E-Health in The Netherlands
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1 E-Health in The Netherlands Van Cauwenberge Joris Verhoyen Gregory Course: Medical Informatics Prof. M. Nyssen and Prof. F. Questier Academic year
2 Contents 1. Intro: The Netherlands compared to Belgium 2. Nation-wide EHR 3. E-prescription 4. E-consultation 5. Conclusions 2
3 INTRO: THE NETHERLANDS COMPARED TO BELGIUM 3
4 EU study (2010) 4
5 E-prescription Already a few years E-prescription Started 2014 Standards (IHTSDO) HL7, Snomed CT, ICD9, ICD10, EN/ISO Telemedicine Patient-to-doctor Doctor-to-doctor Standards (IHTSDO) KMEHR, SUMEHR, ATC, ICPC2, ICD-10, ICD-9-CM Telemedicine Tele-monitoring Elderly Chronic diseases Mobile monitoring 5
6 Identification Citizen service number (CSN/BSN) DigID (not obligated) UZI-register for healthcare professionals Identification eid 6
7 NATION-WIDE ELECTRONIC HEALTH RECORDS 7
8 Development towards nation-wide EHR first ideas for nation-wide EHR ministry of Health, Welfare and Sports (VWS) takes leading role Approval EHR-law by Dutch House of Representatives Push-through nationwide EHR without governmental support. Foundation VZVZ foundation of NICTIZ Start Aorta-project 2008 Obligation Citizens Service Number (CSN/BSN) in healthcare 2011 EHR-law rejected unanimously by Senate 2013 National exchange EHR Regional exchange EHR (except for hospitals) 8
9 Nation-wide EHR For Who? GP s, specialists and pharmacists that have a therapeutical relation with the patient patients can request to look into their data and set authorisation. What can be exchanged? Electronic Medication Record (EMR) Summary of GP s records : o allergies, o health problems o... Juvinile health records Future: maternal facilities physiotherapists... In development: Lab results prescriptions 9
10 Aorta and the LSP Aorta = The national, standardized infrastructure for exchanging and consulting medical records. Responsability of: NICTIZ (standards) VZVZ (technical) Goals: 1. Facilitating the exchange of medical data. 2. Make it possible for the patient to consult his/her medical records. Providers of care UZI/BIG registry? Qualified Patient Portals Qualified Healthcare Information system (QHIS) PKIO Basic services Patient Qualified Client offices National Switching Point (LSP) National Healthcare information hub DigID SBV-Z (CSN) 10
11 Architecture LSP decentralized storage of medical records (by law) National Healthcare information hub Metadata : locations of medical records. Registers all consultations and adaptations. Act Reference Registry (Verwijsindex) Audit Log Identification and authentication Access Contral (Authorisation) Many additional components... UZI/BIG registry PKIO Basic services DigID SBV-Z (CSN) 11
12 Standards Exchange of messages Terminology Snomed CT, ISO 9999, LOINC, ATC,... Text Transport Security HL7 v3 SOAP and HTTP HTTPS Qualified patient portal QHIS client office Two parts that need to be qualified; 1. Software on its own (by private providers) 2. Data communication network (DCN) that uses a private TCP/IP 12
13 Identification & authentication UZI card = Smartcard for registered physicians, assistants or businesses DigID DigID low Login name and password. DigID middle login name, password and sms Public/private key infrastructure (UZI-register) : secure connection to LSP (TLS) Sign documents Based on CSN, yet without public/private key infrastructure insufficient for access! Future prospects : the enik. (started ) 13
14 Authorisation Therapeutic relation obligated, yet technically not necessary! Opting-out Intelligent audit log Authorisation-protocols : who can see what Opting-in (each time) Possibility to exclude or include medical personnel Uses BIG-registry 14
15 Summary nation-wide EHR well-standardized technically OK security andprivacy Costs: 30 million/ year (NICTIZ) no governmental support HL7 v3 Current use of the LSP for exchange of information (5th of may 2014) Absolute number GP practices % GP posts % Pharmacists % Hospitals 28 31% % of population Patient-data unique CSN s 21,5 % 15
16 E-PRESCRIPTION 16
17 E-prescription Safety Year Medication-related acute hospitalization % 20% % 18% avoidable 7000 to 8000 cases in the Netherlands Medication monitoring Responsible care Interactions medication Allergies Incorrect dosage Double medication Contra-indications and other patient characteristics 17
18 E-prescription In 2008 already 62% electronic prescriptions The only way of prescribing from January 1, 2015 Possible to use different software platforms Only qualified ICT-suppliers EMD plus program EHR and EVS software platforms have different suppliers Extra work physician to include records in both the systems 18
19 E-prescription Digital signature with UZI-pas (obligated july 2007) Authenticity integrity Electronic prescribing Digital signature Transmission receiving Process prescription Store prescription prescriber Service provider pharmacy Exchange prescriptions With AORTA via LSP Without AORTA directly to pharmacy HL7v3 standard Digital signature implemented 19
20 E-CONSULTATION 20
21 E-consultation Normal consultation Time Physician: 11 minutes Patient: half day Content poorly remembered E-consultation More flexible More efficient for both doctor and patient Possible to reread content Safe New ICT-applications 21
22 E-consultation 22
23 E-consultation Results 86% satisfied Consultation time from 11 to 4 minutes Safe Almost no waiting time Low cost 23
24 CONCLUSIONS 24
25 Technically, the dutch E-health is quite advanced. Yet legislation lags, and governmental issues persist, causing: difficulties for standardisation. decentralisation. privacy and safety concerns. fewer progression the last years compared to e.g. Belgium. 25
26 References Ministry of Health, welfare and sports: Nictiz: Vzvz: EU-studies: (2010) WHO: 26
27 Thank you for your attention! 27
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