The electronic patient dossier (EPD): why so many great benefits still resulted in a NO.
The use of digital tools in the health care is increasing. This trend is also visible in the Netherlands. To share knowledge about the development of health information systems in the Netherlands and to create more understanding for them, this post will describe one famous case illustrating the difficulty of implementing an information system, regardless of its good prospects. One tool that has been under debate in recent years was the Electronic Patient Dossier (Elektronische patiëntendossier or EPD), which can be defined as a national electronic health record containing the medical data of a patient. The EPD is an example of a health information system that seems to come with great benefits, but also harbors one main ironic drawback.
The first benefit is being able to register medical data more accurately. Information about a patient is readable to all health professionals who have access and no longer subjective to individual handwriting styles. Also, health professionals are given reminders while documenting data in the EPD, which allows the patient dossiers to be more complete. A third benefit is that the EDP prevents less medical mistakes and double examinations, as different health professional views the notes of each other. Furthermore, due to fast exchange of medical data, health professionals can make better decisions during emergencies. Lastly, paper medical dossiers can be viewed by anyone who, legally or illegally, has access to them. The aim of EPD was also to prevent unauthorized individuals to view the patient files. All these benefits came to this: increase efficiency and improvement of the quality of health care. However, with preventing privacy violations in the physical world, privacy concerns of the digital world started to emerge (Centrum voor ethiek en gezondheid, n.i.).
The first proposal for the implementation of the EPD was turned down by the Dutch parliament, a majority of health professionals and the Dutch citizens due to the concerns of privacy, as serious doubts of the security of personal medical data existed. As the EPD was not 100% safe for hackers, it caused fear of exposing personal medical data to persons who were not authorized to view the data (ANP, 2013). This was the main reason why the implementation of the EPD was declined. This case illustrated that regardless of the great benefits one information system might have, it is still subject to different factors that are not necessarily linked to the development and decision-making process of the system. The weight of benefits and drawbacks of one system might be different for the various stakeholders, which leads to difficulties in pushing the system through.
What can be done is such situation? There are two options: Give up on the system or adjust it to minimize the critiques. The proponents of EPD chose for the second option. Three years after the EPD was turned down, two general practitioners (GP’s), together with developers, are creating an alternative for the EPD (Rijksoverheid, 2015). This new version requires the patient dossier to stay at the GP of the patient and the patient needs to give his or her approval each time their data being shared with other health care professionals. Together with the GP, a patient will decide what will be shared and what will not. This means that the dossier will be managed regionally and it cannot be saved by health care professionals other than the GP. This way, the patient and his or her GP will stay in control of patient’s dossier, while only few relevant health care professional will have professionals have access to the patient’s. Fewer people having access to this medical data means that the chances of a hack will be minimized (NOS, 2015). However, the question that remains: will the different stakeholders accept this modified system?
ANP. (2013, 2 5). Moeizame weg naar e-patiëntendossier . Retrieved 9 21, 2015, from NU: http://www.nu.nl/gezondheid/3123666/moeizame-weg-e-patientendossier.html
Centrum voor ethiek en gezondheid. (n.i.). De voor- en nadelen van elektronische patientendossiers. Retrieved 9 21, 2015, from Argumentenwijzer over Elektronische Patiëntendossiers: http://www.ceg.nl/publicaties/Argumentenwijzer_EPD/de-voor-en-nadelen-van-epds/
NOS. (2015, 10 10). De Nederlandse Publieke Omroep. Retrieved 9 24, 2015, from Nieuw systeem moet veiliger patiëntendossier mogelijk maken: http://nos.nl/artikel/2056860-nieuw-systeem-moet-veiliger-patientendossier-mogelijk-maken.html
Rijksoverheid. (2015). Wat is de zorginfrastructuur (eerder het landelijk elektronisch patiëntendossier of EPD)? Retrieved 9 21, 2015, from Patientenrecht en clientenrecht: https://www.rijksoverheid.nl/onderwerpen/patientenrecht-en-clientenrecht/vraag-en-antwoord/wat-is-de-zorginfrastructuur-voorheen-het-landelijk-elektronisch-patientendossier-epd