Diagnosis and treatment plan
The congress, organized by the Federation of Medical Specialists and the VIPP and Registration at the Source programs, consists of two parts. The first part, the diagnosis, is a tour of different developments that together determine today’s digital Umfeld: visibility and insight into the digitization of information (flows) and processes in healthcare. The second part, the treatment plan, offers a perspective for action. Also to take colleagues who are not on the front lines along in the movement that is underway.
Now that almost all hospitals have set up an electronic patient record (EPR), the path is wide open for sharing information with each other. You would think. But it’s not that far yet. Because standardization of what you record is needed for that. And standardization has been a kind of taboo for a long time, says Vincent Buitendijk, managing director of the NVZ. ‘We all want to do it our own way.’ Meanwhile, people are starting to become convinced of the necessity to clearly record for multiple use of information. Now the step to ‘do’.
First get the basics in order
The Registreren aan de bron and VIPP programs, among others, accelerate the hospitals. The first by, among other things, steering towards national agreements on, for example, uniform language, adjustments to the systems and working differently, so that the foundation of clear and one-time registration for multiple use is laid. The second program, VIPP, is an implementation program that realizes both communication between healthcare professionals and communication between healthcare professional and patient. The active involvement of the medical specialist is crucial for achieving the goals of the programs, which is one reason for organizing the congress.
Hospitals have now set up an EPR for the vast majority and have made it accessible to the patient with a patient portal. This raises many questions. Should a hospital want to share all the doctor’s notes with the patient? Neurologist Esther Verstraete (Rijnstate) doubts it. She knows from experience that the excess of information can be quite discouraging for the patient. For example, are the considerations leading to the diagnosis interesting for the patient?
From the audience comes the reaction that we should not want to determine this for the patient. These are essentially patient data, so the patient can decide about them. Internal medicine nephrologist Marc Seelen (UMCG) says in response that the ‘patient’ does not exist. You will have to look at the patient sitting in front of you to decide how much information is needed and desirable. Personalized digitalization, as it were.
ICT: a step deeper
In addition to the developments around the EPR, the patient portal and other communication issues, more is happening in healthcare. Artificial Intelligence, for example. Doctor Joost Huiskens is the Healthcare industry expert at SAS Netherlands. There are many misunderstandings about AI, he explains, such as the idea that AI would make the doctor superfluous. The real question, however, Huiskens tells his audience, is how AI can strengthen the doctor. The doctor must present the problems and the data analyst must provide the solution.
There are few examples of good AI applications. Why is that? AI applications are subject to scientific testing as soon as they are used in practice. This is logical, but you might not expect it if you develop a tool that supports the doctor in his decision-making process by outlining possible options and the doctor is still the one who makes the decision. From the audience comes the question whether the trend is not to develop open source. Huiskens welcomes this for the development of applications. But: ‘As soon as you apply it within the walls of the hospital, it must comply with the rules of the hospital.
The course of action: the how
Knowledge of the developments is necessary, but various speakers today also point to the behavioral change that is needed among doctors. Radiologist Jan Jaap Visser (Erasmus MC) calls on his colleagues to stand up and actively engage with digitalization issues. Radiotherapist oncologist Gabrielle Speijer (HagaZiekenhuis) also advocates taking the lead as a medical specialist.
Speijer points to SNOMED CT; an international medical terminology system for use in direct patient care. Many doctors still write their findings in free text, but how nice would it be if we all do that in the terminology of SNOMED CT? Uniformity and standardization are largely a fact then. Translation into different languages has been set in motion and for the Netherlands that process is fully underway in 2018. ‘You can still join in’, Speijer calls on the attendees.
And also your colleagues
The attendees today may form a vanguard, but how do you take your colleagues with you on the path to further digitalization and uniformity of data? Internal medicine nephrologist Iris Verberk is CMIO at the Maasstad Hospital and tells about the bridge function she fulfills as CMIO between medical staff and ICT. For Verberk, ICT can greatly help to support and strengthen the passion you have as a doctor to make people better. Forge alliances with colleagues who think the same way, she advises. And: ‘Chose your battles, also in this area. Go for what is feasible.’
Head and neck surgeon Guido van den Broek (Radboudumc) changes the behavior of his colleagues with the project. Doctors who already know how to work with the EHR train other doctors in the Radboudumc. Quickly reducing administrative burden is what Van den Broek tells the attendees to do today. By outlining the yield, which is desirable for every doctor, you create the breeding ground for the behavioral change you want: standardization of information and good and efficient use of the EHR. You can immediately want to make quality leaps, but that will not convince colleagues to come over.
From the audience comes a response based on, among other things, the labor-intensive nature of the project. Hospital care is still based on processes from the 1970s. From the audience also comes the relativization that the hospital is after all a complex company, where the privacy of patient data must be paramount. Just some questions that come up:
- If we continue at this pace of change, will the hospitals of today still exist in 2030?
- And what do we think about it when the big data giants start offering more efficient and equally effective healthcare solutions to patients, leaving the hospitals behind?
- Should professional associations not be much more concerned with standardization and standardization in order to make progress and take bigger steps?
Again: the possibilities of AI
Anesthesiologist Bart Geerts (Amsterdam UMC) changes the behavior of his fellow anesthesiologists, nationally and internationally, with data analysis and an algorithm. It all started with the observation that low blood pressure during surgery often precedes complications. But if you only act when there are complications, you are actually too late. Data analysis confirmed the observation.
What was needed then was an algorithm that predicted low blood pressure as early as possible, earlier than the anesthesiologist could see changes in the patient with the naked eye and before low blood pressure was a fact. And so it happened. Now Geerts et al can act proactively. Geerts: “AI allows me to do what I was trained for: to guide people through the operation.” Geerts has not yet published, but the algorithm has proven itself many times. Moderator Bruns: “Behavior change here is the result of technology, of an algorithm.”
How do you actually change behavior?
Paul Smit is a philosopher and comedian and provides a different view of today’s subject. Objectively observing is a difficult story according to Smit. As a surgeon, you can be happy if you see the top of your thumb sharply, the environment of your thumb is at best VHS video quality at best. What does that mean for changing behavior? Smit focuses on the three types of brain that we humans have and which you need to take into account when changing behavior. The first, reptile brain, is focused on safety and acts automatically 99% of the time based on what you believe to observe. The second brain is the mammal brain that is focused on pleasure. That brain teaches us to make things easy; as Smit told us. The third brain is the neocortex, which likes to think.
Safety, passion, and being meaningfully engaged; that is the basis on which behavior change can take place, if you look at our brain, Smit concludes. On those elements, attendees can therefore try to implement a desired change. And: we have to learn to look differently. Don’t think too quickly that we are making an objective observation.
“After today’s session, what will the attendees do differently?” Asks Emma Bruns. On stage, several medical specialists share their ideas. Gynecologist Jeroen Becker (St Antonius) sees huge potential for using technology to encourage behavioral change. And: “You don’t really need to understand computers. Just know what you can do with them.” MDL physician Joyce van Dijk (Albert Schweitzer Hospital) puts the additional workload for doctors, which many are currently complaining about, into perspective. This is a phase, she says. “If we also start digitizing processes, we will save time.” Professor of ENT Henri Marres (Radboudumc) advocates for quick action. The issue we face is about both content and processes, and the doctor must deal with both, he says. And with that, Bruns sums up the day. “Taking the lead” is what the doctor is obliged to do when it comes to ICT issues today.
