The Use of the eID for Health Professionals within the Nationwide Infrastructure in The Netherlands

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The Use of the eID for Health Professionals within the Nationwide Infrastructure in The Netherlands. Sprenger M. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

Health & Medicine

The use of e-ID in the
national infrastructure of the
Netherlands
Michiel Sprenger, PhD
Senior Adviser IT & Innovation
National Institute for IT in Healthcare

e-ID for health care professionals
and providers

Agenda

• Introduction to eHealth in the Netherlands

• e-ID in the Netherlands

• Some application areas

• Questions

The Netherlands in EU

Area: #22/27

Pop: #8/27

IT proliferation

• Hospitals:
• HIS 100%
• PACS 100%
• Clinical overview: 80%
• Order management (CPOE): 30%
• General Practitioners: 100%
• Pharmacies: 100%
• Nursing homes: 10%

Interconnection cross-
enterprise - current
• Many local and regional initiatives
• NO regions in Health system, only in collaboration (+IT)
• Dominant: Edifact messaging:
• >100M messages / year
• Prescriptions
• Lab-results
• Discharge letters
• Patient summaries
• Islands, not interconnected
• Security doubtful
• Need for national standards

Healthcare in
the Netherlands
• Multi-enterprise business model:
• 100 hospitals, 4500 GP practices, 1800
pharmacies, 100 locum tenency services for
GP’s, each responsable for own finance, medical
policies, investments, and IT
• Thus: interoperability problems
are large on all levels
•  Urge for standards
•  Much debate (“polder”-model)

Upfront Choice for health IT

• Leave information at the source
• Responsibility
• Unambiguousness
• Security
• Fits to business
situation
•  Connectivity, not
“system” building

Nationwide electronic
patientrecord (“the EPD”)
• It is not a record, nor a system
• It is an infrastructure
• Leaving information at the source
• In the (electronic) working environment of the
Health Care Professional or Provider (HCP)
• Under the responsibility of the source HCP
• Enabling selective and safe information exchange
between HCP’s and between HCP’s and patients

Standards
• HL7v3 for messaging (www.hl7.org)
• SNOMED-CT for “language” unification
Systematitized Nomenclature of Medicine – Clinical
Terms
(www.ihtsdo.org)
• IHE for implementation guidelines
Integrating the Healthcare Enterprise
(www.ihe.net)
• Many others

Infrastructure

• Standardised communication
• Safe communication
• Logging
• Identification: patients, HCP’s
• Patient consent registration & handling
• Index function: search, find, transfer

HCP register - UZI

• National register of:
• Health care professionals (persons)
• Health care providers (institutions)

• UZI register (Unique HCP Identification)

• UZI card

Health care professionals

• General Practitioners (8.000)
• Pharmacists (1.800)
• Nurses (140.000)
• Medical specialists
• Dentists
• Etc
• Total >200.000
• Role codes: 70

Health care providers

• GP practices (4.500)
• Pharmacies (1.800)
• Hospitals (100)
• Etc

• Total >8000

UZI-certificates

• Authenticity (person + institution)

• Confidentiality (person + institution)

• Non-repudiation (person) – “signature”

Authorisation

• Identification
• Authentication
• Role code
• Authorisation scheme for application
• Patient consent
• Treatment relation

• Logging of transactions

Diabetes - program

• Driver: Quality
• Exchange of all data relevant to diabetes between
the (many) healthcare professionals involved

• Self-management
• Reports

20

Diabetes HCP’s involved

• General Practitioner (often also the manager)
• Diabetes nurse
• Podotherapist
• Physical therapist
• Dietician
• Internal medicine specialist
• Ophthalmologist
• Neurologist
• .....

21

Diabetes - status

• Care standard - ready
• Information model – ready
• Architecture – ready
• Implementation guidelines (44 HL7v3 messages)
– ready
• 2 pilots running

22

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The Use of the eID for Health Professionals within the Nationwide Infrastructure in The Netherlands

1. The use of e-ID in the national infrastructure of the Netherlands Michiel Sprenger, PhD Senior Adviser IT & Innovation National Institute for IT in Healthcare

2. e-ID for health care professionals and providers

3. Agenda • Introduction to eHealth in the Netherlands • e-ID in the Netherlands • Some application areas • Questions

4. Agenda • Introduction to eHealth in the Netherlands • e-ID in the Netherlands • Some application areas • Questions

5. The Netherlands in EU Area: #22/27 Pop: #8/27

6. IT proliferation • Hospitals: • HIS 100% • PACS 100% • Clinical overview: 80% • Order management (CPOE): 30% • General Practitioners: 100% • Pharmacies: 100% • Nursing homes: 10%

7. Interconnection cross- enterprise - current • Many local and regional initiatives • NO regions in Health system, only in collaboration (+IT) • Dominant: Edifact messaging: • >100M messages / year • Prescriptions • Lab-results • Discharge letters • Patient summaries • Islands, not interconnected • Security doubtful • Need for national standards

8. Healthcare in the Netherlands • Multi-enterprise business model: • 100 hospitals, 4500 GP practices, 1800 pharmacies, 100 locum tenency services for GP’s, each responsable for own finance, medical policies, investments, and IT • Thus: interoperability problems are large on all levels •  Urge for standards •  Much debate (“polder”-model)

9. Upfront Choice for health IT • Leave information at the source • Responsibility • Unambiguousness • Security • Fits to business situation •  Connectivity, not “system” building

10. Nationwide electronic patientrecord (“the EPD”) • It is not a record, nor a system • It is an infrastructure • Leaving information at the source • In the (electronic) working environment of the Health Care Professional or Provider (HCP) • Under the responsibility of the source HCP • Enabling selective and safe information exchange between HCP’s and between HCP’s and patients

11. Standards • HL7v3 for messaging (www.hl7.org) • SNOMED-CT for “language” unification Systematitized Nomenclature of Medicine – Clinical Terms (www.ihtsdo.org) • IHE for implementation guidelines Integrating the Healthcare Enterprise (www.ihe.net) • Many others

12. Infrastructure • Standardised communication • Safe communication • Logging • Identification: patients, HCP’s • Patient consent registration & handling • Index function: search, find, transfer

13. Agenda • Introduction to eHealth in the Netherlands • e-ID in the Netherlands • Some application areas • Questions

14. HCP register - UZI • National register of: • Health care professionals (persons) • Health care providers (institutions) • UZI register (Unique HCP Identification) • UZI card

15. Health care professionals • General Practitioners (8.000) • Pharmacists (1.800) • Nurses (140.000) • Medical specialists • Dentists • Etc • Total >200.000 • Role codes: 70

16. Health care providers • GP practices (4.500) • Pharmacies (1.800) • Hospitals (100) • Etc • Total >8000

17. UZI-certificates • Authenticity (person + institution) • Confidentiality (person + institution) • Non-repudiation (person) – “signature”

18. Authorisation • Identification • Authentication • Role code • Authorisation scheme for application • Patient consent • Treatment relation • Logging of transactions

19. Agenda • Introduction to eHealth in the Netherlands • e-ID in the Netherlands • Some application areas • Questions

20. Diabetes - program • Driver: Quality • Exchange of all data relevant to diabetes between the (many) healthcare professionals involved • Self-management • Reports 20

21. Diabetes HCP’s involved • General Practitioner (often also the manager) • Diabetes nurse • Podotherapist • Physical therapist • Dietician • Internal medicine specialist • Ophthalmologist • Neurologist • ..... 21

22. Diabetes - status • Care standard - ready • Information model – ready • Architecture – ready • Implementation guidelines (44 HL7v3 messages) – ready • 2 pilots running 22

23. Questions ? sprenger@nictiz.nl

The Use of the eID for Health Professionals within the Nationwide Infrastructure in The Netherlands

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The Use of the eID for Health Professionals within the Nationwide Infrastructure in The Netherlands