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

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

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 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

Questions ?

sprenger@nictiz.nl