We are here today with Yan Vekemans, country sales manager in Belgium for inner systems and founder of the #one Patient, one record for Belgium campaign. We are also joined by John Godgame, a sales engineer. Intersystems gentlemen, thank you for joining us today.

Thank you, Jordan.

Thanks for having me.

Yeah.

Yes.

I thank you for the opportunity of.

What I'd like to do is I'd like to.

OK.

What I'd like to do is umm we.

You know what?

I'll wait for your signal before I say something.

We're here today with Jan Vekemans, country sales manager in Belgium, founder of the #one Patient One Record 4 Belgium over an intersystems. We're also joined by John Goodgame as sales engineer. INTERSYSTEMS gentlemen, thank you for joining us today.

Thank you, Jordan.

Thank you grabbing.

Umm, what? I'd like to.

Yes, what I like to do is discuss fire adoption and consent policies both in Europe and in the United States. So I'd like to pass it over to John to start. Jan, would you please talk to us about what the current state of fire adoption is in Belgium and Europe more generally?

Well, Jordan, in the last couple of days, I've been here at him since Chicago and that gave me a bit of a perspective of the differences between what's happening in Europe and what's happening over here. And I must say I'm globally, we can say that the world's old fire.

Yeah.

But fire is gaining momentum in Europe and what we can see is that in the larger countries there are in every country at least one major project that is being taking place. What did I'm lacking and what I'm seeing here in the US, much more than in Europe. And John is going to probably contradict me on some of this, but there is more a coordinated.

Effort that is taking place here here in, in the US because in all the boots that I've been to in all the people that I talked to here, we're all having the noses in the same direction, not necessarily in the details, but at least in the story. And when we give talk in Europe, well, when you're in the UK, you get a good story. When you're in Germany, you get a good story, but it's not the same story. And that is still a worry that I have that we're looking at.

A standard that's going to be standardized per country rather than standardized overall.

Yeah.

John, what are you seeing in fire in the United States? So it sort of adoption trends and standards and what is the story that you being here with fire attention?

So yeah, I, you know, generally speaking I I do think that there is a pool in the same direction here and and we're seeing more and more fire use cases being put into service at the hospitals and facilities. I would say you know.

Up until maybe this last year or so.

Most people were saying ohh I'd need to do fire and they do one or two interfaces and then they go yeah we do fire and and that would be the end of it.

And I think there's a misunderstanding about.

What fires really intended to be used for? So I think there's been some, you know, some scars over the last few years of people using it incorrectly, or at least where its current state incorrectly. I mean, maybe one day fire will be used for, you know, the event driven sending information. But generally speaking, you know you see people using the old HL 7V2 dot X for their event driven like ADT.

Where you're feeding another system, a source systems feeding another system, you really don't want to necessarily.

Have that as your fire interface. You really want it to be used in the case where?

Maybe you're you're requesting information from that system, and maybe from a mobile app or from some other device, but you're not like.

Feeding and another system that needs the ADT information. You know, as it happens, it's just, it's just not quite there yet to be used in that use case. But that definitely more and more people are using fire and I think more and more people are gearing their purchases toward using fire.

Umm.

To yawn, I'd like to ask you particular fire use cases in Europe that you've seen. You said that there's a good story in the UK, good story in Germany, but sometimes it's not the same story. Our listeners CIO's are our tell systems in the United States are very interested in having these in listening to anecdotes and hearing exactly what sort of stories are transpiring. And I think that will will straight potentially the differences between Europe and the US. Would you mind sharing a story about fire use cases among some of your customers?

Yeah. Well, let's start with the UK, the UK, the biggest country in in Europe, although we're no, there are no longer part of the EU, they're still part of Europe. What some people sometimes forget. But the NHS, which is the National Health Services, has created something that's called the digital Fire API lab and that is system that will allow developers to test that fire based applications in basically in a sandbox environment.

That is helping enormously also for people to understand what can be done at the current stage with fire because.

One of the problems I saw in the beginning of this year and last year was that people were starting to do what John just said and tried to use fire for everything. You know, fire was going to replace the entire world.

That's not going to happen, certainly not with the current implementation. So having something like a lab that that well verifies and help you in a safe environment, look at what can be done with fire is certainly a good thing. You have the same in France, where the assurance Asante, which is basically E health but then in French is promoting interoperability through the use of fire and in Germany.

You have dematic who is doing the exact same thing, but here again.

It's.

About how to.

Exchange information.

Uh, rather than about.

Doing it all an example in my own country is where we we recently had the data capability call for tenders where Belgium is off. The government is offering 25 projects, €2 million in an effort to get fire based applications out in the market. But what I find a problem with that is.

They have not put any boundaries on it, so if I hear what people are trying to do, they're trying to achieve exactly what they shouldn't be achieving. They were trying to build everything on fire again.

So that's a problem.

John, would you care to counterpoint with merican examples and use cases?

I.

Umm yeah so.

I think we lost John for a minute.

OK.

Let's go on to uh, consent. Uh John, would you speak to us about consent policies in Europe and how that's working?

Yeah. Well, let me let me start by saying you, you when you introduced me, you gave Me 2 titles, one was the the title of a sales manager at Intersystems, the other one was the founding father of #one patient One Record 4 Belgium. And that came into being because I basically as a patient.

Became involved with, well, I had cancer. And then then you get into. I need my data for a second opinion.

Mm-hmm.

And I thought, well, that's simply all sign a piece of paper that gives consent to the hospital to get the data to someone else so that we can have a second opinion. It turned out that it's slightly more complicated than that because the first thing that happened was that they threw GDP are in my face as the reason for not giving me my data, which is kind of funny because if you look at the rules in, in, in GDPR, it says that I am entitled to have an overview of all the data that's available about me.

So that's that's a Side Story that that actually brings me to why consent and and why I think it's important. I think it's important because patient consent shows no respect for the privacy and autonomy of the patient. It is something that that will actually improve the data quality because all of the sudden the patient can help find.

Errors, discrepancies, things that are not completely OK, and he can actually and and this is a short story, I'd like to tell one of the people that I interviewed in the past will have they immune disease.

And she went to a doctor.

And the doctor was not doing a thorough job.

He didn't look through everything that needed to be looked through and gave her the the, you know, the simple wave of a hand and said ohh lady, you have some thyroid gland problems like so many women, blah blah blah blah blah. Instead of she had this disease. There were seventeen other women in her family who had that disease, so it's not like she was going lightly over it, but.

Because of the fact that no consent is required between doctors to see your records.

The 2nd Doctor she went to see who actually had been trained by the 1st Doctor, didn't see the necessity of going deeper into it because his mentor had already judged that she didn't have that disease. In. Long story short, she had to go to five doctors before the disease was actually accurately diagnosed. So if proper consent would have been in place, she could have stopped the 2nd Doctor from seeing the diagnosis from the first one.

Mm-hmm.

Interesting. So that's the topic of of consent among providers. John, I'd like to turn it back to you. What sort of examples?

Of.

It's 10.

Uh use cases from among our your customers or 1000 United States.

Yeah, well, in in the United States, consent can be different from state to state, which makes it very interesting as as the government is really pushing for these, you know, consolidations of of of larger health systems, they start to span States and you know the consent policies have to be available so that you know each facility has you know is following the rules of that particular state. And at the same time these larger.

You know, IDN are actually crossing all the States and and it it, it creates a little bit of a problem especially when you start talking about you know fire.

We're usually thinking of the fire as being more along the lines of a rest type of service, right where you're you're using it for mobile apps, you're using it for other things, and at the same time, these facilities are supposed to track how the information is being viewed or used. And there's this becoming this layer of separation, right. So it's not, I don't think it's gonna be uncommon.

For a facility say ohh download our app.

And someone's walking around with the mobile app and they're in New York City, and maybe they're providers in New Jersey. And so I I'm wondering how those consent policies and and really the regulations are going to apply when people are in two different locations and maybe the facilities don't even know, you know, where that person currently is located and they're they're grabbing information from multiple systems. So with fire, I think we're, we're.

Gonna have to be very careful about what's being used. So in in one case I know of.

UM fires being combined with, you know, other types of data that's being enriched by three or four or five different systems before it's, you know, served up into the patient's mobile app. And so these the consent policy, you sort of get a couple layers away from the actual healthcare system because someone's gonna layer of application or a layer of this and and then you have to think of how do I, as a healthcare system.

Identify who's viewed this information, who's viewed that information, and even if it's your own information, there should be some tracking of that. But I think fires being used for systems as well. So you know, I think there's gonna be layers and layers of applications put in with fire. And I think it's going to create some problems with people trying to track and audit, you know, who's seeing what and when.

Yeah.

That.

Jan, I think when you look at Europe, there may be a comparable, perhaps even more extreme version of what John just said in the United States, you have laws in different States and then you have federal laws. But in Europe you have GDPR, which is applicable to about 27 countries. But then obviously you have individual countries. But let me ask, are IDN or integrated delivery networks generally limited to one country or are you starting to see health systems that go into different countries?

There is, as far as I know, none that crosses a border. It's actually even worse. There are countries where you have, like in Belgium, where you actually have three healthcare systems that are separated from each other even on a state level because you have the Flemish region, you have the Walloon region, and you have the Capital Region. And they actually are even not capable of properly exchanging information amongst each other.

So it gets it gets really difficult to get information from one place to the next and one of the things that when I when I started with #one patient one record for Belgium, what I noticed was that I got calls from Germany from France, from Luxembourg, from Holland, the countries around Belgium. And they said, well, we have people that are cross-border workers and when they get into an accident or whatever and they need.

The care we don't have any data of them.

So are.

So that's how bad the situation currently is.

Is there any effort in Europe to create?

We should exchange within Europe.

There is something called the European health data space that is currently being discussed.

European health data space should.

Uh, facilitate some of this, but my biggest worry with that is that the 1st place where they are looking is secondary use of data, not primary use of data. So it's a bit.

Of a A a problem in itself.

Umm.

So and and on the topic of consent, how? How, what is the status of of patient consent in in Europe? How would it be affected?

With the different political boundaries, how would people access their information or give consent to see to limit who would access their information?

Yeah.

Well, let let let me start with Belgium. The country I live in, the we we have something that's called my health viewer that the government has put together and that actually allows you to give consent to several doctors or or to one doctor to see all of your data. Now the problem with that is that populating that system is proving, let's say, at least challenging.

Because there are six or seven EMR that are active in the country.

There's 169 hospitals. That's how small the country is and.

Communication is haphazard at best.

Hmm.

You know that's how bad the situation is.

John.

If you look at the UK, then between regions like Wales, like Scotland, like the UK itself, those in England, those those things.

Are relatively well taken care of.

But they're also not complete, same as in Germany.

And in France, there is a good effort that's being done, but as far as I hear it's far from correct. And then I'm not talking about Spain or Italy or Greece where these current state of health care is.

Questionable at best.

So we are approaching the end of this podcast episode and John, I'd like to ask you if you'd care to just comment and wrap up if you were able to.

That's.

Uh, have a wish. Something have a genie. Grant you a wish about fire or consent policy. You probably wouldn't want to make a wish about those two topics, but if you were limited to those two topics, what would you like to see in the United States?

I'd like to see, you know, the adoption road map, you know, be laid out for all of the people who are excited about fire, right? Cause I I think.

It would be nice for everybody to sort of be on the same page, like you know what level of maturity is fire at and what what is the most useful use cases in terms of it, you know, put implementing fire. You know, you don't like, you know, like John was saying, you know, it's not everything, right. You don't want to just start going. Oh, I'm gonna do everything in fire because you're gonna create issues for your own healthcare. So system and I think what.

It would be nice to have is is a very basic road map of you know for your fire applications start here you know start start with when you're looking at you know feeding a mobile app when you're looking at feeding interactive communication to help populate some sort of application, whether it's a handheld mobile device or tablet. You know you're trying to do a little bit of light gathering of information about that patient. Fire makes a lot of sense.

Umm, but you know, don't don't overdo.

Uh. Take take on a project at a time and understand what the impact of of using fire is to that particular application. As far as consent, you know, I think it's it's probably as much education about two US as it is you know to the to the patients or anyone else in in the sense that you know things are changing and so there are times where I'm I'm not quite sure you know what the impact is of having a mobile app you know across state lines or having.

You know is is, is that OK? Is it not OK? I'm, you know, am I following the rules of New Jersey or am I following the rules of New York?

Umm, so I think there's some. There's some education on our side as to in terms of you know, how do we approach these large ideas across state lines or in in non's case across countries where they wanna share information and put it into one location and do it in such a way that we're not, you know, breaking any rules or regulations or or, you know, that at the same time we're keeping track of the information in the United States. You have to track anyone who sees any of that. So.

You know you need to be able to do all those things, and I think there's gonna be some interesting conversations over the next few years of of what that looks like.

Yeah.

And I I I you know, personally I feel like I'm, you know in the 1st grade in turn when it comes to fire and I think most of us are right, we're we're all still learning.

But I think it's gonna be some interesting times and hopefully hopefully we can just start with simple things first.

Any closing statement Jan reaction.

Yeah. Well, why, while John was speaking, I I actually had this, this, this little thought that that said actually fire and consent are not that far apart when you when you give it an acronym on the One side fire on the other GDPR.

They're actually in both in the same infancy state, and there they were at a certain stage seen as the solution for the entire problem.

And that's exactly not what they are. They have created their own problems. They have created their own issues, but on the other hand, what they have done is they have given us a handle to get from first grade to 2nd grade.

Yeah.

Use your words John, because I think that was a very good analogy and and what I would wish for us to have would be.

Somebody who's simple enough of mind.

To use these things where they are supposed to be used rather than just use them everywhere.

Alright. Well, gentlemen, thank you for a listeners. It's just been Jan Vekemans, a country sales manager in Belgium for Intersystems and the founder of #one Patient One Record 4 Belgium and John Goodgame as sales engineer for Inter systems in the United States. Thank you so much for joining us today.

Thanks Jordan.

Thanks.