Realizing Interoperability within the Dutch Military Healthcare System

Abstract

The healthcare sector has tremendous potential to increase efficiency and treatment accuracy through technology, resulting in cost reduction which in turn, increases healthcare accessibility. This is particularly critical for military healthcare, as military personnel lack the freedom to choose their healthcare providers. Additionally, the health of our military directly impacts the military position of the Netherlands. The interoperability of medical patient data facilitates efficient care delivery, contributing to cost-effective and improved healthcare outcomes. Therefore, this research aims to systematically identify and analyze the key barriers preventing the Military Healthcare sector from reaching a desired state in terms of the efficient exchange of medical patient data. The conceptual framework utilized in this research combines the gap analysis model and the European Interoperability Framework (EIF). The conceptual framework divides the research into five steps using the gap analysis model in which the EIF provides a segmented overview of the barriers. The five steps of the gap analysis are 1) assessing the current state, 2) defining the desired future state, 3) identifying the gaps and 4) barriers, and 5) providing recommendations to bridge the identified gaps and reach the desired state. In step four, the barriers are segmented according to the EIF in legal, semantic, organizational, and technical layers. A qualitative research design was employed to execute the steps of the gap analysis. Semi-structured interviews and literary research were conducted with a study population consisting of 10 relevant stakeholders involved in handling medical patient data within the Defense Organization. In addition, a semi-structured interview was held with an interoperability expert to provide recommendations. Sampling was done through snowball and purposive sampling. Data collection involved recording and transcribing interviews. The data analysis process utilized thematic coding to identify key themes and barriers. The results showed that an interoperable Military Healthcare system is desired, either by allowing hospitals and other practicians to seamlessly interact or by providing patients with wearables. However, this research showed that the Military Healthcare sector is still far from achieving an interoperable system. The bottlenecks primarily lie in the exchange of information with operational healthcare, between first- and second-line healthcare, and between the CMH and civil hospitals. Barriers to achieving interoperability were primarily identified in the technical layer and organizational layers. In addition, some barriers in the legal and semantic layers are indicated. However, this study points out that the barriers in the technical layer can be easily overcome with the current technological innovations and legal barriers can be overcome by the new WEGIZ law. To overcome the barriers, this study indicates further deepening of the organizational barriers by interviewing more stakeholders and involving DGO leadership and the Minister of Defense. In conclusion, the pursuit of interoperability in the healthcare sector holds immense potential. By addressing the identified barriers and fostering collaboration among stakeholders, the path can be paved for a future where seamless data exchange and interoperability become the norm. Ultimately, leading to better healthcare outcomes not only for the Dutch Defense Organization but for all.