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Please note: The CHN solution has been sun-set and is no longer available.

Throughout the world, the delivery of healthcare is going through an intense period of transformation, brought about by changing expectations, technological advances, economic pressures, sociodemographic shifts, and changes in the patterns of health in communities around the globe.

The Foundation for Collaborative Health Networks ES bundle (CHN) supports the integration of processes across the healthcare ecosystem, in what is becoming known as eHealth, with the primary goal being to increase the effectiveness of treatments while reducing their cost.
The Enterprise Services in this ES bundle should enable secure and instantaneous information access and availability of patient information via a Master Patient Index (MPI) and a collaborative Electronic Health Record (EHR). Currently, for the most part, information is simply not shared and does not cross institutional boundaries. This results in huge overhead and a large number of clinical errors.
The Foundation for Collaborative Health Networks ES bundle is built on top of SAP NetWeaver 2004s and is designed for the purpose of sharing and synchronizing patient data amongst all participating facilities. Depending on the makeup of the network, this may include not only hospitals, but also primary care centers, private GP practices, pharmacies, insurance, and even government, Networks might be regional, national or supra-national, such as state initiatives; or grouped by healthcare institution, such as all of the hospitals affiliated with a University Medical Center or some other entity.

Foundation for Collaborative Health Networks (click to enlarge)


This ES bundle will help organizations work toward benefits such as the following:

  • A shift from institution-centered care to patient-centered care, together with greater empowerment of healthcare consumers
  • A greater emphasis on continuity of services supporting quality, safety, and health promotion and maintenance
  • More integrated healthcare, in which organizational and administrative barriers are invisible to patients
  • The migration from paper-based to electronic media for healthcare transactions, including orders, tests, and results and sharing of patient health information between various healthcare providers

Providers, payers, public health agencies, pharmacies, and commercial labs could benefit from this linked system. Benefits from the integrated approach to healthcare enabled by this ES bundle include rapid and timely access to relevant data, increased safety in prescribing and monitoring compliance, improved coordination in care, reduced redundancy in testing and documentation, and of course reduced clerical and administrative costs. But most importantly, the patient will benefit with improved quality of care through better informed healthcare professionals, decreased costs, and convenient access to personal health information.

System Landscape

This ES bundle is built directly on SAP NetWeaver. The system landscape can optionally include SAP for Healthcare, legacy systems, and a portal.

Audience

The Foundation for Collaborative Health Networks (CHN) ES bundle targets medium and large healthcare providers and institutions across geographies, with a focus on regional and national health organizations, as well as large hospital networks or health insurers.

Figure 1. Foundation for Collaborative Health Networks system landscape (click to enlarge)


The roles that will use this ES bundle include:

  • Doctors
  • Nurses
  • Admissions and administrative clerks
  • Other healthcare professionals

    For details on Service Operations, Business Objects and Process Components, please check the ES Workplace.

     

How to Use This Bundle

In most cases today, information is simply not shared across institutional boundaries. While communication within a given hospital has long been established, communication between hospitals, even hospitals in the same network, is rare indeed. The Foundation for Collaborative Health Networks bundle provides a platform for connected healthcare that enables collaboration among the various components of the healthcare value chain: healthcare providers (hospitals, doctors, nurses, and staff), insurers, regulators, departments of health, and life sciences companies.

This bundle includes the functional blocks Master Patient Index, Electronic Health Record, and Health Professional Index. These data constructs provide the fundamentals for implementing future collaboration scenarios like ePrescription, Emergency Data Set, and eBooking.

The Master Patient Index (MPI) contains demographic data about a patient: name, aliases, affiliation, age, addresses, known IDs, and insurance data. Anything that can assist in identification is in the MPI. The MPI consolidates your information across the network, to ensure that you are seen as one person, not several separate people. The importance of this is that when you start creating an Electronic Health Record you don't want to have your data spread across disparate patient records. The aim is to have one unique clinical history, which is then saved in the Electronic Health Record and associated with one single MPI entry.

The Electronic Health Record (EHR) is where CHN stores summarized data about the clinical encounter history of the patients, irrespective of the type of encounter (ambulatory, inpatient stay, GP visit, phone consultation, and so on).

The Health Professional Index (HPI) is the location for all data on doctors, nurses, admissions clerks, and so on. This is where access levels are set, to define which health professional has access to what level of data. For instance, an admissions clerk can only access the MPI data, not the clinical information that is stored in the EHR. Another use for the HPI is as directory, by gathering a list of doctors and facilities in a particular location, so that a patient can be referred for further help.

As a platform, this ES bundle works behind the scenes. It sits in the middle of a network, waiting for commands or orders from the systems that are connected to it. It is envisaged that users will not see the platform nor interact with it directly, but will instead use their existing, familiar clinical and patient administration systems, that in turn communicate to the platform via Web Services or messaging industry standards like HL7. Exceptions to this may be in the case of Portals or Composite Applications purpose built to directly exploit and leverage the capabilities of the platform.

For example, the process of admitting a patient involves a search to see if the patient exists. Rather than simply searching local systems, as it has in the past, this search will probe the CHN information, allowing the system to find an existing patient record even if that person has never been a patient at this hospital, but was at a completely different healthcare facility affiliated with the CHN.

The idea is that CHN allows distributed systems, all those systems currently spread around in various healthcare facilities, to communicate and share information about patients. A large hospital group that wants to have all its hospitals communicating with each other, or a region, or even an entire country-any entity that has the goal of putting eHealth policies in place-could deploy CHN to meet this need. The ultimate goal is to have everybody connected to everybody, so that when you travel, any healthcare provider or system that is affiliated with CHN will have access to your data and immediately be able to know, for example, that you're allergic to penicillin.

Although this bundle is not yet designed to unify all healthcare systems, it could offer a similar benefit to patients who participate in such a network. A web portal could be built on top of CHN, using the xApp framework. A patient from Canada could be sitting in a doctor's office in Germany and say to the doctor, "I don't have my data here, but if you access this portal and you give my number and this password, you can access my clinical records."

Use Case 1: Registering a New Patient

Jane Deer needs medical attention and enters a hospital she has never been to before. She provides some basic demographic data (e.g., name and date of birth) and the receptionist searches the hospital computer system, which invokes the Find Patient By Elements enterprise service. This enterprise service searches that data on all patients that were ever in any hospital in the entire network that the hospital belongs to, both local and remote. The results of the search will be shown to the user-in this case the receptionist. The patient, Jane Deer, is not found.

Using the Create Patient enterprise service, which uses the Patient business object, the receptionist creates a patient, in this case Jane Deer. The receptionist receives a confirmation message that the creation has been successful and an MPI entry for the new patient has been created. This patient information is now available throughout the distributed network.

Use Case 2: Updating a Health Professional's Authorization Profile

Dr. White, who was recently an intern, has now become a doctor. Her authorization profile needs to be updated since she now has broader access rights.

The Hospital Administrator uses the Find Health Professional by Elements enterprise service to search for Dr. White. CHN finds her record regardless of where it was originally entered. Using the Update Health Professional enterprise service, the administrator changes Dr. White's job title, which results in a regeneration of her Authorization Profile.

Use Case 3: Getting a List of Patient Encounters

Matt Deer brings his wife, Jane Deer, unconscious to the hospital. He says that Jane appeared to become dizzy and then fell. Dr. White is attending Jane and wants to read historical encounter information to verify whether she has had any similar accidents, to determine if there is an underlying medical reason for the fall. Using the Read Patient enterprise service, Dr. White is able to access Jane's records. The doctor then uses the Find Patient Encounter Basic Data by Basic Data enterprise service, asking to display all encounters for the last 5 years. The doctor can inspect a particular encounter by using the Read Patient Encounter enterprise service and look for recurring symptoms, such as dizziness.

Existing Sample Code

To learn more about how to call the Find Health Professional by Elements enterprise service operation from a Microsoft Visual Studio Application, click here.

Future Directions

Possible future directions being considered for this ES bundle include additional functionality for the Electronic Health Record, especially the ability to link documents to it. Other possible future directions include support for various IHE Profiles, facilitating storage and/or indexing of clinical documentation, bridging codes and terminology from various standards, storage of medication history, networkwide scheduling of appointments, and providing emergency datasets (including vaccinations, allergies, and known medical conditions).

System Requirements

  • NetWeaver 7.0 (2004s) ABAP: the Foundation for Collaborative Health Networks is an independent platform based only on the NetWeaver basic stack.
  • NetWeaver 7.0 (2004s) Process Integration: in case you need to connect third-party systems to CHN via messaging industry standards like HL7.
  • NetWeaver 7.0 (2004s) Search and Classification (TREX): to support fast search and indexing capabilities.

Related ES Bundles

SOA Homepage on SDN

HL7 standards
Integrating the Healthcare Enterprise
eHealth News
eHealth Europe
Healthcare IT News
Information Society ICT for Europe
eHealth Impact
Open Clinical's electronic medical record page