chu de liège, it state of play perspectives in the next 10 ......•since 2004, the chu has an...

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CHU de Liège, IT state of playPerspectives in the next 10-15 years

Pr. Philippe KOLH

CIO, CHU de Liège (Belgium)

© HIMSS Europe GmbH

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CHU of Liège, IT state of play


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Level of computerization of clinical tools at CHU of Liège


• University Hospital (CHU) of Liège is an Academic Hospital

• 888 beds and >5.000 staff members

• Activities spread over 7 localizations including 3 hospitalization sites

• Since 2004, the CHU has an Electronic Patient Record (EPR) including medical, nursing and

paramedical informations and a complete RIS-PACS for medical imaging.

• These computer tools allow both the exchange of data inside the hospital and outwards to ensure a

better continuity of hospital care and extramural care.

Hospital IT

Rooms

Operating Rooms

Administration

Clinics

Laboratories

General Practitioner

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HIMSS EMRAM Scale


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CHU of Liège – rated at level 6 EMRAM end of 2016


Assessment of a fully equipped care unit completely equipped with :

• EPR (medical, nurse and paramedical data)

• Electronic prescription for medico-technical examinations

• Electronic management of blood samples, drug and infusion prescription (CPOE) and

administration (cross-matching)

• Electronic transfusion administration (cross-matching)

• Computerized medicine cabinet

• Electronic "whiteboards" with all relevant information for patient care


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But also:

- A pharmacy equipped with 2 robots

- Information management in Emergency Room (EPR)

- Information management in intensive care units with integrated monitorings

- Filmless medical imaging


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CDSS - EPRClinical Decision Support System - Electronic Patient Record


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CDSS – EPR

Clinical Decision Support Systems (CDSS) link health

observations to physicians’ knowledge

Some examples:


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CDSS - EPR

Emergency Room: Risk Evaluation (1)


TIMI score : Estimates mortality for patients with unstable angina and non-ST

elevation MI.


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CDSS - EPR

Emergency Room: Risk Evaluation (2)


Pneumonia Severity Index (PSI) or Fine score : estimates mortality for adult

patients with community-acquired pneumonia


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CDSS – CPOEClinical Decision Support System - Computerised Physician Order Entry


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Drug Interactions


o Drug - Drug

o Drug - Allergy

o Drug – Patient

o Drug - Doses


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CLMA

Closed Loop Medication Administration


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Medications’ Prescription and Administration Plan


Pharmacy robots are driven by (i) physician order and (ii) management

of medication stocks


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Robots identify each medication individually. They are connected to

physician order and match each identifier to one patient, one drug,

one dose, and one administration time.


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Administration

BCMA (Bar Coded Medication Administration)


PDA

Patient wristband

Medications ring


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Towards level 7

CHU of Liège pursues the goal of a JCI certification, but also reaching EMRAM

level 7 for its clinical IT:

- 95% of the CHU equipped with electronic drug prescription and

administration (cross-matching)

- Optimization of the pharmacy organization in relation to:

- Pharmaceutical validation

- Drug stocks management processes and use of barcode

- Data culture systematization for continuous quality improvement

- Implementation of continuity plans.


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Hospital strategy in the next 10-15 years


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It’s obvious :

Health and IT are now closely linked !


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Health and IT are now closely linked

• Robots

• Internet of Things

• Permanent connectivity: connected objects are mostly used for

home care, to ensure a link with the patient. They can also be

used preventively (e.g.: For diabetic patients, connected tool

allows the patient to take his/her insulin units anywhere. This

information can/could be sent to the EPR, which can detect an

error and send an alert to the physician).


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Health and IT are now closely linked

• Hardware less expensive

• Implantable medications (equipped with bio-electric sensors that follow the

patient vital signs and deliver the medication if and when necessary)

• Big data : connexion of numerous systems generating a very large volume

of informations


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The « augmented surgeon »

Robots, more precisely a machine led by a surgeon, like Da Vinci medical robot, have been used for several years for surgery, mainly at abdomen level.

Da Vinci Robot


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Humanoid robots

Humanoid robots are appearing (e.g. Nao, used especially to

communicate with autistic children).

The evolution of their application field is the subject of much

research.


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The « repaired » man

Many perspectives for « repaired » and augmented man…

e.g.: a connected prosthesis that reproduces the sensation of the

lost limb.


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Smart sensors

• Temporary tattoos

From UC San Diego Jacobs School of EngineeringBiostamp, a connected smart patch for pregnancy follow-up


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FDA-approved coloscopy

3D printing

Smart clothes

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://wtfrly.com/category/wtfnoway/tech/biotech/&ei=YaCOVImsHMHAOdX8gOgF&bvm=bv.81828268,d.ZWU&psig=AFQjCNGK2bvLZgAl1pLSnN7REkCvADXx0A&ust=1418719706594022

https://www.aruco.com/wp-content/uploads/2014/10/cityzen-sciences.jpg


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Big data and semantic research


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e.g. Watson for Oncology

Artificial intelligence to answer

questions expressed in natural

language

Watson for Oncology helps physiciansto rapidly identify the keyinformations in a patient EPR and to explore the treatment options to decrease the undesirable care variations


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Key message

The digital evolution is a « progress accelerator »: to study the

evolution of a disease on a large number of patients allows to better

target treatments to each individual case.


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And what is the hospital strategy

in this IT evolution context ?


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• Patients will no longer need to come to hospital for regular

follow-up (e.g. home electrocardiograms connected to the

hospital system).

• Individualized and predictive algorithms will allow to anticipate

health incidents

• Smart objects will diagnose and react according to the

measures by adapting the treatment (e.g.: closed loop

pancreas)

Hospital doctor’s perspective


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Hospital value will no longer lie in the number of beds occupied

or surgeries performed, but on the number of patients to whom

it has avoided hospitalization and on the number of preventive

solutions put in place.



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– Doctors, nurses, patients, technicians, pharmacists, biotech. need to

know in real time where technological innovation is and where it is

going organize information

– The opportunity lies in the possibility for doctors, nurses, patients,

technicians to create new solutions in terms of care using technologies

that converge

– How to integrate / implement all these IT tools available on the

market ?

Are we almost there ?


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Change will begin effectively when :

- crowd will be aware of the costs and inefficiencies of the current

health system:

- 50 % of technical acts are useless (OMS figures)

- 42% inefficiency rate (OCDE 2013 figures)

- 10 % risks of iatrogenic damage(IOM, 1999)

- 5 % of diagnostic errors (Institute of Medicine- US)

- business world (innovative businesses) and medical world will start to

dialogue

- financing plans will be ripe to take the course

- human organization will be ready to adapt around these evolutions

Are we almost there ?


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The hospital in the 21st century health care evolution:

- Preventive medicine more than curative

- Increase of chronic pathologies and ageing population

- Health has to be « thinked » as a system

- Increase of home hospitalization and home care

Hospital is becoming less of a focal point and needs to change its

organization

More controlled budgets

Clever strategies to adopt new IT technologies that will sustain

these evolutions.

-

CHU strategy in the next 10-15 years


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• Renewal of its EPR (more efficient, more multi-actors

focused, more adapted for external integrations and

mobile applications)

• Participation in innovative projects :

– In-house IT developments (new internal IT skills !)

– Collaborations with commercial companies or start-ups

– Optimizing access to hospital information for external doctors and

patients (CHU portals, integration to “Réseau Santé Wallon”

www.rsw.be , mobile apps…)

– …

-

CHU strategy in the next 10-15 years

http://www.rsw.be/


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• Pilot projects for home hospitalization:

– Intravenous antibiotic therapy (120 patients)

– Some oncology treatments (subcutaneous chemotherapy) (15 patients)

• Benefits for patients :

– No more Home<-> Hospital trips

– Decrease in fatigue and stress, no more waiting times in the hospital

– Reduced risk of nosocomial infections

– Well-being and comfort of their usual environment (home)

– Improving the patient's well being: presence of the patient's relatives,

emotional support, on a daily basis, by the home care team

– With the same quality and safety of care as in the hospital

CHU strategy in the next 10-15 yearsSome examples

Home hospitalization


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• In-house development of the « HoDIsée » application:

– Application on stand-alone tablet

– Using web services for all stages of identification, synchronization and

feedback

– Remains autonomous in case of disconnection.

• Special attention to the following points:

– Ease of use for service providers

– Easy synchronization of data

– Maximum security at the data exchange level

CHU strategy in the next 10-15 yearsHome hospitalization


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Objectives:

• Cover EPR management outside the hospital

• Facilitate the transmission and entry of information between home and

hospital

• Benefit from mobile tools (tel., Google Map, Waze, Skype, ...)

Technical principles:

• Multi platform development (Android / iOs - C # Xamarin)

• Using secure web services (https / token)

• Encrypted local data

• Asynchronous Wifi 3G/4G synchronization

• ERP common data

Home Hospitalization

HoDIsée – Applicative Plateform


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Extension and perspectives:

• Internal technical IT skills developped for a Mobile Home Application

• Ready for other features like:

– « Envol » – Early return after childbirth

– Telemedecine COPD (Chronic obstructive pulmonary disease)

– Telemedecine « Heart failure »

• Exploitation of provider program interfaces such as :

– appointments

– Clinical biology

– Billing

– …

Home Hospitalization

HoDIsée – Applicative Plateform


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Access to some shared CHU protocols by outside doctors

through the « Réseau Santé Wallon »

See: www.RSW.be


Integration with “Walloon Regional Network”

Dr André Vandenberghe - 2014

http://www.rsw.be/


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Access to CHU EPR by outside doctors

• Objective

Grant outside doctors access to CHU's EPR from outside the hospital

using their personal material

• Tool

– OP’Portal : access to OmniPro CHU EPR in WEB mode

– Physician identification: Strong authentication via ID card + PIN

code


OP’Portal


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Integration with the app. Andaman 7 that allows CHU

patients to download their medical file on their

Smartphone or tablet.


Integration with App. Andaman 7


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Objective: creation of a monitoring multi-sensor and wearable

device, comfortable for the hospitalized patient, equipped with

an Early Warning score algorithm and compatible with the

IT infrastructure and EPR of Euregio Meuse-Rhine hospitals.


Interreg WearIT4Health Project

www.wearit4health.com

http://www.wearit4health.com/


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for the CHU Cancer institute:

Objectives:

• Improving the quality of oncology care throughout the Euregio.

• Well-designed and realistic actions that focus on organizational and technological innovation with

immediate results for the population.

Action 1- Patient Centered Medicine:

• Development of a teleconsultation network of scientific and medical experts providing personalized

advice on certain patients from partner and associated institutions.

• Development of a portable technology allowing patients to report their assessment of real added value of

the received treatments (PROM).

• Setting up home hospitalization.


Interreg Oncocare Project

https://www.interregemr.eu/projets/oncocare-fr

https://www.interregemr.eu/projets/oncocare-fr


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Action 2 - Quality of care :

Development of quality management (QM) sanctioned by accreditations :

• harmonization of cancer registries

• facilitating the exchange of our data for quality control, comparative analysis

(benchmarking) and clinical research

• set up an effective QM system in each center

• development of a global management software for transplanted patients

Oncocare – Interreg Project


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Action 3 - Access to innovative treatments :

Encourage innovation and its rapid transfer to the clinic :

• development of care itineraries and guidelines

• sharing with associated institutions

• improved access to new treatments through a common clinical trial platform and a

concerted strategy on rare cancers.

Oncocare – Interreg Project


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Stimulation of the vagus nerve to treat some forms of atrial fibrillation

Non-invasive device


Cardiax : Biowin project

www.biowin.org

http://www.biowin.org/


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Cardiax : Biowin project CHU is currently proceeding to an in-house development of the « homelink » (development of the hardware and communication protocols that allows the aVNS device to communicate securely with the eHealth Interface providing data for processing within the Diagnosis Algorithm.


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CHU is collaborating with a « spin-off » of the UCL in order to develop tools for:

- Help in “RCM” codification

- Linguistic research in the EPR

- Better medical history management in the EPR

“Turning medical records into actionable knowledge”


Data mining


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• Need to better organize health care to improve the quality of care and reduce costs associated

with redundant or unnecessary acts

• More and more budget control for hospitals

• Hospital value will no longer lie in the number of beds occupied or surgeries performed, but on

the number of patients to whom it has avoided hospitalization and on the number of preventive

solutions put in place.

• It is evident for Doctors that health is now linked to the world of IT:

– The digital evolution is a « progress accelerator » to study the evolution of a disease on a

large number of patients and to allow to better target treatments to each individual case.

– Predictive algorithms will allow to anticipate health incidents

CONCLUSION


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• Patients will no longer need to come to hospital for regular follow-up (e.g. home

electrocardiograms connected to the hospital system).

• Patient finds himself strengthened in his role of taking charge of his health thanks to the

applications and connected objects that are offered on the market.

• Many innovations are constantly being proposed to health sector by research and industry.

• Collaborations are necessary with the business world to integrate new technologies with the

hospital system.

• A need for strengthening IT skills within hospitals to monitor and integrate technological

developments.

CONCLUSION


Thank you!

Pr. Philippe KOLH

CIO, CHU de Liège (Belgium)

chu de liège, it state of play perspectives in the next 10 ......•since 2004, the chu has an...

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