Information Transfer- Clinical Necessity, Administration Nightmare
Transferring information between various places is fraught with technical challenges and confidentiality issues. New IT systems are, however, streamlining information sharing creating new avenues for a better dissemination of vital information.
During the 20th Century healthcare systems in the developed world, both state run and insurance funded, grew at a phenomenal rate – administration methods, however have changed little from those that evolved a century earlier.
Paper-based systems that were adequate when most people rarely saw a doctor and hospitals had a handful of specialist departments are now struggling to cope with modern patient numbers. The mass of data generated by new investigative techniques in dozens of different departments – which are often distributed in different buildings belonging to a hospital group spread right across a city - just adds to the load.
There are two major aspects to the problem, firstly patient data within a hospital is fragmented; it exists as images, numerical data, free text and encoded data, some of it in digital format, some on paper or film.
Secondly patients visit different hospitals; they may be referred to a specialist unit, they may move to a different district or even emigrate. And they are sometimes taken ill or injured whilst on holiday.
Fortunately 21st Century IT is at hand, and new methods have grown to offer solutions to both problems, unifying data storage within a hospital and facilitating transfer of relevant data to other health care providers.
Bringing it all together
For some years now, many major hospitals have employed Vendor Neutral Archives (VNA) to store various types of medical images regardless of the type or make of device that produced them. VNAs are extremely useful in radiography departments with several different types of imaging device, and they can make images available over a hospital network to clinicians elsewhere in the building - but they only store images, they don't provide access to patients' notes, referral letters and all the other material.
A clinical repository takes this idea a step further by providing a means to store any and all clinical data. But there's no point storing it, if you still need a plethora of different proprietary software packages to read the data. Modern repository systems such as Hitachi's HCR (Hitachi Clinical Repository) offer a means to overcome this issue.
Healthcare Solutions Healthcare Solutions Consultant, Hitachi Data Raj Singh explains that although Hitachi Data Systems have been providing storage solutions for healthcare for many years, HCR is something new.
According to Singh, what makes this different to other storage systems though is the software; HCR collects all digital medical images, electronic health and medical records, and the associated metadata related to each patient.
Based on conventional rack mount hardware, HCR is available in three sizes, up to 25, 50 or 100TB, the system accesses and archive data from existing VNAs, picture archiving and communication systems (PACS), hospital information systems (HIS), radiology information systems (RIS) and other healthcare systems. HCR can index and analyse more than 50 different document types and 400 MIME-types And having imported all this data HCR 'virtualises' it, that is converts every file into something that can easily be transferred to an Electronic Health Record (EHR) or portal retrieved and viewed on any standard DICOM viewer.
Metadata is the key to handling all this according to Singh: "every file comes with its own metadata giving useful, indexable, searchable information about the file – much as home computer users might 'tag' photos or music files to make them easier to find in future."
"Crucially, once the data is organised like this it become relatively easy to make it available outside the institution which currently holds it."
Egton Medical Information Systems (EMIS) and In Practice Systems (INPS) are best known as providers of management systems for general practice health centres in the UK. Systems like these are required by the NHS to be able to export data should a patient move to another practice, but until now other health care providers have not been able to use this data.
The growth of 'out of hours' services providing evening and weekend care for patients registered with different doctors, using different systems has prompted EMIS and INPS to find a way to share relevant data across different platforms. Their solution is a joint venture, the Healthcare Gateway.
Healthcare Gateway provides a medical interoperability gateway (MIG), a web portal through which data from different systems can be transmitted, and a consent model that ensures patient confidentiality and compliance with data protection legislation. At present only the two founding companies are using the MIG to its full extent, but they expect others to join the service. Ad Astra Health is trialling a restricted model and will soon move to the full MIG. Discussions are underway with all the other major healthcare IT systems providers in the UK.
Having created the system initially for primary healthcare, Healthcare Gateway is now piloting a scheme in the north-west of England using the MIG to transfer patient data between primary care and hospitals. As EMIS's CEO Sean Riddell explained the process is very similar to primary care transfers.
The pilot at the Aintree University Hospital is being carried out with the hospital's patient admin system suppliers, System C, using what Riddell refers to as a 'MIG-let', a restricted version of the MIG. The system enables the hospital's A&E department to see the GP records of patients brought in to A&E – having first obtained the patient's consent. Pilots are also taking place in Cumbria and Tower Hamlets in London. Later the system can be extended to other departments.
Healthcare Gateway is in discussion with several other hospital PAS providers. Once other hospitals join in it will be possible to transfer patient records electronically between them.
If you are scooped up unconscious from an Alpine ski slope or rescued from a Florida crocodile it would be helpful for your surgeon to have access to your records back home.
From a technical standpoint transferring data internationally using standard computer formats and HL7 and Snomed CT codes is feasible, though there are problems with things like drug names which vary in different countries / languages.
There are also issues with data protection. Within the EU the problem is relatively small since all member countries have similar data protection laws in place. Other countries vary. Emis's Sean Riddell believes the best way round this is to give access to the patient. If you can see your own medical records online via any web-browser then in an emergency you could give your log-in details to any healthcare provider who treats you. Emis already have this in place for the records held by primary care practices, and at least one anecdote from a patient whose treatment in foreign parts benefited from it.
If Healthcare Gateway is successful in getting hospital PAS providers onboard then there is no reason why a patient should not permit a similar access to records held in hospitals they have attended. But there is the 'crunch' of how many PAS providers will see the clinical and commercial advantages of joining a collaborative system, and how many will stick with the tried and tested 'walled garden' approach of keeping their customers tied in by making their data difficult to move? For the answer we will have to wait and see.