Transcript 5 - Antilope Project

Benelux Ehealth Interoperability Summit
Luc Nicolas
Health Telematics, Informatics and Communication Unit
Public Federal Service Public Health
eHealth certification in Belgium
Ehealth Roadmap
Hub-metahub: system to system
communication
Current situation in ambulatory care
Approach for institutions
Some roads for tomorrow
>Ehealth Roadmap (2014-2018)
Dorian
<Hospitalisation>
<Implant>
<Laboratoire>
<Imaging>
<Sumehr>
<Therapeutic scheme>
<MyCarenet>
<Register>
<RHM>
Mona
<Auto monitoring> <Tele consultation>
<Tele monitoring> <Sumehr>
<Personal health record>
<Electronic Prescription> <eFact>
<eBirth>
4
Sharing data via the
hubs & metahub system
2014: Consultation
reports, discharge letters
and surgery protocols,
other reports and
corresponding data.
2016: Integration of data
of other institutions
2015: Imaging results
and reports, implants
placing
5
25/6/2010
5
27 Standardized web services
Basic services and authentic sources
8
Patients, healthcare providers
and institutions
Health Portal
VAS
VAS
VAS
VAS
RIZIV-INAMI
site
VAS
VAS
VAS
VAS
eHealth
platform
Portal
Care provider
software
VAS
VAS
VAS
VAS
Healthcare
institution
software
VAS
VAS
VAS
VAS
MyCareNet
VAS
VAS
VAS
VAS
Users
Basic services
eHealth platform
Network
ADS
Suppliers
ADS
ADS
ADS
ADS
ADS
Testing and certification
-
-
Mini « connecthatons »:
- First targeted at Hubs and Metahub (Ehealth)
- Opened later to other systems
Certification of individual Hospitals by Hubs.
Certification of ambulatory care systems by
Prorec/Ehealth
Hospital EHR: Minimum data set per discipline mapped with technical and
semantic standards
10
End 2014:
• -Mapping rules to
normallised clinical
language for all main
registers
•- Publication of
functonalities referential
(To be implemented by
2017)
•New standardized
discharge letter
End 2015:
Minimum Content
data set
(implementation end
2016)
End 2016:
- Structure
(instauration fin
2017)
- Schéma de
médication de sortie
2017: EHR partially
coded
End 2017:
Compulsory system
to system
communication for
feeding registers
> Ambulatory care systems
Global: Legal certification
Telematics Commission
Ehealth Platform
Sectorial
Label working-groups
Users working-groups
Producers working-groups
Financial incentives
> Legal context
Chapitre 3 - Missions de la plate-forme eHealth
Article 5
La plate-forme eHealthest chargée des missions suivantes en vue de l'exécution de son objectif:
développer une vision et une stratégie pour une prestation de services et un échange d'informations
électroniques dans les soins de santé efficaces, effectifs et dûment sécurisés, tout en respectant la
protection de la vie privée et en concertation étroite avec les divers acteurs publics et privés des soins
de santé;
déterminer des normes, des standards et des spécifications TIC fonctionnels et techniques ainsi
qu'une architecture de base utiles pour la mise en oeuvre des TIC à l'appui de cette vision et de cette
stratégie;
vérifier si les logiciels de gestion des dossiers électroniques de patients répondent
aux normes, standards et spécifications TIC fonctionnels et techniques, et
enregistrer ces logiciels;
> Content
Block 1 : Criteria
Block 2 : Kmehr
-Technical (incl. security)
-Patient data management
-Key added value services
(data exchange)
-Usability
-Customer Services criteria
(incl.data portability)
>> Kmehr
Kind Messages for Electronic Healthcare Records
Belgian Implementation Standard
> Conceptual model
> Transaction types
> XML implementation
> Coding systems
>> Sumehr
Summarized Electronic Health Record
> Kmehr transaction
> Multipurpose content
> Homologation criteria
> European target
Process
- Voluntary
- Organized every 2 years
- Scenari and testing by PROREC (call for
tender)
- (Partially)funded by industry
- Link with financial incentive for users (800
€/year)
- Partial consolidation of the market ongoing
17
APPROACH FOR INSTITUTIONS
ACTION 2 ROADMAP
REFERENTIALS HOSPITAL EHR
– 1. Fonctionnalities: May 2014
– 2. Content (exchange + registers): Ongoing
– 3. Structure (recommandation): October 2014
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P
A
R
T
1
F
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N
C
T
I
O
N
A
L
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T
I
E
S
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21
Exemple:
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23
CONTENT: Ongoing
2 inputs:
-> Partial normalisation linked to data exchange
Discharge letter
Labo
Specialities reports
Key (observable) data
-> Registers (action 18)
24
Action 18: Inventaire et consolidation des registres
25
End 2014: Detailed inventory of all existing registers and databases
“Cet inventaire détaillera au minimum la description précise des champs de données
collectées, leur statut (facultatif ou non), leur format, les codifications (propriétaires
ou non) utilisées, le type d’utilisateur et d’institutions concernés ainsi que toute autre
Information contextuelle indispensable.”
2014:
referential per profession/context
– Governance criteria for new registers
131 registres (and counting..)
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47.
Ambulatory Care Health Information Lab (RIZIV-INAMI)
Annual Hospital Statistics (FOD-SPF)
Antwerpen registry of congenital anomalies (EUROCAT)
Belgian Abortion Register (FOD-SPF)
Belgian AIDS-reference centres (WIV-ISP)
Belgian AIDS-reference laboratories (WIV-ISP)
Belgian alpha-1 antitrypsin deficiency registry (Alpha One International Registry (AIR))
Belgian Association for Cardio-Thoracic Surgery Database
Belgian Cancer Register: Standard version (Belgian Cancer Registry)
Belgian Cystic Fibrosis registry (WIV-ISP)
Belgian Early Warning System for Drugs (WIV-ISP)
Belgian familial adenomatous polyposis registry
Belgian Langerhans cell histiocytosis registry (LCH)
Belgian Neuromuscular Disease Registry (WIV-ISP)
Belgian patient database for Wilson disease (EuroWilson registry)
Belgian Patient registry for rare bleeding disorders
Belgian Pediatricians Nephrology Registry (BPNR)
Belgian Register for Assisted Procreation (National College of Physicians in Reproductive
Medicine)
Belgian Register Substitution Treatment (FAGG-AFMPS)
Belgian registry of primary immunodeficiencies (ESID European registry)
Belgian registry on acromegaly, epidemiology and quality of care (ACROBEL)
Belgian severe chronic neutropenia patient registry (SCN international registry (SCNIR)
Belgian sickle cell anemia registry
Belgian systemic sclerosis cohort
Belgian Virtual Tumourbank (Belgian Cancer Registry)
Belgian Treatment Demand Indicator Register (WIV-ISP)
BINC: Begeleiding in Cijfers
Biobank of the pediatric granulomatous arthritis international registry (UZLeuven)
Birth Register (VAZG, Observatbru, DGOPLASS, ADSEI)
Central Register of Rare Diseases (WIV-ISP)
Database Farmanet (IMA-AIM)
Database Health Care (IMA-AIM)
Database Population (IMA-AIM)
Database Palliative care (federatie palliatieve zorg Vlaanderen)
Declaration of Infectious diseases (MATRA, WIV-ISP)
Drug Related Infectious Diseases (WIV-ISP)
EFFectiveness of Endometrial Cancer Treatment (EFFECT) (Belgian Cancer Registry)
End of career measures (FOD-SPF)
Electronic Patient Registration Centers Mental Health Care Flanders
European alternating hemiplegia and rare epilepsies registry in childhood (ENRAH)
European Antimicrobial Resistance Surveillance Network (WIV -ISP)
European network for the study of orphan nephropathies registry (EUNEFRON)
European patient registry and cohort for congenital disorders of glycosylation (EUROGLYCANET)
European Point Prevalence Survey (PPS AB & HAI; WIV-ISP)
European registry of human alveolar echinococcosis: Belgium (EURECHINOREG)
European Surveillance of Antimicrobial Consumption (ESAC-Net; WIV-ISP)
Flemish Renal Registry (NBVN)
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Haemoglobinopathies - database
Handhygiën (WIV-ISP)
Head and Neck: orofarynxcarcinomen Project (Belgian Cancer Registry)
Healthcare Associated Infections & Antimicrobial Use in European Long Term Care Facilities
(WIV-ISP)
Hospital Financing (FINHOSTA, FOD-SPF)
Infectious diseases (sentinel laboratories) (WIV-ISP)
Informatiestroom tussen de ziekenhuizen en de administratie gezondheidszorg (VAZG)
Initiative for Quality improvement and Epidemiology in Diabetic Foot clinics (WIV -ISP)
Initiative for Quality promotion and Epidemiology in Diabetes care (WIV-ISP)
Initiative for Quality promotion and Epidemiology in Diabetes care for children and adolescents
(WIV-ISP)
Integrated Computerized Network, INTEGO
Medical Emergency Services: MUGREG (FOD-SPF)
Minimum Hospital Data (FOD-SPF)
Minimum Psychiatric Data (FOD-SPF)
MIRAGE database (IKAROS; Kind & Gezin)
Mortality Register (VAZG, Observatbru, DGOPLASS, ADSEI)
National Surveillance of Antimicrobial Use in Belgian Hospitals (WIV -ISP)
National Surveillance of Healthcare Associated Infections in Intensive Care Units (WIV -ISP)
National Surveillance of Influenza (WIV-ISP)
National Surveillance of Meticillin resistant Staphylococcus aureus (MRSA) in Belgian hospitals
(WIV-ISP)
National surveillance of multi-resistant micro-organisms in Belgian hospitals (WIV-ISP)
National Surveillance of Septicemia in the Hospital (WIV-ISP)
National Surveillance of Surgical Site Infections (WIV-ISP)
Netoverschrijdend ICT-project van de CLB's in samenwerking met het departement Onderwijs
(VAZG)
Newborn college Register
ORTHOpedic Prosthesis Identification Data (RIZIV-INAMI)
Pediatric granulomatous arthritis international registry
Permanent Sample (IMA-AIM)
PROCARE (Belgian Cancer Registry)
Prospective collection of tissue, ascites and plasma samples from patients with ovarian cancer
(UZLeuven)
Qermid©Coronaire stents (RIZIV-INAMI)
Qermid©Endoprothesen (RIZIV-INAMI)
Qermid©Hartdefibrillatoren (RIZIV-INAMI)
Qermid©Pacemakers (RIZIV-INAMI)
Quality Indicators Healthcare Associated Infections (WIV-ISP)
Register POMALYST (Celgene)
Register REVLIMID (Celgene)
Register THALOMID (Celgene)
Rest/care homes (FOD-SPF)
Robot Assisted Laparoscopic Prostatectomie (RALP) (Belgian Cancer Registry)
Sentinel General Practitioners (WIV-ISP)
Sexually transmitted infection (sentinel surveillance) (WIV-ISP)
Shared Arthritis File for Electronic use (RIZIV-INAMI)
Results Inventory
Database
HD code Host
Survey completed
Survey ongoing
Item list completed
Item list Ongoing
register in developm
NO PARTICIP!
Ambulatory Care Health Information Lab
HD001 WIV-ISP / RIZIV-INAMI
1
1
ORTHOpedic Prosthesis Identification Data
HD099 WIV-ISP / RIZIV-INAMI
1
1
Qermid©Coronaire stents (RIZIV-INAMI)
HD104 WIV-ISP / RIZIV-INAMI
1
1
Qermid©Endoprothesen (RIZIV-INAMI)
HD105 WIV-ISP / RIZIV-INAMI
1
1
Qermid©Hartdefibrillatoren (RIZIV-INAMI)
HD106 WIV-ISP / RIZIV-INAMI
1
1
Qermid©Pacemakers (RIZIV-INAMI)
HD107 WIV-ISP / RIZIV-INAMI
1
1
Shared Arthritis File for Electronic use
HD117 WIV-ISP / RIZIV-INAMI
1
1
Belgian Cystic Fibrosis registry
HD008 WIV-ISP
1
1
Belgian Neuromuscular Disease Registry
HD012 WIV-ISP
1
1
Belgian Register of Haemophilia
HD131 WIV-ISP
1
Central Register of Rare Diseases
HD031 WIV-ISP
1
1
Initiative for Quality improvement and Epidemiology in Diabetic Foot clinicsHD071 WIV-ISP
1
1
Initiative for Quality promotion and Epidemiology in Diabetes care
HD072 WIV-ISP
1
1
Initiative for Quality promotion and Epidemiology in Diabetes care for children
HD073
and adolescents
WIV-ISP
1
1
Sentinel General Practitioners
HD114 WIV-ISP
1
1
European Antimicrobial Resistance Surveillance Network
HD048 WIV-ISP
1
1
European Point Prevalence Survey
HD051 WIV-ISP
1
1
European Surveillance of Antimicrobial Consumption
HD053 WIV-ISP
1
Handhygiën
HD066 WIV-ISP
1
1
Healthcare Associated Infections & Antimicrobial Use in European Long Term
HD068
Care Facilities
WIV-ISP
1
1
National Surveillance of Antimicrobial Use in Belgian Hospitals
HD083 WIV-ISP
1
1
National surveillance of Gram-negative multi-resistant micro-organisms in Belgian
HD084 hospitals
WIV-ISP
1
1
National Surveillance of Healthcare Associated Infections in Intensive CareHD085
Units WIV-ISP
1
1
National Surveillance of Meticillin resistant Staphylococcus aureus (MRSA) HD087
in BelgianWIV-ISP
hospitals
1
1
National Surveillance of Septicemia in the Hospital
HD088 WIV-ISP
1
1
National Surveillance of Surgical Site Infections
HD089 WIV-ISP
1
1
Quality Indicators Healthcare Associated Infections
HD108 WIV-ISP
?
Surveillance of Clostridium difficile infections
HD118 WIV-ISP
1
1
HIV viral loads register
HD069 WIV-ISP
1
1
National Surveillance of Influenza
HD086 WIV-ISP
1
1
Notifiable Infectious diseases register (MATRA – BRU)
HD092 WIV-ISP
?
?
Notifiable Infectious diseases register (MATRA Fédération Wallonie-Bruxelles)
HD093 WIV-ISP
?
?
Sentinel hospitals for Severe Acute Respiratory Illness
HD115 WIV-ISP
1
?
HD116 WIV-ISP
1
1
27 Sexually transmitted infection (sentinel surveillance) by STi clinicians
Surveillance of Creutzfeldt-Jakob disease in Belgium by neurologists
HD119 WIV-ISP
1
1
Surveillance of HIV/AIDS by Belgian AIDS-reference centres
HD120 WIV-ISP
1
1
N = 131
- 62 completed web based questionnaires
- 30 incomplete web based questionnaires (in progress)
- 53 completed sets of parameters and list of values
- 34 sets of parameters in progress
- 5 registers in development
- 5 registers refused participation
Info will be available in meta data portal (October 2014)
Intermediate results mapping with
RHM/MZG
> 700 matches between MZG and parameters of Registers
MZG parameter
28
n
MZG parameter
n
1
CODE_DIAGNOSE
370
11
A2_YEAR_HOSP_IN
15
2
PATNUM
67
12
CODE_UNIT
11
3
13
STAYNUM
8
4
A2_CODE_DIAG_CAUSE_D 47
EATH
40
M2_CODE_PROCEDUR
14
YEAR_SPEC_IN
8
5
A2_CODE_SEX
34
15
A2_CODE_DESTINATE
7
6
HOSPITAL
33
16
YEAR_PROCEDUR
7
7
A1_YEAR_BIRTH
32
17
A2_CODE_COUNTRY
6
8
M2_YEAR_PROCEDUR
21
18
A2_CODE_INDIC_NAT
5
9
A2_CODE_ZIP
19
19
CODE_SPEC
5
10
A2_YEAR_HOSP_OUT
19
20
S4_NUMBER_BED
5
Part 3 : Structure (To come)
29
-
Le modèle est basé sur une façon orientée “problème” de documenter les
Il demande aux systèmes d’être basés sur le principe de “période de soins”.
Il implique que tous les contacts avec tous les prestataires en rapport avec
une maladie soient reliés ensemble.
Une fois implémenté il rend possible de regrouper toutes les interventions et
d’évaluer les résultats atteints pour un problème spécifique – sans
considération de qui a fourni le service.
.
Process
•
•
•
•
•
•
- Voluntary
- Bottom-up approach for referentials
- Governance: Federating public institutions
- Exchange (Hubs-metahub) de facto compulsory
- Use of auto-certification ? (security)
- Progressive Meaningful use policy (From 2014 on)
18 Inventoryr and
consolidation of registers
31
13.
Terminology
5: hub-méta-hub
2. Developpement of an
Hospital EHR
Objective
Hospital Patient summary
Snomed based CMV
rhm
To Be
Health
DATA.be
Passer d’une vision de travail en « silo » des besoins vers
une vision intégrée et inter-opérationnelle
1. serveur terminologique
33
Sources et
classifications
ProcessBE cliniques
Utilisateurs
Interfaces
de consultation
Interfaces
de Gestion
diagn.
procéd.
labo
SNOMED
ProcessBE
administratifs
INAMI.
• Mises à jour
• Gestion des
versions
• Couplage,
mapping
• Gestion des
règles
• Validation
Terminologie de
référence
P.T. desc. Snomed ICD-9 ICD-10 …
NL
<txt>
FR
<txt>
• Load/Extract
• Requêtes
• Mapping
SVA
Software
…
•Feed back
• Webservice /
webap.
ICD10
Registres
...
Documentation
• Glossaires
Workflow de validation
• Documentation
et références
• Portail
ProcessBE administratifs
ou médicaux
- Dossier médical,
- Remboursement,
- Registre du cancer, ...
2. Terminology center
34
3. Reference terminology (snomed.be)
ICD_10_Code
SNOMEDID
Fr_Belgium
Nl_Belgium
C08.9
M-81473
Snomed CT number
34603009 Basal cell adenocarcinoma
EN_Clinical_Label
adénocarcinome basocellulaire
basaalcel adenocarcinoom
C16.9
M-81423
37995004 Linitis plastica
linite plastique
linitis plastica
C25.4
M-81513
20955008 Insulinoma, malignant
insulinome malin
maligne insulinoom
C25.4
M-81523
66515009 Glucagonoma, malignant
glucagonome malin
maligne glucagonoom
C25.4
M-81533
19756007 Gastrinoma, malignant
gastrinome malin
maligne gastrinoom
C44.9
M-84013
57141000 Apocrine adenocarcinoma
adénocarcinome apocrine
apocrien adenocarcinoom
C45.9
M-90503
62064005 Mesothelioma, malignant
mésothéliome
mesothelioom
C49.9
M-91333
54124005 Epithelioid
hémangioendothéliome épithélioïde hemangiohemangioendothelioma, malignant malin
endotheliaalsarcoom
C56
M-86003
57622002 Thecoma, malignant
thécome malin
maligne thecoom
C69.2
M-95123
12354007 Retinoblastoma, undifferentiated
rétinoblastome indifférencié
ongedifferentieerd
retinoblastoom
C71.9
M-938FF
gliome
glioom
C71.9
M-94233
12943006 Polar spongioblastoma
spongioblastome polaire
polair spongioblastoom
C71.9
M-94243
78838008 Pleomorphic xanthoastrocytoma
xanthoastrocytome pléomorphe
xanthoastrocytoom
C71.9
M-94423
35262004 Gliosarcoma
gliosarcome
gliosarcoom
C71.9
M-94733
39781001 Primitive neuroectodermal tumor
tumeur primitive neuroectodermique
primitieve neuroectodermale tumor
C75.5
M-86803
paragangliome malin
maligne paraganglioom
C75.5
M-86933
32512003 Extra-adrenal paraganglioma,
malignant
paragangliome extrasurrénalien
malin
maligne extra-adrenaal
paraganglioom
D27
M-84600
22116003 Papillary serous cystadenoma
cystadénome papillaire séreux
sereus papillair cystadenoom
D27
M-90000
74739000 Brenner tumor
tumeur de Brenner
Brennertumor
D76.3
M-77880
15960008 Reticulohistiocytic granuloma
granulome réticulo-histiocytaire
reticulohistiocytair
granuloom
115240006 Glioma
9903002 Paraganglioma, malignant
4. User Interfaces :
– Context sensitive pick list
– Syntactic and semantic search
– Rule Based Code convertor
Priority Use cases
> Some roads for tomorrow
Legislation
From common rules to law?
Standards:
Progressive international alignment of
Technical standards
Certification:
More emphasis on meaningful use?
Thanks
[email protected]
www.health.fgov.be/telematics/label