Implementing an Integrated Care System for Diabetes & COMMODITY12 lessons learned

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Godfrey French
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1 Implementing an Integrated Care System for Diabetes & COMMODITY12 lessons learned Evert Jan Hoijtink CEO & Founder Portavita Member EU FP7 project COMMODITY12 Istanbul May 20 th,

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COMMODITY12 Facts Community financial contribution: 4.051.000 (max) 7th Framework Program Priority 2 Information Society Technologies Strategic objective: ICT-2011.5.1.b: Personal Health Systems (PHS) Instrument Type: Small or medium-scale focused research project (STREP) Duration: 01.

3 COMMODITY12 Facts Community financial contribution: (max) 7th Framework Program Priority 2 Information Society Technologies Strategic objective: ICT b: Personal Health Systems (PHS) Instrument Type: Small or medium-scale focused research project (STREP) Duration: Project Management: German Research Centre for Artificial Intelligence 10 Partners (University Medical Centers, Research Institutes, Universities & SME s) Treatment of Diabetes 1 & 2 patients in Poland and Italy Remote Monitoring, Genetic Markers, Decision Support & Implementation Call identifier: FP7-ICT Contract No.: COMMODITY12-3 -

4 COMMODITY12 Projects partners Sensor Technology Care Management System Sensor Technology Decision Support Implementation Genetics Security Sensor Technology Decision Support Implementation - 4 -

5 COMMODITY12 Logical Structure Analytics Communication Management Care Management Data Management - 5 -

6 Who is this SME and what is their experience in Diabetes care - 6 -

7 About Portavita... Leading European Telemedicine / ehealth supplier Supplier of Integrated / Multidisciplinary Care since 2002 for: 70 medical organizations patients (Treatment, Care and Prevention) patients performing self management medical users (nurses, doctors, specialists) Anticoagulation, Diabetes, COPD, Palliative, Elderly Care,... Customers & Pilots / POC in: Netherlands, Germany, Russia, Poland and Italy Implementing 2015: France, Curacao SME: Portavita = 54 employees (31 developers) ISO and CE certified, IHE, HL7, IHTSDO, CIMI Involved in several European Innovation projects - 7 -

8 jan-02 mei-02 sep-02 jan-03 mei-03 sep-03 jan-04 mei-04 sep-04 jan-05 mei-05 sep-05 jan-06 mei-06 sep-06 jan-07 mei-07 sep-07 jan-08 mei-08 sep-08 jan-09 mei-09 sep-09 jan-10 mei-10 sep-10 jan-11 mei-11 sep-11 jan-12 mei-12 sep-12 jan-13 mei-13 sep-13 jan-14 mei-14 sep-14 jan-15 Patients Portavita patient numbers through time Nr. of Patients NL Patients in treatment ACT_PV ACT_TDAS Diabetes COPD CVRM Elderley Care

Diabetes or Integrated or Regional care These Regional Care Groups organize and execute Multi Disciplinary Care, Treatment and Prevention programs.

9 Diabetes or Integrated or Regional care These Regional Care Groups organize and execute Multi Disciplinary Care, Treatment and Prevention programs. Groups exist of 25 up to 200 General practitioners, but also connections to Diagnostic centers, Physiotherapists, Internal Medics,... Programs for Anticoagulation, Diabetes, COPD/ Asthma, Cardio Vascular Risk Management, Palliative, Elderly Care and Individual Care Plans

10 Diabetes / Integrated care Results Nr. 2 in Europe Strong Point: Integrated Care Weak point: No Diabetes Registry Wien, September 17th, 2014 This report may be freely quoted, referring to the source. Health Consumer Powerhouse Ltd., ISBN The Netherlands nr 2 Portavita First Mover in 2006 & Market Leader Diabetes Care in NL

11 Why Important Finding in the Report Need of a country wide accepted, process based, Treatment Approach Requirement from the Government and accepted by professionals? But you need a reward system for both doctors and IT Suppliers!!!!

12 Diabetes Care In an Integrated setting!

13 Communication Server Portavita Patient Centered Care HUB Roche Bodytel Fitbit Fitbit Nike Apple Internet NPT hub Near Patient Testing FHIR CDA Internet Access & Security Portavita ICS Integrated Care System Internet FHIR IOT hub Lifestyle & Wellbeing CDA Laboratory ORU, QRY, ADT Hospital ADT, Summary HL7 V2 CDA GP ADT, Summary... Portavita Application Data Portavita Application Data copy Data Bus Decision Support Clinical Data Warehouse FHIR Server CDA Server CDA Access & Security Patient Portal Central Patient Repository PHR Personal Health Records FHIR

14 International Only with Standardisation

15 Use of international standards : Barthel Index

16 Lessons Learned Big & Raw medical data

17 Uploaded Sensor data Respiration

18 Uploaded Sensor data Glucose

19 Uploaded Laboratory Data HL7 V

20 Example screen Genetics

21 Integrated care and patient centered care A Vision!

22 Auditing Logging Consent Governance Billing... Portavita Vision for ehealthcare in 2020 Self Containing & By Law LIS Laboratory HIS Hospital XCIS Any Clinic System XIS... X D S X D S X D S X D S Person Wellness Portal AIS Pharmacist X D S X D S IHE Connectivity Layer X D S Market Value GPIS General Practitioner Supplier Portals X D S Patient Portals Research Portals PHR Foundation PHR Personal Health Records Consortium RIVM ZonMW TTP Public / Private

23 Exploration Partners & Roles

24 Exploration International Roll Out Local Healthcare Market Partners: Sales, Services, Integration & Hosting 3 rd party COPD / Asthma... Elderly Care Cardio Vascular Risk Management Security Billing Anticoagulation Diabetes Auth. Portavita Integrated Care Platform IHE XDS,... Local TTP / PaaS solutions provider

25 Lessons Learned Decision Support

26 Example Diabetic Foot Examination Examination Data is automatically combined with administrative and process data

27 Example Diabetic Decision Support EHR / HL7 Version 3 RIM Internally coded using Snomed or Loinc Based on input of the examiner the SIMMS category is calculated Explanation of relevant and up-todate Guidelines

28 Example Diabetic Decision Support Current automatic treatment advices are general rules and not personalized. COMMODITY12 intents to extend this approach using Translational Medicine

29 Example Treatment advices Activities must be executed Advices only based on available medical data

30 Wrap up & most important lessons learned

31 Lessons learned Market acceptance of new technologies is a very slow process New innovative IT solutions bring transparency, efficiency and effectiveness Transparency means control, criticism, not nice Efficiency means somebody in the closed health community get less money Effectiveness means somebody did not do it right before Cooperation between SME and Universities is a big win Universities do not make production ready systems We are able to figure out how new things work It is very good for our image You also need first customers and government / payer acceptance for the innovation in the project! SME need paying customers and approved practices

32 Also Diabetes Integrated Care Step by step approach starting with one disease, via comorbidities towards prevention and individual care Balancing Medical protocols and individualized care How to bring All that Knowledge in the day tot day doctor s practice Substitution of care towards the patient

33 The End

Introducing Portavita

Introducing Portavita Evert Jan Hoijtink Founder & Co-Shareholder Amsterdam, the Netherlands - 1 - Integrated Care in the Netherlands a pioneer Started in 2001 with a web based Anticoagulation Self Management