The living archive

Digital hospital archives used to be rather dull systems that were generally thought of as “data graveyards” for scanned files—but now digital hospital archives play a central role in the information architecture of modern hospitals.

Synedra and ICW have brought new life to hospital archives with their solutions. The demands of data diversity, integration into system landscapes and the clinical routine, viewer functionalities, and data protection, not to mention integration with cross-enterprise records, are constantly increasing. As a result, our clients now expect a “living archive”—a platform that can collect, store, distribute, display and archive all patient-related information.

Synedra has been developing its archive platform Synedra AIM for over 10 years. Building on modern technologies, guided by industry standards, and in close consultation with our clients, we have created a platform for all forms of medical information: documents (scanned, original electronic, unstructured in PDF/A format or structured in HL7 CDA), imaging studies (DICOM and non-DICOM), medical device data, and signals.

The players get networked
In our core markets of Germany, Austria, and Switzerland, we are currently seeing a strong trend towards cross-enterprise data exchange. This is being driven by factors like economic concerns, legal requirements, quality of care issues, and ties to referring physicians as well as patients.

This gives hospital archives a new mission: providing the data basis for cross-enterprise information exchange. The digital hospital archive holds complete in-house patient records, so it makes an excellent gateway for cross-enterprise records.

A blueprint for the implementation of cross-enterprise records is already available in the profiles created by the international standardization initiative IHE.

Stable network architecture
In networking projects, a hospital archive is just one player among many. A stable network architecture must first ensure that patient identities can be established across facility boundaries, and that communication partners know each other and can communicate securely. Another requirement is the infrastructure to register data for external access, control access rights, and manage patient consent for data sharing. All of these modules are gathered in common locations outside of the archive, which are known as “affinity domains” in IHE-speak, but are also called “ELGA [electronic health record] domains” in Austria or “reference communities” in Switzerland.

We looked at experiences with healthcare networking in Austria, where a national patient records system based on IHE profiles has been running efficiently since early 2016.

On the one hand, the archive functions as an IHE XDS repository and registers the data to be shared externally in the registry. On the other, it acts as an IHE XDS consumer by receiving data provided by other institutions and making it available to hospitals. Communication between the archive and the network infrastructure should strictly adhere to IHE standards. However, smooth interaction between the archive’s supplier and the network infrastructure creates an ideal starting point for a successful networking project.

Joint projects with ICW
The collaboration between Synedra and ICW has already been a success. We would like to single out two examples of these projects. In Switzerland, a network infrastructure was created for all nine hospitals in the four hospital districts of the canton of St. Gallen as part of St. Gallen Cantonal Hospital’s medical dossier project. Synedra AIM acts as an IHE repository and uploads documents from all the hospital districts to the ICW registry. This forms the cross-enterprise medical dossier. Since Synedra is also the enterprise image archive for the canton, imaging studies are also registered for cross-enterprise data exchange. The canton of St. Gallen is now ideally prepared for the national electronic patient dossier (EPD).

At the University of Freiburg Medical Center and the University Heart Center Freiburg-Bad Krozingen, Synedra is working with ICW to implement an IHE-compliant “report communication and archiving platform.” The core of the project is building an IHE-compliant archive and an exchange platform both for internal use and to serve as an interface between the participating facilities. In the future, the system will be expanded into an exchange platform for the region.

The outlook for structured data
We believe that future requirements for multimedia hospital medical archives will extend far beyond storage of document-based data to encompass structured data and values. Synedra is relying on the new HL7 standard FHIR (Fast Healthcare Interoperability Resources) to accomplish this. In the upcoming releases, FHIR support in Synedra AIM will be built up and extended in stages.

An archive that can handle structured data and the FHIR standard is open to additional applications, such as integration of mobile and web apps, linking to new types of medical devices (e.g. wearables), and providing data to decision support systems.

ICW is also a trailblazer in the field of FHIR and structured data. Together we will implement standards-compliant solutions for the exchange of structured data in our projects. By combining a standards-compliant archive solution with a standards-compliant network infrastructure solution, Synedra and ICW can create added value for our users, for institutions, and for patients.