Implementation of Electronic Patient Record far from easy in Dutch Health Care

Delft 09 June 1998 Two years ago, the project "Zorg2000" (= Care2000) has been launched by the Dutch National Programme Campaign Electronic Highways (NAP). The initial purpose was to supply the building blocks for an Electronic Patient Record (EPR), to be used by general practitioners (GPs), medical specialists and home care providers for mutual data exchange, in order to promote the concept of shared care. The plan hasn't worked out the way it should be, due to lack of streamlined communication between the various physician organizations, the hospital information systems vendors, and the project managers. In addition, the introduction of standards, codes, and definitions by the CSIZ centre for data standardization management also has failed. Today, new initiatives are undertaken to transform the Electronic Medical Record (EMR) into a real individualized EPR.

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Two years ago, the project "Zorg2000" (= Care2000) has been launched by the Dutch National Programme Campaign Electronic Highways (NAP). The initial purpose was to supply the building blocks for an Electronic Patient Record (EPR), to be used by general practitioners (GPs), medical specialists and home care providers for mutual data exchange, in order to promote the concept of shared care. The plan hasn't worked out the way it should be, due to lack of streamlined communication between the various physician organizations, the hospital information systems vendors, and the project managers. In addition, the introduction of standards, codes, and definitions by the CSIZ centre for data standardization management also has failed. Today, new initiatives are undertaken to transform the Electronic Medical Record (EMR) into a real individualized EPR.

The importance of the EPR for the quality of patient care should not be underestimated. It allows to present medical data in a way that is not possible with the paper based record. The majority of the Dutch GPs (80%) are already familiar with the EMR, according to a study issued by the Dutch Physicians Society (NHG). This positive result forms a heavy contrast to the poor EMR use by the medical specialists and the hospitals. A situation that is most regrettable since the EMR and the future EPR hold in store a variety of applications, ranging from electronic data interchange between medical colleagues over health care assessment to general prevention, reporting to the authorities and research.

The four major suppliers of hospital information systems in the Netherlands are currently combining their efforts to offer electronic access to each other's EMR systems. The IBM subsidiary company Lotus has been asked to design the software with regard to security, workflow and authorization issues. In order to improve EMR use in the hospitals, the HIS industry has developed a Patient oriented Clinical Display Medium (PKPM) for graphical applications. Unfortunately, there is insufficient collaboration between the different health care facilities on the level of electronic data exchange. In turn, the GPs are gradually being provided with up-to-date and officially approved software for optimized EMR information interchange with their colleagues. GPs, using this kind of software receive a financial compensation.

Nevertheless, a lot of questions remain to be solved in the process towards the implementation of a generally accepted EPR. Some of the problems are directly related to the organization of health care in the country. Should the EPRs, for instance, be regionally managed by the health care providers, while adding their information to a single EPR? What are the responsibilities of the various players in the field, such as the pharmacist or the physician? What about legislation with regard to the reporting of the GP's activities to the authorities? All these issues will be addressed in the EPRIMP conference dealing with Electronic Patient Records in Medical Practice, which will take place in Rotterdam from October 8th to 10th 1998. For more details, please consult our calendar. Some of the data for this article have been taken from the Automatisering Gids.


Leslie Versweyveld

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