Hospitals in the Netherlands work together from various electronic patient dossiers (EMR's)


Tjongerschans Hospital and Leeuwarden Medical Centre (MCL) have embarked on a pioneering process with their IT partners ChipSoft and Epic to make their patient dossiers available to each other. The hospitals are now collaborating closely on a consolidated version, but use different software. The challenge: to optimise their collaboration by making structured information from the EMR's available to one another. The objective: to improve patient care.

IT manager Wiebrand Hoeksma from the Tjongerschans hospital and Anton Wegman, data analyst and ZAM project lead at MCL provide context and clarifications for the project. 'We are the only consolidated hospital organisation that uses both HiX and Epic. Integration and exchange are priorities in both Tjongerschans' and MCL's IT strategy. Based on that strategy, we started this project a year and a half ago. Our common objective: to make information available in the right place at the right time so that doctors have a complete and current picture of the patient at all times.'

'We also want to counteract over-diagnosis. Up to now, extra blood was taken sometimes or a CT scan was made unnecessarily, if that data was not available in one of the hospitals. Both hospitals now offer, within the EMR, a complete and current picture of the patients they jointly treat.'

Tjongerschans uses HiX Digital Health Services Platformby ChipSoft, and innovative SAAS solution for the external cooperation in healthcare. The exchange via HiX Digital Health Services Platform is based on international standards and runs using standard building blocks (so-called clinical building blocks, or ZIBs, zorginformatiebouwstenen in Dutch).

Now that Antonius Ziekenhuis Sneek, Nij Smellinghe and Rehabilitation Friesland are also connected, Friesland is a fascinating test case and an example for the healthcare sector. 'The phone is ringing off the hook. Many hospitals are interested in our approach and experiences.'

How did both hospitals open their digital walls?

'A year and a half ago, we thought: if we share the basic data, supplemented with the unstructured documents, then we'll have a dataset we can use to continue care. In Friesland, we organised the availability of images via XDS diffently, which should make exchange more complete. This is the perspective from which we started.'

'In the Friesland region, MCL focuses on complex care; the surrounding, peripheral hospitals, like us, focus on less complex care. For orthopaedics, for example, the first consult takes place on-site in Leeuwarden, then the treatment is later carried out in Tjongerschans and the post-care again in Leeuwarden. For urology, it's the other way around: initial consult in Heerenveen, procedure in Leeuwarden and post-care in Heerenveen. Exchanging patient information among care providers makes patient care better, cheaper and faster.'

Has this exchange been an important reason for implementing HiX Digital Health Services Platform?

'Yes, definitely. The MCL and Tjongerschans were looking for a solution to link the two systems, where both suppliers (ChipSoft and Epic) were able to work together to exchange structured information based on standards. Taking into account, of course, the individual possibilities and equipment of both solutions.'

'Another important reason is that Tjongerschans has insufficient capacity to be able to offer all of this on its own. Despite the technical expertise that we have in-house, as a small hospital we cannot unlock all this data by ourselves. That is why we opted for a kind of universal "plug" based on national and international standards, which we can plug into an infrastructure that provides a link to personal health environments (PGOs), hospitals, general practitioners or other healthcare institutions. So that you can then exchange data quickly and adequately in a safe and responsible manner. Tjongerschans uses HiX Digital Health Services Platform by ChipSoft for this, and MLC uses "Care Everywhere" by Epic.'

How did you start?

'We started ambitiously by bringing all parties together to listen to each other's ideas and starting points. The MCL and Epic, as well as Tjongerschans and ChipSoft, quickly found each other in their desire to be the first in the Netherlands to start this kind of exchange. We had to deal with different perspectives that had to be made compatible. The springboard provided by HiX Digital Health Services Platformhas helped to ensure that information is properly integrated into each other's environments. The important thing is that both EMR's support data exchange according to the same national and international standards. In this way, we have fulfilled our ambition: during the coronavirus crisis, the successful transfer of the basic data between the two systems has been achieved.'

And then the coronavirus crisis brought so much crashing down...

'Yes, indeed. This makes the urgency of data exchange clear to everyone in one fell swoop. This reality resulted in an offer by ChipSoft to connect other hospitals to HiX Digital Health Services Platformvery quickly, so that information could be shared nationwide. This quickly led to some 40 new hospitals joining Zorglatform. These recently connected hospitals benefit from the result of the cooperation between MCL/Epic and Tjongerschans/ChipSoft.'

How do you ensure that the patient consents to the sharing of information?

'In order to be able to share information, the patient's consent is crucial. The MCL had already taken steps in this direction at an previous stage by recording the consent of a large number of their patients. In Tjongerschans, we still faced a challenge, because we had not yet registered the correct permissions for all patients. To speed up this process, we have been helped a bit by the coronavirus crisis. When the clinics re-opened, all patients were called two days before they came in to go through the coronavirus questionnaire. We also included the request for permission to exchange data. We also ask our patients this question on our online portal. In a relatively short span of time, we received a lot of confirmations of consent: no less than 99.46% of the patients we asked gave their consent. So patients do not have any trouble granting consent, and we're aiming for 100%! This way, we continue to provide the best care to the patient.'

What are the most important tips you would like to give your fellow healthcare institutions?

'Simply Do with a capital D. Because you have to think big and start small to get innovation up and running. Start the dialogue with all the parties, determine the starting points with each other, as well as the long-term goal on the horizon. Tjongerschans and the MCL had a head start, given the long-standing relationship and regional cooperation agreements. The collaboration between the various EMR suppliers was also very positive, because all parties agreed with the principles. They may be open doors, but this approach brought us where we are now. Of course, we cannot ignore privacy legislation, but think in terms of possibilities. A solution to many issues can be found with all parties involved.'

There is a lot of interest from other healthcare institutions for this project. What are the most frequently asked questions?
'The questions are in relation to the GDPR, how it functions and options for using HiX Digital Health Services Platformin HiX and other EMR's. What is important to all healthcare institutions is the user-friendliness for the healthcare professional. It can be done from a technical standpoint, but it will only be a success if it is used by the healthcare professional. The exchange of patients' medical information among healthcare providers makes care better and faster and is also safer for the patient, because there is always a current picture of the patient. Through Epic this can be done with 'Care EveryWhere' and through HiX Digital Health Services Platform for HiX hospitals.'

What are the reactions of your healthcare professionals?

'The initial reactions are positive. Healthcare professionals involved, especially the doctors, find that it is an improvement, and they see the potential. A good example is that one of our orthopaedists wanted to discuss a patient with a colleague from Antonius Sneek. Thanks to this new solution, that could take place simply, quickly and securely. A participating urologist also sees the added value, because he can view his colleague's OR report from the MCL in HiX on the spot, without having to perform any additional actions or logging into the other EMR.'

And the patient?

'That's why we're doing all of this. We recently inquired with one of the patients involved in this project. The care for this patient is spread over three hospitals, and the patient was favourably surprised about his current data being available, which meant less time was needed to convey and provide supplementary information. He said it was only logical, and of course he is right; in this day and age, there is little reason not to share data.'

'I expect this to become more and more an integral part of the doctor's records in the coming period; to have access to what is available in relevant medical data across hospitals.'