Aims and scope
MijnGezondheid is a partnership between more than twenty public and private actors, who implemented a portal website between 2017 and 2018, with which a citizen would be able to access his/her medical information more efficiently. The portal website is connected with different other databases to redirect the user (via single sign-on) to the right database, without the need for exchange of the data itself.
The creation of a Personal Health system (such as MijnGezondheid) on which citizens can consult most of their patient information was a major objective of the 2013-2018 eHealth policy plan (eHealth Roadmap) of the Belgian federal government. In past years, patient information had become more and more digitalized by local initiatives of regional governments, hospitals and other health care providers. This caused the medical information of citizens to be fragmented in diverse information systems. The federal government proposed to tie-up these diverse information channels so the citizen could have access to all or most of his medical information using only one system. The initial proposal of the federal government was oriented towards the creation of a Personal Health Record. This would centralize the patient information in one system. The Personal Health Record would be able to retrieve the health information of citizens from the different databases when called upon by the citizen. This idea was proposed in 2015 (i.e. start of the ideation phase of the project). Because of the relatively fragmented eHealth landscape at that moment and the many autonomous organisations that were involved in health care provisioning, the federal government decided to initiate a network to work out this idea and manage the various stages of the process.
MijnGezondheid is a portal website for patient information. It provides a central portal where citizens can access their medical information more efficiently. The data itself is not stored in MijnGezondheid (it is not a database of patient information). There is also no data transfer between the databases and MijnGezondheid. MijnGezondheid is a central portal that uses single sign-on to communicate with other servers where patient information is stored. The citizens using MijnGezondheid are directed to these other servers, without needing to login on all of these servers separately. ITSME, a federal encryption tool that uses double authentication, is incorporated into MijnGezondheid. When a citizen logs in with ITSME (or eID or a security code) on MijnGezondheid, he sees an overview of the medical information he can access in a tile structure for optimal visibility. When a citizen clicks on one of the tiles, he is directed to the server where his information is stored, without the need for another login on this server. Doing so, the citizen can consult all of his medical information that is already digitalized and connected to MijnGezondheid through the portal website, without needing to know on which platform/website the information is stored. This makes the access of medical information a lot more efficient. Because the patient information of citizens is fragmented and not all the organisations responsible for this information were able to connect with the portal website at the time of the release, MijnGezondheid receives new releases every few months, evolving into an encompassing portal website.
Main collaborative innovation conditions
The idea generation in MijnGezondheid was ambiguous. Because of the strong influence of the Federal Public Serivce for Public Health and the cabinet of the Minister of Health, combined with the policy directions in the eHealth Road Map, some of the general ideas already existed before the start of the project. However, these general ideas changed quite fundamentally with the transition from Personal Health Record to Personal Health Viewer. This points to a learning curve in the process. The complexities in the partnership impeded the idea of a Personal Health Record to come to fruition. Through active interaction (dialogue, discussion, deliberation, persuasion, …) between the actors in the partnership, the idea for a central portal for health information (i.e. Personal Health Viewer) received more and more support in the partnership. The idea of a Personal Health Viewer was initially proposed at the very start of the project in 2015 but was abandoned later on in the process. It was only when the project stagnated and the new coordinators (from the Federal Public Service for Public Health and the cabinet of the Minister of Public Health) became involved in the project that this idea was reconsidered. In other words, the idea for a central portal did not emerge because of the interactions between the individuals. It was brought up by specific actors in the project at specific points in time. The actors in favour of this idea interacted with each other in search for consensus, not to generate the idea itself. Examples of these new ideas were the visualisation of the website using tiles which correspond to specific health services, the framing of the information on the portal website so it would be understandable for citizens, the use of ITSME as an authentication tool for citizens, etc. In other words, at the general level of the idea (central portal website), interactions between the partners were directed towards finding consensus between the partners for the idea. At the specific level of the idea, interactions between individuals were directed towards producing new ideas which could be added to the general idea of the central portal website.
There were a lot of user organisations involved in the project. Some of these user organisations (VPP and LUSS, both representatives of patient organisations) were part of the governance structure of the partnership and fulfilled important roles (for instance the role of chair of some of the project groups). VPP and LUSS are umbrella organisations of the Flemish and Walloon patient organisations. This gave them an important role in directing the project towards the demands of the patients. Although these two actors were at the centre of the partnership, other user organisations were involved as well throughout and after the project. Examples are Domus Medica (interest group of physicians), SeniorNet (interest group of elderly people), and several other actors who had experience with the impact of such innovations on patients/citizens (e.g. PraktijkCoach, HealthConnect, Wit-Gele Kruis, …). Some of these actors (for example SeniorNet) were involved mostly after the project to communicate the website to specific user groups, while other actors (for example Domus Medica) were already present in the project groups from the very beginning (2015). Other actors (for example PraktijkCoach) were primarily involved in testing and improving the website and communicating it to the media. Therefore, the roles user representatives took on varied.
Implications and lessons learned
A combination of several factors was crucial for this innovation process. First of all, almost every stakeholder who could contribute to the project was involved in the innovation process. This not only caused an increase in support for the project, but it also allowed the project to explore the knowledge and resources of these stakeholders. Especially the users were very closely involved in the project. Second, and related to the first factor, the project established and maintained a clear governance structure, which made the role of the various partners clear and stimulated the interactions between the partners. Third, clear dialogue and consensus building behaviour of all of the partners resulted in issues being addressed before they could create huge problems. In general, the amount of energy invested in the interaction between the partners was substantial. Fourth, the arrival of the two new coordinators gave a new dynamic to the process, which was at that time almost in an impasse. The two coordinators explored possibilities, stimulated interaction between the partners and created a way forward by active interventions (e.g. making strategic decisions, bilateral dialogues, stimulating engagement and commitment, etc.). Fifth, the innovation process was flexible. Although there was not always room (or time) for experimentation, the process evolved naturally towards a certain outcome, being pushed and pulled between the different partners and their activities. This allowed the partnership to react quickly to changing circumstances without becoming entrenched in passive behaviour.
To read more about the case study, see D7.1 – Practices of external collaboration for service delivery. Comparative case studies on external collaboration in eHealth partnerships report.
About the Authors
Chesney Callens, University of Antwerp
Dries Van Doninck, University of Antwerp
Koen Verhoest, University of Antwerp
Emmanuel Dockx, University of Antwerp