In the future, every person in Switzerland will be able to give the doctors treating them access to their medical information via an electronic patient dossier (EPD). The federal law establishing the legal framework for this system takes effect in the spring of 2017. The “eHealth Switzerland strategy” calls for the operational and technical work, e.g. involving organizational or technological issues, to be handled by working groups in the form of subprojects. One of these subprojects deals with standards and architecture. The members of the project team reviewed various standards and recommended them for implementation in the nationwide architecture for EPDs. Ensuring the interoperability of systems in different regions and cantons is a constant concern. The IHE profiles are also very important, as they are internationally recognized and are already being used in many systems.
Building an MPI back in 2008
Establishment of the EPD in Switzerland is based on decentralized implementation projects. The canton of St. Gallen in Eastern Switzerland was one of the first to start building the systems necessary for EPD implementation. “We wanted to gain initial experience with implementation from a very early stage,” says Hansjörg Looser, the canton’s Director of eHealth. Implementation of a master patient index (MPI) for unique patient identification started at 10 cantonal hospitals back in 2008. The canton chose ICW’s Master Patient Index solution through a bidding process. The deciding factors were its extensive functionality and in particular the IHE interfaces to provide interoperability with the integrated systems. The MPI was built and integrated into the information systems at the linked hospitals within six months. Today they have unique patient identification across facilities thanks to the linkage of patient data from the various systems. The MPI is also scanned whenever patients are admitted in order to prevent duplicate data records.
Centralized access to documents and image data
The next step was to implement a cantonal document registry in St. Gallen. The necessary modules came from ICW. They were used to set up a document registry based on IHE XDS (Cross-Enterprise Document Sharing), followed by standards-compliant integration of the hospitals’ document and image archives. “We were able to achieve simple and sustainable linkage of all the existing systems for long-term storage of medical documents and image data,” says Looser. For several years now, the discharge reports generated after hospital stays have been exchanged with a regional network of physicians in this way, provided the patient has consented to this kind of electronic communication. This cross-network data exchange between the inpatient and outpatient environments is also based on the IHE-compliant ICW modules.
“Patients can access their hospital records through our Evita portal.”
Access portals for patients and a healthcare provider directory
In the foreseeable future, patients within the St. Gallen Hospital Association will be able to access their hospital records online via the Evita portal. Evita accesses data and documents via interfaces that comply with IHE standards and the recommendations of the coordinating body, eHealth Suisse. There are also plans to expand the solution landscape with a healthcare provider directory (HPD), which will greatly simplify the management of data from St. Gallen Hospital Association partners.
Impressive value and a reliable partner
Both the Master Patient Index and the IHE XDS-based document registry have clear benefits for the St. Gallen Hospital Association. Duplications are avoided and processes are greatly simplified. “It’s not just ICW’s technical solutions that provide clear added value for us with their functionality and strong performance,” Looser says. “We have also found ICW’s staff to be reliable, highly customer-focused partners.”
Ideal preparation for the future
There are currently “communities” and “reference communities” being formed in Switzerland for the decentralized EPD implementation project mentioned above. These are organizational units consisting of healthcare experts and their institutions. The communities must ensure that treatment-relevant information is accessible via the EPD and that processing of that information is documented with logs. Reference communities have wider-ranging responsibilities. Their job is to enable citizens to open or withdraw EPDs, as well as to access their information within the EPD, collect their own information, and grant or modify EPD access rights. With its current technical solution landscape, the St. Gallen Hospital Association is in an ideal position to meet these challenges.