The primary aim of the Dutch government's IT policy for the healthcare sector is to improve affordability, access and quality by setting a foundation for an optimum and safe usage of ICT. The introduction of the Electronic Health Record (EHR) with corresponding infrastructure was founded as a springboard for other ICT applications in, including teleradiology and telemedicine.
An IT & Innovation Steering Group, consisting of a selection of representatives of the umbrella organisations (Ministry of Health, Welfare and Sport, NICTIZ, healthcare providers, patients and insurers) meets once every six weeks under ministerial leadership to take decisions on and monitor the progress of these IT and innovation projects. The Ministry of Health, Welfare and Sport has been working in cooperation with the National IT Institute for Healthcare (NICTIZ) and the Central Information Point for Healthcare Professions (CIBG) on the development of a nationwide system for the electronic exchange of medical data. However, the promotion of ICT in healthcare does not stop at the geographical borders of the Netherlands.
Many initiatives have also been launched in the international domain, aimed at improving the affordability, accessibility and quality of healthcare through the deployment of ICT (e.g. Large Scale Projects, SNOMED, Sustainable Telemedicine). Another trend is increasing mobility among patients and professionals. Further objectives are being pursued at political level to give shape and form to trans-border mobility and preventive medicine.
National Identification Numbers Key
To ensure that data is registered consistently and that patients, healthcare providers and insurers communicating at a distance are properly identified, unique national identification numbers are applied, namely:
1. The Citizen Service Number (BSN) for patient identification. The introduction of this number into all government organisations will be regulated by law. Separate legislation will be drawn up for the use of this number in the care sector.
2. A Unique Healthcare Professional Identification (UZI) exists for the identification and authorisation of relevant care providers. A register of care providers has been set up, which also sees to the issuing of UZI passes and UZI certificates for identifying and authenticating care providers.
3. Unique Health Insurer Identification (ZOVAR) exists for the identification of health insurers. A register of health insurers is set up and certificates issued to confirm identities when data is exchanged electronically. The EHR is connected to the national infrastructure, called AORTA.
AORTA is the Dutch national infrastructure for the exchange of data between healthcare providers. The infrastructure specifications include a description of technical, organisational as well as implementation aspects. The focus of this programe is to facilitate the realisation of a national "continuity of care" oriented EPR. AORTA uses HL7 version 3 messages and documents as its core mechanism for information exchange. Data from different healthcare information systems are linked in the EHR. The digital exchange between healthcare providers takes place via the AORTA model, an architecture consisting of different components, including the Citizen Service Number (BSN), the Unique Healthcare Provider Identification (UZI), the National Switch Point (LSP) and the information systems used by the healthcare providers, as discussed here.
Role of the National Switch Point
On 31 January 2006 the National Switch Point (LSP) for the healthcare sector was established. This was an important step, as the National Switch Point is the 'traffic control tower' behind the secure electronic exchange of upto- date patient data throughout the Netherlands. With the National Switch Point as the heart of national operations on this level, healthcare professionals across the country can retrieve up-to-date patient information from the systems of hospitals, pharmacies and GPs.
The primary advantage of the National Switch Point is that care institutions and suppliers of ICT applications for the healthcare sector have one point of contact for specific services:
• The National Switch Point manages a 'national reference index', which can swiftly track patient data when a healthcare provider requests specific information. The patient data are not stored at a central point. The reference index keeps track of which patient data are stored in which information system in the country.
• At the same time, the National Switch Point confirms that information is supplied only to healthcare providers with the requisite authorisation. The switch point checks the provider against the national UZI register. The provider must prove his identity with an UZI pass.
• The National Switch Point also confirms with the aid of the Citizen Service Number that the correct patient data are being supplied. The government is responsible for issuing and controlling this national patient identification number.
• Finally, the National Switch Point ascertains which information the healthcare provider may access (authorisation) and keeps a record of the provider and the consulted data (logging), so that the authorisation regulations can be monitored.