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

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

3. 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

4. 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, 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

6. Adoption EHR in GP in EU

7. Use of Decision Support Systems by GP’s in EU

8. Use of administrative component of EHR

9. Change in use EHR in time

10. Change in use EHR in time

11. Impact of use of EHR

12. 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)

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

14. 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)

15. 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

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

17. Privacy issues

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

20. 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

21. Journal items
Prescriptions
Diagnostic results
Correspondence
Episode

22. 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

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