The ELIN projects

1. The ELIN projects • User oriented development of electronic communication between electronic patient records • Vision: • Relevant and necessary information when needed for patient care

2. 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!

3. What does ELIN mean? Electronic interchange of health information The project is from the small medical offices point of view. (Both GP’s and specialists)

4. 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 communicationbased 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)

5. 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

6. 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

7. 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. Commonpharmaceutical 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

8. 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

9. Seamless Communication Seamless Communication The ELIN method of testingfunctional requirements Testscenarios Approved message standards Testserver Functional test of EPR communication EPR GPs EPR others Test- hospital Pilot B-test Test Lab Functional requirements SAT Site Acceptance Test FAT Factory Acceptance Test

10. Standards of content (health information) Message header (administrative information) Application receipt personal signature ebXML - framework (enveloping, addresses, transport receipt, encrypting, authentication, cooperation certificate) Norwegian Health net Mailbox Address catalogue PKI- catalogue Internet Seamless communication requires an architecture of electronic interoperability

11. Coding lists Health registers Pharmacies National Insurance Office Health units in the communities Code register EPR systems (EPJ, PAS, Lab, PACS/RIS, ..) ELIN Test and approval Relevant documents • Use of XML • Data types • Attachments • FAQ • Help functions • Concepts Internet Norwegian Health Net Address- catalogue ebXML PKI- catalogue Application receipt Message header Content standard(health information) Personal signature Mailbox

12. Suggestion of an organisation that put user requirements in front Laws and regulations National health plans International standards Development and tests Methods and coordination National standards ELIN-o User groups Functional requirements Functional requirements Functional requirements User groups User groups EPR EPR EPR Hospitals Gen. practitioners Projects Projects Community care Projects ELIN(-a) ELIN-s ELIN-k 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 Functional requirements Functional tests and approval Seamless communication