of the Austrian Healthcare
System between States and the Federation according to §15a B-VG
Hospital und Convalescence Law (KAKuG)
Physician Law 1998
Hospital Laws of the Federal States

                             Christian Stark                           20

Implementation Guidlines

ELGA does not only standardize purely technical aspects but also content!
One key part of ELGA are Implementation Guidlines
For each document type an officially approved Implementation Guidline + LOINC
must exist before it may be registered for ELGA!
     Implementation Guidlines describe structure, content and technical implementation of an ELGA
     Document in CDA
     Generation of an Implementation Guidline requires intentsive discussions among clinical and
     technical experts  big effort!
Currently the following ELGA Implementation Guidelines are available
     Allgemeiner CDA-Implementierungsleitfaden (Version 2.05)
     Implementierungsleitfaden Entlassungsbrief Ärztlich (Version 2.05)
     Implementierungsleitfaden Entlassungsbrief Pflege (Version 2.05)
     Implementierungsleitfaden Laborbefund (Version 2.05)
     Implementierungsleitfaden Befund bildgebende Diagnostik (Version 2.05)
     Implementierungsleitfaden e-Medikation (Version 2.05)
… further Implementation Guidlines will follow
                                          Christian Stark                                          21

Non-ELGA Scenario

                       Specialist         Pharmacy
                       Institute

                                                      Acute Care for
      Specialist                                        Inpatients

                                Patient
                                                      Nursing Homes
          GP                                            After Care

                                                                      Source: Arge ELGA

In a fragmented non-ELGA scenario patient data exist in different unconnected
information silos

                                    Christian Stark                                       22

Integrated Patient Care with ELGA

                   External
                                                         Pharmacy
                   Institute

                                                                    Acute Care for
Specialist                                                            Inpatients
                                     Patient
                                                                    Nursing Homes
   GP
                                                                      After Care

                    Extramural               other extramural
                       Care                     Providers

         Identification                Information                      Documentation

                               Security-Architecture

                       Health Care               Document
  Patient Index                                                       WebPortal
                      Provider Index              Registry
                                       Christian Stark                                  23

Relevant Initiatives and Standards
                              for ELGA

Integrating the Healthcare Enterprise (IHE)
   Technical Framework
   IHE-Profiles
   Syntactical Interoperability
      ability of systems to exchange data on a technical level by applying approved standards
  Semantic Interoperability
      ability of systems to interpret data automatically via metadata (information about data)
  Process Interoperability
HL7
   Reference Information Model (RIM)
   Clinical Document Architecture (CDA)
LOINC (Logical Observation Identifiers Names and Codes)
   Coding Standard for Lab-Parameters, Documents …
DICOM
   Including WADO (Web Access to DICOM persistent Objects)
                                       Christian Stark                                           24

IHE-XDS Profile

Cross-Enterprise Document Sharing (XDS) Profile
   enables registration, distribution and cross-enterprise access to information stored
   in localized Electronic Medical Records of a patient
   IHE XDS is the core profile for ELGA                           Source: ELGA GmbH

                                          Christian Stark                                 26

is a virtual EHR linking Data stored in
                       decentralized Repositories

Source: ELGA GmbH         Christian Stark                     27

Architecture

ELGA will be realized around the XDS-Profile via SOAP based Web Services.   Source: ELGA GmbH

                                         Christian Stark                                        28

Central Components of ELGA
                                Architecture

L-PI (Local Patient Index)
   Local PIX of an ELGA Domain
Z-PI (Austrian Central Patient Index)
   Austria wide identification of patients & linking of Local Patient Indices
PAP (Policy Administration Point & Policy Repository)
   Administration and storage of general and individual policies
ETS (ELGA Token Service)
   Issues Authorization-Assertions (SAML Tickets) for ELGA Users
GDA Index (GesundheitsDiensteAnbieter … Healtcare Provider Index)
   Directory servicing the identification of Healthcare Providers (Hospitals, Physicians etc.)
KBS (Kontaktbestätigungsservice … Contact Confirmation Service)
   Saves Contact Confirmations (Kontaktbestätigungen)
A-ARR (Aggregated Audit Record Repository) & Protocol Data Warehouse
   Summarizes protocol messages from decentralized ARR‘s for the patient
e-Medication
   Central Component handling e-Medication in ELGA
ELGA Portal
   Provides access to ELGA for a patient / citizen
                                       Christian Stark                                            29

ELGA Access System
                                   (ELGA Berechtigungssystem)

ELGA Access System (ELGA Berechtigungs-
system) consists of
• ELGA-Token-Service (ETS)
      •   Central Patient Index (Z-PI)
      •   Healtcare Provider Index (GDA-I)
      •   Policy Administration Point (PAP)
•   Kontaktbestätigungsservice (KBS)
•   ELGA-Access Gateways (AGW …
    Anbindungsgateways)
ELGA Token Service utilizes the services of
Z-PI, Policy Administration Point (PAP),
Healthcare Provider Index (GDA-I) and
Contact Confirmation Service (KBS) to issue
an ELGA Authorization Assertion (SAML-
Token).
Each ELGA Domain needs one ELGA- Access
Gateway („ELGA Anbindungsgateway“) to
communicate with the ELGA Central
Components and to enable XCA Access to
other ELGA Domains.
An ELGA-Access Gateway (ELGA An-
bindungsgateway) will be provided as                            Source: ELGA GmbH
downloadable VMWare by Bundes-
rechenzentrum (BRZ).                          Christian Stark                       30

Document Query in ELGA

•   Document Consumer initiates search
    for a patient‘s ELGA Documents
•   ELGA Token Service (ETS) checks if the
    Document Consumer may access the
    patient‘s ELGA due to a confirmend
    patient contact.
•   Via      Cross-Gateway-Queries     the
    Initiating Gateway provides a list of
    encounters + links to ELGA Documents
    for the Document Consumer.
•   If the clinician on the Document
    Consumer side wants to fetch a
    document from another GDA
    (GesundheitsDiensteAnbieter, such as
    a hospital from another organization)
    he has to click on the document link
    on the ELGA encounter list.
•   The requested document will be
    fetched from the Document Source
    Repository using a Retrieve Document                       Source: ELGA GmbH
    Transaction.
                                             Christian Stark                       31

Which content must be provided
                                for ELGA?

Content which has to be registered by Healthcare Providers when ELGA starts:
   From Inpatient Stays
         Physician Discharge Document
         Nursing Discharge Document (if available)
   From Outpatient Stays
         Lab Report
         Radiology Report
Other content, such as Outpatient Reports, Pathology Reports, Images (Dicom) etc.
may only be registered after the ELGA Implementation Guidline has been released on
this!
Further ELGA content will be
   Outpatient Reports
   Pathology Reports
   Images
   Mother-Child Pass
   …
                                   Christian Stark                              32

Important Facts about ELGA I

ELGA is based on latest international security standards
  Connections between all ELGA Components (Affinity Domains, Central Components) via
     closed and secure Networks
  Digital Certificates
No centralized Repository
  Decentralized Registries and Decentralized Repositories
ELGA will start empty – no preload
ELGA will make only documents available < than 10 years old
  After 10 years content will be set to status “deprecated”
ELGA is an Opt Out System
    Opt Out only for eMedikation
    Opt-Out only for eReports  only e-Medication will be available in ELGA
    General Opt Out  no ELGA participation at all
    Situative Opt Out (SOO)
    Patient wants to keep all information regarding a specific encounter out of ELGA

                                     Christian Stark                                    33

Important Facts about ELGA II

Additional control mechanisms available for a patient
  Patient can grant long term access to his ELGA for a physician or an institution he trusts
  Declare proxy status for other trusted persons (e.g. children, parents)
  Hiding specific information (documents etc.)

Access Logging
  Every access into a patient’s ELGA will be logged
      Who accessed ELGA when and from which institution?
    Patient can see the access protocols

ELGA Access for GPs , Hospitals or Pharmacies only in case of a
patient contact
  GPs: ELGA can only be accessed for 28 days after the contact to the patient has been
     confirmed (plugging of the eCard in the GPs office)
    Hospitals: ELGA can only be accessed after the patient admission has been
     communicated to the „Contact Confirmation Service“. Access is possible until 28 days
     after discharge.
    Pharmacies: ELGA can be accessed by the pharmacist for 2 hours after a patient‘s eCard
     was plugged in the pharmacy
                                      Christian Stark                                      34

Situative Opt Out (SOO)

SOO aims for the „medical case“, which is not exactely identifiable in IT systems. So the
regulations allow the following variants to realize SOO:
   Visit / encounter related: SOO is valid for only a specific visit
   SOO with limited duration: for all encounters in a hospital, which are within a specified
    time frame (standard: 28 days)
   Administratively defined timeframe: case related, e.g. for a sequence of encounters
    belonging to the same treatment
Each GDA (GDA … GesundheitsDiensteAnbieter - each hospital of a Holding like Tirol
Kliniken is a separate GDA, each GP office is a GDA) can select the most appropriate
form of SOO for implementation.
An SOO always refers to a specific GDA, but not for all hospitals of a legal entity
SOO Implementation
   Each organization has to make a desicion for one of the three possible SOO variants
   SOO administration has to be implemented into patient administration system and CIS
   Training of administrative personnel, nurses, physicians in handling an SOO

                                       Christian Stark                                  35

Delegation of Patient Contact

•   Delegation is the mechanism for enabling ELGA Access for other institutions (e.g. an external
    pathology, other external laboratories etc.) which are involved in patient treatment and where
    only specimen, tissue etc. of the patient shows up, but not the patient himself.
•   Delegation means, that the patient contact from the primary treatment institution can be
    expanded to another secondary institution, that will be involved but which has no direct contact to
    the patient himself.
•   After the delegation the secondary institution can access the ELGA of a patient.
•   If the patient declared an SOO at the primary institution this SOO must be transferred with the
    delegation to the secondary institution. In this case the secondary instituion may only read in ELGA
    but not write into ELGA.
•   All delegations will be visible for the patient in ELGA.
•   Electronic Delegation Mechanism is still under discussion and construction …

                                                Christian Stark                                    36

ELGA Benefit Expectations

Optimized support of cross-institutional patient-centered treatment processes
 Saving costs and time
   Eliminating the isolation between information silos

   Seamless  information exchange between intramural and extramural
   institutions
   Avoiding double exams

   Avoiding double prescriptions and Adverse Drug Events

Sustainable investment by relying on international standards and initiatives
 Highest level of security  encrypted mechanisms for authentication, data
transfer and logging
Patient himself will be empowered to govern over his ELGA

                                   Christian Stark                             37

GNT2ELGA PROJECT

      Christian Stark   38

ELGA Predecessor Project
                        GesundheitsNetz Tirol (GNT)

ELGA Predecessor IHE Domain „GesundheitsNetz Tirol“ (GNT) is up and running
since 2009
GNT Project started 2007
current GNT partners
  BKH Reutte, BKH Schwaz, BKH St. Johann, University Medical Center Innsbruck and
     all other Hospitals of Tirol Kliniken
Go Live: October 2009
GNT-Technology        , developed by ITH-icoserve
  ITH-icoserve is a Siemens & Tirol-Kliniken subsidiary (ca. 70% Siemens, 30% Tilak)
           is IHE a approved
What has been achieved until now?
  Implementation of the IHE Affinity Domain GNT
  Implementation of decentralized repositories
  Registration of > 7 Mio. CDA Level 1 documents since 01-01-2009
       Discharge Documents (outpatient + inpatient)
       Radiology Reports
       Dermato-Histology Reports
       Endoskopy Reports
  Integration of GNT into local CIS
                                          Christian Stark                           39

Basic GNT Infrastructure

                                                      Community Node:
                                                      Provides central IHE-Registry,
                                                      ATNA Profile and the Affinity
                                                      Domain-wide Patient Index
                                                      (PIX)

Local Node:
Each GNT participant needs a
sense Local Node providing the
interface to local CIS and EHR
Repository.
Registration also runs via Local
Node.

    Christian Stark                                                                    40

sense® is Connectathon approved

                  ATNA, BPPC, CT, NAV, ODS, PDQ (v2/v3), PIX (v2/v3), SVS, XCA,
                  XCA-I, XCPD, XDM, XDR, XDS.b, XDS-I.b, XDS-MS, XDS-SD,
                  XUA/XUA++ ... and many more profiles
                  .. with all actors.

                  Certified by EuroRec.

Christian Stark                                                                   41

GNT Access from Cerner Millennium

   After the consent form has been printed
   and signed the physician confirms its
   existence by activating a checkbox 
   then he can continue.

Christian Stark                                                 42

GNT Filter Adjustment

                   Starting Search   for   encounters   and
                   documents

Christian Stark                                               43

Fetching a Document from another Institution
                      and importing it into own Repository

Christian Stark                                                  44

GNT2ELGA Project – Implementing
                              the official ELGA Domain for Tirol

    GNT2ELGA Project = Project for implementing the official ELGA Domain „GNT-ELGA“ for all
    hospitals and nursing homes in Tirol
    Plan: GNT-ELGA Domain should be ready for GIT (General Integration Test with ELGA GmbH)
    in Q3‘2016
    Connecting all Hospitals in Tirol via a secure virtual network „GNT Backbone“
    Implementation of 3 ELGA-Environments and connection to CIS, RIS, LIS, internal tests
    Clarification of all topics around the operation of the GNT-ELGA infrastructure
      •   Monitoring, Ticketing, Business Continuity Management (BCM), SLAs
•   Organizational preparations
      •   Administration of SOO
      •   Handling and communication of „delegations“
      •   User Training (administrative personnel, physicians, nurses etc)
      •   Signing Contracts with ELGA GmbH and GDAs
    GIT with ELGA GmbH
    Go-Live of the Domain GNT-ELGA + all Tirol Klinken Hospitals
    Sukzessively going live with all hospitals in Tirol

    Predecessor „GNT Classic“ will most likely be shut down.

Tirol Kliniken Registration Strategy

syngo.share Multimedia Archive is the central instance for the registration of ELGA content
CDA-Documents must be provided by Document Source System via MDM-Messages including
all Meta Data necessary for registration

                                      Christian Stark                                         46

Administrating SOO in GNT-ELGA

          Christian Stark        47

Looking into ELGA: List of Patient Encounters plus
  Links to available Documents across Austria

               Christian Stark                       48

Sense Consumer Application showing a CDA previously
             fetched ELGA Document

               Christian Stark                        49

Project Status

    Christian Stark   50

ELGA Project Plan

• Project Plan until End of 2014
    Big „ELGA Master Plan“
    Deadline ELGA Go-Live 01.01.2015 could not be met

• Strategy Change and current Project Plan
    First 2 ELGA Domains (KAV Wien + KAGES Steiermark) will go live
      01.12.2015
     Thereafter about 3 – 4 month of stabilization and consolidation period
     Next 2 ELGA Domains (AUVA + Niederösterreich) are planned to go live
      end of Q2‘2015
     All other ELGA Domains for Public Hospitals (e.g. GNT-ELGA in Tirol)
      and big Clerical Hospital Organizations, such as Vinzenz Group, will be
      scheduled for Go-Live soon

                                  Christian Stark                          51

Current ELGA Project Status

• Currently intensive Testing in Lab Environment with KAV
  (Krankenanstaltenverbund Wien), KAGES (Steiermärkische KH
  Holding), ELGA Central Components and Software Vendors

• GIT (General Integration Tests) including KAV Wien, Steiermark,
  Central Components and ELGA GmbH will start soon

• Still issues to clarify
    ELGA Berechtigungssystem (ELGA Access System)
    ELGA Portal
    Organizational Details
    Ticketing System & Service Levels

                              Christian Stark                       52

ELGA Environments

Each ELGA Domain has to provide and operate 3 environments for ELGA
permanently:
• Integration Environment
    – To test new ELGA Access Gateway Software or new sense-Releases
• Pre-Production Environment
    – Shall be equivalent to PROD-Environment (ressources, release state
      etc.)
    – Will be needed for analysis in case of problems in PROD and for test
      and release of software patches / new software
• Production Environment

Tricky  all 3 Enviroments have to be connected with the clincal source systems for
ELGA content (e.g. CIS, LIS, RIS …) but in reality there are not always 3 separate
instances for all clinical systems available.

                                    Christian Stark                              53

Tasks for Tirol Kliniken until
                                  ELGA starts

Enabling the provision of documents for ELGA in EIS (ELGA Interoperability
Stage) Enhanced (CDA Level 2) or EIS Full Support (CDA Level 3)
     Inpatient Stays
           Physician Discharge Document
           Nursing Discharge Document (if available)
     Outpatient Stays
           Radiology Reports
           Lab Reports
Implementing the 3 ELGA Environments for our GNT-ELGA Domain
     Domain Registry (sense from Siemens / ITH-icoserve)
     Dezentralized Repository (syngo.share from Siemens / ITH-icoserve)
     Implementing the Registration Logic in syngo.share
     Integration of all Source Systems (CIS, RIS, LIS …)
     Seamless integration of GNT-ELGA Consumer Application into CIS (Cerner Millennium)
     Integration of sense Consent Application for SOO Administration
     Domain internal testing with all Healthcare Providers connecting to GNT-ELGA
     Performing the official GIT (General Integration Test)
Organizational Tasks
     Providing ELGA Support Structure (Ticketing System, Support Organization, SLAs, BCM etc)
     Training of ELGA Users (Physicians, Nurses, Administrative Staff, IT-People, etc.)
     Successively Go-Live with the Domain GNT-ELGA and all Hospitals in Tirol
                                                                                                54

Some Details to be worked out …

• Generation of CDA Documents in all Source Systems (CIS, LIS, RIS …)
     –   Applications / Tools for Clinicians to generate CDA Level 2 and 3 Documents?
     –   Workflow for the Generation of CDA Level 2 and 3 Documents?
     –   Will all Source Systems be able to provide all necessary Metadata for ELGA?
     –   Clarification of all technical details with vendors
           • LOINC for LIS
           • MDM instead of ORU
•   OID Concept for all Systems in all ELGA Environments
•   Public Key Infrastructure
•   Usage of Certificates
•   Identity Provider Mechanism for ELGA Users
•   …

                                          Christian Stark                               55

ELGA – an exciting, never
                                    ending Journey …

•   ELGA is scheduled to start in Dec. 2015
•   Successive go live of further domains from
    2016 on
•   e-Medication
•   Additional value for clinicians can be
    provided when content will be available as
    CDA Level 2 or 3 documents
      •   with CDA Level 3 content a „Patient
          Summary“ can be generated.
•   Advanced Search Mechanisms
•   Availability of further Implementation
    Guidlines will expand ELGA content to all
    kind of clinical documents and images
•   Mother Child Pass etc. in ELGA
•   Support for shared care of oncology and
    chronically ill patients (tumor boards etc.)
•   …

                                               Christian Stark   56

Thank you for your
    attention!

        Christian Stark   57