Erik Gerritsen departed from his role as secretary-general of the Dutch Ministry of Health, Welfare and Sport on 1 June 2021, after six years in the role. Described by his peers as the 'ambassador' of digitisation in the healthcare sector, Gerritsen has overseen various social and healthcare digital implementations during his term. He is set to start a new role as the chairman of the board of the Ymere housing corporation, one of the largest and oldest housing associations in the Netherlands, where he aims to continue delivering his social mission of improving the lives of vulnerable groups. During this transitional period, he spoke to Healthcare IT News about the ambitions of the Ministry of Health, the digital health strategies he has admired in other regions, and words of advice for other nations at the beginning their digital health journey.

This interview has been edited for length and clarity.  

HITN: Can you talk us through the ambitions of the MoH and how it has delivered on these aims?

Gerritsen: In the Netherlands, it always starts with a why. So why do we have to do anything at all? That's because if we think of ourselves as still being one of the best healthcare systems in the world, but if we keep doing the things as we always did, then we will move to a kind of big crisis, because we are one of the best healthcare systems, demand for care will grow because people get older and sicker.

But they can still more and more live with these chronic illnesses. In the labour market, there are growing shortages of labour, and also the number of informal caretakers is going down. So, that's the big challenge we face.

The good news is, there's a way out of it, we can transform and innovate out of this. We call this the right care at the right place. Also, the right data in the right format, for the right person too.

We have to put more emphasis on prevention and lifestyle. Digital possibilities are just waiting to be used. So you have this urgency, and this vision of right care at the right place. The possibilities of digital technology play a very important role in implementing this new vision.

If you look at this vision, we call it cold technology to deliver warm care. It's the same everywhere in the world. In the Netherlands, there's a big consensus that this is the way forward. So that's good news. If you travel around in the Netherlands, you see all those things already in pilots already implemented with success. But the big challenge is scaling up.

As I said, in one of my HIMSS Europe keynotes, the devil is in the implementation. There is no lack of vision strategy. We know from practice-based evidence that things are working with happy doctors, happy nurses, happy caretakers, happy patients. However, the scale is still not a national scale or, or even an international scale. So it's the implementation. In essence, we developed a policy in the Netherlands aimed at this, we call it a flourishing health ecosystem. For this, you need two things, you need a positive climate and fertile ground.

"We have to put more emphasis on prevention and lifestyle. Digital possibilities are just waiting to be used."

For the positive climate part, we as a government took the role as a convening power, making health deals when everybody wants to change, but they're pointing it towards each other. We put the whole system in the room and helped them jump together.

HITN: How has the focus of the Netherlands transformed during the pandemic?

Gerritsen: We did a lot of skill development. We had the health innovation school that started on a national scale, and brings together all the innovators from the hospitals, the pharmacies, the primary caretakers, the general practitioners and long-term care.

We are working on making learning communities. We work on removing obstacles, when they say we want to innovate but we cannot get paid for it, then we made that happen. Of course, we increased the subsidies to stimulate many of these developments.

Of course COVID, made it all go faster. You can look at it from the point of view of, this is a bad crisis, never waste a bad crisis. I don't like the term never waste a good crisis, because it's a really bad crisis.

Even if it's a bad crisis, don't let it go to waste, use the momentum to speed up the scaling up. On the other hand, you could say we should be a bit ashamed that we needed this crisis to make the acceleration happen.

Then again, the good news is, because I'm an optimist and optimism is a moral duty issue. The good news, again, is that the same people, the same hospital governors, the same professionals, the same doctors, nurses, patients, politicians from municipalities that are facing challenges with implementation, are doing it because of the crisis.

What we have to remember is that when the crisis is not there anymore, that the same people without any legislations or other big structural reforms, were able to innovate, to implement, to cooperate beyond their own domains.

We also organised eHealth weeks and launched the Smart Care Relay. We did a lot on making people conscious of all the good things that digital healthcare brings. The second pillar is about the fertile ground. If you have a good climate, you do a lot to make digital health grow and flourish. It can only grow and flourish if the ground is fertile. This is another way of saying we need interoperability.

"We did a lot of skill development. We had the health innovation school that started on a national scale, and brings together all the innovators from the hospitals, the pharmacies, the primary caretakers, the general practitioners and long-term care."

We need a good infrastructure that makes it possible that all the digital information systems can communicate with each other. This includes hospital systems, pharmacy systems, GP systems, but also with our programme MedMij. This has created a trust framework for personal health data that enable all the digital information to flow into the personal health environments so that the patient is the owner of the medical information that is available for him or her.

We have this national health information council I chaired. The whole system in the room on a national basis, and we worked on making this thing happen partly on a voluntary basis, using a lot of temptation, tactics and using the positive intrinsic motivation, that's always there. 

We have many subsidy programmes aimed at freeing up the data from different silos. And as a kind of a cherry on the cake, many people in the field told the ministry, this is all great and we love it when we do this on a voluntary basis. But still, it's so difficult because we have a lot of players, nobody has the authority to rule in this complicated healthcare system.

We need a law that makes it mandatory for all the information systems to be interoperable. A few weeks ago, our Cabinet agreed on this law that made the digital exchange of information interoperability mandatory. It's been sent to the parliament. As far as I know, this is unique in the world, having a law that makes it part of the quality of care that doctors, hospitals, pharmacists, and general practitioners work with information systems that are interoperable with the other systems. If a healthcare professional doesn't, then they don't have a complete picture of a patient. You are per definition not able to give the quality of care that is required and we can revoke your practicing license.

In our country where we don’t have these national health data exchange systems and the government has no direct authority, we used the ecosystem approach. The proposed law is a big step forward in this. We are proud of it. This is a long-term project. In a few years, it will be made mandatory that these gold bars of medical information will have to be interoperable.

HITN: Are there any digital health strategies you have admired in other countries?

Gerritsen: On the one hand, it's primarily about inspiration, because the other healthcare systems are so different. Then when you get inspired by great things other countries are doing such as in the Scandinavian and Nordic countries - they are a big example for us. Also the Baltics, but sometimes also the United States or Australia or India and even sometimes, African countries because they are leapfrogging. There's an amazing amount of inspiration in other countries. On the other hand, you have to go through your own learning cycle and implementation cycle, feeding to the healthcare system that you're having in your country. 

Estonia has a truly amazing digital infrastructure. I love that digital identity card, for example. Which by the way shows the importance of international standards. Finland is doing amazing things with health data for research and development.

"What we have to remember is that when the crisis is not there anymore, that the same people without any legislations or other big structural reforms, were able to innovate, to implement, to cooperate beyond their own domains."

I've been to the US and seen what amazing things are developed and used there. Again, our main theme, when we were abroad, not only inspiring and getting inspired but also expanding our own agenda of interoperability. For interoperability, we need the US, we need Australia, we need India, and Europe - especially the countries where the big IT suppliers are because when the Netherlands itself is a mouse and you know when we stamp our feet, the elephant is not going to dance.

I especially have warm feelings looking back on the cooperation. Also, making strides in interoperability has been facilitated by HIMSS many times, because this is not a national question. This is not a European question. It's an international question.

HITN: What are some words of advice you would give to other nations at the beginning of their healthcare digital transformation?

Gerritsen: I would say don't be too modest. Just realise that when you're lagging behind, especially with digital healthcare, you are in an eminent position to leapfrog and show us our backs within maybe five or 10 years.

I already saw great things, for example, in Kenya, where, because there are no hospitals, but they have 4G, and they have digital things. They can do a lot more online, with all the distance in ways that make me even a little bit jealous.

If you're not there yet, if you still at the beginning, make sure that from the beginning you use the international standards, and also focus on interoperability.  

HITN: In your opinion, what are the best ways to create meaningful impact in healthcare systems?

Gerritsen: It's about the implementation, it's about change management. It's not about the quality of the individual doctor or nurse, they're great already. It's not about vision, it's there in abundance. It's not about practical evidence, it's already there.

It's this scaling thing. It's in a situation where there are a lot of players but nobody is boss. Everybody's very busy with surviving and keeping their head above water because of the challenges not only from COVID but also those already present before COVID, and the lack of personnel.

If you are either a professional, a patient, a director or minister, or a state secretary, you can work on simple principles. Think big, act small, start today. Do that every day and then after two years, you look back and notice you made huge progress. But that's only what you can do as a person.

"Just realise that when you're lagging behind, especially with digital healthcare, you are in an eminent position to leapfrog and show us our backs within maybe five or 10 years."

Also, ask for help. Everybody that is remotely successful in healthcare already has the competence of taking care of himself or knowing how to get things done. But the competence of asking for help is a bit underdeveloped. If you cannot do it alone, ask your colleagues, your friends and your network partners.

The last one is also a very personal one because a lot of challenges do not just have one problem owner. Take responsibility for things you're not responsible for, without taking over responsibility. If everybody starts doing this, we'll be having a sustainable healthcare system within five years. Otherwise, it will take 10 or 15 years.

Learn more about the Netherland's digital health strategy at the upcoming HIMSS21 European Digital Health Conference on 7-9 June 2021. Click here to find out more information and register. The event is free of charge for employees of health and research institutions.

Healthcare IT News is a HIMSS Media publication.