The University of Freiburg Medical Center (UKF) has achieved a comparatively high level of digitization in patient care over the past few years. The Meona patient data management system (PDMS), which is used in all its regular and intermediate care (IMC) wards, has completely replaced paper documentation (“charts”). The system’s core functions are physician orders, medication administration records, and medical and nursing records. In the intensive care units, treatment is documented using the Copra6 PDMS. Outage-proof bedside systems collect the patient’s vital signs and feed them into the patient chart. Physician orders, medication administration records, and all intensive care medical and nursing records are also part of the fully digitized process chain. Mobile visits are largely paperless in many areas at UKF. Physicians, nursing staff, and therapists also use tablet solutions to facilitate their other day-to-day tasks.
INTERACTIVE SERVICES FOR PATIENTS ARE EXTREMELY IMPORTANT ELEMENTS IN THE DIGITIZATION OF CARE PROCESSES.
MEDUNA: Medical Universal Archive including standards-compliant structured data
The introduction of MEDUNA an IHE-compliant multimedia report communication and archiving platform, which was developed using solutions from Synedra and ICW, beginning in 2015, modernizes and expands the existing well introduced central data hub for findings and other data.
In addition to data from radiological procedures, which has been stored continuously in the digital PACS (picture archiving and communication system) for two decades, MEDUNA consolidates the available structured data (ca. 20 million reports, e.g. lab reports), digitally generated reports and documents (ca. 15 million), and scanned paper records (ca. 14 million documents comprising 90 million pages) and makes them available for data protection-compliant use via an integrated access system.
The system employs integrated medical communication standards like IHE XDS and HL7 FHIR to comply with the increasingly exacting regulations concerning research projects and the growing requirements for a universal abstraction layer for mobile applications and IoT solutions.
The IHE-compliant multimedia report communication and archiving platform is not just the “backbone” of UKF’s best-of-breed IT architecture — to an increasing extent, it is also becoming the linchpin of networking scenarios that will be a critical success factor in the implementation of the Medical Center’s digitization strategy for years to come:
1. Networking the University Medical Center:
ICW’s Master Patient Index (MPI) module was put in place for a cross-enterprise collaboration between the University of Freiburg Medical Center and the University Heart Center Freiburg-Bad Krozingen (UHZ) back in 2014 (see Perspectives No. 1, p. 8). Building on that, the next step will be to enable IHE-compliant exchange of patient documents between the two institutions via an affinity domain. In theory, this architecture principle can be expanded to include other partner institutions. One of the challenges is data protection-compliant implementation, which means that a more nuanced access management system within the affinity domain must be added to the current technological concept.
2. Digital patient services:
Portal solutions for the pre- and post-hospitalization stages and interactive services for patients are crucial elements in the digitization of care processes. These include onboarding, patient briefings, providing tailored information services, and requesting discharge letters, checkups, and other treatment records. These patient services can improve the flow of information between the various service providers and the patient and optimize treatment processes within hospitals. Ensuring mission-critical deep integration with the core components of the hospital information system is vital, which is why UKF relies on a tight technological linkage with MEDUNA in this area as well. The major benefit of an integrated service portal: The right to data portability, established in the EU General Data Protection Regulation, is already built in.
3. Integration into patient infotainment:
The University of Freiburg Medical Center is in the process of updating its current traditional media offerings in patient areas (Internet/wifi, TV, radio, phone) to become a patient infotainment system that includes value-adding services. It is clear that integrating the patient services described above into a bedside infotainment solution is associated with significant synergies and facilitates access for patients with lower IT affinity. This can be expected to increase acceptance of post-hospitalization use of portal services.
4. Networking patient care and research:
The Medical Faculty of the University of Freiburg and the University of Freiburg Medical Center will undertake an extensive upgrade of their IT-based research infrastructure in the next few years, thanks in part to a grant from the Federal Ministry of Education and Research’s medical informatics funding scheme. The goal is to make expertise, methods, data, and technologies available in a platform intended to support all areas of clinical and basic research. The centerpiece of this type of platform is a clinical data warehouse that enables the exchange of data between the clinical and research information systems.
This will allow not only for secondary use of routine data from the hospital information system, but also the reverse: use of research data in routine clinical practice. Here too, the universal archive for medical data will serve as the clinical counterpart and the source for data protection-compliant supply of clinical data to the research platform (particularly via FHIR resources).