Re: Rural Health Grant - "You are not alone ... ", CRISNET in Belgium

[Etienne Saliez]

Will Ross and Bruce Slater, You are not alone.  We are dealing here with very similar problems. Our project is called "VIRTUAL CARE TEAM ", focusing on the support for improving collaborative work between all the care providers in charge of the same patient. The care team of the patient includes the coordinating GP, and depending on the needs of the particular patient, specialists in diverses organizations, nursing at home, etc...  most of the partner having various softwares from various commercial providers. The care team itself is recorded as an element of the patient record, i.e. a short list of users or groups of users having been mandated by the patient for his/her own care. In our view the underlying main problem is the coordination role of the " Family Doctor " in " Primary Care " .  In that way the project is as well "rural" as "urban", because the need for sharing patient records exist everywhere. In our country patient identification is less difficult because nearly every adult is always carying an " identity card " and a " social security card ". By the way, both of these cards include the same national citizen ID number.  Moreover the current identity card on paper begin to be replaced by smartcard, having a legal value for electronic authentication and signatures. But even in that case there are still difficulties in some situations.  I believe that the solution is to accept that a person may have more than one identifier, on condition that these identifiers links to only the unique right person.  Many kinds of medical ID numbers are already around and could continue to exist.  Of course one of these alias identifiers is the descriptive identity i.e. the set of " first name - last name - date of birth - sex ", although of limited reliability because this is not always unique in large populations. CRISNET is a small not for profit organization created by a group of GPs in Belgium.  We certainly cannot achieve alone all things we are dreaming of.  That is the reason why we must find Open Source collaborations. I will read more in details the  " http://openhre.org/ " website. A simple medical record in web mode is already operational in a medical center for about 40 doctors, working completely paperless. Have a look at a summary of the project: http://www.crisnet.be/Presentations/LSM-2004/Index-Roadmap-Components.html Much remains to be developed, particularly about the workflow of Services :  the management and follow up of many types of "Orders" as e.g. request for specialist consultation, request for lab, prescriptions, etc.... There is already a generic UML model, based on a GEHR like appraoch, but needing further developements. However sinds many partners in the Care Team may have very different softwares, very basic minimal exchanges have be defined as a local Belgian standard using XML : http://www.chu-charleroi.be/kmehr/htm/kmehr.htm I am seeking partners for the creation of a coherent set of web pages, in principle on the web site or linked from the web site of the IMIA Open Source Working Group We intend to participate in a workshop during or after the MIE-2005, Medical Informatics Europe, this year in Geneva, on August 28- Sept 1  :  http://www.mie2005.net/ Could you join in Geneva and discuss your views ? The question is to evaluate how far the requirements are similar and how far specifications could be formulated in a way meaningful in different regions. However some cultural differences may exists and will need to be precisely identified. The pragmatic goal is to arrive at agreements to share at least a few software components. Best Regards, Etienne Saliez, MD http://www.crisnet.be/index-uk.html clos des Pommiers 4 La Hulpe, B-1310 Belgium tel   + 32-26541759 will ross wrote: On 12 Dec 2004, at 7:34 PM, Bruce Slater wrote: To the List:   We have a grant to study the feasibility of connecting a state-wide group of hospitals, clinics, private offices and labs. The grant is a planning grant (<200K US) for an implementation grant (<2M US) to make the system happen. The goals of the system would be:   A patient from any entity would be recognized at any of the other entities and identified from others of similar name, age and demographic characteristics.  A provider could request, with proper authentication and permission from the patient, any information at a linked facility for electronic delivery to the providers facility. A provider could order tests, imaging and consults to be done at any linked entity for their patient.   Constraints: The entities have completely unrelated commercial vendors (none open source) and some have no electronic infrastructure. The entities have local customization expertise across the spectrum from none to a team of experts.  Bandwidth is variable from fiber to dial-up.   I searched back over the last year or so in the list and picked out some posts referring to MPI and like subjects.   So, the opportunity are a couple at least:  An open source patient identifier functionality An open source record exchange system An open source EHR to be distributed to facilities currently without such.   We are currently surveying the participating facilities (less than a 100) for their level of automation and data availability.   We have a consultant named Neal Neuberger of Health Tech Strategies, LLC. who organizes the monthly meetings which have just started.   Appreciate any thoughts about next steps, reference documents, implementation consultants.    Thanks   Bruce Slater, MD, MPH Medical Director Computerized Decision Support University of Wisconsin Hospital and Clinics Bruce, You are not alone. We've been playing in a very similar place for the past year. We've met a couple other projects looking for a similar solution. In August we launched a portal to kick up the collaboration a notch. Take a look at it (Open Health Records Exchange) and give me a call.   http://openhre.org/ With best regards, [wr] - - - - - - - - will ross technology project management suite 206 216 west perkins street ukiah, california 95482 [voice]  707.272.7255 [fax] 707.462.5015 http://www.phoenixpm.org - - - - - - - -