Histories of the electronic medical record in The Netherlands 1970 - 2015

Abstract

The thesis describes the history of the electronic medical record in the Netherlands between 1970 and 2015. Its roots can be traced back to the reform of medical education and practice in the United States in the beginning of the twentieth century. Case-based teaching and improvement of practice required structured medical records with templates for patient complaints and history, findings, diagnostic tests, diagnosis, treatments, outcomes, and a standardized medical nomenclature. By the eve of the Second World Ware structured records were the norm in American hospitals. Dutch physicians were fully aware of these developments, but rejected them because of the perceived infringement of professional autonomy. Only after the war the position of Dutch physicians gradually changed. In the 1970s medical specialists agreed on a structured approach for medical record keeping. For general practitioners it started already in 1956 with the founding of their scientific society. The structured medical record was seen as necessity to enhance the scientific basis of primary care practice. By the time that affordable computing became available, general practitioners were ready to adopt the electronic medical record. In medical specialist care paper-based records were only relegated to the bin of history by 2015. Computing in hospitals was for a long time focused on financial and resource planning. Since 1990 a number of incentives moved medical specialists gradually to medical computing. The incentives included regulation, increased communication between physicians, quality of care initiatives and not the least the improvement of the position of the patient. Therefore, different histories of the electronic medical record in the Netherlands can be told. The thesis is guided by the arguments of the historian of science Michael S. Mahoney that computing finds it roots much earlier that the firsts in technology and the work of pioneers.