EHR in General Practice in the Netherlands It’s getting better all the time Brasov 2014, Arie van Beelen GP

Presentation history present situation EU comparison developments data exchange privacy EHR architecture

History of Dutch EHR for GP 1985 Commission coördinating IT development GP’s 1990 Insurance companies provide funds to stimulate ‚Green card’ became EMR Several software parties developing software Requirements for GP-IT-systems established bij WCIA (reference models and certification) Different levels of experience and use of systems Werkgroep Coördinatie Informatie Automatisering; making lists of requirements, list of imformation generally used in GP; several versions of reference models 1990, 1995, 2005 to which GP-software should comply with; they act as approval commission and provide certificates for software

Present situation 100% of GP’s use EHR 4 major sofware developers user/experience level increased (graphical) user interface improved possibilities extended (teledermatology/cardiology, etc) referencemodels well developed (Unified Modelling Language) possibilities: online appointments, email consultations, repeat prescription-exchange with pharmacy HIS-reference models latest version 2005 version 4, which was finished in 2007; only develop functional demands/specifications for computer information systems (lists, tables), software developers build the software Past specifications were sometimes unclear and could be interpreted in multiple ways; now specified in UML which is also used by software developers

Adoption EHR in GP in EU

Use of Decision Support Systems by GP’s in EU

Use of administrative component of EHR

Change in use EHR in time

Change in use EHR in time

Impact of use of EHR

Developments disease specific online EHR (DM, COPD, CVRM) accessible to all involved healthcare workers exchanging data EHR interface improvement online specialist consultation sytems (nephrology, dermatology, cardiology) integrated online decision support systems (NHG doc alert)

Need for data exchange availability EHR during out of office hours incomplete medication records safe integrated decision support systems

National database for EHR Nictiz started 2002 (national competence center for health IT ) developing plans to interconnect EHR Health Minister proposed National database EHR: EPD 2012 Senate barred this decision (privacy) LSP (National Service Platform) interconnecting EHR GP, EC, hospitals and pharmacies regionally VZVZ (Union of Careproviders for Care Communication)

VZVZ (Union of Careproviders for Care Communication) founded by national organizations of GP’s, pharmacists and hospitals funded by health insurance companies 50% and participating organizations 50% approval of privacy guarding institutions development of interconnecting system LSP legislative advice, privacy issues, access procedures, paying costs of implementation, providing access cards

Privacy many privacy guarding institutions patient data in LSP only after personal consent 2008 national opt-out letter 2009-2011 many debates in Parliament fear of abuse data by health care professionals, (hackers, insurance companies, employers)

Privacy issues

Outcome regionally is safer, because smaller patient access (watch who sees my data) opt-in consent

Architecture core Episode centered registration chronological collection of different medical data concerning one health problem of one patient, which descibes the changes in condition during time consists of journal items, diagnostic results, medication, referral/discharge letters SOEP-registration in medical journal Consultations can be seen in same line of a diagnostic or therapeutic process In past POR problem oriented registration

Journal items Prescriptions Diagnostic results Correspondence Episode

Episode Centered Registration Medical Summary -open episodes -medical policy -last consultations -latest diagnostics -latest messages -present medication Medical Journal Episode Centered Registration Medical Policy Prevention -open/closed -text summary -long term goals -selecting, inviting, executing -individual<>practice organizational -past operations -important treatments -allergies/intolerance -family history -social- and contact data -life testament Addition Diagnostic results -measurements -lab values -radiology/imaging -ECG/ultrasound Medical policy: single note in journal moves out of scope -specialist referral -specialist discharge -third parties Correspondence Private Notes Attention Page Marking Facilities Query Builder

Regional EHR GP-EHR Insurance companies Laboratories National switch point Hospital EHR Emergency centers Pharmacies