Health data must be digitally "available, accessible and usable" at all times for everyone, from health professionals and researchers to citizens and patients. This was decreed by outgoing Minister Kuipers last year in his National Vision on the Health Information System. Despite his firm language, this ambition will not become reality in the coming year.
As far as Kuipers is concerned, digitization is the recipe for keeping Dutch healthcare affordable, accessible and of high quality in the years to come. As a result of an aging population and personnel shortages, the demand for care is increasing. To temper this demand for care, citizens must take more control over their own health and care. Access to their own health data is essential for this.
Innovation requires data
Moreover, the care recipient encounters more and more different caregivers and also receives care more often at different locations. This means that patient information is recorded in more and more places and by more and more different healthcare providers. All of this reinforces the need for seamless digital information transfer. And then there is medical innovation itself, which is increasingly dependent on large amounts of digital data.
Shred
The need for digitization is reflected in the National Vision of the Health Information System and in the Integral Care Agreement (IZA). Regarding the current situation, Kuipers makes no bones about it: "The current health information system is not tailored to the current and future challenges." This is due, among other things, to its fragmented nature, technical set-up and lack of openness. These shortcomings, in turn, are largely related to the way the ICT market functions in Dutch healthcare. The dominant position of IT suppliers has reinforced the trend toward segmentation and limited interchangeability.
Wegiz
The Electronic Data Exchange in Healthcare Act (Wegiz), which has been in effect since July 1, 2023, requires electronic data exchange between healthcare providers. Ulco de Boer, policy advisor for data exchange at the Ministry of Health, Welfare and Sport, says: "The purpose of this law is that ICT systems can communicate with each other so that healthcare providers can easily share data with each other."
Steps have also been taken at the European level by 2023 to enable the digital exchange of health data. This year, the European Commission is speeding up the introduction of the European Health Data Space (EHDS). The EHDS must ensure that health data -precisely as Kuipers wants- become available across borders for patients, researchers and professionals.
SPD in two flavors
The tightening of the legal frameworks does not alter the fact that there are still numerous structural problems surrounding healthcare digitization. Dutch Health Hub recorded several stories that illustrate this. Board chairman David Jongen of Zuyderland complained in the run-up to Zorg & ict 2023 about the -in his words- capricious behavior of IT suppliers.
Because provider SAP-Cerner pulled out of the Netherlands prematurely, Zuyderland was forced to look for a new EHR. In addition, Philip discontinued the Vital Health software package. "Done, plug out, so we can look for a new supplier again. I find that unthinkable, but it just happens," Jongen said. "We have now borrowed 44 million euros from the bank, forty-four million! And then you get to choose between ChipSoft and Epic. You have your back against the wall."
Complex implementation
In order to be stronger in the negotiations, Zuyderland tried to team up with neighboring hospital Maastricht UMC+, which also had to get rid of SAP, in the search for a new EPD. In terms of care content, there was also every reason to choose the same EPD, as both South Limburg hospitals work closely together. Still, the joint procurement combo did not get off the ground. "The joint implementation ultimately turned out to be so complex," said Maastricht UMC+ board chair Helen Mertens. "Care processes have to be brought together. Then you actually have to discuss every detail. And that at the speed at which we have to implement..." So Zuyderland chose ChipSoft and MUMC+ chose Epic.
Data quality
In addition to fragmentation, healthcare IT is also struggling with another persistent problem, that of poor data quality. If digital healthcare is to live up to its potential, better, cleaner data is desperately needed, argued Diederik Gommers, intensivist and Intensive Care department head at Erasmus MC.
Only when data is clean and uniform can the doctor really do something with it. Only then can data be the raw material for new applications such as artificial intelligence (AI) and machine learning (ML). To improve the reliability and traceability of data, Gommers and his colleagues in Rotterdam are busy every day 'putting a label on each data point'. An intensive and time-consuming process, but crucial to the success of digitization.
AI model helps doctor
"We need to go back to basics," Gommers said at Care & ict 2023. "We are now at 80 percent of the data quality needed and can get started with simple models. But if you want to take that next step and really help doctors and nurses make decisions at the bedside, it just has to be 100 percent."
Still, Gommers sees this happening in the foreseeable future. "Before I retire, I want an AI model that can give the right advice to the doctor. A model that helps make the right decision to start treatments or not."
The 5 most read articles in 2023 on the topic Digitize:
- David Jongen finds erratic behavior of IT vendors 'non-existent'
- Diederik Gommers: 'To treat or not to treat? AI helps decide'
- Diederik Gommers: 'Data quality hinders healthcare digitization'
- MUMC+ puts line through 140 discharge letters with new EHR
- Minister Kuipers breaks open stalled debate on data sharing
