Theo Hooghiemstra: 'MGO requires careful process'

Hooghiemstra is considered an expert on data protection. At the request of MedMij, which develops and manages the agreement system behind the Personal Health Environment (PGO), he wrote an opinion.

This opinion focuses on the potential impact of MGO on the appointment system. In his opinion, Hooghiemstra also touches on the broader legal context. And that is quite complicated. By developing its own application and managing data, VWS has to take into account both the Market and Government Act and the General Data Protection Regulation (AVG). To these will soon be added the European Health Data Space (EHDS), albeit that this law seems to actually provide room for a facility like MGO.

Long-term trajectory

According to Hooghiemstra, questions must first be answered before VWS can confidently go ahead with MGO plans. "What is the need for MGO? And: what is the need for MGO alongside private PBMs? Is the government going to sit in the chair of the market?" said Hooghiemstra. "This is a trajectory that takes several years and whose outcome is not certain in advance. I'm not saying it can't be done, but you don't have it settled in a back afternoon."

My Pension Statement

"VWS is aiming with My Health Overview at something like My Pension Overview, which I was involved in as an advisor. Almost all the same questions were involved there, but that was regulated by an underlying law and a separate Pension Register Foundation, which was given a defined legal task. There has been little comment on that. It is perhaps one of the few government ICT projects that people are enthusiastic about. So it can be done. My point is: because there is great time pressure, it might be tempting not to go through all the steps of the process."

Legal Basis

A legal basis for processing personal data is a requirement, according to Hooghiemstra. "Just asking permission is not enough. AVG-technically, PBM vendors may indeed process that data on the basis of consent. But because the government has a lot of power over citizens, the government may not. That's the way it is in the law. There is no equal power. And with that data, the government has power over citizens. So the government has to have a legal basis for that, even if you say: it's just an overview, even in that case you are processing personal data."

Image

VWS sees My Health Overview as an important step towards data availability for citizens. This should enable citizens to have more control over their own care and health. Hooghiemstra believes that not every citizen will immediately understand this message. Good substantiation is therefore of great importance.

"The idea behind it is that every Dutch person should have access to a health overview, even those who do not have a PBM. If you say: I am doing it in the interest of the citizens, then you have to communicate this well. As a government, you want to prevent people from thinking: the government has built a kind of national patient file. That is not the case. But such an image can quickly arise. We have also seen this with the failure of the national EPD. The Senate had an image that did not match reality, but was politically decisive."

Authentication

Besides good communication, Hooghiemstra says it is important for the success of MGO that VWS takes the steps in the right order. In his view, setting up an authentication service is a logical first step. "Good authentication is a precondition for access to information. It enables users to log in safely and user-friendly. That's how you build trust. Moreover, identification is already a government task. Think of the issuance of passports. There is no competition involved in that. So it is something that you have to arrange anyway and with which you also help the PBMs. Therefore, it is a logical first step."

Competition?

The implications of the Market and Government Act also need to be clarified quickly, Hooghiemstra believes. "VWS itself says it does not compete with the PBM suppliers. All suppliers must soon be able to use the MGO facility. VWS must then be able to demonstrate that."

EHDS

As far as Hooghiemstra is concerned, the EHDS also deserves a prominent place in further plan development. "The EHDS requires the government to very carefully draw up ground rules for access to data. It gives the government the task of establishing a service that gives citizens access to data. You could say that MGO can play a role in that. But then you have to think about whether or not that is appropriate at each step. The EHDS at least gives the government an additional obligation to get it right."