Balancing Supply and Demand of an Electronic Health Record in the Netherlands; Not too open systems for not too open users.

About twenty suppliers of electronic health records (EHR) battle for the favor of about hundred hospitals in the Netherlands. The Minister of health has been promising for over a decade that every citizen in the Netherlands can have an EHR. Until now this promise has not been met. One of the main requirements for this national EHR is an agreed definition of an open EHR by both vendors and users. This paper first studies the demand side using the results of thirty eight interviews with end users asking them their core processes and their expected value of an EHR. Next we have a look at the supply side with an overview of the Dutch market and a focus on open EHR's as possible overall solution. This solution is further elaborated by using the experience with enterprise application integration (EAT) in industry. The contribution of this paper is twofold. First from a combined analysis of our data our main conclusion is the supply of EHR in the Netherlands is not open yet. Only suppliers with a small market share really offer external process integration. Only if the main suppliers are stimulated (by the government) to open up, a national EHR can arise. Secondly from a detailed analysis the following results stand out: majority of the end users (demand side) do not get support in their relevant working processes. Communication is badly supported and direct patient contact (what they think most important in their work) is even endangered by new systems. Availability, a benefit where all stakeholders agree upon, does not seem to be enough to open the market and create a good diffusion of EHR in the Netherlands. Much more focus should be laid on quality of care and communication with patients and colleagues