Hospital IT does not necessarily need an outside IT partner – as the Centre Hospitalier du Nord in the cities of Wiltz and Ettelbruck (Grand Duchy of Luxembourg) impressively demonstrated: For more than 20 years the two facilities have been using exclusively “home-made” IT systems. With the adoption of the 2015 Law on Electronic Archiving, the Medical Devices Law of 2009 and the EU Data Protection Regulation, which is scheduled for implementation by 2018, this autonomy however can no longer be upheld. And since change was unavoidable, the Luxembourg IT team did go for complete change – lock, stock and barrel.
In the past, medical data of the Centre Hospitalier du Nord existed in several and entirely different sub-systems. The Law on Electronic Archiving that came into force last year requires hospitals inter alia to ensure long-term archiving and to document each data access. “When this law was in the wings we knew we had to look for the know-how and the innovation power of a specialized healthcare IT provider in order to be able to comply with the new rules,” says Tom Hemmen, CIO of the Centre Hospitalier du Nord. Before he and his team started their search for a suitable external partner they had decided they wanted more than just any old kind of data consolidation; they wanted a system that archives their data in a very structured way as to allow them in the medium-term to integrate the data in their HIS, the so-called Dossier Patient Informatisé, or in any other medical systems.
Medical Archive as the foundation of future-oriented data management
With this tall order the team of the Centre Hospitalier du Nord – despite being novices with regard to cooperation with external partners – all of a sudden found itself at the very top of the technology table. Unifying 120 sub-systems and migrating them into a single IT system that can map the different formats in a structured way is no mean feat in healthcare IT.
“We knew we would need a very high degree of standardization in order to be able to realize our plan. Therefore we looked for a partner who is at home in the world of standards such as HL7 or IHE,” the CIO explains.
On their quest the hospital IT team came across VISUS and its solution JiveX Medical Archive. The vendor-neutral archiving solution of the Bochum-based manufacturer scored points in two important areas: the consistent use of internationally recognized standards and the excellent viewer which displays all medical data in a patient-focused way and according to the individual hospital’s defined requirements.
Georges Bassing, Administrative Director of the Centre Hospitalier du Nord, is in charge of legal compliance and thus had a different set of knock-out criteria for the new system: “The VISUS JiveX Medical Archive is CE certified and fulfills all requirements regarding a medical device according to the medical devices directive. This is very important in the context of liability and VISUS was the only provider to deliver peace of mind here.”
Structured integration of medical findings and synergies with the HIS
Currently, the IT team of the Centre Hospitalier du Nord and the VISUS project team are in the process of evaluating and jointly defining which data of which modality will be integrated into JiveX in which format. While this primarily involves taking stock of the existing data, ideas how the data will be migrated to the Medical Archive are already being bandied about.
“What’s clear at this point is the fact that the JiveX Medical Archive will accept all data independent of their original format and it will convert them if need be in order to create a uniform data pool. Thus image data in DICOM format will move straight into the Medical Archive, while medical reports will be integrated via HL7 MDM,” explains Stephanie Heuschling who is in charge of implementation of the Medical Archive within the IT team.
In short: all data that are elements of the electronic patient record and which are subject to documentation will be stored in the Medical Archive.
The Luxembourg installation has one peculiarity: structured integration of medical findings should – whenever possible – happen on HL 7 CDA Level 3. Thus medical findings will not be presented in a static pdf file but in a dynamic system which allows semantic analysis of data, e.g. regarding medication. “We want to use current technologies to their full extent and establish a data management system which will allow us to comply with future requirements. This includes, in the medium term, structured presentation of patient data in our internal HIS and in the systems of external healthcare providers,” Tom Hemmen adds.
At the Centre Hospitalier du Nord the future integration of JiveX in the planned HIS by Medasys plays an important role. The JiveX Viewer will be used within the HIS without having to call up a separate system. With regard to medical technology the hospital has been creating a solid foundation over the past few years by acquiring exclusively modalities that integrate well into the hospital IT structure. DICOM-enabled devices such as OR towers or ultrasound systems will be able to communicate directly with JiveX via DICOM. For non-DICOM devices JiveX is equipped with the Analog Modality Gateway which transforms objects into a standard format.
The parallel implementation of an external HIS and the Medical Archive is a major challenge for the project team, not only because of the data migration into the HIS. “This is another issue where we rely heavily on the JiveX Medical Archive. We will be using it as a migration tool when we transfer data into the new HIS, which is scheduled to go live in March 2017. That means we will create reports from the different legacy systems which we will move into the JiveX Medical Archive. The deep integration with the HIS allows us to call up these reports straight from the HIS.”
There was an important non-IT challenge the team had to master: to get buy-in from the staff. The colleagues had to be convinced that they will benefit from the new IT infrastructure. First-time use of an external system is more than changes on the surfaces and different key strokes or mouse clicks, says Tom Hemmen: “Our colleagues were used to having an internal IT team that painstakingly implemented all their software-related wishes. This is going to change. Obviously we will continue to respond to the wishes of the staff as far as possible. But at the same time our focus will shift towards processes that are proven to enhance the quality of care. Wishes of individual users will have to take a back seat.”
This strategic decision reflects the ambitious objectives of the IT team in Ettelbruck: the infrastructure aims to comply with the strict requirements of the Joint Commission International and receive ISO 27k certification. Moreover, the IT team wants to reach HIMSS EMRAM (Electronic Medical Record Adoption Model) stage 6 in the next few years – the second highest stage! “VISUS is a partner who supports us on our road towards these goals and who will develop solutions, such as the structured integration of medication data, that help us optimize patient care in a sustainable manner,” Tom Hemmen concludes.