Pictures of the Future      Fall 2008

Health on File

Rhön-Klinikum AG is in the process of networking its 46 clinics based on the use of Web-based patient files. The objective is to generate a dramatic improvement in the quality of care.

A patient suffering from chest pains has just been admitted to the emergency room. After obtaining the 55-year-old man’s consent, his attending physician checks the patient's electronic file. The file indicates that the man has already undergone a bypass operation, does not tolerate certain contrast agents, and is diabetic. Moreover, the document displays earlier ultrasound and X-ray images, and laboratory test results, as well as electrocardiogram data. Thanks to these, the patient can be treated promptly.

In situations such as this, but especially in treating the chronically ill, patients gain considerable benefit if their medical histories are available to attending physicians in as complete a form as possible. The latest IT solutions now make this possible.

The Rhön-Klinikum AG—a private hospital group and health service provider—is a pioneer in these efforts. In the near term, all patients handled by the group—more than a million each year—will profit from electronic patient files. All this effort makes the enterprise one of the largest privately-financed IT projects in the German healthcare system. At present, patient files are being implemented in the group’s own medical care centers in Frankfurt/Oder (near Berlin) and Giessen near Frankfurt, Germany.

The Web-based e-health solution, which Rhön-Klinikum AG calls WebEPA, was conceived in cooperation with Siemens’ Healthcare Sector, and is undergoing continuous development. Its advantages are enormous. With a few clicks of a mouse, medical professionals have digital access to medical findings and diagnoses—be they X-ray images or laboratory blood test results. Any authorized person in the wards, examination and treatment rooms, or in the operating room who requires rapid access to a patient’s overall situation can examine the relevant information in the file, using a standard personal computer and the Internet. "Regarding admissions or transfers, the patient no longer needs to bring along documents and images from previous examinations," says Dr. Peter Heil, business manager for eHealth at Siemens Healthcare.

Access to individual patient data is strictly controlled. Upon admission to the hospital, the electronic patient file is explained in detail to the patient. Only after the patient has given consent are access rights granted—and then only to the attending physicians. Mechanisms for secure authentication as well as rule-based access control ensure that only authorized persons have access to the files. New findings and diagnoses automatically flow into the file. If the attending physicians require the support of other departments, they can expand access rights as needed; for example, to a radiologist. Every instance of digital access to patient data is logged, and therefore traceable. If an electronic file is dormant for an extended period, its access rights expire. The data can then be accessed only in the case of an emergency. However, if the patient is readmitted at a later time, new access rights can be granted. The file is reactivated, and the individual medical history can be traced back over years. All things considered, WebEPA adds up to an extremely stringent data privacy regime.

"The comprehensive patient information offered by WebEPA helps doctors avoid unnecessary duplication of examinations—a key advantage of the patient file," says Heil. Until now, admission to the hospital often resulted in examinations that had already been conducted by the patient’s private-practice doctor. That will no longer be the case. For instance, X-rays provided by the patient’s own specialist will be automatically available—even if the patient has forgotten to bring them along. On the other hand, when it comes to operations, up-to-date blood tests will continue to be ordered, even if recent results are available.

To make use of WebEPA’s advantages, an increasing number of doctors in private practice are joining Rhön-Klinikum’s project, and the software is also being implemented by other associations. In the near future, community hospitals and doctors in and around Bamberg, Germany will examine this form of cooperative effort. They will draw on the same technological base as Rhön-Klinikum.

Standardized Platform. The IT product employed in Bamberg and by Rhön-Klinikum is part of Soarian Integrated Care, a comprehensive eHealth solution that Siemens has been offering since 2003. Beyond patient files, it supports vital management and treatment processes. "The advantage of the Siemens solution is that existing IT systems may continue to be used. WebEPA integrates systems that previously provided patient or billing information, and combines them in a unified platform," says Heil. Previously, these so-called primary systems, which, for example, distributed the results of computed tomographs or other diagnostic devices from various manufacturers, were often mutually incompatible. Soarian Integrated Care, on the other hand, uses standard interfaces such as HL7. In this way, primary systems can be integrated and data made available in a Web-based patient file. Experts from Siemens IT Solutions and Services have tuned this application—ultimately, a "translator" between existing systems—to precisely meet the requirements of Rhön-Klinikum’s existing infrastructure.

For example, using this system, Rhön-Klinikum doctors can discuss complex cancer treatment online. "Specialists, such as oncologists and radiologists, can exchange views during conferences. Together, they can digitally access test results, and discuss these in real time, even though they are located at different facilities," says Heil.

In the past, preparation for such conferences was, as a rule, time-consuming for participants. WebEPA has changed all of that. Its advanced IT functions improve efficiency as well as treatment comfort. What’s more, specialists agree that the technology offers considerable potential for cutting costs and improving care.

For the Rhön group, these are the main reasons for successively linking all of its clinics. Experience in everyday clinical operations will show exactly where the heavy lifting needs to be done, and how significant overall savings may be. Meanwhile, electronic patient files are already demonstrating their greatest value—to the patients themselves.
                                                                                                   Andreas Kleinschmidt