project abrumet proposal for a regional medical network vrije universiteit brussel r. van de velde...
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Project “ABRUMET”Project “ABRUMET”Proposal for a Proposal for a Regional Medical Regional Medical NetworkNetwork
Vrije Universiteit
Brussel
R. Van de Velde
University Hospital Brussels AZ VUB
1 december 20051 december [email protected]@health.be
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Vrije Universiteit
Brussel
R. Van de Velde
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 .
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Vrije Universiteit
Brussel
R. Van de Velde
Why?
Why?
What?
How?
When?
Why?
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Vrije Universiteit
Brussel
R. Van de Velde
What if a physician requests a patient record?
H1 H2 H3
May I please have the Patient Record?
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Vrije Universiteit
Brussel
R. Van de Velde
The Answer is Yes, but …
Hospitals :
H1 H2 H3 x x Do not share information
Lock up data in proprietary formats
Perceive competition
Have distinct security approaches
AZ-VUBAMIS
UZLLISA
. . .
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Vrije Universiteit
Brussel
R. Van de Velde
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 !
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Vrije Universiteit
Brussel
R. Van de Velde
What if we gave GPs a tool to request their records electronically?
H1 H2 H3 x x
First Phase:
Abrumet
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Vrije Universiteit
Brussel
R. Van de Velde
Clinical Encounter Clinical IT System
RecordsSent
Laboratory Results Specialist Record
Hospital Record
The challenge: Finding and accessing easily documents from other care providers in the community.
Finding Records: Manual Approach
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Vrije Universiteit
Brussel
R. Van de Velde
Clinical Encounter
Clinical IT System
Temporary Aggregate Patient History
3-Patient data presented to
Physician
1-Patient Authorized
Inquiry
3-RecordsReturned
Laboratory Results Specialist Record
Hospital Record
2-Referenceto Records for Inquiry
Finding Records: The Abrumet Way
Index of patients records(Document-level)
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Vrije Universiteit
Brussel
R. Van de Velde
What?
Why?
What?
How?
When?
What?
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Vrije Universiteit
Brussel
R. Van de Velde
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,…)
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Vrije Universiteit
Brussel
R. Van de Velde
General Practitioner
Other Specialized Care
Typically, a patient goes through a sequence of encounters in different Care Settings
The Patient “Longitudinal” Record
Clinical A
Clinical B
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Vrije Universiteit
Brussel
R. Van de Velde
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
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Vrije Universiteit
Brussel
R. Van de Velde
Clinical B
Clinical A
Laboratory
Abrumet Portal
Master Patient Index
DocumentRepository
Submission of Patient & Doc References
Retrieval of selected Documents
The Master (Community) Patient Index
14355
L-716
M8354673993
Patient Registry
Document Registry
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Vrije Universiteit
Brussel
R. Van de Velde
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, ...
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Vrije Universiteit
Brussel
R. Van de Velde
SUMEHR (Summarized Electronic Health Record)
Patient IdentificationId
Patient PresentationNameForenamesSexBirth dateUsual language
Contact person Author
Health care practitioner IdGMD relationship
RisksAllergiesAdverse drug reactionsSocial factorsOther 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
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Vrije Universiteit
Brussel
R. Van de Velde
Future CPR Environment
FirstClass
Healthcare
PATIENT Records
Clinic & Hospital Records
PERSONAL Records Consumer &
e-health records
PUBLIC HEALTH/POPULATION Records Community Records
Data Banks Repositories
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Vrije Universiteit
Brussel
R. Van de Velde
How?
Why?
What?
How?
When?
How?
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Vrije Universiteit
Brussel
R. Van de Velde
The Architecture (1/3)
S Med
A Med
S Med
Pharmacy
Data Keepers
AbrumetDoctors
Specialist
Hospitals
ST. PIERRE
UniversitairZiekenhuis VUB
A Med = Access MediatorS Med = Service Mediator
S Med
Nw Med
S Med
S Med
Labo
SécuritéSociale
Network
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Vrije Universiteit
Brussel
R. Van de Velde
SMed
SMed
Hospitals
St. Pierre
Universitair Ziekenhuis VUB
Abrumet
Documents
Documents
SécuritéSociale
NwMed
Link
SMed
Pharmacy Prescription
Dr. X
Dr. YDr. Z
AMed
Abrumet Clients/Users
The Architecture (2/3)
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Vrije Universiteit
Brussel
R. Van de Velde
The Architecture (3/3)
tunnel
VPN
MPI
t= 1 month
Access Mediator
Auth
JournalAccess
Messages
HTTPS
ImportWeb Portal
Visualisation
Msg
Ser
vice
Med
iato
rs
JournalAccess
ACLAuth.
Network
SécuritéSociale
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3
4
5
6 7
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Vrije Universiteit
Brussel
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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
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Vrije Universiteit
Brussel
R. Van de Velde
When?
Why?
What?
How?
When?
When?
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Vrije Universiteit
Brussel
R. Van de Velde
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
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Vrije Universiteit
Brussel
R. Van de Velde
When ?
2005 20072006
Study Group« Preparation Public Tender »
09-200609-200606-200606-2006
12-200512-2005
Vendor Selection
Public Tender« Publication »
Public Tender« Closure »
11-200611-2006 06-200706-2007
First« Prototype
»Test
12-200712-2007
Production
