Some thoughts on health and healthcare

Introduction The European Health Data Space (EHDS) changes digital health from a national modernization agenda into a binding European interoperability, patient-rights, and secondary-use agenda. The EHDS Regulation establishes a common EU framework for electronic health-data exchange, strengthens individuals’ access to and control over their health data, enables regulated reuse for research and policymaking, and introduces harmonised interoperability and security requirements for EHR systems (European Commission, 2025a). For Belgium, the issue is not whether digital health exists: Belgium already has strong assets, including the eHealth platform, regional data vaults, ePrescription infrastructure, patient portals, Belgian Integrated Health Record (BIHR), BeSafeShare/Be-SafeShare (Belgian Coordination Authority for Secure Standardized Multidisciplinary Health Data Exchange), Fast Healthcare Interoperability Resources (FHIR) implementation work, and the Health Data Agency (HDA). The cen...

Abstract An acute hospital can be clinically successful and financially healthy only when quality management, clinical practice, operational efficiency, patient outcomes, and reimbursement are governed as one integrated system. The Donabedian model provides the conceptual logic: structures shape care processes, and processes determine outcomes. Value-based healthcare (VBHC) adds the strategic objective: maximize patient-relevant outcomes relative to the cost of achieving them. Evidence-based medicine and evidence-based practice provide the epistemic standard for clinical decisions, while Diagnosis Related Groups (DRG) impose a financial discipline by linking hospital revenue to case mix, coding, resource use, and length of stay. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) ensure that “success” is not reduced to mortality, complications, throughput, or margin alone. The Electronic Health Record (EHR), supported by Clinical Decision Support ...

Abstract Implementing a modern Electronic Health Record (EHR) in a hospital is fundamentally an exercise in representing, exchanging, and reusing clinical information safely across time, teams, and systems. This requires clarity about three related but distinct notions: syntax (how information is structured and encoded), semantics (what that structured information means), and ontology (a formal, explicit specification of the domain concepts and relations that underpin shared meaning and enable computational reasoning). In this essay I want to distinguish these concepts and demonstrates how their differences translate into concrete design, integration, governance, and patient-safety considerations in real-world hospital EHR implementations. 1. Introduction Hospitals depend on EHRs not only to store a longitudinal patient record, but to coordinate care across departments (e.g., laboratory, pharmacy, radiology, admissions), across professions, and often across organizational boundaries...

Inleiding Elektronische patiëntendossiers (EPD’s) zijn tegelijk een cruciale infrastructuur voor veilige zorg en een bekende bron van administratieve belasting. In de literatuur wordt documentatiebelasting expliciet in verband gebracht met burnout, lagere tevredenheid en “work outside of work” (o.a. avond- en weekendregistratie). Daarnaast wordt slechte EPD-bruikbaarheid geassocieerd met hogere belasting en ongunstige werkervaringen. Tegen deze achtergrond ontstaat een dubbele ontwerp- en governance-opgave: (i) minimaliseer registratielast voor artsen en verpleegkundigen, en (ii) maximaliseer de klinische herbruikbaarheid van data zodat zorgprocessen daadwerkelijk datagedreven kunnen worden ondersteund (kwaliteit, veiligheid, continuïteit, populatiemanagement). Hier doe ik een bescheiden persoonlijke poging om m.i. enige relevante elementen te formuleren waaraan een modern EPD idealiter zou kunnen voldoen om beide doelen simultaan te realiseren. De eisen worden benaderd als een socio-t...