|Implemented in this survey?|
The Dutch Ministry of Health is establishing a national infrastructure for data exchange between electronic patient records (EPR's). The core of this infrastructure is an index that connects all EPR's of a patient. In 2008 the first pilots come to an end and the first subsystems will be rolled out. It is a highly complex development with many stakeholders involved, which makes a successful outcome not yet evident.
It is important that healthcare providers share patient medical information in a fast and reliable way. This will prevent communication errors and enhance quality of care. The Dutch Ministry of Health aims at establishing a national infrastructure for data exchange between electronic patient records (EPR's). By this way, health-care providers that are connected will always have up-to-date information about the patient. The core of this infrastructure is the "national switch point", an index with pointers to all registered EPR's of a patient. In 2008 the first regions are being connected to the switch point. No information will be stored centrally on the switch point itself. The EPRs reside with the providers.
The national infrastructure consists of
The implementation follows the following order of priorities:
The first will mainly affect primary care, the second will also affect hospital care.
Patients (better care, more control of medical data), providers (better communication, less medical errors, better quality of care), insurers (better cost control, efficiency gain), authorities (better quality control, more transparancy)
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
There is a certain pressure to comply with the EU standard for EPR's (CEN13606), but so far the Dutch authorities stick with the (American) HL7v3 standard. There is an international development to merge both standards, but the outcome is still uncertain.
New legislation (see above) to be empowered in 2009.
Communication standards, either HL7v3 or CEN13606.
|Implemented in this survey?|
The main driving force behind the EPR development in The Netherlands is the Ministry of Health. The EPR program can be seen as part of a broader authority-driven development to restructure the Dutch healthcare. Pillars of this restructuring are a shift of power from providers to consumers and a shift of control from authorities to insurance companies. The national EPR infrastructure fits well in these shifts.
The idea of a national EPR infrastructure is developed by NICTIZ (the National IT Institute for Healthcare in the Netherlands) which was founded in 2002 and which grew out to a national coordination point and knowledge centre for IT and innovation in the healthcare sector.
The implementation of the EPR infrastucture is coordinated by the Ministry of Health itself.
The approach of the idea is described as:
new: The EPR program follows a steady strategy from initiation to development and implementation since 2002. The time frame of the program hampers, since every phase is confronted with serious delays.
Pilot project - In the Enschede region there is a pilot of the electronic out-of-hours record; in the Amsterdam and Rotterdam regions there are pilots of the electronic medication record.
New legislation that makes the use of the new authorisation system obligatory, is now in the approval phase and will be active in 2009.
|Ministry of Health||very supportive||strongly opposed|
|hospital sector||very supportive||strongly opposed|
|GP organisations||very supportive||strongly opposed|
|Payers||very supportive||strongly opposed|
|patient organization NPCF||very supportive||strongly opposed|
|Information system vendors||very supportive||strongly opposed|
|Parliament||very supportive||strongly opposed|
|Ministry of Health||very strong||none|
|hospital sector||very strong||none|
|GP organisations||very strong||none|
|patient organization NPCF||very strong||none|
|Information system vendors||very strong||none|
Health providers, in particular general practitioners, support the idea of an EPR but doubt the viability of the plans. They make much of each setback to prove that they're right. Setbacks have been caused by technical problems, privacy concerns, and time-consuming calls for tender.
One of the pilot projects (Enschede) has been evaluated by a regional research institute (Telematica Instituut). This evaluation has led to several suggestions for improvement, e.g. about the distribution of ID cards.
Strong points of this development are:
Points of concern are:
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
This is a highly complex development with many stakeholders involved, which makes a successful outcome not yet evident.
Dr. Huibert Tange