University Hospital Brussels 1 december 2005 Telematics@health.be Project “ABRUMET” Proposal for a Regional Medical Network R. Van de Velde University Hospital Brussels AZ VUB Vrije Universiteit Brussel

About Abrumet : Organisation for Telemedicine in Brussels Members GP  FAMGB, BHAK Hospitals  AZ-VUB, CHIREC, Clinique de l’Europe, Erasme, C. de Paepe, Sanatia, Saint Jean, Saint Luc  IRIS (hospitals – CTO) Objectives To foster availability, accessibility and portability of patient records by means of Health Information Networks (HIN) Collaboration: ability to share medical information between authorized HC workers To stimulate confidence of general Practitioners and increased investment in CPR Bilingual To encourage patients to take a more important role in managing their health records .

Why? Why? Why? What? How? When?

What if a physician requests a patient record? May I please have the Patient Record?

x Hospitals : Do not share information The Answer is Yes, but … x Do not share information H1 H2 H3 Hospitals : Have distinct security approaches AZ-VUB AMIS UZL LISA . . . Lock up data in proprietary formats Perceive competition

Even when information is electronically available The Answer is Yes, but … Even when information is electronically available in an electronic medical record in a pharmacy system in a digital radiology system …. The patient is generally given at personal inconvenience, a hard copy No “export” function available !

What if we gave GPs a tool to request their records electronically? x x H1 H2 H3 Abrumet First Phase:

Finding Records: Manual Approach Laboratory Results Specialist Record Hospital Record Records Sent The challenge: Finding and accessing easily documents from other care providers in the community. Clinical Encounter Clinical IT System

Finding Records: The Abrumet Way Laboratory Results Specialist Record Hospital Record 3-Records Returned Temporary Aggregate Patient History 3-Patient data presented to Physician Clinical Encounter Clinical IT System Index of patients records (Document-level) 2-Reference to Records for Inquiry 1-Patient Authorized Inquiry

What? Why? What? How? When? What?

Publication & Visualisation Documents Services Publication & Visualisation Documents Distributed Location – Written Consent Bi-directional Data Keepers Messaging (Push/Pull Model) Location messages : secured centrally Specific e-mail system (uniform access method) SMS : “Event-driven” For Critical Messages (Panic Lab Values, Emergency Adm,…)

The Patient “Longitudinal” Record General Practitioner Clinical B Other Specialized Care Clinical A Typically, a patient goes through a sequence of encounters in different Care Settings

Requirements (1/2) Foundation for a federated Health IT Infrastructure: Focussing on a shared Electronic Health Record, in a community, region Distributed: A “federated” system composed of distinct, distributed, disparate, decentralized systems defined as “data keepers”. Each Health Care organization “publishes” clinical information for authorized users. Information that remains in the original location of creation. Document Centric: Published clinical data is organized into “clinical documents” based on agreed standard document types Sharing of documents between General Practioners, clinics, pharmacists, … with different medical IT systems Consistent graphical user interface: Care providers are offered means to query and retrieve clinical documents of interest in the same consistent way independent of the source of information

The Master (Community) Patient Index 14355 L-716 M8354673993 Master Patient Index Document Registry Patient Registry Document Repository Laboratory Clinical B Abrumet Portal Clinical A Submission of Patient & Doc References Retrieval of selected Documents

Requirements (2/2) Cross-Enterprise: A Master Patient (Community) Index provides an index for published information to authorized Healthcare Patient maintains control and can grant access to selected portions of his/her medical record (ACL) for authorized users specific to their role Physicians can be granted access to the record or portions of it to read or write. Should the patient choose they may be locked out at a future time. Collaboration is optimised Standardized Queries: Are based on Web Services and KMehr standard Easy access based on Single Sign On (SSON) without installation of specific software at the user site with the same tokens/cards Interconnectivity: The system enables links to other related networks such as CareNet, Be Health, Social Security, RIZIN-INAMI, ...

SUMEHR (Summarized Electronic Health Record) Patient Identification Id Patient Presentation Name Forenames Sex Birth date Usual language Contact person Author Health care practitioner Id GMD relationship Risks Allergies Adverse drug reactions Social factors Other factors Relevant personal antecedents [ICPC2, ICD10, Other Code, Begin date, End date, text, links] Actual problems list [ICPC2, ICD10, Other Code, Begin date, text, links] Actual medications [CNK or other Id, Various administration informations, Begin date, text, links] Vaccination status Administrated [CNK or other Id, Date] To be administrated [CNK or other Id, Date] Contextual comment

Future CPR Environment PATIENT Records Clinic & Hospital Records PERSONAL Records Consumer & e-health records First Class Healthcare PUBLIC HEALTH/ POPULATION Records Community Records Data Banks Repositories

How? Why? What? How? When? How?

The Architecture (1/3) Network S Med S S Med Med A Med Nw S Med Med S Hospitals ST. PIERRE Universitair Ziekenhuis VUB Pharmacy Data Keepers S Med S Med S Med Network A Med Abrumet Doctors Nw Med S Med S Med Sécurité Sociale Labo Specialist A Med = Access Mediator S Med = Service Mediator

The Architecture (2/3) A Med S Med S Nw Med Med Prescription Documents Dr. X Dr. Y Dr. Z A Med Abrumet Clients/Users S Med Pharmacy Prescription S Med Hospitals St. Pierre Universitair Ziekenhuis VUB Abrumet Documents Sécurité Sociale Nw Med Link

The Architecture (3/3) Access Mediator Network Service Mediators MPI 2 Auth 1 tunnel Network Messages 6 7 4 Journal Access HTTPS Import Msg Web Portal VPN Visualisation Sécurité Sociale Journal Access t= 1 month ACL Auth. 5

ACL (Access Control List) Scenario: Example Logic Do Not release the record of the dermatology specialist(SOAP) Do Not release 1 specific document Everything what is treated by the department of Psychiatry Do Not release 1 type of document Everything what is entered by a specific physician Do Not release all documents related to one physician Keep everything protected during a specific period Time constraints

When? Why? What? How? When? When?

Ongoing Work : Project Life Cycle Public Tender: Hardware-Level Servers, Location: to be determined Software-level E-mail tool, Mediators, Portal-site (consisting), Authorization Server, Web Services Health Information Network Telecom: Security & Access (Tokens) between points of care (with broadband connectivity) Member Fees- Quid? Helpdesk

When ? Study Group « Preparation Public Tender » 09-2006 06-2006 2005 2007 2006 Study Group « Preparation Public Tender » 09-2006 06-2006 12-2005 Vendor Selection Public Tender « Publication » « Closure » 11-2006 06-2007 First « Prototype » Test 12-2007 Production

Questions ? rvdv@az.vub.ac.be Thank You