Europeans look to EMR as healthcare consolidation tool

The concept of a ubiquitous electronic medical record has global appeal, particularly in Europe. Three papers presented at the RSNA conference covered EMR iterations in Spain, Norway, and Germany.

In Spain, a pilot Internet 2 project is under way to evaluate implementing digital radiology in the county of Osona. The goal is to provide 24-hour EMR access to all authorized providers. The Spanish EMR includes digital images, no matter where in the county's 16 public and private institutions the exams originate.

Digital images are provided by a remote application service provider, with short- and long-term archives located 70 km and 100 km from Osona, said Octavio Barbero of the UDIAT Diagnostic Center in Sabadell, Spain. His paper, "Using Remote ASP and Internet 2 for Integrating Digital Radiological Images with a Regional Information System in a New Population-based Purchasing System for Public Healthcare Provision," was a finalist in the longest title competition.

"The aim of the project is to inspire providers to collaborate in order to provide improved healthcare to the public," Barbero said.

EMRs are also taking off in Germany, where an increasing number of patients are demanding access to their own clinical data, particularly imaging studies, from physicians' offices or even from home, said Dr. Peter Gocke, a radiologist at Essen University Hospital.

"In our installation of a full-scale departmental integrated RIS/PACS, we added a system for patient remote access over the Internet to a database server with links to patient data," Gocke said.

On client PCs, a Java-enabled Web browser, but no additional software, is necessary to display the data, following one-time download of a Java applet.

"Any standard Web browser provides access to clinical data, improving medical communication and patient care," Gocke said.

Additional improvements will combine smartcard and flash memory functionality, for personal storage, he said.

Integration of PACS with the EMR in Norway has revealed cultural differences between Europe and the U.S. In the U.S., PACS/EMR integration is one of two types. A shallow desktop integration enables clinicians to move between the EMR and PACS even though the systems aren't truly integrated. The other type uses PACS as a tributary feeding the EMR data river, submitting reports and images via a messaging mechanism, but true integration is still absent.

Dr. Petter Hurlen of Akershus University Hospital in Nordbyhagen proposed a third type of integration, in which PACS is part of the EMR. Exams in the PACS would behave as if they were part of the EMR.

"To achieve this, PACS must either itself behave as a record system or be encapsulated by software in such a way that it behaves as an EMR," Hurlen said. "This includes full tracking of all modifications to report and views, and storage of window/level settings and any views used for image interpretation."