Welkom en Dutch Grand Rounds, Grote Visit - 4th Edition!

Health Management Rx has the unique privilege to host the first US-based Dutch Grand Rounds today!

Due to the language barrier (ours, not theirs!), the format of this Grand Rounds will be text heavy - some posts are in English, some in Dutch.

Our Dutch colleagues have kindly translated many Dutch links to English text for us, so content of those posts is included below en total.

Since we have so much great 'imported' material to cover, I'll keep the intro short and sweet.

It's a privilege to provide inside perspectives from my adopted homeland. This is a rare chance for the American health and medical blogosphere to hear what's really going on over there in the Netherlands, and how Dutch bloggers view international healthcare fumblings.

Or, as e-Patient Dave and Susannah Fox put it recently: "What's with the Dutch?"

What's amazing is we don't often hear about Holland over here in the insular US of A, unless you're a tech and/or design addict (check out Dwell, Wired, Fast Company, etc. to read about the latest, including Dutch design superstars like Tord Boontje). Or a windmill enthusiast.

These are my friends who reclaimed a homeland from the sea, create beautiful art, pottery, food, families and literature, and bought New York before anybody else across the pond could sense future value.

Point: The Dutch are at the forefront of what's new and what's next, in tech, in architecture, in health.

We're building a global network of healthcare firestarters, connecting with new friends in Israel, Canada, Hungary, and of course the USA.

What you need to know about Holland:

1. Yes, we ride bikes. Alot. Ask us about 'oma fiets.'
2. No, we don't wear clogs. Usually.
3. Ignore us at your peril. We are all on Twitter. Are you?

You might say we're a nation where being a maverick is the norm. No wonder I feel so at home...Lekker!

Why pay attention to the Dutch healthcare ecosystem and blogosphere?


1. They are further along in PHR development. And they let people who are patients 'own' medical and health data.

Why does this matter? Because there isn't a snowball's chance in hell we'll reach agreement on who 'owns' data until someone builds a killer app that let both patients and providers have access and sharing/privacy rights.

As John Sharp said on Twitter yesterday:

JohnSharp @jenmccabegorman As Health 2.0 epatients, we can take charge of our health info but the docs still write the scripts 05:05 PM October 06, 2008 from web in reply to jenmccabegorman

I say again, they let PEOPLE WHO ARE PATIENTS OWN MEDICAL AND HEALTH DATA.

From Robert (@hout): PHR-On-A-Stick (Netherlands)

Two doctors at Maastricht University Medical Centre, in cooporation with Cinsol corp., have developed a cardiologic Personal Health Record, on a Flash memory stick, called Cardiostick.

Cardiostick contains personal data, insurance data, and medical info about pacemakers, operations, heart rhythms, x-rays, ECGs and scans.

When plugged into the computer, an emergency page appears with all important medical information in four languages.

The patient owns the Cardiostick and is able to add and edit password protected information. He also can grant access to others (doctors).

Cardiostick is currently being used by apprx. 500 people.

http://www.health20.nl/2008/10/01/epd-on-a-stick/

Good luck ;-)
Robert


2. They are paying attention to genomics. Again, watching where the puck is going, not where it is (thanks @gapingvoid).

From Laika's MedLibLog, an excellent analysis of DTC (direct-to-consumer) genetics firm 23andme's recent price cut in "23andMe: 23andMe, not yet."

Can't believe I missed the "celebrity spit party" - @unitystoakes can you tell us more about it at Stoaked?

And check out the comments in Laika's blog entry, where Dr. Steven Murphy tells us about a new group, HelixGene, dedicated to "better genomic medicine."


3. They've agreed they need a NATIONAL EHR/EMR SYSTEM.

Lodewijk Bos, @icmcc, Founder of the International Council on Medical and Care Compunetics (ICMCC), has an excellent commentary here.

His main point? A tethered EMR will never live happily ever after with an untethered PHR. We need a comprehensive design, or a system to link the two interfaces - and buena suerte with building that one.

Or, as Lodewijk puts it: "The concept of a separate EHR and PHR is fundamentally wrong."

The first article to which Lodewijk refers, by Martijn Hulst, is published in Dutch, but Martijn has been kind enough to translate it for us Dutch n00bs.

From Martijn Hulst comes a translated summary his blog-article about electronic health records (http://www.martijnhulst.nl/weblog/pivot/entry.php?id=472) in Holland.

The post, in Dutch (via the link above) gives an overview of the EHR-debate in the Netherlands.

What you need to know about systemic, national EHR implementation in Holland (per Martijn):

1. The government is trying to get a law through our Parliament.

2. In this law they demand that on September 2009, every caregiver is connected to the main EHR-application, so that the exchange of health data between caregivers is possible.

3. When they made the initial law there were many reactions:

• The Council for Public Health and Health Care said in an article that the whole idea of the EHR and the law isn't looking at what is possible with the web.

• A general practitioner published an article and wrote that the EHR of the government is nothing more than an 'air castle' (castle in the clouds) and that it won't work in such a short period.

• The society of general practicioners aren't willing to help, because they don't believe in the EHR and because there's another discussion between them and the government about payment. (It's always about the incentives eh Martijn?!)
  

• A lawyer, who studied privacy-questions about EHR, said the EHR is not good for the privacy of patients, because caregivers wouldn't have the approval from the patients to look in the health records of their or others patients.

• A consultant about EHR's wrote an opinion-article and said some things about who is owner of the EHR (patient versus physician, another recurring theme).
  

• The insurance companies and the dutch association of patient-consumers (NPCF) said that regardless of the critics we must go on with the law, because patients are waiting on a main EHR-exchange and that it lead to some prevention and less mistakes in healthcare.

4. They believe in consumer-centric, human t0 human care.

From Martijn Hulst:

"In my posting I give another view and write about the world patients live in (the 'health2.0-world'). In this world patients are already exchanging information, meeting each other, monitors online his / her health, and so on. This world is far from the world of the law. And, well, you know already, this is not a technical problem, but an organizational and culture problem. This is also studied in the model of Bettine Pluut (from Zenc). I put a diagram of this model in my posting.

In my conclusion I write that the whole implementation of EHR's must not be a question for IT-companies, but must be a question for organizational-(change)-consultants. You can't force caregivers to work in a short period with a nationwide EHR, you can't force caregivers to exchange their information and you can't force healthconsumers ('im-patients') to choose for an old idea of EHR's, when they already explored online a world of possibilities."

And from Jacqueline, @fackeldeyfinds, a look at putting human-to-human healthcare into practice here.

An Energizer Bunny who outsparks even yours truly, Jacqueline has an overview of the intersection of people and tech (or lack thereof) in healthcare here (in Dutch but check out the images on the slideshow - you'll get the drift).

5. They are connectors extraordinaire who will give anyone a chance. They live well but move around, a lot.

They are statespeople, diplomats and are not shy about taking risks, like including somone blogging about getting rid of a pot belly in Dutch Grand Rounds.

How can you NOT want to make healthier eating choices, in Holland, the US, and abroad, after reading DietBlueBook's description of, ahem, an apple shaped appreciation for good living?

"Hidden under my shirt is a jiggly treasure trove of human belly fat - perfect for some fun loving squeezing and a show of wealth perhaps in some poorer countries, but to me, it’s a sad reminder that I’m out of shape and have been hitting the ice cream cartons and Asian carryout meals a bit too hard."

Yeah, really I just couldn't figure out how to fit this one in there (no pun intended).

But eat too much pie in Holland and you too will be dealing with Dutch double belly.

AdmirableIndia's post, has, on the other hand, nothing specifically to do with healthcare, or Holland, but DOES have some very nice therapeautic photos of sunflowers.

AND since Van Gough was particularly fond of this flora, you made it in by a hair AI.

Thanks for brightening our day.

Tomorrow a quick followup and announcement of the next gathering place for Dutch Grand Rounds.


Until then, be well, do good work, and think seriously about booking a trip to Holland.

Tulip fields are lovely in the spring, and I know a little place we can brainstorm.

Tot ziens all!