ehealth in Belgium : focus on the laboratory

eHealth in Belgium : focus on the laboratory

23 maart 2016 Dr. Tom Fiers - Universitair Ziekenhuis Gent

© 2013 CoZo – Collaboratief Zorgplatform

www.cozo.be

Healthcare evolutions

Increased complexity, treatment options and regulations Better healthcare -> More chronic diseases (eg cancer, HIV, diabetes) Budget squeeze Shift to prevention, home monitoring, POC , telemed, mobile Patient empowerment Shift to networked transmural collaborative medicine (and payment models)

CoZo – Collaboratief Zorgplatform

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Solutions to a bigger & shared EPR world

vs


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So is the shared EPR a happy love story ? - many hopeful couples -

COST REDUCTION

PRIVACY

QUALITY OF CARE

PATIENT RIGHTS

The proof of the pudding is in the eating: “Does the patient feel safe enough?” CoZo – Collaboratief Zorgplatform

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Shared patient record in practice… Opt Out Cost No ther. relations No exclusions

smaller, Opt-IN CoZo – Collaboratief Zorgplatform

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Shared patient record in practice…

2009

Feb 2010

Apr 2010

Dec 2011 (est: 2014) CoZo – Collaboratief Zorgplatform

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And what about Belgium? “eHealth” itself Basic services, Authentication, Encryption, Timestamping … Added services: Link to authentic sources Some websites eHealthbox, connector, ...

Organisation Politiek ICW – sectoraal comite – CCU – Working groups

Building blocks HUB-metaHUB Regional initiatives: Intermed, BruSafe, Vitalink Authentic sources: INAMI, COBRHA, SAM, RETAM , … Other: eg GFD, HealthData, BelRai, Recipe etc etc CoZo – Collaboratief Zorgplatform

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Informed consent = Information + Consent Nationaal: www.patientconsent.be Website Folder Brieven Mut/riziv bij registratie

Hub specifiek Posters Folders Website (www.CoZo.be) Patientenportaal Leaflets Onthaalprocedures


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De HUB’s CoZo: • 75 instellingen • 37 Ziekenhuizen • 33 Psy ziekenhuizen • 4 Rev. Centra • 1 lab

•

> 4000 actieve artsen


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eHealth: HubMetahub & vaults

Vitalink pat EHC

GP

Vitalink Vaccinet GP

eHBox EHC

CoZo Web

PSY 1-33 RX

Reval LAB

ZH ZH 1-9 1-24

ZH ZH ZH 1-34 1-24 1-24

KWS ARH

Leuven

CoZo

ZH ZH 1-17 1-24

MetaHUB

POCT, DOP, ,…

Thuis zorg

Abrumet BruSafe

GP CoZo – Collaboratief Zorgplatform

RSW

EHC eHBox

RSW pat

Intermed

ZH ZH ZH 1-48 1-24 1-24

PSY RX

LAB

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Welke bronnen zijn beschikbaar ? CoZo Hub (www.cozo.be/contact) (inclusief Antwerpen) Ziekenhuizen (alg+psy), reval, lab

Interhub Réseau Santé Wallon (RSW) Abrumet HUB Leuven

Beelden: 14 ZH CoZo, InterHUB Vitalink (WIP) : vaccinaties, sumehr, (medicatieschema) Patient Data : DOP, Glucometer POCT data Coming Soon:

Cross-Border: Zeeland Thuiszorg: WGK PACS uitbreiding naar privé-radiologie CoZo – Collaboratief Zorgplatform

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Patienten portaal en patient empowerment Voor chronische ziekten is er in de literatuur bewezen meerwaarde (zorg + financieel) bij uitgebreide patient empowerment (bv. zelf resultaten opvolgen, journaal etc) Doctoraatstudie UGent Huisartsgeneeskunde: noden en verwachtingen literatuur bevestigd in grote focusgroep (1250 personen) Europese Epsos project + conclusies en raadgevingen FOD symposium rond patient empowerment + pilootprojecten daarrond Visiedocument Vlaams patientenplatform rond patientenrechten en toegang voor patient


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CoZo Patientenportaal Waarover gaat het: Admin info, consentstatus, relaties actieve artsen,… Logging Afspraken DOP piloot (onco zorgplan informatie op maat, afspraken, chat) Glycemie piloot Beelden raadplegen Medische resultaten (na mediatie huisarts/arts) 3/2016: > 500/m medische resultaten door patienten zelf via CoZo


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Logging easily accessible for the patient


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Patient access to his/her medical record • Patients can totally block their access and can modify delays / category • Reinstating previously blocked access activates a 30day grace period to ensure free will.


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Block access to selected results for all caregivers Mediation via GP or Specialist Only blocking caregiver can de-block


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Patient access to medical record


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Mandatering: Kinderen / wilsonbekwame patienten Conform vertegenwoordiger zoals wettelijk bepaald. Kan bij CoZo enkel ingesteld worden bij en door een zorgverstrekker met actieve therapeutische relatie eHealth zal daarnaast ook een register hiervoor ontwikkelen


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Changing management of healthcare New & changing opportunities for POC in primary / home care New opportunities for existing well established POC by integrating into the eHealth fabric and better sharing and utilizing existing data Some Existing POC solutions may become affordable in a network model (a currently ‘expensive’ POC test may be cheap compared to TCO avoided care)

New POC models (eg Familyware hassle free rent-a-POC-suitcase, Qualcomm 2NET cloud solutions) New POC technologies (eg IMEC spirometry, cardiac monitoring etc)


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Piloot chronische zorg - Diabetes Example: antidiabetic farmaca in Belgium (€) 160.000.000 140.000.000 120.000.000 100.000.000 80.000.000 60.000.000 40.000.000 20.000.000 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Need for data sharing to limit secundary costs CoZo – Collaboratief Zorgplatform

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Data knowledge => Impact on treatment


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PHR: POC Glycemie Piloot Eenmalige link patient - glucometer via CoZo door arts/educator Patient download firma specifiek programma thuis van www.cozo.be Metergegevens worden (bruut, xml webservice) automatisch doorgestuurd, verwerkt, en ter beschikking gesteld via CoZo, patient ontvangt een confirmatie. Ruwe data wordt momenteel bewaard op een beveiligde kluis gekoppeld aan de CoZo HUB (zoals bv voor zorgpaden en GGZ), mogelijk in toekomst op andere PHR kluizen of andere afh. van eHealth actieplan evolutie


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Toevoegen nieuwe meters


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Ontvangen data


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POC Glycemie Resultaten Beschikbaar in CoZo, onder thuismonitoring


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The big challenges for patient empowerment Where to store the patient data How long to store the data How structured do we need to store the data Identification INSZ (cross-border, bis, tris) Privacy

Expanding ehealth reach (ap19) POCT integration: yes: business case is clear Mobile health: rugged terrain…


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CoZo-m CoZo mobiel toegankelijk maken voor: Fase 1: Zorgverstrekkers (Fase 2: Patienten)

Vereist oa oplossingen voor authenticatie in overleg met ehealth, gekoppeld aan een tablet / telefoon Discussie level 1-4 (europa 1-3) Discussie hardware/software Discussie toepassingsgebied-scenario’s Discussie schaalbaarheid


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Status for Laboratory data sharing via eHealth All hospital lab’s shared & accessible (>>PDF, < TXT) eHealth Roadmap: private lab to HUB connection in 2016 Currently 3 private lab’s online (1 CoZo, 2 RSW) Some ongoing

Intention Letter from eHealth/FOD to private labs distribution to be seen but to be expected >> like psy


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Praktisch Geen case by case overleg meer zoals voor de eersten Voor CoZo 2 infomomenten reeds voorzien (locatie UZ): 29 april 13:30 – 15:30 12 mei 13:30 – 15:30 Inschrijven via [email protected]

In een notendop Aansluiting + goedkeuring op SG, RVB CoZo Opzetten Site-to-site VPN Deel van CoZo cookbook te implementeren (kmehr webservices) Beperkte participatie in kostendelende struktuur CoZo


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Status for Laboratory data Point to Point Communication

Private / Hospital Lab

GP / Specialist Architecture: Mediring, eHBox: Medimail, Hector Structure: H1, Medidoc, Medar (+ dialects) Semantics: Propietary, ACTH, medidoc codes


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Structure & Semantics Visualisation in your typical GP-EPR Not quite a happy love story


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Wat zijn dus de noden? Fase1: connectie op HUB’s in ‘leesbaar’ formaat Implementatie deel van HUB Cookbook

Fase 2a: Werken aan mapping lab-eigen codering met nationale codering voor de meest gebruikte concepten & de eenheden Fase 2b: Versturen uit lab en ontvangen in huisartspakket met 1 gestructureerd nieuw eHealth lab formaat, waarin gebruik van de standaard codes Antwoorden aan de HUB’s in gestructureerd formaat


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Coding systems LOINC (one code, one concept) vs SNOMED (pre/post coord) The case for LOINC: Covers most lab concepts Most important axes covered (analyte, specimen, scale, kind of quantity (method))

Problems with LOINC: Too much (eg 68 times ‘glucose’, 734 starting with ‘glucose’, 72000 concepts) Too little sometimes (eg calculations, specialised hemato, some method specific things eg for creatinin)

Code + specimen + unit (Kind of Quantity) detailed unit: UCUM vs SNOMED (relationd) CoZo – Collaboratief Zorgplatform

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Logical Observation Identifiers Names and Codes (LOINC) A unique code (format: nnnnn-n) is assigned to each ‘distinct’ concept 6 main fields for every code: Component- what is measured, evaluated, or observed (example: urea,...) Kind of property- characteristics of what is measured, such as length, mass, volume, time stamp and so on Time aspect- interval of time over which the observation or measurement was made System- context or specimen type within which the observation was made (example: blood, urine,...) Type of scale- the scale of measure. The scale may be quantitative, ordinal, nominal or narrative Type of method- procedure used to make the measurement or observation


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Coding

Authentic source in eHealth NL,FR,GE,EN Sponsored by FOD, top 90% of most common concepts covered (400+) Link to LOINC, specimen (and method if applicable) Notes & remarks Double validation of codes in progress + release

https://www.vas.ehealth.fgov.be/webretam/retam/ CoZo – Collaboratief Zorgplatform

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Coding

Preferred units Synonyms Remarks and preferred usage if necessary Also deprecated but commonly used concepts Grouping: it’s a free world CoZo – Collaboratief Zorgplatform

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UCUM (Unified Code for Units of Measurement) As LOINC maintained by Regenstrief institute Advantages: Structured Related Designed for lab results

Practical examples:


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http://www.health.belgium.be/eportal/Healthcare/Telematics/HealthNetworks/Message/index.htm#.VuwumtLhCHu


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Downloads & Mapping of analytes & units


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Help my code is not (yet)(really) there in the LOINC set…. Code preference in order of: (Belgian) LOINC Albert Propietary code

Suggestions, remarks can be made in Retam & FOD page


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Structure (the message) Prelude: IHE exercise Belgium CDA-LAB, Mapping/integration with Kmehr

Needed from eHealth : Clear cookbook and examples accepted by industry and aligned to international developments but respecting existing and in the mean time heavily utilized HUB-WS infrastructure Validator for new messages (both P2P and WS) Visualisation tool for messages

Current status: HL7 CDA lab Message largely ready (foreseen half 2016)

Timing for production: Roadmap: before end of 2017 CoZo – Collaboratief Zorgplatform

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eHealth is finally flying

questions? © 2012 CoZo – Collaboratief Zorgplatform

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ehealth in Belgium : focus on the laboratory

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