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					Austrian Research Centers GmbH - ARC



   Opportunities and Challenges for eHealth in
   Cardiac Rhythm Management

   Alexander Kollmann, PhD
   Günter S h i PhD, MSc
   Gü t Schreier, PhD MS

   Austrian Research Centers GmbH – ARC
                      g
   Information Management & eHealth
   Graz - Hall in Tirol - Wien

                  alexander.kollmann@arcs.ac.at
                  http://www.h elga.at/ http://www.arcs.ac.at
                  http://www h-elga at/ | http://www arcs ac at




www.arcsmed.at
Austrian Research Centers GmbH - ARC                     eHealth systems



Content
     Cardiac Rhythm Management
            Challenges
            Opportunities
     Solutions
            H.ELGA - Herz.ELektronischeGesundheitsAkte
            SPRINT - Standardized PRogrammer INTerface
            Telemedicine and remote ECG processing
     Remaining Challenges
     Conclusions
Austrian Research Centers GmbH - ARC                           eHealth systems



Cardiac Rhythm Management (CRM)




  Devices                              Systems & Services         Vendors


 US                                             88                    $16 4
“US demand for cardiac implants will increase 8.8 percent annually to $16.4
billion in 2012” (Freedonia Group Inc, September 1, 2008)
Austrian Research Centers GmbH - ARC                                         eHealth systems



Challenges
     Heterogeneous environment

            devices: vendor proprietary systems, interfaces, and data models

            information management: paper based or electronic (incompatible
            data formats and data models)

            hospital IT: lack the flexibility and the possibility to exchange data with
            external services

            therapy management: many institutions involved (surgery, cardiology,
            primary healthcare sector)

            routine care <-> research: “single entry point” to access data from
            routine care, telemedicine services, and clinical trials
Austrian Research Centers GmbH - ARC                                       eHealth systems


Opportunities - Integrated Cardiac Rhythm Management

     Data integration: accumulation of data from different sources in a
     central data management system
            filed interoperability concept based on standards (e.g. IHE - Profiles)
            interfaces to vendor proprietary systems (programmer & home-
            monitoring services)
                              p                       p
            interfaces to Hospital-IT and healthcare provider


     Process integration: continuity of care, synchronisation and
     coordination of tasks and workflows between participating sites
            workflow support for therapy management and clinical trial management


          increase safety and efficiency
Austrian Research Centers GmbH - ARC                                                  eHealth systems



Interoperability framework
                     In-Clinic         Telemedicine      Home-Monitoring


 Observation                                                                  IEEE X73




                                                                                                                                                     vations)
     Creator                                                                 (1073.1.1.3)




                                                                                                                          ntable Device Cardiac Observ
                                                                                               IHE IDCO - Profile
                                                                            HL7 – Message




                                                                                                      O
                                                                                                                                        C
                                        SPRINT                    Data         HL7 RIM
  Observation
   Processor                               &                   Processing
                                        H.ELGA                              LOINC, ICD-10




                                                                                                                    (Implan
                                                      Report                    CDA



 Observation               Hospital Information System                          IHE - Profile
  Repository                Electronic Medical Record                         PIX, ATNA, XDS
Austrian Research Centers GmbH - ARC     eHealth systems



H.ELGA - Herz.ELektronischeGesundheitsAkte
Austrian Research Centers GmbH - ARC          eHealth systems



SPRINT - Standardized PRogrammer INTerface




 vendor                                healthcare provider
Austrian Research Centers GmbH - ARC   eHealth systems



Telemedicine / remote ECG processing




 general practitioner                      in-clinic
Austrian Research Centers GmbH - ARC                             eHealth systems



Web-based eHealth platform for integrated CRM
              p                                       y    p
     eHealth platform for CRM at the Medical University Hospital Graz
     (online since 11/2006)
            two clinical trials (different sponsors)
            more than 500 patients registered
            more than 20 (study) physicians

     fully integrated into the hospital IT (“sub-system”)
            patient data exchange
            report exchange

     telemedicine support and remote ECG signal processing (under clinical
         l ti )
     evaluation)

     SPRINT - Standardised PRogrammer INTerface
Austrian Research Centers GmbH - ARC                               eHealth systems



Remaining Challenges for eHealth in CRM
     Information management & research

            Interoperability and standardisation – IDCO profile

            Link to national EHR infrastructure (identity management) - to
            enable the exchange of information also across health care
            providers and even national borders

            Bridge the gap between routine care and research
Austrian Research Centers GmbH - ARC                          eHealth systems



Remaining Challenges for eHealth in CRM
     Economic aspects

            telemedicine and home-monitoring concepts in the CRM domain
             eed e business ode s
            need new bus ess models

            appropriate reimbursement for CRM-devices AND services

     Regulatory aspects

                           home-monitoring
            telemedicine / home monitoring services
              • national law and guidelines, patient safety
              • data protection and security

            software (eHealth services) as medical devices
             • Medical Device Directive (2007/47/EC)
Austrian Research Centers GmbH - ARC                                    eHealth systems



Conclusion
     to tap the full potential of modern health information systems data-
     and process integration are essential to ensure data consistency
     and coherence with existing workflows and processes

     the advancing eHealth landscape in Europe needs integrated care
     concepts in the CRM domain
           p

     eHealth concepts bring
            opportunities for CRM to become more efficient and safe but also
            new challenges for the healthcare system with reimbursement,
            regulatory issues.
Austrian Research Centers GmbH - ARC              eHealth systems



New links …


     www.eHealth2009.at
       eHealth 2009 & eHealth Benchmarking 2009
       Health Informatics meets eHealth
       Vienna, 7. – 8. May 2009




14. Mai 2009                                                        14

				
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