March 28, 2018Version 1.0

Terminology day

Roadmap e-Gezondheid/e-Santé

Some history

2

2012: round table on priorities of digitization of health

Participation > 300 health-care professionals and

representatives of citizens

Roadmap eGezondheid 2013 - 2018

Update in 2015 Roadmap 2.0

All governments agreed and support

3

4

Roadmap 2013 – 2018

5

Roadmap 2013 – 2018

AP

09

AP

11

AP

12

AP

02

Support &

Incentives

1. GMD = EMD => Sumehr

2. Hospital EPD

3. Medication schedule

4. Elektronic drugprescription

5. Sharing data via Metahub/Hub by all general anduniversity hospitals

6. Sharing data with paramedical professionals

7. Psychiatric & all other institutions share data via Metahub/Hub

8. Implementation of unified evalution tool (BelRAI) based in InterRAI

9. Incentives to stimulate adoption & use

10. Access to data for the individual patient (PatientHealth Viewer)

11. Program Communication

12. Education and IT-support for care providers

13. Standaards & Terminology

14. MyCareNet : bi-directional connection to mutualities (nsurance institutions)

15. Administrative simplification

16. Tracebality of implants and drugs

17. General use of eHealthBox (secure mailbox for care providers) & central register of administrative data on care providers (CoBRHA)

18. Inventarisation & consolidation of registers (collection of health-data for research en consolidatie van registers

19. Mobile Health

20. Governance, roll out & monitoring e-Health

Base systems

AP 17 AP 13

Systems & information-

flows between actors in

Health

AP

10

AP

05

AP

08

AP

04

AP

06

Optimization of

administrative

processes

AP

07

AP

19

AP

01

AP

15

AP

16

AP

14

AP

18

Information

for research

& politics

Clustered Action Points (AP)

AP

03

Landscape of care actors in Belgium

#

General practitioner (‘huisarts’) 21.600

Medical specialist (‘arts-specialist’) 28.000

Dentists (‘tandarts’) 9.000

Pharmacist (‘apotheker’) 4.900

Physiotherapist (‘kinesist’) 31.000

Nurse (‘verpleging’) 186.000

Midwife (‘vroedvrouw’) 11.000

Paramedic (diëtist, occupation therapist, logopedist, …) 55.900

Hospital 120

Psychiatric hospital 60

Residental care (‘woon-zorg centrum’) 1.400

> 11.200.000 citizens

Some results so far

8

Informed consents 6.692.124

revoked 14.193

Therapeutic Relationships 20.769.594

Published documents 313.239.319

Published SumEhr 2.972.480

Patients with published SumEhr 2.126.291

Schedule of medication 484.383

Electronic prescriptions entered /month 3.806.515

Electronic prescriptions delivered 3.183.424

Results of deliverables roadmap e-Gezondheid 2013-2018

9

20 AP’s (action points = projects), 206 initial deliverables

Progressive insights and adaptation to reality and changing priorities

Delivered ? # %

Yes 156 72%

No 60 28%

Total 216 100%

72% of deliverables OK

Near & far future

Update current roadmap -> Version 3 2019-2020-2021

Extra accents

‘Patient’ ‘Citizen’

Citizen co-pilot and controlling the sharing & use of his/her health-data

Operational Excellence

support, training, pro-active maintenance, availability, performance, quality & useability

Collaboration and sharing of information

Innovation support

Europe / International

10

(re-)enter standards & terminology

Details on specific projects

11

AP02 Belgian Meaningful Use Criteria (BMUC)

ID Functionaliteit

P1 1. Unieke patiëntidentificatie en -beschrijving

P2

2. Lijst van problemen die een samenvatting bevat van de medische

geschiedenis van de patiënt en een beschrijving geeft van de huidige

situatie van de patiënt

P3 3. Lijst van allergieën en intoleranties

P4 4. Elektronisch voorschrijven van geneesmiddelen

P5 5. Geneesmiddeleninteracties

P6 6. Elektronisch register van de toegediende geneesmiddelen

P7 7. Elektronische ontslagbrief

P8 8. Registratie van geïnformeerde toestemming

P9 9. Registratie van de therapeutische wilsverklaring van de patiënt

P10 10. Elektronische communicatie met HUB’s en interactie met e-Health

P11 11. Multidisciplinaire registratie en informatie-uitwisseling

P1212. Controle van het interdisciplinaire behandelingsplan en van de

taken van elke discipline via het EPD

P13 13. Registratie van afzonderingen

P14 14. Registratie waarnemingen

P1515. Ondersteuning om resultaten – protocollen - van intern

aangevraagde maar extern uitgevoerde onderzoeken te integreren

12

Roadmap to a full integrated EPD in hospitals

Defined and elaborated with hospital sector

Incentives to stimulate implementation

Financial

Best pratices

Sharing of experiences

13

AP03 VIDIS: prescriptions out of drug-schedule

Medication Scheme (t)

Hospital

Prescriber Hospital

pharmacistOthers

4.a. Get current Med.Scheme

at admission to hospital

4.c. Set new Med.Scheme

at hospital discharge

Ambulant

Prescriber

Dispensary

pharmacist

Others

1.a.

Create

medicinal

prescriptio

n

Residential Care

Coordinator

physician

Nurse

Patient

6.a. Get current

Med.Scheme

when needed

5. a. Get current Med.Scheme

when reviewing (CMP)

6.b. Set current

Med.Scheme

with notified

information

2.a. Execute

prescription

Recip-e2.d. Feedback for

changes (posology,

substitution)

5.b. Set new Med.Scheme

after review (CMP)

DPP

2.b. Register

delivery

VIDIS = Virtual Integrated Drug

Information System

AP 04 Electronic prescription

Mandatory use of SAM V2 (central database of drugs)

Start project dematerialisation

- 14 -

AP 05 Sharing of information

Hubs-Metahub-system = system of posting of medical data/information between care providers

Consultation reports (‘raadplegingsverslag’)

Operation reports (‘operatieverslag’)

Dismiss (‘ontslagbrief’)

protocols of medical imaging

Results of lab tests

SumEHRs,

Schedule of medication (‘medicatie-schema’)

Opportunity for care provider to access available medical documentation on specific patient, indepedent of

location of storage ot the documents

Location of connection to the system

16/05/2017

15

Hubs & Metahub - Schedule

16/05/2017

16

Collaboratief Zorgplatform (Cozo)

Vlaams Ziekenhuisnetwerk KU Leuven (VZN)

Réseau Santé Wallon (RSW)

Réseau Santé Bruxellois (RSB)

01/04/2017: 18.736.964 relations

Hubs & Metahub – How ?

16/05/2017

17

AP 10 Personal Health Viewer

AP19 : mobile Health

M3

•Requires M2

•Positioned within Belgian health system

•Conditional financing (expert committee)

M2

•Requires M1

•Validated by administrations (or trusted third parties)

•Security - Authentication (eHP)

• Interoperability (eHP + SPF-FOD)

•Scientific evidence (publications)

M1

•CE Certified as Medical Device (AFMPS-FAGG)

•GDPR compliant

•Belgian Privacy law compliant

Mobile Health applications Validation piramid

BE mHealth

Validation

CostBenefit

Triple Aim

List of Mobile Health Applications

Hosted by Agoria/BeMedTech

Free market

Self declaration

Informative

Labels, certificates

Publications,documents

CE

Medical device

AP13 Standards & Terminology

Base component in multiple AP’s (= action points = projects)

AP 01: GMD = EMD → Sumehr

AP 02: EPD in hospitals

AP 03: Medication Schedule

AP 05: Sharing data by all general & university hospitals

AP 06: Sharing data with paramedical professionals

AP 07: Sharing data by all other institutions

AP 08: BelRAI : uniforml instrument of evaluation

AP 15: Administrative simplication

Federal Public Service Health, Food Chain Safety & Environment

authentic source of terminology and classification

Organise translations

Belgian (sub)sets

Coordination, information, facilitating

Embrace and streamline initiatives and specific uses