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?