McKesson and the Dutch national electronic patient record

McKesson-Nederland B.V. is a Dutch Hospital Information System (HIS) and Electronic Patient Record (EPR) system vendor in the Netherlands. In 2000 Dutch federations representing patients, doctors and the government agreed to develop a National Healthcare ICT infrastructure. NICTIZ was funded by the government and tasked with developing a national infrastructure to make personal medical data available nationally. After years of development an architecture for the national EPR (AORTA) has been created. The architecture is based on decentralized storage of medical data at the point of creation. The National EPR project infrastructure only provides authentication, a directory of available data and secure transportation. The first applications, which have been completed are ‘Medication Exchange’ and the ‘General Practitioner Observation data’. The general practitioners system is intended to share data amongst general practitioners. For McKesson’s customers the Medication Exchange system is much more relevant. It will allow medical professionals and their medication prescription systems to view all prescribed and dispensed medication for their client. Participation in this project will be mandatory. A law covering the mandatory implementation by healthcare Providers of this National EPR was adopted by the Dutch House of Representatives, but eventually struck down by the Dutch Senate. Consequently, the federations of Medical Professionals and the health insurers have taken over the project and its infrastructure. This thesis explores the needs of McKesson’s customers and the implications for the functions of McKesson’s products in relation to the National EPR project. Firstly the requirements set for participation in the national infrastructure were reviewed. The National EPR project requirements are called ‘Well Managed Care’ (WMC) system requirements. These requirements not only impose a standard and a method for exchanging data, but also require e.g. the ability to manage all National EPR content for a single person in one operation. In the case of McKesson customers, this content will most likely be stored and used in separate systems from multiple vendors. Also, doctors will want to access multiple types of data using multiple systems in one session. It is for these ‘front end’ requirements that in the future there will have to be a way to coordinate the use of multiple specialty systems to ‘manipulate’ a person’s entire National EPR record. The main consulting physician should be able to review all data stored in separate specialty systems with the patient and publish (make available for the National EPR) them while authenticating with his UZI card only once. In order to find out what services are expected and/or needed by the customers of McKesson and how ready they are to implement the National EPR, in comparison also to competitors’ customers, a survey was conducted amongst the IT staff of McKesson customers and non-McKesson customers. A total of 70 responses were received. Of these responses, 46 were from McKesson customers, 24 were from non- McKesson customers. The numbers clearly showed that non-McKesson customers are better prepared for the National EPR than McKesson customers. This is understandable, because the vast majorities of competing vendors is actively working on National EPR developments and are probably informing their customers about this fact. Trough the survey, it was discovered that McKesson products are combined and complemented with mostly the same products of other vendors. The National EPR in such a case requires cross-system coordination. This is in accordance with the needs for data- and process-integration that are driving new developments in the general field of IT applications. In this case it necessitates a sustainable, low-maintenance solution, facilitating integration of organizational as well as IT processes. Integrated processes will be needed to achieve better results and greater efficiency. This solution will have to compete with competing ‘suite’ vendors, which deliver all the important systems in a hospital and therefore can more easily integrate them. After looking at some specific scenarios for implementation of the national EPR at the typical McKesson customer, an integrated enterprise architecture is proposed. This will support both the envisaged National EPR and the advancement of McKesson’s systems towards the state of the art in process integration and support. This integrated enterprise architecture entails the use of a business bus and a dynamic process manager in order to facilitate (dynamic) process support and decision support. In order to realize this long-term vision, McKesson should focus on the virtual organization it forms with complementing vendors in order to compete with the larger suite vendors, which have an advantage when it comes to data and process integration across applications. The National EPR will firstly affect the hospital pharmacy and medication systems. In order to stay competitive and comply with a strict interpretation of the National EPR requirements, McKesson should strive to enable doctors to seamlessly use the multiple applications containing the data made available by and to the National EPR.