The

eDL mobile app

Improving communica5on between hospitals, pa5ents and community physicians
Heerlen, October 25th, 2012

Dr. Leonardo Lezcano, UAH, Spain Dr. Hendrik Drachsler, OUNL, Netherlands

Discharge LeAer exchange scenarios

CommunicaDon between hospitals and local medical ocers and GPs.
Specialist

Summary data which clinical coders PaDent rely upon for clinical classicaDon. Medico-legal purposes, nancial and administraDve funcDons.

PaDent

GP

GP A

GP B

They contain: administraDve info, follow-up appointments, clinical info, problems on admission, diagnosis, procedures performed, medicaDons on discharge Support conDnuity of care.

Discharge LeAer
Sample 1
Balmain Hospital, Sidney, Australia (2005)

HandwriAen (legibility) Free text, narraDve

(accuracy)

Unstandardized Errors, omissions Slow prep. (boAleneck) Terminology bindings Dicult integraDon in EHR systems

Discharge LeAer
Sample 2
Paterson et al. (1999), Discharge Summary Study Group, Canada

Terminology bindings HandwriAen (legibility) Free text, narraDve

(accuracy)

Unstandardized Errors, omissions Slow prep. (boAleneck) Dicult integraDon in EHR systems

eDischarge LeAer
Sample 3
Paterson et al., Dalhousie University Canada (2002)

Terminology bindings Semi-Structured Controlled

Vocabularies

Faster prep. Unstandardized Errors Dicult integraDon in

EHR systems

eDischarge LeAer
Sample 4
Bludau et al. Department of Internal Medicine, University of Heidelberg, Germany (2003)

Terminology bindings Structured

Controlled Vocabularies Faster prep. EHR standards Seamless integraDon in

EHR systems

Limited to the boundaries

of healthcare systems

Remaining problems of eDL

It is not necessarily the case that electronic summaries are of higher quality than handwri?en ones [] electronic summaries may contain more deciencies than handwri?en summaries (Callen et al., 2007)
We need a widely adopted standard for DLs: Candidate terminologies: ICD, SNOMED, MeSH, UMLS, MEDCIN) EHR standards: HL7-CDA, openEHR, EN13606 In spite of being very similar, there are syntacDcal, structural and semanDc dierences that must be solved. NaDonal e-Health TransiDon Authority (Australia) & CLAS

Privacy and Security Issues (II)

some health care providers were apprehensive about the electronic transfer of documents, and four GPs refused to receive electronic documents at all one hospitals psychiatric ward declined electronic transmission of their discharge summaries because of the highly sensiDve nature of the data contained therein (Schabetsberger et al. (2006) signature funcJonality must be integrated into the workow surrounding document creaJon, ideally by using Public Key Infrastructure (PKI). (Brandner et al. (2002) some countries have privacy legislaDon that prohibits the electronic transfer of discharge summaries. (NaDonal E-Health TransiDon Authority, 2006)

The eDL mobile app (I)

Technical Benets No internet connecDon required PaDent No sehng up required for the transfer. No pairing required. Maximum distance 4 cm GP (security and privacy). Mobile devices supporDng NFC technology are growing in popularity GP B E.g. Google Wallet is based on NFC.

Specialist

PaDent

GP A

The eDL mobile app (II)

The eDL mobile app (III)

Benets for both the healthcare provider and the paDent

Bridging the gap between primary and secondary care. Fully structuring and semanDcally describing data. Improving legibility when compared to handwriAen DLs. Easing preparaDon of DLs & work pracDces of hospital clinicians. Assessing GP preferences in order to reach a suitable DL standard. DetecDng adverse events and error rates. Providing support across heterogeneous systems (e.g. cross country) Improving the security oered by paper based DLs (electronic signature) Preserving the privacy oered by paper based DLs.

Derived benets for the paDent

PaDent empowerment In contrast with centralized soluDons, the paDent is the carrier of the informaDon MedicaDons noDcaDons Follow up and appointment management Reducing handling operaDons and paper saving. UlDmately, increasing paDent safety and quality of care.

app demo