1. Marc de Graauw marc@marcdegraauw.com AORTAthe Dutch Healthcare Infrastructure

2. Marc de Graauw marc@marcdegraauw.com Healthcare Information System HIB BSN (“Burger Service Nummer”) Registry Messa- ging Services Healthcare Information System Patient Registry Healthcare Information System Provider Registry UZI (PKI) Registry Healthcare Information System Act Registry

3. Marc de Graauw marc@marcdegraauw.com The Netherlands “AORTA” is the national backbone Healthcare Information Systems at institutions and GP’s will be online 24x7 No clinical data at backbone, only an index of where clinical information resides Clinical data stays at the source Only possible with dense infrastructure Patient, provider registries et cetera

4. Marc de Graauw marc@marcdegraauw.com NICTIZ (Dutch EHR Standards Organization) Timeline Medication File Primary Care Summary 2003: start 2006: Healthcare Information Broker delivered 2006/7: First HIS qualifications 2009: General availability

5. Marc de Graauw marc@marcdegraauw.com NICTIZ & Dutch Healthcare Communication between: Healthcare Provider (GP, hospital etc.) Healthcare Information Broker (HIB) HIB provides: index of which parties have patient data no patient data itself messaging services aggregation services Health Level Seven version 3 (HL7v3)

6. Marc de Graauw marc@marcdegraauw.com Ministry of Healthcare NICTIZ National Institute for ICT in Care CIBG Healthcare Professionals Authority UZI-Register Healthcare Provider Registry SBV-Z Unique Person Id Registry Provider Healthcare Information Broker Gov Hospitals Others Pharmacists GP’s Market Healthcare System Suppliers Healthcare Access Providers Regional Facilities

7. Marc de Graauw marc@marcdegraauw.com Healthcare Information System HIB BSN (“Burger Service Nummer”) Registry Messa- ging Services Healthcare Information System Patient Registry Healthcare Information System Provider Registry UZI (PKI) Registry Healthcare Information System Act Registry

8. Marc de Graauw marc@marcdegraauw.com Healthcare Information System HIB BSN (“Burger Service Nummer”) Registry Messa- ging Services Healthcare Information System Patient Registry Healthcare Information System Provider Registry UZI (PKI) Registry Healthcare Information System Act Registry

9. Marc de Graauw marc@marcdegraauw.com AORTA all messages go through healthcare information broker three basic patterns: HIS sends message to other HIS, HIB just routes HIS sends message to HIB (mainly for registry updates and queries) HIS queries several other HISses, HIB does registry lookups, accumulates data

10. Marc de Graauw marc@marcdegraauw.com HIB Healthcare Information System Message to HIS Message to HIB Act Registry Healthcare Information System Query (to multiple HIS) Act Registry Healthcare Information System

11. Marc de Graauw marc@marcdegraauw.com Healthcare Information System HIB BSN (“Burger Service Nummer”) Registry Messa- ging Services Healthcare Information System Patient Registry Healthcare Information System Provider Registry UZI (PKI) Registry Healthcare Information System Act Registry

12. Marc de Graauw marc@marcdegraauw.com UZI Registry provide Dutch healthcare PKI standards provide and distribute smartcards with private keys to all authorized healthcare institutions to all authorized healthcare personnel provide smartcard readers, and necessary software publish and maintain certificate revocation lists also provides authentication forwarding software

13. Marc de Graauw marc@marcdegraauw.com Healthcare Information System HIB BSN (“Burger Service Nummer”) Registry Messa- ging Services Healthcare Information System Patient Registry Healthcare Information System Provider Registry UZI (PKI) Registry Healthcare Information System Act Registry

14. Marc de Graauw marc@marcdegraauw.com “Burger Service Nummer” Unique Id for every Dutch person Based on social security number Law is amended to permit use in care Maintain BSN Registry Provide access to registry query for BSN based on name, address, birthdate query for name, address, birthdate based on BSN Web Service direct and through HIB / HL7v3

15. Marc de Graauw marc@marcdegraauw.com Healthcare Information System HIB BSN (“Burger Service Nummer”) Registry Messa- ging Services Healthcare Information System Patient Registry Healthcare Information System Provider Registry UZI (PKI) Registry Healthcare Information System Act Registry

16. Marc de Graauw marc@marcdegraauw.com HIB (Healthcare Information Broker) Routing of messages between HIS’s Act Registry: which HIS has information on which patient for which kind of data add/change/delete Act Information Patient Registry (partly gateway to BSN) Provider Registry (partly gateway to UZI) Collection of query data Logging, access control VPN based, TCP/IP, HTTP network

17. Marc de Graauw marc@marcdegraauw.com Healthcare Information System HIB BSN (“Burger Service Nummer”) Registry Messa- ging Services Healthcare Information System Patient Registry Healthcare Information System Provider Registry UZI (PKI) Registry Healthcare Information System Act Registry

18. Marc de Graauw marc@marcdegraauw.com Infrastructure example

19. Marc de Graauw marc@marcdegraauw.com Actually, it’s not that simple...

20. Marc de Graauw marc@marcdegraauw.com Healthcare Information Systems Must qualify “Well Maintained HIS” performance, security, maintenance, uptime etc. Implement National Guidelines Do logging Do local authorizations