eHealth in Belgium : focus on the laboratory -...

© 2013 CoZo – Collaboratief Zorgplatform

eHealth in Belgium : focus on the laboratory

23 maart 2016

Dr. Tom Fiers - Universitair Ziekenhuis Gent

www.cozo.be

2CoZo – Collaboratief Zorgplatform

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)


Solutions to a bigger & shared EPR world

vs


COST REDUCTION

QUALITY OF CARE

PRIVACY

PATIENT RIGHTS

So is the shared EPR a happy love story ?

- many hopeful couples -

The proof of the pudding is in the eating:

“Does the patient feel safe enough?”


Shared patient record in practice…

Opt Out

Cost

No ther. relations

No exclusions

smaller, Opt-IN


2009

Feb 2010

Apr 2010

Dec 2011

(est: 2014)

Shared patient record in practice…


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


Informed consent = Information + Consent

8

Nationaal: www.patientconsent.be

Website

Folder

Brieven Mut/riziv bij registratie

Hub specifiek

Posters

Folders

Website (www.CoZo.be)

Patientenportaal

Leaflets

Onthaalprocedures

http://www.patientconsent.be/

http://www.cozo.be/


De HUB’s

CoZo:

• 75 instellingen

• 37 Ziekenhuizen

• 33 Psy ziekenhuizen

• 4 Rev. Centra

• 1 lab

• > 4000 actieve artsen


BruSafe

ARH

Vaccinet

eHBox

eHealth: HubMetahub & vaults

CoZo Leuven

MetaHUB

EHC

GP

Vitalink

Intermed

CoZo

Web

Abrumet

RSW

eHBox

EHC

GP

EHC

GP

POCT,

DOP, ,…

ZH

1-24

ZH

1-24

ZH

1-48

ZH

1-24

ZH

1-24

ZH

1-34

ZH

1-24

ZH

1-9

ZH

1-24

ZH

1-17

PSY

1-33

RXLAB

Reval

Thuis

zorg

KWS

PSY

LABRX

RSW

pat

Vitalink

pat


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

http://www.cozo.be/contact


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


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


Logging easily accessible for the patient


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.


Block access to selected results for all caregivers

Mediation via GP or Specialist

Only blocking caregiver can de-block


Patient access to medical record


Mandatering: Kinderen / wilsonbekwame

patientenConform 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


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)


Piloot chronische zorg - Diabetes

Example: antidiabetic farmaca in Belgium (€)

Need for data sharing to limit secundary costs

0

20.000.000

40.000.000

60.000.000

80.000.000

100.000.000

120.000.000

140.000.000

160.000.000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011


Data knowledge => Impact on treatment


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

http://www.cozo.be/


Toevoegen nieuwe meters


Ontvangen data


POC Glycemie

Resultaten Beschikbaar in CoZo, onder thuismonitoring


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…


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


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


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


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


Structure & SemanticsVisualisation in your typical GP-EPR

Not quite a happy love story


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


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)


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


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/


Coding

Preferred units

Synonyms

Remarks and preferred usage if necessary

Also deprecated but commonly used concepts

Grouping: it’s a free world


UCUM (Unified Code for Units of Measurement)

As LOINC maintained by Regenstrief institute

Advantages:

Structured

Related

Designed for lab results

Practical examples:


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


Downloads & Mapping of analytes & units


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


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

eHealth in Belgium : focus on the laboratory -...

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