A greater reach and broader functionality. That is what Health Cloud Initiative (HCI) aims for with the integration of the two personal health environments (PHE) Uw Zorg Online (UZO) and Quli. “A logical combination,” says innovation director Gideon Kreytz. Both PGOs already operate under the HCI flag. Further integration combines the logistical power of Uw Zorg Online with Quli's personalized approach.
Both Uw Zorg Online as Quli are considered pioneers of the PGO. Quli – short for 'Quality of Life' – started in 2013 as a social initiative of a number of healthcare organizations. The initiators wanted to develop a digital environment with Quli that gives people and their loved ones more control over their lives, health and care. Originating from the online platform for primary care Pharmeon is Uw Zorg Online has been active for over twenty years. With over 3,5 million users, it advertises Uw Zorg Online itself as “the healthcare platform of the Netherlands”.
Patient-oriented features
Uw Zorg Online and Quli have two different approach routes, but that is why they fit together well, believes Kreytz. “Quli is based on the person of the citizen. Quli focuses on the person and the network that surrounds them. The Uw Zorg Online-environment is much more of a logistical environment. General practitioners, pharmacies and others can participate in this with their e-services, so that you as a patient can make an appointment. But of course it is also good if specific functions are included that have direct added value for you as a citizen or as a person. In addition, the informal care aspect is explicitly present in Quli. This digitally supports self-reliance and self-reliance. Within Uw Zorg Online we are still missing patient-oriented features, such as a diary and positive health. That is why we are a good fit for each other.”
User need
With the integration it seems HCI to anticipate the efforts of the Ministry of Health, Welfare and Sport to to consolidate the market for PGOs. There are currently ten active providers, but VWS now wants to reduce this to three through a tender. According to Kreytz, the integration of Uw Zorg Online and Quli not primarily motivated by tactical motives but by user needs. “You see that different worlds are increasingly growing closer together. In the long term, we will open up more and more healthcare segments. In addition to general practitioners, hospitals and mental health care, this also includes rehabilitation, care and paramedics. In this way, we really create an environment for you and for me. If, thanks to the MedMij agreement system, I can also exchange information between healthcare domains, then you have a PGO, as it was once thought.”
Goal-means confusion
As the founder of Pharmeon and Uw Zorg Online Kreytz closely follows the developments surrounding PGOs. What he notices is that, in his opinion, the government has not always been able to keep the means and the end separate over the years. “In my view, a confusion of ends and means has indeed arisen. If the government had limited itself to creating standards and setting conditions for their use, the government would have made it easier for itself and we would have come further. Ultimately, people started to attach more value to PGOs and creating a market than to unlocking the data itself. That is a pity. Subsequently, it was not possible to make PGOs fly properly. So now we are backtracking on the idea of a PGO market.”
MedMij system
This does not alter the fact that, according to Kreytz, a lot has been set in motion. “It MedMij system, which allows healthcare users and healthcare professionals to exchange health data safely and reliably, is in itself particularly valuable. That proves itself every day. We now have an initiative where patients can bring their own file for a second opinion. We could not have done that across the board without the MedMij system.”
“We have come quite far in the Netherlands. In the general practitioner world, you have two major environments: MijnGezondheid.net and Uw Zorg Online. They cover almost all GP care in the Netherlands. So if I, as a care recipient, want to view my file digitally, I can. And if I want to pick up my file at the hospital, I can at least pick up part of that file via the MedMij system. So we've actually come quite far."
PGO unknown
That the average Dutch person still has no idea what PGO stands for does not worry Kreytz. “What the average Dutch person should experience is that he can simply access his data when he selects a health app. That app must be reliable and safe and meet certain requirements. That someone then came up with the idea that such an app should be called a personal health environment, I as a user do not even need to know.”
Own direction
Kreytz's relativizing commentary cannot conceal the fact that the government has big plans for the PGOs. Government policy is aimed at ensuring that every citizen who wants to have access to his or her health data digitally via a PGO from next year. In the maximalist variant, the PGO is even presented as the linchpin for personal control over care and health. Kreytz views this view with the necessary scepticism: use should never be a goal in itself. In his view, the importance of the PGO lies primarily in its availability for the time being.
Value
“It is not primarily about how often you use it. I think that is a mistake in thinking. That is like hanging a fire extinguisher in my house and saying after a year: it has never actually been used, so I will just take it away. So it has no value? No, it has value because it is there. It is the same with healthcare data. That availability has value. If you make the data available, it will develop further automatically. If it is interesting for me as a citizen to be in a digital environment where I can combine data from my wearable with that of my GP, then I will do that. For one person that has value, but for another none at all. Of course, there are many people with disabilities or chronic conditions for whom data and support can often be of significance. But the government should not want to control the market in this regard. That data is important. Even if I, as a citizen, do not use that data every day, I am happy that I can access it myself when necessary.”
Data availability
Even when it comes to the near future of PGOs, Kreytz continues to hammer on data availability. “Data availability remains a barrier in healthcare. If you go to retrieve your hospital information as a patient, you will notice that it is limited. That was the situation before MedMij and it is still the case after MedMij, albeit slightly less so. Why? There are still parties who have an interest in being able to control access to data. With the introduction of large language models, data has become even more important. There is so much value in that. So I say to the government: focus on that data availability, ensure that there are requirements for parties who make data available or use it and then let the market do its work. Then I see innovation increasing rapidly.”
Source: Dutch Health Hub