More and more healthcare providers in Germany, including hospitals and medical practices, are joining together to form healthcare networks. Most of them use some type of shared patient record that facilitates data and process management in clinical care. A major factor in the success of these networks is interoperability, i.e. the ability of organizations and their information systems to work together. The profiles created by the worldwide initiative Integrating the Healthcare Enterprise (IHE) have become the common platform for interoperability in the healthcare sector. IHE profiles use existing standards like HL7 or DICOM to describe use case-driven collaboration scenarios and implement them in a standardized way. In addition to the advance of networking, there is another trend to be seen: More and more digital health services are becoming available in the form of useful apps. The data generated by these apps is often incompatible and is sometimes stored in obscure cloud infrastructures where the data protection situation is often unclear.
THE PHELLOW APP’S STATUS BOARD
The phellow app allows patients to maintain sovereignty over their health information at all times and to be integrated into processes digitally with its Timeline, Medication, Network and Share Data functions.
Keeping an eye on data
For these reasons, phellow seven envisioned a secure, smart, and mobile health dashboard that lets the user control and manage health-related processes and activities digitally. In addition, the user can always keep track of things and know where each kind of data can be found, and they are free to decide which data and content to make available to whom, and for how long. The dashboard is lean and can be customized at any time by using additional services and apps.
The phellow app, available for Android or iOS, is the main user interface for the health dashboard. As a lightweight client for IHE-based health networks (known as affinity domains), the app can selectively manage multiple networks, separately or in a single view. The patient logs in with their username to get access to their stored health information or to other services, such as consent management, depending on the individual network’s level of development.
Users can also create a phellow seven account. In addition to the basic functions, an account provides a verified, secure digital identity within the healthcare system and private, secure data storage in the phellow seven cloud for copies of information from the integrated networks or user-generated data. The latter can include camera scans of old paper records, highly structured data generated by third-party apps or sensor technology, or medication lists digitized by scanning a data matrix code in accordance with the German E-Health Act (see p. 16).
The diagram to the left shows the overall architecture of the phellow seven platform. The phellow app and other apps and services within the phellow seven ecosystem, or from third-party vendors, use the HL7 FHIR-based personal health interoperability interfaces (PHII), which also have libraries (PHIL) available for Android and iOS. Data is stored in a FHIR server. An ID and user management component controls user accounts in the integrated networks, including authentication and authorization. A policy server handles data access for third-party apps. The Aphinity component is responsible for managing and coordinating multiple affinity domains; this includes endpoint management of IHE services in the individual domains or coordination of the XDS value sets they use.
Aphinity can be integrated into existing affinity domains in two ways: It supports classical IHE XDS with SOAP and SAML, but also the new generation of IHE profiles using MHD with OAuth.
The platform and the integrated apps meet all the current requirements for data protection and security. If required, platform and app components will be developed that comply with the German Medical Devices Act and the European Medical Devices Regulation.
Always standardized and mobile
Users have a central health dashboard that gives them access to and control over their health information at all times. They use a central digital identity for the healthcare system, but can also link other identities to it, and thus have a fully integrated picture of their own health data, regardless of whether it is located in one or more health networks (IHE affinity domains), or in their personal phellow seven cloud. By combining modern standards with established e-health infrastructures, the phellow seven ecosystem allows integration of other apps and data sharing with the user’s own healthcare providers.
Vendors offering digital health services, such as online consultations or personalized diabetes management, benefit from a high degree of visibility and scalability with low integration costs. They use a standardized interface (PHII) and have potential access to many established health networks and facilities. Network- or facility-based implementation is not required.
When combined with existing networks like those provided by the modules in ICW’s eHealth Suite, phellow seven offers these added values: digitization and streamlining of all processes in which patients are included. A notable example of this is its support for discharge management and for the transparency and information obligations of the new EU General Data Protection Regulation. Healthcare service providers also benefit from better customer retention resulting from up-to-date digital services and communication on equal terms
Integration with PEPA
With ICW as its main technology partner, Heidelberg University Hospital (UKHD) has been developing a personal cross-enterprise health and patient record (PEPA, www.pepa.eu) based on IHE profiles since 2006, making it one of the pioneers of patient-centered, standards-based networking of healthcare facilities in Germany (see ICW Perspectives No. 2, p. 6ff.)
ICW and phellow seven are now working together to implement digital patient integration based on the existing PEPA throughout UKHD. This will be accomplished using MHD, an IHE profile based on HL7 FHIR, in combination with the authorization framework OAuth. The phellow app will use the App Connect and Patient Onboarding modules in ICW’s eHealth Suite.
All patients are given PEPA access at admission. During the multi-phase rollout, patients will be given read-only access to the contents of the PEPA at first. This allows them to retrieve from the PEPA network any letters, findings, reports, medications, lab results, radiological data (such as x-rays or CT scans), and other discharge documents from any of the partners involved in their treatment.
It is also possible to use other apps from the phellow seven ecosystem, or apps and services from its range of partners. Their content can be shared with healthcare providers in the PEPA network—and in the future, with other health networks as well. Anyone wishing to do so can take the next step and arrange for access control over their PEPA through the phellow app.
The phellow seven team (from left):
Atakan Poyraz, Dr. Oliver Heinze, Konstantin Kinzel, LisaKrebs, Nicolas Weiß, Maurice Fahn, Kevin Schorpp. Not pictured: Gerd Schneider, Janine Proft