Putting the patient at the centre

Putting the patient at the centre

Patients need to be convinced of the benefits of electronic health records before they can be introduced according to Professor Jan A. Hazelzet MD PhD CMIO / Professor in Healthcare Quality and Outcome, Department of Public Health in the Netherlands.

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Putting the patient at the centre

The Netherlands is only now moving towards establishing a national electronic patient record (EPR) system as a result of a major setback in 2007. “We had a political failure eight years ago when the government attempted to force people to participate in a national electronic medical record system”, explains Jan Hazelzet, Professor in Healthcare at Erasmus University Rotterdam.

“They tried to do this without explaining what kind of data was going to be shared and people naturally reacted very negatively to this. We are now approaching it much differently. It is important to convince people of the benefits of such a system, tell them what information will be shared, why it is needed, and ask for their permission.”

Despite this reverse he believes the system is now moving in the right direction, albeit from a rather poor position. “The way it is now when a patient goes to their GP the GP knows a lot about them. But when the patient is referred to another care provider they have to tell their story all over again. And this is repeated over and over again. Even in the same organisations we have instances of patient information being stored in different systems which are not shared.”

This situation is about to change, however. “The different systems in The Netherlands have agreed on a standardised form and dataset for patient records. This will mean that it won’t matter where the patient is, the same information will be recorded. We are using a minimal dataset and with standardised terminology to ensure that the data is consistent.”

The SNOMED (Systematic Nomenclature of Medicine) system has been chosen as the standard. “This is used in 27 countries around the world and has been translated into several languages. It is the most important standard for this type of information. If you use SNOMED you can take the data almost anywhere and it will be understood. This information is the basis for everything. If you don’t have it how can you continue care in another organisation?”

Current system structure

He believes the current system structure is not suited to patient needs. “The system starts with different caregivers and that is wrong. You need to start with the patient. Everyone is born somewhere, lives somewhere, and has interactions with the health system. We need to record what treatments they have had, if they have allergies and other important information about them. This has now been accepted by the two main hospital organisations.

We are now discussing it with the IT systems vendors. We are asking them to implement the dataset in their systems.”

This should not present a major issue for those companies as the dataset includes information under just 17 headings. “We include basic details such as name and address as well as very important items such as medications the patient is on, procedures they have had, any instructions such as ‘do not resuscitate’, if they have oxygen supplies in their home, if they are a wheelchair user and so on.”

Having this sort of information held in one record accessible whenever and wherever it is needed will bring real benefits to patients. “What is happening now is that nice fancy health apps are being designed for smartphones but these don’t make much sense if the patient has to update their information every time. The records will be updated automatically. Point of care documentation will only have to be prepared once and will be capable of being reused many times.”

The health system will also benefit. “You can use the records to obtain information in an anonymous way and this offers the basis for secondary use of the information. It will be possible to look at the length of stay for patients with the same conditions in different hospitals, for example. It can also be very useful for epidemiological purposes.”

And the proposed system is being designed to minimise the possibility of errors. “We will use codes and terminology appropriate for physicians. At the moment patient information can be recorded in free text and this is very complicated for a computer to read.”

It is hoped to have the new system up and running by the end of the decade. “We have to convince the patients and the IT vendors. We hope to have it in place within the next two to five years.”

He believes there are lessons which Ireland can learn from the Dutch experience. “Because of the past experience our health ministry is very cautious about the introduction of electronic health records. We know that patients need to be convinced and that is why we are proposing a minimal dataset. It will only contain the information which is absolutely necessary and is capable of being completed in just one way, rather like your income tax form. You file your tax form electronically and it can only be used in one way. I believe the majority of people will say yes when they are given all the information and they understand that the records will only contain the data that is needed to improve the quality of their healthcare.”

Given that the roll out of electronic patient records has been delayed by up to 13 years as a result of the mistakes made in the first attempt this is a valuable lesson for any country with plans to implement a similar system.

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