Dutch Healthcare Digitalization Journey and Challenges

Digital healthcare initiatives have grown over the last couple of years. The health crisis instigated by the coronavirus has accelerated not only a shift in the way healthcare is delivered to patients (e.g., eHealth) but also the modernization of supply chains by streamlining procurement processes to accommodate current and future needs.

Several digital initiatives have taken place in the Dutch healthcare sector to improve overall care. For example, in August 2021, the St. Antonius hospital implemented AFAS' ERP. The cloud-capable system is a step up as it simplifies the registration and ordering of implants.

In November 2021, the University Medical Center Groningen (UMCG) invested €2 million in the development of AI, data science, and eHealth applications as the medical center expects technology to continue to play a major role. It will continue to invest in AI to improve diagnosis, treatment, and monitoring, while e-health applications and medical devices leveraging sensors and data analytics can help healthcare providers to act quicker and provide better care for patients in need. This was also one of the smart hospital initiatives deployed by the University Medical Centre Utrecht in April 2022. The UMC selected Fujitsu's Asset Tracking solution to instantly pinpoint medical equipment for maintenance, cleaning, repair, stocking, and replenishment, reducing unnecessary spending.

Despite these IT and digital investments, there's still much room for improvement. According to a 2022 study commissioned by the Ministry of Health, Welfare and Sport, the report "Digitisation in Healthcare: A Closer Look" found that the Dutch healthcare sector lacks adequate IT infrastructure, organizational capacity, and healthcare applications funding. Institutional interoperability, i.e., when systems exchange data, is also lacking as each institution has its own approach to IT. In PAC's view, the Netherlands lacks a nationwide network that promotes interoperability in the sector supported by the government.

What's more, cognitive technologies deployed and embedded within applications are often misunderstood or misinterpreted by medical professionals that lack a deeper understanding of what role technology and AI play. Questions arise, such as what happens to the data obtained? Where is data being stored? How do these algorithms/technologies come to a particular conclusion? There is a need for healthcare professionals with a technical-medical background to overcome specific challenges, including hesitation and skepticism toward adopting intelligent applications and technologies.

These smart devices and modern supply chains also raise further security challenges due to increased vulnerability exploits such as user authentication attacks. Broken object level authorization (BOLA) is one of the most common attacks on APIs, targeting, for instance, the user object ID.

In November 2021, Z-CERT (a Computer Emergency Response Team) an organization set up to help Dutch healthcare institutions with cyber security protection and incident support, and Forescout (an automated cybersecurity provider) concluded that thousands of medical machines (2,233 used in the Dutch healthcare sector) suffered from software vulnerabilities – Nucleus NET's Real Time Operating System. New medical devices may be able to be patched over-the-air (OTA), but older equipment needs a manual approach. Therefore, Fujitsu's Asset Tracking solution can also play a critical role in cybersecurity.

Overall, many challenges lie ahead despite the Dutch government's encouragement of using eHealth and further digitalization and interoperability of the sector. The government should take a leading role, stimulate funding, and facilitate legislation to support the sector's modernization.

Indeed, it has put in place several initiatives, e.g., Zorg voor innoveren (government-led central point of contact connecting care innovation and vendors), VIPP programs (Acceleration Program Information Exchange Patient & Professional), the MedMij website (playbook for safe electronic healthcare data exchange), eHealth Now (existing eHealth cases and initiatives), digivaardigindezorg.nl and a digicoach program (digitally upskilling medical professionals in various topics, e.g., ethical and transparent AI). Despite these initiatives and programs, these have had little impact on transforming the Dutch healthcare system.

There continue to exist many opportunities for IT providers in this sector, but to transform nationwide, the government needs to play a more active and leading role.