June 5, 2023
June 5, 2023
Exchanging data of oncology patients quickly, wholly and securely during multidisciplinary team meetings (MDTs) increases the quality of treatments. With this goal in mind, six hospitals and other healthcare stakeholders have established a regional MDT infrastructure managed by Data Delen Midden Nederland (DDMN).
The first project of digitally supported MDT meetings in the DDMN is already running successfully with the help of the Vitaly platform. Other regional oncology networks can now join as DDMN’s ambitions extend further, say the initiators.
“We want to develop this initiative for more specialties in this region as well as for the same specialties in other regions.”
Corné Mulders and Peter-Paul Willemse (UMC Utrecht) and Arjo Boendermaker (Data-Sharing Central Netherlands).
Data exchange is growing rapidly in the healthcare industry. The secure, standard data exchange will become mandatory by the Dutch Wegiz Act. The regulation of European Health Data Spaces (EHDS) also outlines a clear framework for the exchange of medical data between healthcare providers and patients.
Data exchange also plays a major role in MDT meetings, intended to provide the best possible treatment plan from all relevant specialties and functions. In order to provide high-quality care, MDTs are becoming increasingly important.
How important are MDT meetings?
“From a clinical perspective, the emphasis on quality control has grown in recent years,” says Peter-Paul Willemse.
As chairman of regional MDT and oncological urologist at UMC Utrecht, he is involved in the development of DDMN’s regional MDT infrastructure.
“At least in the oncology field, we want to review every patient in the MDT meetings. That way, we can monitor and optimize the quality of care. Also, the patient’s treatment improves because multiple disciplines are involved.”
Secondly, standards have become progressively stricter to ensure the quality of care. Willemse continued. “The volume of patients increased greatly! And because of that, specialists who attend MDT meetings need to be able to read up and prepare the cases faster than before.”
The third rule is that all regional hospitals discuss their cases with the University medical centre (UMC). UMC must provide that opportunity through an MDT meeting. It has a legal role in stimulating data exchange in the region, adds Corné Mulders – UMC Utrecht’s Chief Information Officer.
“That also means making care easier in innovative ways. Care is becoming increasingly complex, partly because of the growth in the number of patients with more conditions at the same time. And because specialization is increasing, cooperation with other hospitals and institutions is growing. Multidisciplinary, but also as centralised as possible.”
Corné Mulders: “As specialisation increases, cooperation with other institutions grows.”
The importance of data exchange
There are three reasons why fast and high-quality data exchange is so important, argues Willemse and Mulders. You want to get all the relevant data at the push of a button for the best possible diagnosis, advice or treatment. And that requires a digital platform, as you can’t travel everywhere for every MDT meeting.
This led to the first digital MDT five years ago, in which all practitioners involved could connect via a video link. However, data exchange was still poor. The patient’s list was circulated with a medical diagnosis but without further content. Involved healthcare professionals were unable to prepare cases or insufficiently so. Patients were presented during the MDTs and had to be assessed immediately, while advice also had to be given.
“That was very time-consuming, well… actually more like impossible,” Willemse noted. “That’s why we started to look for a platform where we could thoroughly prepare the discussion of all patients in advance and could optimally participate in an MDT meeting to discuss a case properly, efficiently, and make optimal use of the expertise present.”
Data Sharing Central Netherlands (DDMN)
This demand created Data Delen Midden Nederland (DDMN), explains project leader Arjo Boendermaker. A partnership of six hospitals affiliated with the regional oncology network Oncomid and six IT vendors.
“There were clear needs that we wanted to meet. One was to reduce the high administrative burden at MDTs. Doctors and their secretaries were typing information from one system to another.”
“As the need for MDTs grew, it happened more and more often that they did not take place because the administrative burden was too high. By providing a digital platform that minimized this burden, we wanted to simultaneously give a quality boost to MDT meetings by making them as accessible as possible.”
Less burden, improved quality, privacy and security were the reasons to look for a suitable MDT platform, adds Boendermaker.
“There was already a kind of intermediate portal where data from the patients could be uploaded, after which it was manually put into the UMC’s Electronic Medical Record (EMR). But besides being administratively burdensome, this is not the most secure way of working.”
Arjo Boendermaker: “As the need for MDT meetings grew, it happened more and more often that they did not take place.”
Why Vitaly platform?
DDMN focuses on facilitating the preparation and execution of the digital MDTs using the Vitaly platform from Parsek, which is a part of Open Line company. Vitaly was specifically designed to facilitate things like MDT meetings, digital referral management and digital data transfer.
“Many platforms were looked at, but based on the vendor comparison, Vitaly came out on top.”
Boendermaker says: “We chose Vitaly because they had the best integration capabilities. On the one hand, you want an MDT platform to support the entire workflow – including proper planning and preparation. But the links with EMRs and XDS infrastructure are also important for good data exchange. Vitaly brought all of that together.”
Meanwhile, the first digital MDT (for urological oncology) has been running successfully for quite some time. All of the hospitals’ wishes have been realised, says Boendermaker.
“Such as registering a patient from your own EMR, and not via URL where you had to go to another system and then have to log in again to transfer the data. But also getting the report in your own EMR after discussing a patient. And third, linking patient data from the XDS system to patient’s registration so that you can get real-time data via XDS.”
“What we are still working on is that sometimes a hospital wants to get the patient data in their own EMR as well, in case a patient is referred to that hospital. This creates a new demand further down the healthcare chain that the Vitaly platform would have to meet.”
From a clinical perspective, Willemse believes it is especially important that the MDT advice can be immediately forwarded in writing and automatically to the general practitioner and other specialists involved.
“Furthermore, it is important that the system makes it possible to implement the MDT meetings according to the SONCOS standards – the foundation for interdisciplinary knowledge sharing and development in oncological care. SONCOS has made many rules since 2012 to make the changes for the sake of quality in the field of MDTs. We can meet this with the Vitaly platform.”
Peter-Paul Willemse: “We can meet the relevant quality requirements with our new Vitaly MDT platform.”
Willemse further believes it is important that this system allows everyone to see in real-time what is being documented and have a say in what is being decided.
“That secures quality control. And finally, the system is set up so that hospitals can use it for quality control and their quality cycle.”
Built to scale
The initiators hope for and expect an oil-slick effect. For example, there are 11 tumour working groups in Utrecht, nine of which have MDTs. “We are working with them to prepare for the introduction of the platform,” says Boendermaker.
“There is also potential outside the region. There are already discussions with several of them about reusing what has been realized in the DDMN.”
Boendermaker emphasizes that there is already concrete interest in DDMN’s infrastructure for birth care and also for cardiovascular specialities.
“We based ourselves on all relevant standards, such as Nictiz (local) and IHE (international). The information standard was not there yet, so we coordinated it with all the Citrien regions for oncology networks to prepare for national scale-up.”
“If you look outside oncology, that information standard will be different – which patient data do you want to share to conduct an MDT. For everything else, we have come a long way with the foundation we have now laid.”
Incidentally, according to UMC Utrecht-CIO Mulders, the health insurers – who co-funded DDMN – had also made the use of national and international standards a condition for funding so that scaling up could take place after the project.
“It’s completely logical because it’s not like you have completely different work processes in Maastricht, for example. The necessary functionalities and standards that serve as a framework are largely the same. We want to develop this initiative for more specialties in this region as well as for the same specialties in other regions.”
The ecosystem
Finally, Boendermaker emphasizes that there is an entire ecosystem involved in DDMN.
“The three of us are just the representatives of that ecosystem: Zorgverzekeraars Nederland, the association of Dutch Healthcare insurers, was willing to pay for this innovative project, the hospitals UMC Utrecht, St. Antonius Hospital, Meander Medisch Centrum, Diakonessenhuis, Ziekenhuis Rivierenland and Tergooi have realized the project with their healthcare professionals, ICT professionals and administrators. We got this done together.”