The Liechtenstein National Hospital (LLS) is an independent hospital in the Principality of Liechtenstein and a central medical care provider. Each year, around 180 staff deal with the 7,000 emergencies, 10,000 outpatients and 2,000 inpatients that come through its doors. As part of its corporate development, the LLS has engaged in numerous projects over the past few years on the subjects of digitisation, lean management, quality assurance and quality improvement. In 2017, this also included the tender for an IHE-compliant medical eArchive; the creation of a central and standardised database for digital transformation. The contract was awarded to the NEXUS / ECM system. The system is now going live
NEXUS / ECM as a medical eArchive and IHE-connector
The project aims were clearly defined. First of all, the new DMS and archive system is intended to ensure the audit-compliant archiving of documents and their availability over the legally prescribed 30-year retention period. All images and documents from the patient’s medical record in NEXUS / HIS and the peripheral systems (external laboratories, RIS etc.) are to be archived in the NEXUS Archive only, thus relieving the hospital information system (HIS) and serving as a backup system. An important requirement was that all processes relating to the archiving and later access to the data were logged in a traceable manner and that no unauthorised manipulations could take place. A second aim of the project is to use the NEXUS Archive System as an eHealth connector to the planned, nationwide electronic health record.
“Because we were already using the HIS and PATNG from NEXUS, an archive from the same provider seemed very advantageous in terms of interface handling,” explained Martin Kalberer, Corporate Development Manager at LLS.
Integration of electronic and hard copy documents
The NEXUS Archive is now an integral part of the IT landscape at LLS. The master patient data are transferred from NEXUS / PATCL to NEXUS / ECM via the NEXUS / INTEGRATION SERVER. Test results are received from the Dr. Risch laboratory and Schiller-Medizintechnik systems in PDF format. Clinical and administrative documents are transferred directly from NEXUS / HIS via a document interface - including test results and reference links to DICOM image series saved in the Synedra PACS system. DICOM images are transferred from the imaging equipment to NEXUS / ECM for auditable archiving.
However, until LLS reaches the necessary level of digitisation, a hard copy medical record will also be kept during the patient’s stay. Once the case is closed, this will be scanned in-house, imported into NEXUS / ECM and then destroyed. Existing records will only be digitised if a patient is re-admitted. Alongside the option of “later scanning”, documents brought with the patient can also be scanned immediately (“early scanning”), for example on admission or in an emergency. After it has gone live, the scanning process is to be optimised according to the lean management principle “Plan-Do-Act-Check”. “Only when the digitisation process has proven itself in practice will the hard copy records be destroyed,” said Kalberer, explaining the next steps.
In order to ensure their audit compliance, all documents will be given a time stamp when they are entered in the NEXUS Archive, to preserve their evidential value in the long-term. The digiSeal archive solution provided by the NEXUS partner secrypt is used for this. The time stamp ensures that a document has not been changed. In addition, all documents are processed in an IHE-compliant manner, to permit future communication with the nationwide patient record.
Preparation for the national health record
With a view to the coming connection of the LLS to the nationwide electronic health record system (eHealth), relevant precautions were taken in the project. “To ensure the integration with eHealth runs smoothly, we had to map the NEXUS / ECM documentation types to the document types of the future eHealth structure (which are based on the Swiss IHE standard) as early on as when drawing up the archive plan. The HIS structure also had to be considered, taking into account the consolidated document list register,” said Martin Kalberer, describing one of the project’s challenges. “NEXUS were able to give us first-rate advice on these conceptual considerations regarding the IHE structure and document types.”
Medical eArchive goes live
“All in all, we were very happy with the project management,” summed up the Corporate Development Manager. “We were bowled over by the advisory skills and experience of NEXUS.” Kalberer also had a good impression of the NEXUS / ECM system, particularly the user interface. As it goes live, the NEXUS eArchive can truly come into its own. Kalberer is particularly pleased that the patient data can now be accessed much faster – with fewer searches, ambiguities and transfers, and less duplication, thus allowing a focus on the essential, which is entirely in line with the idea of lean management. And LLS is also optimally prepared for integration with the nationwide health record system.