Some thoughts on health and healthcare

The European Union is remarkably absent as a coordinating and operational force in the current COVID-19 crisis. Why can't Europe coordinate the healthcare emergency caused by COVID-19? The reason for this is hidden deep into the roots of the European Union. We want Europe 'ma non troppo' and then we blame Europe for not being capable to act. Is there a way to create a European public and personal healthcare ecosystem, serving our European patients and our healthcare workers in a time of this COVID-19 crisis and beyond? Not within the limited framework of the Treaty on the Functioning of the European Union (TFEU, aka The Treaty of Rome) and the Treaty on European Union (The Maastricht Treaty). According to Article 168(7) of the 'Treaty on the Functioning of the European Union', Member States are responsible for the definition of their health policy and for the organization and delivery of health services and medical care. The EU can only adopt health legi

 As a pandemic such as COVID-19 is a global problem, we will need to act on a global scale in order to prepare for future pandemics, as this will not be the last one we will have to deal with. The consequences of this COVID-19 pandemic will also have an impact for years to come.   From the report of the WHO 'Independent Panel for Pandemic Preparedness and Response': "The COVID-19 pandemic is a sign of how vulnerable  and fragile our world is. The virus has upended societies, put the world’s population in grave danger and exposed deep inequalities. Division and inequality between and within countries have been exacerbated, and the impact has been severe on people who are already marginalized and disadvantaged. In less than a year and a half, COVID-19 has infected at least 150 million people  and killed more than three million. It is the worst  combined health and socioeconomic crisis in living memory, and a catastrophe at every level."  The Independent Panel for Pandem

 The idea of 'value-based healthcare' (VBHC) isn't entirely new. The concept of evidence-based quality improvement goes back to the 1850s with Florence Nightingale and her collaboration with the medical statistician William Farr (E.C. Kudzma, 2006). In medicine, a result- or outcome driven approach goes back to the 'End Result System' of Ernest A. Codman and his article on ' A Study in Hospital Efficiency: As Demonstrated by the Case Report of the First Five Years of a Private Hospital ' (1914), in which he stated: "Every hospital should follow every patient it treated to determine whether the treatment has been succesfull for this patient, and should inquire - if not - why not - with the view to prevent similar failure in the future" (E.A. Codman, 2013). Codman put forward three core principles of quality assurance (QA): Examining quality measures to determine if problems are patient-, system-, or clinician-related Assessing the frequency and p

 Already in 1863, Florence Nightingale in her ' Notes on Hospitals ', wrote: "In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purposes of comparison. If they could be obtained, they would enable us to decide many other questions besides the one alluded to. They would show subscribers how their money was being spent, what amount of good was really being done with it, or whether the money was not doing mischief rather than good: they would tell us the exact sanitary state of every hospital and of every ward in it, where to seek for causes of insalubrity and their nature; and, if wisely used, these improved statistics would tell us more of the relative value of particular operations and modes of treatment than we have any means of ascertaining at present" (F. Nightingale, 1863, p. 176; G.O. Barnett, 1989, p. 85).

  By using a SNOMED CT enabled EHR, data can be mapped to ICD-10-CM ( I-MAGIC ) and ICD-10-PCS ( MAGPIE ). Both SNOMED CT, ICD-10-CM and ICD-10-PCS allow for analysis of different aspects of healthcare, an interesting combination for developing value based healthcare (VBHC).

  Een van de uitdagingen waarmee onze Belgische ziekenhuizen worden geconfronteerd, is om hun zorgprocessen te verbeteren in kader van laagvariabele zorg. Dan is het handig om een instrument bij de hand te hebben zoals process mining om je zorgprocessen of klinische paden in kaart te brengen en door te lichten. Aan de UHasselt hebben ze daarvoor bupaR (open source) ontwikkeld, waarmee je aan de slag kan. Vertrekkende vanuit bijvoorbeeld je Admission, Discharge & Transfer (ADT) gegevens kom je al een heel eind en krijg je inzicht in je zorgprocessen om gericht met je procesverbetering te starten. Enige kennis van R , Python en de  PM4Py python library kan uiteraard geen kwaad.

  The COVID-19 pandemic made clear that we desperately need to improve the international interoperability of our health data.     The SNOMED CT Global Patient Set (GPS) is a managed collection of existing reference sets available to any user at no cost. It's positioned to support cross-border interoperability and enhanced digital maturity as users move towards decision support and full analytics capabilities in their respective strategies. The SNOMED CT GPS offers clinical content across dentistry, renal, family & general practice and nursing areas, and includes IHE, DICOM, and HL7 International Patient Summary (IPS) domains and activities. SNOMED CT content supports the HL7 IPS and also the terminology to underpin the CEN European Standard for the Patient Summary.  

  The COVID-19 crisis made clear that technical and semantic interoperability between the different European health infrastructures and IT systems is of strategic and lifesaving importance. As part of a European Health Data Space the European Union seems to be contemplating a common EU SNOMED CT license ( eHealth Network Summary report 18th eHealth Network meeting (Teleconference) 12-13 November 2020 ). However, it will take an eternity before our European legacy systems will be capable to deal with SNOMED CT or any other modern terminology (LOINC, …). We are still living in a European software museum with regard to our strategic and vital healthcare software infrastructure.  

  Onze noorderburen hebben op 31 maart 2021 een mijlpaal bereikt in Eenheid van Taal en in totaal 265.000 medische begrippen en synoniemen uit het internationale medisch terminologiestelsel SNOMED CT vertaald. Hiermee is SNOMED CT beschikbaar in het Nederlands en samen met de onlangs gelanceerde NationaleTerminologieserver kunnen gezondheidszorgsystemen in Nederland voortaan gebruik maken van meer (inter-)nationale terminologieën en classificaties. Een welgemeende proficiat aan Pim Volkert en iedereen die hier in Nederland aan heeft meegewerkt! Het echte werk kan nu beginnen om onder andere de verouderde systemen die in de gezondheidszorg draaien SNOMED CT enabled te maken. Op dit moment kunnen in onze contreien slechts enkele Amerikaanse EPD’s (Epic, Cerner) natief met SNOMED CT werken. De ziekenhuizen die hiermee werken krijgen nu toegang tot al het moois dat SNOMED CT te bieden heeft. De rest zal waarschijnlijk nog enkele jaartjes mogen wachten.  

An interesting white paper by Nictiz on 'The importance of a joint European approach to information exchange in healthcare'. In the paper, they discuss the Refined eHealth European Interoperability Framework (ReEIF model, Refined eHealth European Interoperability Framework ). There is a growing awareness that if European countries join forces internationally in the area of healthcare interoperability, this will speed up developments and stimulate healthcare innovation. It also has the potential to improve our desperately needed resilience and robustness in times of crisis.

While individual rare diseases affect only a small percentage of the European population, they collectively affect up to 30 million people in the EU. Being able to share European data for research and innovation would benefit patients all over Europe ( European Rare Disease research Coordination and support Action ). The Institut national de la santé et de la recherche médicale (Inserm) and SNOMED International have created a map from SNOMED CT to the Orphanet Nomenclature of Rare Diseases ( INSERM, SNOMED International and Orphanet ). Orphanet nomenclature files for coding  

Bij een spoedgeval, wanneer elke seconde telt, kan digitale overdracht van gegevens tussen ambulance en het ziekenhuis levens redden. Het ziekenhuis kan zich voorbereiden op de patiënt die eraan komt en met intelligente systemen kan zo nodig een zorgproces in gang worden gezet (OK, cathlab, interventieradiologie, traumacentrum, …). Daar moeten dan wel goede afspraken over worden gemaakt en de communicatie dient landelijk georganiseerd en gestandaardiseerd zodat de verschillende systemen mekaar begrijpen. Bij de noorderburen hebben ze daarvoor in hun informatiestandaard Acute Zorg SNOMED CT geïntroduceerd voor eenduidige gegevensuitwisseling. Als we dat nu eens voor heel Europa voor mekaar kregen, dat zou pas fijn zijn en meteen goed voor onze artsen en hun patiënten.  Nictiz vernieuwt informatiestandaard Acute Zorg

  De evolutie van COVID-19 varianten in België tot begin mei 2021, waaronder B.1.1.7 (20I/501Y.V1), B.1.351 (20H/501Y.V2), P.1 (20J/501Y.V3) en B.1.167 (Data van ECDC & GISAID:  https://www.ecdc.europa.eu/en/publications-data/data-virus-variants-covid-19-eueea ). Meer besmettelijke varianten, zoals o.a. B.1.1.7, verhogen de exponentiële verspreiding van het virus, wat zorgt voor een snellere overbelasting van de gezondheidszorg. Wat B.1.167 ons gaat brengen is nog enigszins af te wachten ( https://twitter.com/AdamJKucharski/status/1343567425107881986 ).