EHTO Trends in Health Telematics in the European Union
  
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Updated: Dec 6, 96
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BELGIUM |
POLICY AND FUNDING
In Belgium a policy aimed at encouraging the development of IT in university hospitals was launched in 1970. To support the introduction of computerisation, initially specific funding was provided for IT investment and for certain projects such as the Minimum Clinical Data and Minimum Nursing Data Sets (MCDS/MNDS). There was substantial user involvement in the preparation of these initiatives. The use of MCDS and MNDS in hospitals became mandatory in 1988 and 1990 respectively. An Informatics Commission was set up in 1974, composed of representatives of the National Insurance Institute (INAMI), the Mutualities, hospitals, doctors and pharmacists. This Commission has competence to deal with all questions relating to data processing within the health system including, for example, hospital and laboratory billing systems, medical data sets, statistics.
The Ministry of Health and Social Affairs established a Health Telematics Committee in 1995. The committee is defining data exchange in Healthcare; the messages can be considered as national implementations of the European data standards. By Belgian law, hospitals will be encouraged to follow these standards in order to get accredited and to obtain more efficient reimbursement of costs.
KEY INITIATIVES
New health care telematics programmes have been launched both at national and regional levels. These focus on the use of ISDN and broadband, on the exchange of different types of data (text, images voice and signals) and on standardisation. National programmes deal mainly with standards in telematics, while regional projects are mostly oriented towards pilot applications. Specific projects of interest include a telematics pilot project involving direct access by general practitioners to radiology protocols and to clinical laboratory reports; a network of sentinel general practitioners; and a network of microbiology laboratories,looking at the possibilities of telematic data transmission. The external Quality Assessment System is proposing the introduction of EDI for all participating laboratories. The Ministry of Public Health is currently developing a policy of transfer of information through networks for hospital management, based on inter-hospital medical and financial data comparisons, using anonymous data sets from similar categories of institution.
DEGREE OF PENETRATION
About half of Belgian practitioners have computers. Of these approximately one third use them for management applications and a quarter for medical records. Belgian hospitals however are largely computerised, but the existing systems are used mainly for administrative purposes such as budgetary control, invoicing, personnel management and health insurance documentation. Laboratory and radiology management systems are very widespread, and systems for managing medical images are becoming fairly common. There are moves to computerise medical records in university hospitals but this is complicated because medical records are maintained within specialties rather than in centralised record systems.
Belgium has a very comprehensive and detailed uniform data set system based on discharge diagnoses in all acute care hospitals (seven million MCDS a year), as well as a detailed description of all procedures performed in hospitals and ambulatory care. This unique information system facilitates health care planning activities, and the planning and evaluation of the appropriateness of care. At national level the database facilitates dialogue between government, doctors, nurses, administrators and insurers. As an example, since 1994 DRGs have been used for hospital financing, with resources being transferred between hospitals on the basis of their performance.
TRAINING
Since 1970 medical informatics has been available as an optional course in most schools of medicine but is not included as a compulsory subject either in basic nurse training or in undergraduate medical courses. Informatics teaching does however constitute an important part of postgraduate nursing education, and is included also in university postgraduate programmes in hospital management or public health.
Most Belgian universities do not have a chair of medical informatics but possibilities exist for those wishing to undertake postgraduate studies in medical informatics. A number of advanced informatics courses are provided by the Ministry of Public Health for their own staff but also for coding personnel. In addition, since 1995 courses have been organised for doctors wishing to learn about the interpretation of hospital activity data.
DATA PROTECTION
Considerable attention has been accorded to confidentiality issues both with a specifically legal framework and by the Belgian Medical Council (Ordre des Medecins) culminating in a new confidentiality law in December 1992. Among its specific aspects, personal medical files have to be declared to the Commission on the Protection of Personal privacy, a doctor has to be designated as "holder of the file" and the objectives of data capture have to be specified. Every patient must be informed as to the content and purpose of any file where personal data will be processed. He may access the file through the intermediary of a doctor of his choosing.
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