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Integrated Care
& (the need for)
Semantic Interoperability
Evert Jan Hoijtink - Vice-Chairman OIZ
Managing Director Portavita & MGRID
Introduction
Current activities:
• Portavita BV – Managing Director / Founder
• MGRID BV – Director / Founder
• OIZ / Dutch Branch organisation for Health IT Industry – Vice-Chairman
• NEN / Dutch Normalisation Institute - Member Policy Committee Health IT
• DCM Governance – Initiator
Working experience:
• Pharmaplaza.com – CIO
• Oracle - EMEA Director of eCommerce
• CapGemini – Account Manager / Senior Consultant
• Honeywell-Bull – Sales Representative
• Akzo Nobel - Industrial Accountant
Mission of OIZ (in short)
• Realize pre-competitive cooperation between
Health ICT suppliers;
• Support initiatives that make exchange of data
between Healtcare information systems
possible;
• Contribute to standardization activities;
• Networking - Represent the Health IT Supplier;
• Formulate the OIZ standpoints;
• Organize network meeting / Information
transfer.
Integrated Care Issues
Some of the Integrated Care (f.i. Diabetes) issues
are:
• No clear (1) Medical Guideline for involved
participants (GP, Internal Medic, Nurse, Patient)
• Not clear who is responsible for what
• Current ICT is organization oriented and does
not support networked health (>1 organization)
• Hardly any semantic interoperability
• No payment for providing Integrated Care
Challenge
The “HISKIS Treaty:
• Initiative of 4 IT Suppliers representing 65%
of the GP's and 70% of the Integrated
Diabetes Care organizations;
• Agreed to produce standards for medical data
integration and Single-Sign-On between GP
System and Integrated Care Systems;
• Found out that off all 300 Data elements that
are needed to exchange only 1 was modeled
in the same way.
Other Issue - Examples
• Not only the medical data for a specific
observation like the “Foot Examination” was
modeled differently also the way the foot was
examined was different!
• Also issues like Wellness of a patient:
GP system 1 : Free text
GP system 2 : 3 point scale
ICS 1: 5 point scale
ICS 2: 5 point scale
Germany:
• 10 million Diabetes patients (12,5 %)
• 8.000 new persons with blindness yearly
• 7.500 new patients for kidney dialyse
• 54.000 feet amputations per year
• Diabetes patients with complications 10 X more expensive
Holland:
• 1 million Diabetes patients (6%?)
• 800 new persons with blindness yearly
• 750 new patients for kidney dialyse
• 3.000 feet amputations per year
• Cost 2003 € 1.2 billion
• Diabetes patient with complications … X more expensive
Source: Deutsche Diabetes-Union
Source: NDF - Nederlandse Diabetes Federatie
Diabetes & Complications
Cost of complications / opportunity (NL):
• 1 Feet amputation = € 45.000
• 3.000 = € 135 million
• Possibility for improvement = Less complications 50% = € 67 million
Source: Nitel
Source: VU, Hoornse study
So What ...
Treatement Standard
GuidelineGuideline
Protocol
Medical Data
Protocol
Medical Data
Protocol
Medical Data
Domain HEALTH & ICT
Sub-domain HEALTH
Sub-domain ICT
HL7 Template CEN Archetype Other
DCM
Detailed Clinical Model
DCM Approach
DCM Initiative
• 3 year project to provide “DCM Governance”
• In the Steering Committee:
– KNMG - Royal Dutch Medical Association
– OIZ - ICT Industry
– NPCF - Patient Organization
– ZN - Health Insurance Branch Organization
– Nictiz - National IT Institute for Healthcare
• Training, Repository, Quality Assurance and Stamp,
Distribution, International Re/Search and Promotion of
Detailed Clinical Models
Questions?