At the end of June 2023, the Dutch Association of Podotherapists (NVvP) launched the 'Data Space' together with the podiatry practices Voetencentrum Wender, Hermanns, Innofeet, Lectoraat Podotherapy (Hogeschool Saxion/Fontys) and privacy technology specialist Roseman Labs. The aim is to provide insights into the effectiveness and added value of podiatric care based on data - and to further improve it where possible.
The Data Space uses Multi-Party Computation, an advanced cryptographic technique from Roseman Labs, with which data from different parties can be securely combined and analyzed for the first time.
The first project within the dataspace has now started, aimed at people with diabetes mellitus. They often have to deal with a lot of suffering, caused by serious foot problems. Diabetic foot wounds and the associated amputations cost Dutch society half a billion euros a year.
Social costs
Years ago, the Dutch government chose to put more emphasis on preventive diabetic foot care and to transfer the funding to the basic insurance. The reason for this is that by focusing on prevention it seems feasible to reduce the incidence of foot ulcers by 75% (Bus and Van Netten 2016). This basic insured care is now purchased from podiatrists as the main practitioner of the risk factors. Rutger Sonneveld, NVvP Board Member for Quality:
“There is a great need for data collaboration for systematic health care evaluation. This allows the effectiveness and efficiency of (preventive) podiatric care and the risk factors of people with diabetes to be investigated at a national level. This initiative is a good translation of the Integrated Care Agreement into practice. The urgency is high, both in terms of patient care and financially”.
The average cost of healing one foot ulcer is around 10,000 euros. The average cost of a major amputation is about three times as high. This is evident from the Eurodiale study conducted in 2008 among 14 European hospitals (Prompers et al 2008). Assuming that there are about 1 million people with diabetes mellitus in the Netherlands, of whom up to 15% have an increased risk of developing foot ulcers, this amounts to 150,000 patients. By being able to carry out quality evaluations more easily and with multiple practices, podiatry practices, the NVvP and academia can gain more insight into the effectiveness and impact of the treatments provided and the associated healthcare costs.
Resolving bottlenecks
Data collaboration within (preventive) foot care has so far presented three challenges. To begin with, patient data is special personal data that may not simply be shared with third parties. Many podiatry practices are also reluctant to share data with other podiatry practices and there are also major differences in the method of registration. This last point is partly due to a lack of standards.
Until now, these challenges have stood in the way of bringing together data from different podiatry practices, and some important questions can only be answered by using a large dataset. Multi-Party Computation (MPC) - as applied in the dataspace - makes it possible to perform analyses on personal data from various sources, while the data itself remains secured. By means of this advanced cryptographic technique, the data is securely linked and analysed, without the individual data, such as name, patient number, age, gender, becoming visible.
Game changer for patients
Data collaboration within (preventive) foot care has a major social impact - but is also a game changer at the patient level. Currently, limited use is made of data and supported tools to make decisions when providing treatment. By conducting analyses of the various patient groups treated by podiatrists, risk factors can emerge for each patient that make a care process more appropriate. For example, it may come to light that a patient can be treated longer in primary care instead of by a specialist in the hospital. It can also ensure that patients are helped earlier by the right specialist, if needed. In short, the insights help to organize care appropriately and to deliver the right care in the right place.
The results of the first project of the dataspace are expected to be delivered at the end of 2023.
