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03 February 2025 | Country Update
Wegiz – electronic data exchange
2.7. Health information management
High-quality information on health care provision receives a great deal of attention in the Netherlands, not just for monitoring the performance of the health care system, but also to inform the actors in the health care system. Patients, for instance, need information to make informed choices about where to seek care and which insurance policy best fits their situation. More on patient information systems is provided in section 2.9.
2.7.1. Information systems
Requirements for information systems in health care are growing. Many hospitals are investing in new systems that allow them to share information both within the organization and with partners in care chains, such as GPs, pharmacists and laboratories. Most GPs in the Netherlands use information systems that enable them to link electronic patient files to an expert system (such as guidelines), communicate with pharmacists and generate data for disease prevention and research. For example, the NIVEL Primary Care Database (NIVEL Zorgregistratie, NZR) gathers data from a large representative sample of GP practices to monitor GP care in the Netherlands for health policy and epidemiological purposes.
A national roll-out of the Electronic Patient Record (Electronisch Patiënten Dossier, EPD) failed after vigorous debate and opposition. The national EPD was not meant to be a central database of patient data, but rather an infrastructure for care providers drawing from local databases of individual health care providers. It aimed to reduce the likelihood of medical errors resulting from lack of information, especially in out-of-hours care. Many GPs resisted a central exchange of patient data because they feared unqualified access to the information. Eventually the roll-out was blocked in the Senate because the privacy of patients was insufficiently guaranteed. Currently more pragmatic new initiatives seek to exchange patient data in a more feasible way. A new system called Care Infrastructure (Zorginfrastructuur), which is the new name for EPD, allows care providers to exchange information on patients and the use of pharmaceuticals on a voluntary basis. GPs, pharmacists and medical specialists may only exchange data from patients who have explicitly given consent. It should be noted that the current system does not allow patients access to their medical data. Since 2012, the Association of Care Providers for Care Communication (Vereniging van Zorgaanbieders voor Zorgcommunicatie, VZVZ) has been responsible for Care Infrastructure (https://www.vzvz.nl/).
National Basic Registration Hospital Care (Landelijke Basisregistratie Ziekenhuiszorg, LBZ; or before 2014 National Medical Registration, LMR) collects medical, administrative and financial data for the care of patients admitted to hospital, in day care, in long-standing observation, and outpatient hospital treatment. LBZ data are elaborated and analysed by DHD (Dutch Hospital Data), which has jointly been established by the NVZ and the Dutch Federation of University Medical Centres. The National Information System for Diagnosis–Treatment Combination (DIS, Landelijke DBC-informatiesysteem) is a database including all declared care products from hospitals, mental health care providers and forensic care. It is based on data from these care providers.
Mortality data are collected from the population register (bevolkingsregister). In case of death, a death certificate (doodsoorzaakverklaring), produced by a physician, has to be included in the population register. The provision of these data is a legal requirement. Mortality statistics are published by Statistics Netherlands (CBS).
Data on adverse drug reactions (ADRs) are collected by the Netherlands Pharmacovigilance Centre Lareb (Bijwerkingencentrum Lareb). It registers ADRs notified by physicians, pharmacists and patients with the aim to prevent harm from pharmaceuticals by tracing unknown side-effects. The legal basis for this is laid down in the Medicines Act (Geneesmiddelenwet).
Health care providers must notify the occurrence of 43 infectious diseases, including smallpox, poliomyelitis, diphtheria, rabies, tuberculosis, variants of hepatitis, whooping cough, rubella and mumps. Voluntary reports are registered for infections with methicillin-resistant Staphylococcus aureus (MRSA) and bacterial meningitis. Infectious diseases are monitored by the Infectious Diseases Surveillance Information System (Infectieziekten Surveillance Informatie Systeem, ISIS). ISIS is organized by GGDs and does not have nationwide coverage.
Food contamination and poisonings are registered by the Dutch Food and Consumer Product Safety Authority (Nederlandse Voedsel- en Warenauthoriteit, VWA). The VWA monitors the health of animals and plants; animal welfare; and the safety of consumer products. The VWA controls the whole production chain, from raw materials to end products and consumption.
Data on victims of injuries and those who are treated in emergency departments of Dutch hospitals are registered in the Injury Surveillance System (Letsel Informatie Systeem). Personal data and details of the circumstances of accidents are used for epidemiological research and management purposes in the participating hospitals.
The Ministry of Health, Welfare and Sport keeps an online account of all medical information and registration systems in the Netherlands. A website (www.volksgezondheidenzorg.info/zorggegevens) provides information on: the content of the registration system or database; the availability of the collected data; the collectors of the data; the contractors of the data collection; and the users of the data. For steering and coordination regarding the provision of information in health care, the Ministry of Health, Welfare and Sport has installed an Information Committee (Informatieberaad) in which relevant issues are discussed among stakeholders.
The Netherlands introduced a new act (Wegiz) focused on electronic data exchange from 1 July 2023. This act obliges healthcare professionals to exchange patient information, for example, healthcare files, electronically. The implementation is set to be gradual, with the first step being that GPs are obliged to prescribe electronically from 1 January 2024 onwards. Ultimately, patient health information is no longer allowed to be shared on paper or DVD and whenever possible it should be additionally shared in a personal patient health environment. In this way, information on the treatment and health of a patient can be made available faster and with a lower risk of errors. The act is part of a bigger initiative to improve electronic data exchange in the Netherlands.
Wegiz is an initiative from the Dutch Healthcare Institute, the Ministry of Health and other important stakeholders. Its main aim is the standardization of electronic data exchange and availability of information in the patient’s own online personal health environment. The act, Wegiz, is not about the need for data exchange, but about data exchange arrangements.
References
Wegiz: elektronische gegevensuitwisseling | Zorginzicht https://www.zorginzicht.nl/ondersteuning/wet-elektronische-gegevensuitwisseling-in-de-zorg-wegiz
Wet elektronische gegevensuitwisseling in de zorg: Wegiz – Samen voor goede zorg https://www.zorginzicht.nl/binaries/content/assets/zorginzicht/algemeen-ondersteuning/wet-elektronische-gegevensuitwisseling-in-de-zorg-wegiz---samen-voor-goede-zorg.pdf
Meerjarenagenda Wegiz | Gegevensuitwisseling | Data voor gezondheid https://www.datavoorgezondheid.nl/wegiz/uitleg-over-de-wet/meerjarenagenda-wegiz
Eerste Kamer stemt vóór Wetsvoorstel elektronische gegevensuitwisseling in de zorg | Nieuwsbericht | Rijksoverheid.nl https://www.rijksoverheid.nl/actueel/nieuws/2023/04/18/eerste-kamer-stemt-voor-wetsvoorstel-elektronische-gegevensuitwisseling-in-de-zorg
2.7.2. Health technology assessment
Evidence from health technology assessment (HTA) is essential for policy decisions on the benefit package and on appropriate use of medical devices. Criteria of effectiveness and cost-effectiveness that guide these decisions have addressed the need for economic assessments of new and current technologies (Berg, van der Grinten & Klazinga, 2004). In the early 1990s the National Fund for Investigative Medicine (Fonds Ontwikkelingsgeneeskunde) was created to finance such evaluations (den Exter et al., 2004). In 1999 the fund was replaced by a programme called Efficiency Research (DoelmatigheidsOnderzoek), coordinated by the ZonMw. The Ministry of Health, Welfare and Sport considers the programme a major instrument to achieve better and affordable care. In 2014 it provided almost 30 million euro to prolong the programme for the period 2016–2018.
The Medicines Evaluation Board (College ter Beoordeling van Geneesmiddelen, CBG) is responsible for the supervision and assessment of the efficacy, risks and quality of pharmaceutical drugs for humans and animals. Furthermore, the Board is in charge of the assessment of the safety of new human foodstuffs. The Board is an independent organization, whose members are appointed by the Minister of Health, Welfare and Sport.
Authorization of a drug by the Board does not imply reimbursement by the health insurers. The reimbursement decision is taken by the Minister on the basis of advice from the ZiNL, which absorbed the former Committee on Pharmaceutical Care (Commissie Pharmaceutische Hulp, CFH) in 2014.