In June 2015 it took seven work sessions with over 200 Belgian stakeholders to rewrite the original "Actionplan eHealth", dating from the end of 2012. Over the summer their proposals were validated by the nine cabinets and the different administrations, involved in the electronic exchange of patient data.
The result is the "Actionplan eHealth 2013-2018" : a detailed description how the Belgian stakeholders want to roll out a fully functional system to improve patient care trough more collaboration and data exchange between healthcare providers and institutions.
This article is a synopsis of the 20 chapters, condensed in just 4 pages. Visit he new website
and discover the summarized descriptions for each of the 20 chapters / action points of the plan. Clicking on each title below, gives you immetiate access to the more detalied chapters of the plan.
NB: "short term" means ± by 2016 - begin 2017;
"long term" means ± by the end of 2017 - 2018.
AP 1 Sharing the patient summary file between doctors
The “Sumehr” (Summary Electronic Health record) is an extraction / synopsis of the EPF (Electronic Patient File) a general practitioner keeps. It provides the essential information about a patient to other doctors / specilalist / on-call centres / hospital admission.
- The short time aim is to generalise the use of Sumehr’s by GP’s and to start the exchange with hospitals and on-call-centres (“wachtposten”).
- The long term aim is to develop a second generation of Sumehr’s that will allow more integration of data from different sources (e.g. the vaccination scheme from Vaccinnet; the common medication scheme; see AP 4)
AP 2 The Hospital Electronic Patient File
Hospitals will have to use more standardised and integrated EPF’s, allowing to share all relevant data between hospitals and other healthcare providers. The concept of Meaningfull Use will be the main driver.
- The short term aim is that every hospital has an internal ICT plan (planning the necessary migrations over the next 4-5 years).
- The long term goal is to finance the development of 3 or 4 modern Hospital EPF solutions in an ”accelerator program”. This will be a “bottom-up” initiative, probably starting from a number of existing, good solutions and financed by the authorities.
AP3 Sharing a common Medication scheme
Sharing medication information is probably the most effective and elegant way to start interdisciplinary collaboration. two approaches are combined:
Pharmacists will be obliged to compile and share a common medication delivery history, an overview of delivered medication over the last 12 months (GFD – Gedeeld Farmaceutisch Dossier – shared pharmaceutical file).
Doctors, pharmacists and nurses are encouraged to share a common medication scheme, a picture of the medication and dosage a patient is taking right now.
- The short term aim is to generalise their use throughout the ambulatory (first line) care and to extend their use into nursing homes and hospitals.
- The long term goal is to combine the separate platforms into an integrated data flow, from prescription, reimbursement and delivery into follow-up and improving therapeutic adherence and outcome monitoring (the "VIDIS" concept).
AP4 Electronic Prescribing
Generalizing computer-assisted prescribing and safe transmission of prescriptions.
- The short term aim is to upscale the use of the Recip-e platform for medication prescriptions in ambulatory care to the hospitals (for out-patients) and to other care sectors (nursing, physiotherapy, imagery and clinical laboratory prescriptions)
- The long term goal is to “dematerialize” all types of prescriptions (paperless).
AP 5 Sharing patient data between hospitals & psychiatric wards and nursing homes (AP7)
This action point is intimately linked with AP2 (the Hospital EPF).
- The short term aim is to define and use more standards in different types of data exchange within the (existing) hospital hubs and to generalize the use of the meta-hub as a reference register, where data are available concerning a patient. Nursing homes will develop standardised EPF’s and will be linked to the meta-hub.
- The long term goal is to extend the exchange to ambulatory specialists and extramural lab’s, for all types of diagnostic data, in particular (complex) radiological images.
AP 6 “Sharing to collaborate”
Starting as much as possible from the existing patient data exchange systems, “collaborative platforms” will provide “windows” to each healthcare profession, allowing them look at each others data; each to the extend of his own necessities. The individual consent of the patient is crucial for the necessary trust in this kind of exchange and use of his personal data.
- The short term aim is to document which relevant data each healthcare profession has to bring to the “collaborative platform” (= making it available for each other and for other types of professionals) and to elaborate EPF’s for those professions that don’t yet have a standardised EPF.
- The long term goal is to define the “windows” and the necessary filters, allowing each profession to efficiently get access to the data that are relevant for them, filtered and presented in an clear and practical way.
The "collaborartive platform & windows" concept will also be used to give patients acces (see also AP 10) and to re-use data for scientific purposes (obviously with strick respect of privacy !).
AP 8 BelRAI (a uniform patient evaluation instrument)
BelRAI will become a uniform and standardized instrument to evaluate the dependency of each patient in need of medical- and social support.
The detailed plan, that was already elaborated by the ad hoc Working Party with federal and regional stakeholders, will be executed.
AP 9 Incentives for use
All (financial) incentives will be linked to the effective use of e-health services. In time, they should become part of the basic healthcare model and –reimbursement.
AP10 Access to patient data
The Plan provides a framework to give patients access to all their relevant data and to provide them with a platform on which to collect and share personal data they generate themselves.
- The short term aim is to develop the ad hoc framework and to solve the problem of access to data of minors (parents / trusted person).
- The long term goal is to provide access to all data in the context of AP 6 (providing a sharing platform and “windows” to view each other data, not only to all professionals but also to the patients).
AP11 Communication & training and ICT-support (AP12)
Learning to use e-health services is mainly a “change management” problem. A comprehensive, permanent communication plan and several training & support initiatives must help both patients and healthcare providers to understand and get familiar with the use and benefits of sharing patient data.
- In the short run a consistent communication plan will be put in motion (the website on which the plan is presented and the federal communication initiative concerning the “informed patient consent” are the first visible results). Helpdesks will be better coordinated and a digital training platform will allow providers to learn and practice multidisciplinary data exchange.
‘User days’ will bring together all the stakeholders to discuss and exchange information on all relevant issues 3 x per year.
- The long term goal is to include the use of e-health services in every basic- and continuing education curriculum and to make e-health proficiency a part of the competence profile of every healthcare provider.
AP13 Standards and terminology
The original Plan focused mainly on the implementation of SNOMED to standardise terminology in hospitals and medical practice. That part of the plan is now elaborated in detail in the first part of this action point.
But the scope has become much larger: we need standards for data, messages and functions in every type of exchange and service. The new plan provides e.g. better technical interoperability for lab results, using international standards.
- The short term aim is to collect and compile existing standards for data, messages and functions as described in many existing “cookbooks” of e-health services.
- The long term goal is to develop the “connector” model, developing a standardised ICT solution / module for each profession. The connector module describes how the software should interact with all the available services at once. This is a holistic approach, developed in close collaboration with each professional group. It describes the interaction with the “basic services” of the eHealth Platform and the different e-health services (including encryption/decryption) on one side. On the other side the exchange between the connector module and the software of the end user is reduced to simply transferring a set of (standardised) data blocks per service.
AP 14 MyCareNet
The past 3 years, the MyCareNet platform already rolled-out a number of solutions for the electronic consultation of ‘insurability’ and reimbursement authorisations along with the first e-factoring solutions.
- The short term aim is to extend these solutions to almost all types of care and professions.
- The long term goal is to completely digitalise the document flow of ‘care certificates’ . Today, doctors write >3 million of them (on paper) each year, by which patients get reimbursed.
AP 15 Administrative simplification
The plan describes four administrative paper flows that will be digitalised: HANDICARE (establishing handicap of patients), OCCUPATIONAL DISEASES E-FORMS, MEDIPRIMA (standardising the reimbursement of medical care by local social services (OCMW / CPAS) and BACK TO WORK (reintegration of disabled persons).
AP 16 Traceability of medical devices and medication
This action point implements the European directives on standardized traceability.
AP 17 eHealtBox and CoBRHA
eHealthBox is a standardized solution for the exchange of all types of messages between two known providers. It is already well used for the exchange of diagnostic data from hopsitals and labs to GP’s.
CoBRHA is a standardized “address book” of all registered healthcare providers and institutions.
- The short term goals are to extend the use of eHealthBox to all types of users and to develop more standards for messages, also allowing automatic processing of the data upon reception. The data of every provider will be available in CoBRHA and a “unique electronic counter” will be developed, providing a simple update solution for their own relevant data.
AP 18 Consolidation of all Health Registers
Providing information for health registers is a time consuming activity, although necessary for policy- and scientific purposes.
- The short term aim is to make a comprehensive inventory of all existing health registers, including their description and the standards used for collecting the data. Business processes for collection will be streamlined and new registries will have to adapt the streamlined and standardized approach from the start.
- The long term goal is to work on a consolidated “health data” platform and to implement the “Clinical Building Blocks” approach (cq. Standaarden NICTIZ)
AP 19 Mobile Health
mHealth is a completely new chapter. Over the last years the importance of an integrated policy has become evident. The free market, with an abundance of app’s and devices can not be stopped. But patients need more guidance on the quality, reliability and confidentiality of the applications. And the health insurance has to decide which relevant and EBM application deserve to be prescribed and reimbursed.
- The short term aim is to develop a regulatory and legal framework for mHealth applications, with a focus on telemonitoring. A platform, allowing patients to download and share data will be developed. Five specific areas are chosen: stroke, cardiovascular care, diabetes, mental health and chronic pain.
- The long term goal is to evaluate this policy in order to adapt and extend it.
AP 20 Governance, roll-out and monitoring the execution of the plan
This was the Achilles heel of the original plan. In the mean time, the redistribution of competences over 9 ministries has only increased the need for coordination of policies, governance, budgets and execution.
- The short term aim is to name a Program Manager (responsible for the overall coordination & execution) and Project Managers for every action point. Each will be supervised by an administration of cabinet, providing the necessary political drive.
This action point also contains a number of very practical elements: an expert panel will clarify professional responsibilities while using (or not using) shared patient data. Software for health professionals in the future will be registered (in order to use the basic services of the eHealth Platform) and receive permission to use specific e-health services. This should give a better view of the effective implementation of these services in the different software solutions, proposed to healthcare professionals.
- The long term goal is the full realisation of this Actionplan eHealth by the end of 2018…
Dirk BROECKX – 21 October 2015
Lexicon (explaining a number of concepts and terms, commonly used in e-health in Belgium)
CLICK HERE FOR DUTCH
CLICK HERE FOR FRENCH
Overview of the extended descriptions of the action points (in Dutch and French):