The use of e-ID in the national infrastructure of ... - World of Health IT

The use of e-ID in thenational infrastructure of theNetherlandsMichiel Sprenger, PhDSenior Adviser IT & InnovationNational Institute for IT in Healthcare

e-ID for health care professionalsand providers

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

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

The Netherlands in EUArea: #22/27Pop: #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 crossenterprise- 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 inthe Netherlands• Multi-enterprise business model:• 100 hospitals, 4500 GP practices, 1800pharmacies, 100 locum tenency services forGP’s, each responsable for own finance, medicalpolicies, investments, and IT• Thus: interoperability problemsare 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 businesssituation• Connectivity, not“system” building

Nationwide electronicpatientrecord (“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 theHealth Care Professional or Provider (HCP)• Under the responsibility of the source HCP• Enabling selective and safe information exchangebetween HCP’s and between HCP’s and patients

Standards• HL7v3 for messaging (www.hl7.org)• SNOMED-CT for “language” unificationSystematitized Nomenclature of Medicine – ClinicalTerms(www.ihtsdo.org)• IHE for implementation guidelinesIntegrating 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

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

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

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

Diabetes - program• Driver: Quality• Exchange of all data relevant to diabetes betweenthe (many) healthcare professionals involved• Self-management• Reports20

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 running22

Questions ?sprenger@nictiz.nl