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

2. 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 .

3. Why?
Why?
Why?
What?
How?
When?

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

5. 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

6. 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 !

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

8. 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

9. 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

10. What?
Why?
What?
How?
When?
What?

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

12. 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

13. 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

14. The Master (Community) Patient Index
14355
L-716 M
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

15. 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, ...

19. 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

20. 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

21. How?
Why?
What?
How?
When?
How?

22. 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

23. 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

24. The Architecture (3/3) Access Mediator Network Service Mediators MPI2
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

25. 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

26. When?
Why?
What?
How?
When?
When?

27. Ongoing Work : Project Life Cycle
Public Tender:
Hardware-Level
Servers, Location: to be determined
Software-level
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

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

29. Questions ?
Thank You