DMMG : Minimum Medical Record for Practitioners on Duty Didier Leclercq, CEO & Owner Professional Computing Solutions sa (PCsol)

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• Advantages of the DMMG• DMMG and the Emergency Services• DMMG and the Healthcare Sector

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

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

Agenda



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

General Diagram

Center medical Specialised

Hospital 2 Hospital 1

INTERNET DMMG MEDITEL SERVER

primary practitioner

Centre Duty

GP on duty

VIM Ambulance

Administration MEDITEL

Consulte

Générateur de DMMG

message d'information si le médecin de garde

consulte les donnéesque le médecin traintant a déposé

Emergency Services Emergency Services

Gestion des rôles de garde

Centre médical Spécialisé

Hopital 2 Hopital 1

INTERNET MEDITEL SERVEUR DMMG

Médecin traitant

Centre de garde Médecin de garde

VIM Ambulance


Consulte




Urgences Urgences


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.


DMMG Meditel ServerInternet

Under the supervision of ASBL MEDITEL, access rights to the server are managed based on the active duty roles (GP and emergency practitioners)


Hopital 2 Hopital 1


Médecin traitant


VIM Ambulance


Consulte




Urgences Urgences



MEDITEL Administration

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.


Hopital 2 Hopital 1


Médecin traitant


VIM Ambulance


Consulte




Urgences Urgences



GP on Duty AmbulanceMedical Intervention Vehicle

Emergency ServicesHospital 1

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.


Hopital 2 Hopital 1


Médecin traitant


VIM Ambulance


Consulte




Urgences Urgences




Agenda



Transmission process

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…)

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

Return of information to the PPAfter 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…

Agenda



Duty

Browser

Secure Server

General Infrastructure

GP

DMI

DMMG ServerData Flow

meXi Mail meXi Tunnel

meXi Mail meXi Tunnel

Duty Interface

GP Interface

DB

3-tier Architecture and Open Sources Components

In ternet

Tom catJetspeed

Jboss

Pos tgresqlDatabaseLayer

A pp licationLayer

P resen tationLayer

D atabases objects

B usiness objects

P resentations objects

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

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.

Agenda


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

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)

Rights and obligations

The 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

Rights and obligations

The 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)

Agenda



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

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

Agenda



Structural Problems Within Emergency Services

Dumont 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

Organisation Problems

Emergency Process DMMG Solutions

Reception : access to information

Data previously provided

Medical triage : priorities constantly revised

Important decision support based on patients’ previous history

Assessment : various information systems

Information provided in standard format

Consultation : various contributors

-

Orientation of the patient at departure

Guaranteed healthcare continuity

Non-stop activity Permanent & easy access

Traps to be avoided

Traps DMMG

ErgonomyEasy & quick access, at every place

Legal & Ethical

Guaranteed confidentiality, integrity and authenticity.

Certified information trans-mission.

Organisational Compatible and standardised

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

Agenda



• Ageing population

• Development of new treatments adding to the old ones

• Price explosion of more and more complex material

• Increasing number of double examinations

Constant growth of healthcare expenditures (6% / year)

• 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)

Verviers Experience

DMMG : a solution

DMMG is a first step towards a shared medical file

Questions

Thank You

More information onwww.mexi.be

Professional Computing Solutions (PCSol)Avenue Hanlet 5bB-4802 [email protected]

DMMG : Minimum Medical Record for Practitioners on Duty Didier Leclercq, CEO & Owner Professional Computing Solutions sa (PCsol)

Documents

dmmg dmmg

dmmg server

emergency services dmmg

dmmg data file

pcsol slide

healthcare sector slide

comments slide

france slide