Electronic case record

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The electronic case file ( EFA ) describes a communication concept for the digital exchange of medical data between (regionally) distributed doctors regarding a complex case of illness of a patient.

The main goal of the electronic case files is to enable a complete, regional supply network, which enables the case-specific, digital networking of the actors with the help of diverse health data services. The existing data protection requirements in the German medical sector are fully taken into account.

history

The first activities in the field of electronic case files began in 2006 when several private hospital chains and the German Hospital Association (DKG) founded a corresponding project initiative to improve communication between inpatient and outpatient areas. From this initiative, the Electronic FallAkte eV emerged in 2009, which since then has been promoting the development and dissemination of the Electronic FallAkte in cooperation with the Fraunhofer Institute for Software and System Technology (ISST) and the Fraunhofer Institute for Open Communication Systems (Focus).

In 2007, version 1.0 of the EFA specification was finalized and initially only implemented as part of a proof of concept . In February 2008, EFA version 1.2, the first public major release of the EFA specification, was approved by the sponsors of the EFA initiative. The first implementations followed at the end of 2008 as part of pilot projects .

At the same time, most system manufacturers with their developments in the area of interfaces for cross-facility / cross-system data exchange were moving in the direction of the IHE XDS profile, which was previously considered logically but not technically in the EFA specification. In order to improve the acceptance of the EFA by system manufacturers and to facilitate integration into existing system infrastructures, it was decided to use IHE as the technical basis for the EFA specification in the next version. In spring 2012, the Bundesverband Gesundheits-IT bvitg eV and the Electronic FallAkte eV association founded the “EFA on top of IHE” working group. The aim was to develop a specification for a doctor-led case file, which was adapted to the German framework conditions and based on the international IHE standard.

With the publication of the EFA 2.0 specification in autumn 2013, it was achieved that the electronic case file takes into account recognized IHE profiles and uses the standards laid down therein.

specification

The specification is freely available on the pages of the HL7 and IHE consortium (Technical Specification of the Electronic Case File). It includes the conceptual , the logical and the implementation perspective of the electronic case file. The conceptual perspective represents the content framework of the EFA with the data protection concept , the description of the actors as well as the relevant business objects and use cases . The logical perspective describes the technical models as well as the specialist and security services of the EFA. The implementation perspective shows how these are technically implemented using existing standards. The following standards are used, among others:

The EFA2.0 specification was expanded in spring 2014 to include functions for peer-to-peer networking of EFA providers.

Technical integration

The EFA can be implemented deeply in IT systems (e.g. hospital information systems ). The advantage here is that the functions of the EFA can be integrated into the technical processes of the primary system. This deep integration requires a high implementation effort by the primary system manufacturer. As an alternative, the "EFA-Box" principle can be implemented. With this solution, the EFA functionalities are bundled in the "EFA box" and can be connected to the existing IT systems in med via easily integrated interfaces, so-called "EFA plugs". Facilities are connected.

Demarcation

The concept of the cross-institutional (intersectoral) Electronic Case File (EFA) is characterized by the fact that it focuses on the specific treatment of a specific medical case of a patient. The patient consents to the storage of his medical data, which is limited to the duration of the illness and which is kept in the form of electronic documentation (the case file) in the sovereignty of the doctors authorized by him. With a personal electronic patient file (pEPA), on the other hand, the responsibility for the content of the medical documentation lies directly with the patient. He or she can add information to the patient's file himself or, if necessary, instruct a doctor to do so.

With a cross-institutional electronic patient record (eEPA), certain authorization filters can be used to implement documentation areas with the properties of an EFA as well as a pEPA.

outlook

The Electronic FallAkte is to be integrated into the future German telematics infrastructure as one of the first value-added applications . Testing for this will begin around 2016.

Several projects are currently underway in Germany to set up or expand an existing platform for operating the electronic case file. As a so-called EFA provider, the Aachen University Hospital already operates the "Case File Plus" portal through its subsidiary Healthcare IT Solutions GmbH. The portal and its applications can be reached across Germany via the secure network of the National Association of Statutory Health Insurance Physicians ( KV-SafeNet ).

See also

literature

  • R. Kuhlisch, B. Kraufmann, H. Restel: Electronic Case Records in a Box: Integrating Patient Data in Healthcare Networks. In: Computer. vol. 45, no.11, Nov. 2012, pp. 34, 40.
  • Claudia Reuter, Jan Neuhaus, Jörg Caumanns, Oliver Boehm: The electronic case file - a standard for cross-institutional communication. In: Achim Jäckel (Ed.): Telemedizinführer Deutschland 2009. 10th edition. Medizin Forum AG, Bad Nauheim 2009, pp. 157–162.
  • Christoph P. Neumann: Distributed Case Handling. Publishing house Dr. Hut, Munich 2013, ISBN 978-3-8439-0919-8 . (Dissertation at the University of Erlangen-Nürnberg 2012)

Individual evidence

  1. ↑ fallakte.de
  2. ↑ E-case file is becoming a permanent therapy tool. In: Doctors newspaper. No. 145, August 19, 2011, p. 9.
  3. ↑ bvitg.de
  4. ↑ Federal Association of Health IT - bvitg e. V. and the Electronic FallAkte e. V. develop concept EFA on top of IHE. In: the hospital. Issue 10, 2012, pp. 1081-1082.
  5. ↑ wiki.hl7.de
  6. ↑ Volker Lowitsch, Wolfgang Deiters, Jörg Caumanns: Electronic case files : Efficient information exchange. Technology concept, data protection, integration in IT systems and international standards, as well as practical applications of the EFA. In: German journal for clinical research. No. 2, 2013, pp. 53-56.
  7. ↑ Recommendations for action to establish cross-institutional electronic patient files in Germany. Publisher HEALTH-CARE-COM, 2014.
  8. ↑ Telematics infrastructure: The health network will be in place in mid-2015. In: Deutsches Ärzteblatt. Issue 9/111 of February 28, 2014, p. 336. ISSN  0012-1207
  9. ↑ hit-solutions.de