Patient Monitoring Outcome FHIR Implementation Guide, published by My Organization. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/patient-monitoring/ and changes regularly. See the Directory of published versions

TOTeM

DRAFT: 2024-11-25

Note : This is currently a project that exists out of multiple carepaths. This will eventually be split up into multiple carepaths.

Care Pathway Overview

TOTeM stands for Transmurale Opvolging met TeleMonitoring na chirurgie.

Improved surgical techniques allow patients to go home earlier and earlier after their surgery. Complications are possible with any surgery. It is important that they are noticed in time so that the necessary action can be taken by the appropriate healthcare provider.

TOTeM aims to send patients home after surgery as early as medically possible, with quality and specialised follow-up in the home environment.

The patient can recover in a familiar environment and is more involved in the recovery process. For the hospital, faster discharge offers the opportunity to optimise length of stay and bed occupancy. The social cost of care falls.

With support from the FPS Public Health, some TOTeM projects are being rolled out in 6 hospitals in a pilot project; and this for specific types of surgery (depending on the hospital’s choice): colon surgery, obesity surgery, kidney surgery, bladder surgery, pancreatic surgery and anti-reflux surgery.

Process and Workflow Description

Start-Up

• Parameters Monitored:

  • Heart Rate
  • Blood Pressure
  • Body weight
  • Respiratory rate
  • Saturation
  • Body temperature
  • Abdominal pain
  • Pain surgical wound
  • Pain puncture wounds
  • Pain during urination
  • Renal pain
  • Pain in calves
  • Pain provoked by eating
  • Well-being
  • Flatulence
  • Bowel movement
  • Distended abdomen
  • Nausea
  • Vomiting
  • Coughing
  • Productive cough
  • Pression on chest
  • Shortness of breath
  • Shoulder pain
  • Color of urine
  • Hematoma
  • Volume of 24-hour Urine
  • Skin surrounding stoma red

• Frequency: 3 times a day, 7 days a week.

Data Collection

• Data is automatically collected via connected devices or manually entered into the system.
• Technology is CE-certified, with end-to-end encryption and GDPR compliance.

Integration Modules for EPD

Outcome Module - FHIR Integration

Vital Signs

• Frequency: Maximum of 5 updates per day, on average 1 update per day (per measurement).
• LOINC Codes:

General

Colon surgery specific

Bariatric surgery specific

Nefrectomy specific

Cystectomy specific

These FHIR modules ensure standardized data exchange between systems and guarantee consistency of the vital parameters.

Specification:

For detailed specifications, refer to the

• Heart Rate Example
• Blood Pressure Example
• Weight Example
• Respiratory rate Example
• Saturation Example
• Nausea Example
• Abdominal pain Example
• Pain surgical wound Example
• Pain during urination Example
• Pain in calves Example
• Distended abdomen Example
• Shortness of breath Example
• Shoulder pain Example
• Pain puncture wounds Example
• Leakage catheter Example