Removing digital boundaries within the care sector

Data exchange between patient applications and care systems based on the FHIR Specification

As a result of greater patient self-management, Dutch mental healthcare institutions are increasingly dealing with various types of eHealth, such as apps and games (gamification). The data gathered by these tools are essential for building a proper picture of patients, and consequently the course of treatment. The biggest challenge arising as a result of this, is integrating eHealth tools with healthcare systems. The Koppeltaal Foundation is an initiative by the Dutch mental healthcare sector that aims to make this integration a reality.

Sergej van Middendorp is project leader at Koppeltaal. His team helps IT vendors work together as a single community. “Mental healthcare providers, IT suppliers and health insurers are all represented in Koppeltaal. Bringing together these various stakeholders, with a range of different interests, required some coordination. Only when you share a vision can you determine your objective and start working towards achieving it.”

Benefits for all involved
The overarching objective is to ensure data exchange between eHealth modules and eHealth platforms. There are many advantages to this. For example, patients can work on their own treatment independently and involve those around them, for instance through apps and games. In addition, mental healthcare institutions benefit from an optimal mix of modules that they can offer, and reduce labour costs at the same time. Health insurers, in turn, benefit from better care quality at lower costs.

Game for children with autism
Van Middendorp mentions ‘Kick-ass’, a game for children with autism, as an example of an eHealth application in mental healthcare. This game, which was the result of co-creation, helps children deal with complicated social situations, and thereby to function better in daily life. “Several healthcare providers joined forces to develop this game. Then it was an obvious step to link the game to different eHealth platforms. This approach formed the foundation of Koppeltaal.”

Belief in FHIR
Autism is a complex area, involving both structured and unstructured data. There is structured data in the form of scientific research and substantiated treatment data, and unstructured data in the form of feelings and emotions. There are only a couple of fixed principles; the rest has to be learned when work on development and use starts. “At the end of 2014, we were asking ourselves if there were any standards that could handle these two data profiles,” says Van Middendorp. “HL7 FHIR proved to be the answer, because flexibility is integrated into the standard. In addition, FHIR is tailored to the latest online standards, and easy to expand. At that time, the standard was still in its infancy, but we believed in FHIR and that’s why we chose it.”

Integration via Koppeltaal server
Koppeltaal set up its own server where applications exchange data securely through FHIR. Each mental healthcare institution can choose its own eHealth platform. Connecting to the Koppeltaal server integrates all available eHealth treatments, regardless of the chosen system or app. The result is a more complete picture of a patient. Van Middendorp explains, “These might be, for example, the effect measurements of treatments, and we are currently working on linking electronic patient files.”

Removal of digital thresholds
According to Van Middendorp, Koppeltaal’s vision and approach also offers opportunities for other applications. “The question we all have is, how are we going to manage to integrate platforms and applications into a digital care system in the Netherlands? Our ultimate aim is to remove digital thresholds. We’re looking at how Koppeltaal can support this. This perfectly reflects the recent BETER met ELKAAR (BETTER with EACH OTHER) report, which was recently presented to the Minister of Education, Science and Culture. This report describes how we want to offer health and vitality to more people.”

Koppeltaal already has 16 different links with mental healthcare applications. “The number of messages exchanged through the server doubles every month,” says Van Middendorp proudly. “Koppeltaal is currently still a project organisation. Now that the product has proven itself, and more and more parties are joining in, it is important to safeguard continuity and management. We are talking with the VZVZ (Association of healthcare providers for care communication) about this at the moment.”

4-layer IT-system model in mental healthcare
– eHealth modules – self-management of support, therapy and monitoring
– eHealth platform – self-management, group therapy and monitoring as part of a treatment plan
– Electronic patient files – supporting care professionals in managing and documenting patient contacts
– Hospital information systems – logistic and administrative support for planning and implementation