The highway network for digital information exchange in healthcare. That's what CumuluZ wants to be. Achieving that ambition requires investments. Major investments, rising to a total of some 450 million euros. But these are going to pay off, believes Mark Janssen, member of the Radboudumc board of directors. "We're going to save a multiple when healthcare providers no longer have to duplicate or triple administrative and other operations such as diagnostics."
Academic hospitals, united in the NFU, launched their plan for a nationwide data availability network in September 2022. With the recent IZA implementation agreement, CumuluZ has received a big push. The agreement identified CumuluZ as the blueprint for system-independent data exchange.
Eight thousand data sources
"The great thing about this development is that healthcare has taken back control a little bit," Janssen says. "Data availability is really something we need." Now that data availability is far from optimal. Health data are recorded and stored in different ways. And exchange can only be done using specific applications and expensive links. "We are talking about data in more than eight thousand data sources," Janssen clarifies. "If you want to have access to all those sources, you still need all specific solutions now, and that doesn't work."
Digital highway
Within the industry association of university hospitals NFU, Janssen is one of the directors responsible for the plans for a national digital infrastructure. In layman's terms, that infrastructure can best be compared to the main road network, according to Janssen. "The road layout in the Netherlands is the same everywhere. Exits all have the same format. Whether it's a truck, motorcycle or passenger car, if you have a driver's license and your vehicle meets the vehicle requirements, you can drive on that road network."
Utility
Regardless of origin, size and form, digital health information should be able to move similarly across the digital highway. And the comparison doesn't end there. "Like the main road network, the exchange infrastructure should become a kind of utility function," Janssen says. "It has to be non-competitive and non-commercial. We don't have two or three different highway networks in the Netherlands either. On that infrastructure we are not going to compete or turn a commercial profit. That also means no specific suppliers or owners."
CumuluZ Coalition
For now, the development and design of CumuluZ has been a matter for the teaching hospitals. This does not mean it is a plaything of the MUMCs. "We may have started it, but CumuluZ is of and for the entire healthcare system," Janssen responds.
"The perception that CumuluZ is something imposed by the teaching hospitals is unjustified. If it were a party of the umc's, it's not going to work either. We want to grow together toward a public function for a national data infrastructure." With the cooperation between NVZ, Santeon, mProve, ZN and NFU within the CumuluZ coalition, the first steps in this direction have been taken. Other healthcare industries are being actively approached to join.
Living Labs
Now that the IZA parties have designated CumuluZ as the target architecture, that ambition comes a lot closer. But with scaling up and broad implementation comes a lot on CumuluZ developers as well. Is CumuluZ ready for this?
"We are still in the initiative phase," Janssen said. "We are continuing to work on gaining support in the healthcare field. But we do have a number of living labs by now. In the next phase, we will start several more and scale up successful living labs. Ultimately, you have to be able to copy something that works in one region to another region, so we don't duplicate things and keep reinventing the wheel."
Investment estimate
To take the next step, Janssen says it is crucial that financial resources are made available. The CumuluZ coalition is specifically looking at the 1.4 billion euro transformation funds from the Integral Care Agreement (IZA). "Until now, we as NFU have provided budget. That has been used to start up and set up the organization, the program team and the living labs. Apart from the time that many people have put into it, it amounts to 3 to 3.5 million euros. The preliminary investment estimate we made for the period from 2024 to 2028 is about 450 million."
Remote care
Socially, a hefty sum. "I think we're going to save many times the investment in caregivers' time, because the things that are being duplicated or tripled now or diagnostics that need to be done over are no longer necessary. And with data readily available, a lot of care can be done better and easier remotely."
Vendor lock-in
In addition to financial and healthcare benefits, Janssen says CumuluZ offers another advantage: a public infrastructure can help healthcare providers break free from the vendor lock-in that many are stuck in. "Right now, a vendor can still say, you can only work with certain links. With CumuluZ, there will be a world connector, so anyone can just plug in and connect, regardless of whether your connector has two or three legs."
Old behavior
This in no way means that the role of suppliers has been played out, Janssen emphasizes. "They are and will remain partners, so there will always be room for them, perhaps even more than now. Come up with a good product and there will be plenty of room. Of course, with a nationwide infrastructure, there will be more room for smaller parties to make partial applications, so that a healthcare provider no longer necessarily has to buy the entire product from one supplier. If vendors do continue to exhibit old behavior, I predict they will put themselves out of business."
Collaboration Microsoft
How closely the market and healthcare sector are tied together is shown by the example of CumuluZ itself. For continued development, CumuluZ relies heavily on cloud computing platform Azure from Microsoft. "You want to avoid going from one vendor lock-in to another, so we are making CumuluZ so that we can work with other parties as well," he says. The cloud could soon be Amazon, Google or others. At Radboudumc, we have 275 colleagues sitting on ICT alone. Other academic hospitals have similar teams. We can assess very well what we can and cannot do. That's why we can also work together with parties like Microsoft."
Divestment
Asked about possible bears on the road, Janssen acknowledges that there are "pretty exciting times" ahead. "Getting ready to connect to the nationwide network could be costly for some providers. In recent years, healthcare providers have invested a lot in all kinds of subsystems. As CumuluZ progresses, some of those systems may become obsolete and users will have to stop using them. A party in such a situation may start to slow down the movement. Understandable, but that is not good for the Netherlands. In addition to a realistic transition period, there may then have to be room for disinvestment, compensation to keep the momentum going."
Leader
And then there is the hot breath of politics. "The drive for tangible results can be at odds with the technical challenges, and they are not small," Janssen said. "We need to remain critical of the technology, but confident that these are the right steps. Let's not turn it into a political game, as happened in 2011 around the national EHR."
At the time, the Senate cited the danger of data breaches and privacy mishaps as reasons to torpedo the SPD. Janssen points out that this danger has only grown as a result of the cancellation of the national EPD. All the more reason to really work on a nationwide infrastructure now. "Give us the space to take this step. The Netherlands will only benefit from this. As far as digitization of healthcare is concerned, we have not been a frontrunner in Europe for a long time. We can soon be again when it comes to data availability."
Data availability is one of the core themes during Zorg & ict 2024. The largest health tech event in the Netherlands will be held from April 9 to 11 at Jaarbeurs in Utrecht. Mark Janssen will be the keynote speaker on the Tech Mainstage of Zorg & ict on April 9 at 14:00. Register for free here.
