Electronic Health Records (EHR) in PROMED platform in ... - ICMCC

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Electronic Health Records (EHR) in PROMED platform in ... - ICMCC

Electronic Health Records (EHR) in PROMED platform

in accordance with the Romanian legislative

framework

Roxana ANTOHI a , Cristina OGESCU a , Daniel BISTRICEANU a

Livia STEFAN b , Silviu DUMITRU b

a -The Company for Research, Development, Engineering and

Manufacturing for Automation Equipment and Systems -IPA SA,

Bucharest Romania

b - Institute for Computers- ITC SA, Bucharest Romania

The project is financed by the CEEX - National Program in Romania


PROMED platform is able to process unitary the information regarding

different kind of patient healthcare services, namely ambulatory treatment,

family doctor consultation, hospitalization in different hospitals.

►The existing informatics’ systems are accomplished for a specific hospital or

private patient clinics and therefore the patient who needs his Electronic

Patient Record has to collect his record from each hospital where he was

hospitalized or private patient clinic where he was in treatment.

► By using the PROMED platform the patients will be able to visualize their

healthcare evolution through a unitary Electronic Patient Record in a single

request. The patients can also present to their current physician the

Electronic Patient Records completed by other physicians. In this way the

diagnosis decision process of physicians can be shorter.


Hospital Emergency Room

Emergency

Physicians

Patient

Internet

Ministry of Public Health

Administrator

Health Assurance

The infrastructure of the Multifunctional Platform


The technical specifications of the application were established by means of

diagrams to point the main action for:

� Authentication;

� Security;

� Data Saving and Retrieving.

The diagnosis registered in the electronic patient medical record is compliant

with ICD-10-AM (CIM – the 10 th OMS revision 2/2001VOL1). The procedures

for interventions in the health field are from ICD-10-AM (CIM 10–AM) revision

3/2002 edited by The National Centre for Classification in Health Sydney,

translated into Romanian.

∎ In the case of platform PROMED the data is stored on the server.

∎ There is a requirement that the entire database should be copied on to a

backup media.

∎ Oracle Recovery Manager (RMAN) has been recently enhanced to provide

sophisticated backup and recovery services for huge databases.

∎ These enhancements mean that storing volumes of medical data in an

ORACLE Database is now feasible.


The main purpose of an electronic health record

(EHR) is to support the multidisciplinary

communication, cooperation and decision-making

in the patients’ care process

The basic characteristics of an electronic health

record (patient-centered, longitudinal,

comprehensive and prospective) can be acquired

only in the context of an Integrated Care EHR in

accordance with the a healthcare data

management system


The general principles that need to be considered by a healthcare

data management system are:

• The responsibility of the Public Authorities for data collection,

stocking and analysis;

• To provide specifications of the information flows;

• To ensure protection of the fundamental rights of the persons;

• To ensure the data security;

• To provide definitions of the data processing domain and conditions;

• To provide access of the deciding persons to the existing data and

information;

• To ensure data confidentiality;

• To ensure access of the persons/patients to the general and

healthcare information.

The implementation of the Promed Platform took into consideration

these general principles


The PROMED multifunctional platform is implemented as a web

portal application being able to centralize the data from different

regions of the country from hospitals, ambulatories, private patient

clinics etc

The Public Authorities can use the PROMED Platform to easily

collect the data and view analysis by means of the “Medical

statistics and research” module integrated in the Platform

This module is intended to present synthetic information

regarding the health status of the entire population. Various

reports are designed to be used for medical research and

statistics and for healthcare providers reporting needs


Medical statistics and research

Public - Age group patient Rapport

Public - The average duration of the hospitalization Report

Public - Surgical cases number Report

Public - Patients ‘ Number with allergies Report

Public- Patients ‘ Number with chronic diseases Report

Public - Neoplasm diagnosed Patients number Report

Public - Birth Number Report

Confidential - The patients list of the physician


Age group patient Report Surgical cases number Report


Patients ‘ Number with allergies Report Patients ‘ Number with chronic diseases Report


Neoplasm diagnosed Patients number Report


In order to access the Promed Platform, the patient receives a “Patient

consent” form which must be completed by giving his name, surname, national

personal identification number and e-mail address.

Also, the patient must express his consent regarding the registration of his

health data in the platform.

The patient is the only person who can access the entire health record by giving

his user name and password, sent by e-mail by the platform’s administrator

following a the patient registration.

•The physician has access only to his patients’ data and to his patients’

treatments. The patient has the power to give the physician access to her/his

entire Electronic Patient Record only if he/she decides to.


The patients list of the physician


The PROMED platform is a useful tool at the patient’s disposal and also for

correct diagnosis in case of an emergency (life risk situation) when the

physician can access the platform through mobile devices (smart phone,

PDA) by introducing the national personal identification number. The

physician has access in this way to vital information regarding the health

status of the patient, namely the blood group, the Rhesus factor, chronic

diseases, allergies to drugs or other substances.


The “Primary Care Electronic Patient Record”

This module is intended to be used by primary care providers (family

doctors, ambulatory healthcare carers). This module manages all the data

referring to the patients reported into the ambulatory, allows to view and

modify various information from platforms database according to specific

right access.

The module has access to the following information:

• patient's administrative data and “patient’s anamnesis” section which

manages the medical history data as it is declared by the patient in

ambulatory;

• all the patient’s data restrictive to emergency information: the major

illnesses, allergies, etc. and the specific pathology (e.g. obstetrical

anamnesis for women

The module :

• manages the data regarding patient’s health status during the treatments;

• manages the patient’s data about the functional explorations prescription;

• manages the patient’s data about laboratory analysis prescriptions;

• manages the patient’s data about medication prescription during the treatments.


After accessing the platform’s site www.rommed.ro, the physicians enter on

the Physician page. The physician introduces the user name and the

password (given by the Administrator). If the physician wants to change the

password, he has this possibility by using the "Change Password" button. If

the physician wants to see his patients will use the “List Patient” button and a

list of patients will appear.


If a patient is present, the physician will introduce the national

personal identification number. If the patient is already in the database,

the minimal electronic patient record will be listed and the physician

can update the record.

After saving the patient‘s data, the physician will open the window

“Examination details“ .During the patient’s examination the

physician can update the patient‘s data and the patient’s anamnesis in

this window.

If all the introduced data is correct, the physician will use the “Save“

button and the patient is introduced in the “ Physicians examination

list“.


If the physician will take the patient in treatment, he has the

possibility to record the evolution of the patient in the “Evolution”

window, which appears when a patient is selected from the

“Physicians examination list“.

The physician can prescribe medication during the treatment

using the window “Medication“ and also can prescribe functional

explorations from CIM -1 AM ed 3 /2002


When the physician considers that he has all the data for the examination

finalization, he will use the ”Examination finalizing “button. The physician has

the possibility to modify the first diagnosis to introduce new data about the

patient, resulted from functional explorations.

If the physician considers that he correctly recorded all the data, he will

use the “Final Examination“ button. As a consequence, the patient will

disappear from the “Examination list“ and will appear in the “Patient

list“ of the physician and the data about the examination will appear in

the “Patient” page.


Conclusion

The PROMED platform supports all the medical specialties

The PROMED Platform ensures the confidentiality of the data

registration, the patient identification being made with the national

personal identification number. The patients’ registration in the database

is performed following a signed patient consent / agreement.

We consider that the PROMED healthcare information platform will

eliminate many current problems occuring in the national health

system, ranging from paper format healthcare records managing

problems to cooperation between healthcare providers. Currently, we

make experiments with PROMED platform in a pilot system with a

4G database. The PROMED Platform is presently tested by physicians

from two hospitals in Iassy and Bucharest, Romania


IPA SA

Roxana Antohi - roxanth@ipa.ro

Cristina Ogescu – cris@ipa.ro

Daniel Bistriceanu dbistriceanu@ipa.ro

Thank you

ITC SA

Livia Stefan – livias@itc.ro

Silviu Dumitru sdumitru@itc.ro

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