chu de liège, it state of play perspectives in the next 10 ......•since 2004, the chu has an...
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CHU de Liège, IT state of playPerspectives in the next 10-15 years
Pr. Philippe KOLH
CIO, CHU de Liège (Belgium)
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CHU of Liège, IT state of play
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Level of computerization of clinical tools at CHU of Liège
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• University Hospital (CHU) of Liège is an Academic Hospital
• 888 beds and >5.000 staff members
• Activities spread over 7 localizations including 3 hospitalization sites
• Since 2004, the CHU has an Electronic Patient Record (EPR) including medical, nursing and
paramedical informations and a complete RIS-PACS for medical imaging.
• These computer tools allow both the exchange of data inside the hospital and outwards to ensure a
better continuity of hospital care and extramural care.
Hospital IT
Rooms
Operating Rooms
Administration
Clinics
Laboratories
General Practitioner
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HIMSS EMRAM Scale
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CHU of Liège – rated at level 6 EMRAM end of 2016
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Assessment of a fully equipped care unit completely equipped with :
• EPR (medical, nurse and paramedical data)
• Electronic prescription for medico-technical examinations
• Electronic management of blood samples, drug and infusion prescription (CPOE) and
administration (cross-matching)
• Electronic transfusion administration (cross-matching)
• Computerized medicine cabinet
• Electronic "whiteboards" with all relevant information for patient care
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CHU of Liège – rated at level 6 EMRAM end of 2016
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But also:
- A pharmacy equipped with 2 robots
- Information management in Emergency Room (EPR)
- Information management in intensive care units with integrated monitorings
- Filmless medical imaging
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CHU of Liège – rated at level 6 EMRAM end of 2016
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CDSS - EPRClinical Decision Support System - Electronic Patient Record
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CHU of Liège – rated at level 6 EMRAM end of 2016
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CDSS – EPR
Clinical Decision Support Systems (CDSS) link health
observations to physicians’ knowledge
Some examples:
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CDSS - EPR
Emergency Room: Risk Evaluation (1)
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TIMI score : Estimates mortality for patients with unstable angina and non-ST
elevation MI.
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CDSS - EPR
Emergency Room: Risk Evaluation (2)
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Pneumonia Severity Index (PSI) or Fine score : estimates mortality for adult
patients with community-acquired pneumonia
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CHU of Liège – rated at level 6 EMRAM end of 2016
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CDSS – CPOEClinical Decision Support System - Computerised Physician Order Entry
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Drug Interactions
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o Drug - Drug
o Drug - Allergy
o Drug – Patient
o Drug - Doses
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CHU of Liège – rated at level 6 EMRAM end of 2016
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CLMA
Closed Loop Medication Administration
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Medications’ Prescription and Administration Plan
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Pharmacy robots are driven by (i) physician order and (ii) management
of medication stocks
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Closed Loop Medication Administration
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Robots identify each medication individually. They are connected to
physician order and match each identifier to one patient, one drug,
one dose, and one administration time.
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Closed Loop Medication Administration
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Administration
BCMA (Bar Coded Medication Administration)
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PDA
Patient wristband
Medications ring
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Towards level 7
CHU of Liège pursues the goal of a JCI certification, but also reaching EMRAM
level 7 for its clinical IT:
- 95% of the CHU equipped with electronic drug prescription and
administration (cross-matching)
- Optimization of the pharmacy organization in relation to:
- Pharmaceutical validation
- Drug stocks management processes and use of barcode
- Data culture systematization for continuous quality improvement
- Implementation of continuity plans.
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Hospital strategy in the next 10-15 years
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It’s obvious :
Health and IT are now closely linked !
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Health and IT are now closely linked
• Robots
• Internet of Things
• Permanent connectivity: connected objects are mostly used for
home care, to ensure a link with the patient. They can also be
used preventively (e.g.: For diabetic patients, connected tool
allows the patient to take his/her insulin units anywhere. This
information can/could be sent to the EPR, which can detect an
error and send an alert to the physician).
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Health and IT are now closely linked
• Hardware less expensive
• Implantable medications (equipped with bio-electric sensors that follow the
patient vital signs and deliver the medication if and when necessary)
• Big data : connexion of numerous systems generating a very large volume
of informations
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The « augmented surgeon »
Robots, more precisely a machine led by a surgeon, like Da Vinci medical robot, have been used for several years for surgery, mainly at abdomen level.
Da Vinci Robot
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Humanoid robots
Humanoid robots are appearing (e.g. Nao, used especially to
communicate with autistic children).
The evolution of their application field is the subject of much
research.
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The « repaired » man
Many perspectives for « repaired » and augmented man…
e.g.: a connected prosthesis that reproduces the sensation of the
lost limb.
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Smart sensors
• Temporary tattoos
From UC San Diego Jacobs School of EngineeringBiostamp, a connected smart patch for pregnancy follow-up
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FDA-approved coloscopy
3D printing
Smart clothes
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Big data and semantic research
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e.g. Watson for Oncology
Artificial intelligence to answer
questions expressed in natural
language
Watson for Oncology helps physiciansto rapidly identify the keyinformations in a patient EPR and to explore the treatment options to decrease the undesirable care variations
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Key message
The digital evolution is a « progress accelerator »: to study the
evolution of a disease on a large number of patients allows to better
target treatments to each individual case.
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And what is the hospital strategy
in this IT evolution context ?
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• Patients will no longer need to come to hospital for regular
follow-up (e.g. home electrocardiograms connected to the
hospital system).
• Individualized and predictive algorithms will allow to anticipate
health incidents
• Smart objects will diagnose and react according to the
measures by adapting the treatment (e.g.: closed loop
pancreas)
Hospital doctor’s perspective
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Hospital value will no longer lie in the number of beds occupied
or surgeries performed, but on the number of patients to whom
it has avoided hospitalization and on the number of preventive
solutions put in place.
Hospital doctor’s perspective
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Hospital doctor’s perspective
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– Doctors, nurses, patients, technicians, pharmacists, biotech. need to
know in real time where technological innovation is and where it is
going organize information
– The opportunity lies in the possibility for doctors, nurses, patients,
technicians to create new solutions in terms of care using technologies
that converge
– How to integrate / implement all these IT tools available on the
market ?
Are we almost there ?
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Change will begin effectively when :
- crowd will be aware of the costs and inefficiencies of the current
health system:
- 50 % of technical acts are useless (OMS figures)
- 42% inefficiency rate (OCDE 2013 figures)
- 10 % risks of iatrogenic damage(IOM, 1999)
- 5 % of diagnostic errors (Institute of Medicine- US)
- business world (innovative businesses) and medical world will start to
dialogue
- financing plans will be ripe to take the course
- human organization will be ready to adapt around these evolutions
Are we almost there ?
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The hospital in the 21st century health care evolution:
- Preventive medicine more than curative
- Increase of chronic pathologies and ageing population
- Health has to be « thinked » as a system
- Increase of home hospitalization and home care
Hospital is becoming less of a focal point and needs to change its
organization
More controlled budgets
Clever strategies to adopt new IT technologies that will sustain
these evolutions.
-
CHU strategy in the next 10-15 years
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• Renewal of its EPR (more efficient, more multi-actors
focused, more adapted for external integrations and
mobile applications)
• Participation in innovative projects :
– In-house IT developments (new internal IT skills !)
– Collaborations with commercial companies or start-ups
– Optimizing access to hospital information for external doctors and
patients (CHU portals, integration to “Réseau Santé Wallon”
www.rsw.be , mobile apps…)
– …
-
CHU strategy in the next 10-15 years
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• Pilot projects for home hospitalization:
– Intravenous antibiotic therapy (120 patients)
– Some oncology treatments (subcutaneous chemotherapy) (15 patients)
• Benefits for patients :
– No more Home<-> Hospital trips
– Decrease in fatigue and stress, no more waiting times in the hospital
– Reduced risk of nosocomial infections
– Well-being and comfort of their usual environment (home)
– Improving the patient's well being: presence of the patient's relatives,
emotional support, on a daily basis, by the home care team
– With the same quality and safety of care as in the hospital
CHU strategy in the next 10-15 yearsSome examples
Home hospitalization
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• In-house development of the « HoDIsée » application:
– Application on stand-alone tablet
– Using web services for all stages of identification, synchronization and
feedback
– Remains autonomous in case of disconnection.
• Special attention to the following points:
– Ease of use for service providers
– Easy synchronization of data
– Maximum security at the data exchange level
CHU strategy in the next 10-15 yearsHome hospitalization
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Objectives:
• Cover EPR management outside the hospital
• Facilitate the transmission and entry of information between home and
hospital
• Benefit from mobile tools (tel., Google Map, Waze, Skype, ...)
Technical principles:
• Multi platform development (Android / iOs - C # Xamarin)
• Using secure web services (https / token)
• Encrypted local data
• Asynchronous Wifi 3G/4G synchronization
• ERP common data
Home Hospitalization
HoDIsée – Applicative Plateform
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Extension and perspectives:
• Internal technical IT skills developped for a Mobile Home Application
• Ready for other features like:
– « Envol » – Early return after childbirth
– Telemedecine COPD (Chronic obstructive pulmonary disease)
– Telemedecine « Heart failure »
• Exploitation of provider program interfaces such as :
– appointments
– Clinical biology
– Billing
– …
Home Hospitalization
HoDIsée – Applicative Plateform
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Access to some shared CHU protocols by outside doctors
through the « Réseau Santé Wallon »
See: www.RSW.be
CHU strategy in the next 10-15 yearsSome examples
Integration with “Walloon Regional Network”
Dr André Vandenberghe - 2014
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Access to CHU EPR by outside doctors
• Objective
Grant outside doctors access to CHU's EPR from outside the hospital
using their personal material
• Tool
– OP’Portal : access to OmniPro CHU EPR in WEB mode
– Physician identification: Strong authentication via ID card + PIN
code
CHU strategy in the next 10-15 yearsSome examples
OP’Portal
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Integration with the app. Andaman 7 that allows CHU
patients to download their medical file on their
Smartphone or tablet.
CHU strategy in the next 10-15 yearsSome examples
Integration with App. Andaman 7
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Objective: creation of a monitoring multi-sensor and wearable
device, comfortable for the hospitalized patient, equipped with
an Early Warning score algorithm and compatible with the
IT infrastructure and EPR of Euregio Meuse-Rhine hospitals.
CHU strategy in the next 10-15 yearsSome examples
Interreg WearIT4Health Project
www.wearit4health.com
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for the CHU Cancer institute:
Objectives:
• Improving the quality of oncology care throughout the Euregio.
• Well-designed and realistic actions that focus on organizational and technological innovation with
immediate results for the population.
Action 1- Patient Centered Medicine:
• Development of a teleconsultation network of scientific and medical experts providing personalized
advice on certain patients from partner and associated institutions.
• Development of a portable technology allowing patients to report their assessment of real added value of
the received treatments (PROM).
• Setting up home hospitalization.
CHU strategy in the next 10-15 yearsSome examples
Interreg Oncocare Project
https://www.interregemr.eu/projets/oncocare-fr
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Action 2 - Quality of care :
Development of quality management (QM) sanctioned by accreditations :
• harmonization of cancer registries
• facilitating the exchange of our data for quality control, comparative analysis
(benchmarking) and clinical research
• set up an effective QM system in each center
• development of a global management software for transplanted patients
Oncocare – Interreg Project
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Action 3 - Access to innovative treatments :
Encourage innovation and its rapid transfer to the clinic :
• development of care itineraries and guidelines
• sharing with associated institutions
• improved access to new treatments through a common clinical trial platform and a
concerted strategy on rare cancers.
Oncocare – Interreg Project
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Stimulation of the vagus nerve to treat some forms of atrial fibrillation
Non-invasive device
CHU strategy in the next 10-15 yearsSome examples
Cardiax : Biowin project
www.biowin.org
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Cardiax : Biowin project CHU is currently proceeding to an in-house development of the « homelink » (development of the hardware and communication protocols that allows the aVNS device to communicate securely with the eHealth Interface providing data for processing within the Diagnosis Algorithm.
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CHU is collaborating with a « spin-off » of the UCL in order to develop tools for:
- Help in “RCM” codification
- Linguistic research in the EPR
- Better medical history management in the EPR
“Turning medical records into actionable knowledge”
CHU strategy in the next 10-15 yearsSome examples
Data mining
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• Need to better organize health care to improve the quality of care and reduce costs associated
with redundant or unnecessary acts
• More and more budget control for hospitals
• Hospital value will no longer lie in the number of beds occupied or surgeries performed, but on
the number of patients to whom it has avoided hospitalization and on the number of preventive
solutions put in place.
• It is evident for Doctors that health is now linked to the world of IT:
– The digital evolution is a « progress accelerator » to study the evolution of a disease on a
large number of patients and to allow to better target treatments to each individual case.
– Predictive algorithms will allow to anticipate health incidents
CONCLUSION
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• Patients will no longer need to come to hospital for regular follow-up (e.g. home
electrocardiograms connected to the hospital system).
• Patient finds himself strengthened in his role of taking charge of his health thanks to the
applications and connected objects that are offered on the market.
• Many innovations are constantly being proposed to health sector by research and industry.
• Collaborations are necessary with the business world to integrate new technologies with the
hospital system.
• A need for strengthening IT skills within hospitals to monitor and integrate technological
developments.
CONCLUSION
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Thank you!
Pr. Philippe KOLH
CIO, CHU de Liège (Belgium)