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• User oriented development of electronic communication between electronic patient records

• Vision:– Relevant and necessary information when needed for patient care

The ELIN projects

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The ELIN project is a project on a national basis to implement standards of interfaces and medical content in electronic communication in the Norwegian health care system.

Less paper!

More health!

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Electronic interchange of health information

The project is from the small medical offices point of view.

(Both GP’s and specialists)

What does ELIN mean?

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•Background:

•Agreement on the need of electronic co-operation in health care based upon functional requirements from physicians.

•Somebody has to represent the small medical offices

•Departmental initiative, recommended in report

•Gains:

•Development and testing of several new solutions on electronic communication based upon national standards

•Finances

•The Directorate of Health (ShDir)

•The National Industry Fond (Innovation Norway)

•The Norwegian Medical Association (Dnlf)

•National committee of hospital IT-solutions (NIKT)

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Some aspects taken in account in the project

• Continuity in health care– The patient must experience a chain of continuity in health care

• The secondary care physician must know the patient history from primary care• The GP must know the history from hospital treatment when taking further care• The level and content of information must be adequate

• Quality in health care– Establishment of best praxis

– Avoidance of unintentional events

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The project runs through 3 phases

• Phase 1– Until December 2004

• Discharge letters and lab.results with application message receipt excluding the simultaneous sending of paper. Some Internet patient service. Public Key Infrastructure.

• Phase 2– Until July 2006

• Referrals and requisition. Communication with the patient. Internet booking of appointments.

• Phase 3– Until December 2007

• “The good referral” and “The good discharge report”. Dialogue message. From Edifact to XML for all solutions. National encrypted enveloping (ebXML). Refinements of the solutions

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The functional requirements• Part 1 - Generals from all parts

– National standards and security. General requirements.

• Part 2 - Requisition and answers– Decision support system included in some solutions

• Part 3 - Referrals and discharge letters– Some demands on content and presentation

• Part 4 - Medical certificates and reports of disability– Electronic management at the National Insurance Administration

• (Part 5 - Prescription)– Separate national project. Common pharmaceutical lists of medicaments. Signature.

Management of a central part of the national ePrescription project. Separate requirements.

• Part 6 - Communication with the patient – Automatic documentation in EPR, integrated solution. Direct booking of appointments

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The ELIN method of developing functional requirements• An expert group of physicians define work processes and develop functional

requirements that ultimately can be tested.– Validation against law and regulations. – Validation against national standards of EPR and health communication

• Close cooperation with national standardisation authorities

– Validation against response groups• Physicians with no special IT interest or knowledge• Programmers of EPR systems

– Validation against functional testing• Development of test procedures

– Approval of the expert group– Integrated in the vendor development agreements– Updated after each development iteration– Final approval of expert group

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The ELIN method of testingfunctional requirements

Approved message standards

EPR GPs

Test-hospital

EPR others

Testserver

Seamless Communication

Test LabFunctional

requirements

PilotB-test

Testscenarios

Functional test of EPR communication

SeamlessCommunication

FATFactory Acceptance Test

SATSite Acceptance Test

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ebXML - framework (enveloping, addresses, transport receipt,

encrypting, authentication, cooperation certificate)

Standards of content (health information)

Message header (administrative information)

Application receipt

personal signature

Norwegian Health net

MailboxAddress catalogue

PKI-catalogue

Internet

Seamless communication requires an architecture of electronic interoperability

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Norwegian Health Net

Internet

Mailbox

Applicationreceipt

Content standard(health information)

Message header

Personal signature

ebXMLPKI-

catalogue

Address-catalogue

ELIN

Test and approval

•Use of XML•Data types•Attachments•FAQ•Help functions•Concepts

Relevantdocuments

EPR systems (EPJ, PAS, Lab, PACS/RIS, ..)

Health units in the communities

Coding lists

Health registers Pharmacies

National Insurance Office

Code register

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Laws and regulationsNational health plans

Development and testsMethods and coordination

Nationalstandards

User groups

Hospitals Community care

EP

R Functional

requirements

ELIN-kELIN-s ELIN(-a)

Functional

requirements

Functional

requirements

User groups

User groups

Functionalrequirements

Gen. practitionersProjects Projects Projects

Functionaltests and approval

Seamless communication

International standards

Preliminary project will start in 2007

Planning of several main projects

Patient summary project

ELIN stops end of 2007

ELIN-a follow up from 2008 may be realised

ELIN-k in community care

Phase 1 in 2007

EP

R

EP

R

Suggestion of an organisation that put user requirements in front

ELIN-o