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Agenda

DMMG : Minimum Medical Record for Practitioners on Duty Didier Leclercq, CEO & Owner Professional Computing Solutions sa (PCsol). Agenda. Presentation of PCSol Objectives and General Operation of DMMG Structure of the Transmitted Information Technical Infrastructure Legal Aspects

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Agenda

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  1. DMMG :Minimum Medical Record for Practitioners on DutyDidier Leclercq,CEO & OwnerProfessional Computing Solutions sa (PCsol)

  2. Agenda • Presentation of PCSol • Objectives and General Operation of DMMG • Structure of the Transmitted Information • Technical Infrastructure • Legal Aspects • Advantages of the DMMG • DMMG and the Emergency Services • DMMG and the Healthcare Sector

  3. Our Company • Starting Date : 1988 • Staff : 20 • Turnover 2003 : 2.5 Mn € • Shareholders : private 66 % - SRIW 33 % • Core Business : IT Solutions Integrator • For SMB • ehealth

  4. meXi Secure Solutions • Activity launched in 1992 • Leader in the french-speaking part of Belgium for secure transfer of medical data • Used in 85 hospitals and by 1700 GP • Participation in FLOW project of Public Healthcare Ministry in Belgium • Ongoing project with Quebec Ministry of Health and Social Services, projects in Luxemburg and in France

  5. Agenda • Presentation of PCSol • Objectives and General Operation of DMMG • Structure of the Transmitted Information • Technical Infrastructure • Legal Aspects • Advantages of the DMMG • DMMG and the Emergency Services • DMMG and the Healthcare Sector

  6. Objectives and General Operation • When on duty, practitioner has quick access to critical information about patient via DMMG • Improves the quality of care for the patients • Respects patient rights • Positions the usual Primary Practitioner (PP) at the center of the healthcare process • Meets the new social challenges of emergency services

  7. Duty MEDITEL Centre GP o n duty Administration Emergency Services Emergency Services Hospital 1 Hospital 2 DMMG MEDITEL SERVER primary practitioner INTERNET VIM Ambulance Gestion des rô les de garde Specialised medical Center Consulte Générateur de DMMG message d'information si le médecin de garde consulte les donnéesque le médecin traintant a déposé General Diagram

  8. DMMG Meditel Server Internet primary practitioner With the agreement of the patient, the primary practitioner transmits in a secure way all medical data considered relevant to a central server in order to set up a minimum data file for the duty roles.

  9. DMMG Meditel Server Internet MEDITEL Administration Under the supervision of ASBL MEDITEL, access rights to the server are managed based on the active duty roles (GP and emergency practitioners)

  10. DMMG Meditel Server Internet Emergency Services Hospital 1 Ambulance Medical Intervention Vehicle GP on Duty DMMG data file is then available for all General Practitioners on duty, Emergency Practitioners and medical intervention vehicles (VIM). Remote reception of data (out of the hospital) is done on a laptop or PDA via GSM (GPRS) connection.

  11. DMMG Meditel Server Internet primary practitioner In case of intervention, the service on duty has access to DMMG. Every consultation or added data is later transmitted to the primary practitioner in order to ensure healthcare continuity.

  12. Agenda • Presentation of PCSol • Objectives and General Operation of DMMG • Structure of the Transmitted Information • Technical Infrastructure • Legal Aspects • Advantages of the DMMG • DMMG and the Emergency Services • DMMG and the Healthcare Sector

  13. The primary practitioner selects the data to be exported from his DMI to the DMMG server : • Name, first name and birthdate • Persons to contact • Personal health history • Active healthcare elements • Chronic treatments • Last contact • Last biological test • Vaccines • Intolerances and allergies • Notes (preferences, comments…) Transmission process

  14. No double input : PP simply has to tick off data to be transmitted.

  15. Return of information to the PP After a consultation on duty • Within medical house • Within emergency services • At patient’s bedside • In Intervention Vehicles primary practitioners will be informed on DMMG access by a secure e-mail describing : • Name of the Emergency Practitioner • Name of the Patient • Date - time • Reason • Complementary explanations • Diagnostic or care elements • Follow-up of the treatment : hospital, return, death, transfer…

  16. Agenda • Presentation of PCSol • Objectives and General Operation of DMMG • Structure of the Transmitted Information • Technical Infrastructure • Legal Aspects • Advantages of the DMMG • DMMG and the Emergency Services • DMMG and the Healthcare Sector

  17. Data Flow DMMG Server GP Interface General Infrastructure Secure Server DB Duty Interface meXi Tunnel meXi Mail Duty Browser GP DMI meXi Tunnel meXi Mail

  18. 3-tier Architecture and Open Sources Components

  19. Exchange Standards • Web Services SOAP (Transport) • Uses standard format Sumehr (Summarized Electronic Health Record), customized version of the Kmehr-Bis format for emergency files (grammar) => DMMG is compatible with all DMIcertified by the Ministry of Public Healthcare

  20. Security • Guaranteed by the meXi Secure Solutions software suite • Transmission of messages from DMI to DMMG is done by meXi Mail • Consultation of DMMG via an Internet browser is secured by meXi Tunnel • These two pieces of software use a public key infrastructure (PKI) based on asymmetrical encryption algorithms and on a certification process specific to the healthcare sector.

  21. Agenda • Presentation of PCSol • Objectives and General Operation of DMMG • Structure of the Transmitted Information • Technical Infrastructure • Legal Aspects • Advantages for the General Practitioner • DMMG and the Emergency Services • DMMG and the Healthcare Sector

  22. Legal Aspects • This project has been completed in conjunction with the Centre de Recherche Informatique et Droit (CRID - Université de Namur) which defined the general conditions of use • With respect to the legislation (8/12/1992 concerning private life protection & 22/08/2002 concerning patient’s rights)

  23. Rights and obligationsThe patient • Gives his agreement during the set up of the DMMG file • Can request the withdrawal of his data whenever he wants to • Has access to his DMMG file via his PP or via ASBL Méditel

  24. Rights and obligationsThe doctor • Must use information with respect to ethical rules and within the limits set by the project • His access to a patient’s DMMG file is granted based on his duty role (which is managed by ASBL Méditel)

  25. Agenda • Presentation of PCSol • Objectives and General Operation of DMMG • Structure of the Transmitted Information • Technical Infrastructure • Legal Aspects • Advantages of the DMMG • DMMG and the Emergency Services • DMMG and the Healthcare Sector

  26. Advantages for the Patient • Ensures availability of reliable data about his health condition (responsibility of the patient for his health) • Avoids wasting time giving incomplete medical explanations in difficult or emergency situations • Provides better communication within the medical world • Completely free for the patient

  27. Advantages for the primary practitioner • Ensures healthcare continuity even during his absence • Keeps him in the middle of the healthcare process • Provides better communication with his colleagues • Maintains trust relationship with his patients • No investment needed for doctors who already have a DMI

  28. Agenda • Presentation of PCSol • Objectives and General Operation of DMMG • Structure of the Transmitted Information • Technical Infrastructure • Legal Aspects • Advantages of the DMMG • DMMG and the Emergency Services • DMMG and the Healthcare Sector

  29. Structural Problems Within Emergency ServicesDumont Véronique, Lobet-Maris Claire et Rousseau Anne, « Urgence aux urgences. L’informatique une solution ? » Presses Universitaires de Namur, Namur, 2004, 184p. • Growing number of patients in emergency services • Patient flow is unpredictable and out of control • Patients coming out faster (decrease in the number of beds) • Emergency services are reaching saturation point

  30. Organisation Problems

  31. Traps to be avoided The book also identifies three traps to be avoided when integrating ICT in the medical sector (emergency services)

  32. Agenda • Presentation of PCSol • Objectives and General Operation of DMMG • Structure of the Transmitted Information • Technical Infrastructure • Legal Aspects • Advantages of the DMMG • DMMG and the Emergency Services • DMMG and the Healthcare Sector

  33. Constant growth of healthcare expenditures (6% / year) • Ageing population • Development of new treatments adding to the old ones • Price explosion of more and more complex material • Increasing number of double examinations

  34. Verviers Experience • Creation of a Duty Medical House where duty roles are ensured by primary practitioners in strong collaboration with the hospitals of the region. • Ministry of Public Healthcare financing « Duty Medical Houses » in ten large cities before July 2005 (Le Soir, 25/09/04)

  35. DMMG : a solution DMMG is a first step towards a shared medical file

  36. Questions

  37. Thank YouMore information onwww.mexi.beProfessional Computing Solutions (PCSol)Avenue Hanlet 5bB-4802 Vervierswww.pcsol.beinfo@pcsol.be

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