Exclusions

A patient’s file is shared with a healthcare provider when a therapeutic relationship is established between the patient and this healthcare provider. A therapeutic relationship is a relationship between a patient and a healthcare provider in the context of which healthcare is provided, or simply put, the relationship of trust between patient and healthcare provider.

In the absence of a known therapeutic relationship in the system, healthcare providers do not, in principle, have access to the patient’s medical records. However, several other scenarios are possible where access to the file is required. Some examples to illustrate this:

• When a healthcare provider sends a sample to the hospital laboratory, a clinical biologist or laboratory technician can consult the patient’s file;
• Within the framework of clinical studies, medical data from health records may be consulted by a researcher;
• A healthcare provider is called by the patient’s general practitioner with questions about a report of a treatment some months ago;
• When a patient arrives unconscious in an emergency room and their representative cannot be reached in time, the healthcare provider will be able to consult the patient’s record in order to administer appropriate care.
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In the above cases, the healthcare provider must apply the ‘break the glass principle ‘. This will also be logged in the system with the corresponding justification of the care provider (e.g. the therapeutic relationship is not yet known by the system).

A patient can choose to deny specific healthcare providers access to their file (so-called “exclusion” of a healthcare provider). As a result, a healthcare provider may, in principle, no longer access the patient file in any way whatsoever. The patient may request an exclusion regardless of whether or not a therapeutic relationship exists or has existed. This allows a patient to apply for a preventive exclusion (e.g. if an ex-partner is a healthcare provider).

In order to ensure continuity of care, a temporary override of an exclusion may be applied. Suppose that an excluded healthcare provider is the only one on duty for a specific medical discipline for which the patient requires urgent care, this healthcare provider will still be able to gain access to the health record.

There are two different types of exclusions:

1. eHealth exclusions: via the eHealth platform, healthcare providers (with a NIHDI number) can be excluded. These are included in the nexuzhealth applications (starting at Q1 2023), but can only be managed via the eHealth platform (e.g. to stop an exclusion) which can be reached via https://www.mijngezondheid.belgie.be/.
2. nexuzhealth exclusions: via the nexuzhealth healthcare institutions healthcare providers and staff can also be excluded. These can be accessed and managed via mynexuzhealth, but are not taken over by the eHealth platform.

In order for an exclusion to have the broadest possible effect, it is therefore advisable to register it via the eHealth platform, where non-nexus healthcare institutions can also consult these exclusions (starting at Q1 2023).

Via the nexuzhealth care institutions, care providers as well as support staff can be excluded. For example, an administrative employee who can no longer consult the patient’s agenda due to an exclusion.Via the eHealth platform, only healthcare providers with a NIHDI number can be excluded for the time being

An exclusion cannot be registered directly by the patient via mynexuzhealth. In order to register an exclusion, the patient must contact the hospital where the relevant healthcare provider or staff member is active. An application form will have to be completed.

If a healthcare provider or staff member works at several nexuzhealth healthcare institutions , the exclusion registered by one of these healthcare institutions will take effect in all nexuzhealth healthcare institutions. The patient can find the correct contact details via ‘Your healthcare facility’ in the mynexuzhealth (web) application or via the website of the hospital in question.

The federal eHealth platform is used as a so-called metahub and connects all regional hubs (such as CoZo or VZN KUL) so that healthcare providers who have a therapeutic relationship with this patient can consult the available documents about the patient (provided the patient has given their global consent). The patient can register exclusions in the eHealth platform that will result in the excluded healthcare providers no longer having access to the health record via the eHealth platform.

Nexuzhealth supplies an Electronic Health Record (EHR) to the nexuzhealth care institutions. The exclusions of healthcare providers and staff members that the patient has registered via a nexuzhealth healthcare institution has effect in all nexuzhealth healthcare institutions.

In addition, the nexuzhealth applications take over the exclusions registered in the eHealth platform (starting at Q1 2023), so that the healthcare providers who were already excluded for the health record in the eHealth platform are automatically excluded for the health record in the nexuzhealth healthcare institutions.
Conversely, the eHealth platform does not take over any exclusions from the nexuzhealth applications.If the patient wants to stop an exclusion, this requires going through the same process as for the application. In concrete terms, this means that an exclusion originally registered via the eHealth platform must be stopped via the eHealth platform. An exclusion requested via a nexuzhealth healthcare institution can be stopped via the mynexuzhealth (web) application or via the nexuzhealth healthcare institution.

A nexuzhealth exclusion takes effect immediately in the nexuzhealth applications as soon as the application form has been registered and processed by the nexuzhealth healthcare institution. The patient will then see the exclusion in the mynexuzhealth (web) application. An exclusion via the eHealth portal will be visible in mynexuzhealth when the patient logs in, up to one hour after registration (starting at Q1 2023).

When an exclusion has been registered, it will remain valid until the patient wants to stop it or at a predefined time requested by the patient.

The patient can manage their nexuzhealth exclusion(s) directly in the mynexuzhealth (web) application. An exclusion can be stopped by clicking on the ‘Restore access’ button.

When the exclusion was initially registered in the eHealth platform, it can only be stopped in the eHealth platform. By stopping an exclusion in eHealth, it will no longer be visible in mynexuzhealth after a maximum of one hour (starting at Q1 2023).

If the patient is not a mynexuzhealth user, the patient can contact their nexuzhealth healthcare institution who can stop the exclusion.

Stopping an exclusion has an effect in all nexuzhealth healthcare institutions.

The patient can only request an exclusion with the name of a healthcare provider or staff member. It is not possible to exclude a group or department of healthcare providers.

It is allowed to exclude multiple healthcare providers, but this will require several individual applications. Per application it is possible to exclude two care providers or staff members.

There are two different aspects to the scope of an exclusion:

1. If the patient has excluded a healthcare provider or staff member, this exclusion will have an effect in all nexuzhealth healthcare institutions. If this healthcare provider or staff member works at several nexuzhealth healthcare institutions, the patient does not have to request the exclusion for each institution. No distinction can be made: e.g. excluding healthcare provider X only in healthcare institution A, but not in healthcare institution B, is not possible.
2. An exclusion only concerns access to the health record itself by the healthcare provider or staff member. This means that the excluded healthcare provider or staff member no longer has access to the health record, but the patient’s name will still appear in, for example, attendance lists for the relevant department or the list of radiology requests. This is necessary to ensure the proper functioning of the service. It is also possible that another healthcare provider shares information with an excluded healthcare provider (for example, information from a doctor to a nurse).

Exclusions can affect the provision of quality healthcare. A few possible consequences:

• If an excluded healthcare provider is on duty and is the only healthcare provider available, this healthcare provider cannot, in principle, provide healthcare to the patient if information from the health record is necessary to help the patient.
• For example, if the patient is not satisfied with the care provided by different healthcare providers on the same service, it may be better for the patient to transfer to another (less suitable) service or even another healthcare institution.
• If an excluded healthcare provider has a therapeutic relationship with the patient, but is not given access to the necessary data by the patient, the provider may have to terminate the treatment relationship with the patient. After all, it can have dangerous consequences for the patient if the care provider has to continue providing care without adequate information about the patient.

If the patient suspects that a healthcare provider has wrongfully looked into their health record, the patient can consult the ombudsman service of the hospital concerned. They can look at the record’s audit logs with the patient to see which healthcare providers or staff have opened the record. If a healthcare provider has unlawfully accessed the record, they can be called to account for this.

An exclusion only concerns access to the health record itself by the healthcare provider or staff member. This means that the excluded healthcare provider or staff member no longer has access to the health record, but the patient’s name will still appear in, for example, attendance lists for the relevant department or the list of radiology requests. This is necessary to ensure the proper functioning of the service. It is also possible that another healthcare provider shares information with an excluded healthcare provider (for example, information from a doctor to a nurse).

It remains possible for a healthcare provider to access the health record for which they are excluded, in order to safeguard the continuity and quality of care. In the event that the patient needs urgent assistance and the excluded healthcare provider is the only one available, it must remain possible to implement a temporary override of the exclusion . This temporary override will only allow access to the record for 24 hours. The healthcare provider must justify why a temporary override is necessary and the patient will be informed.

A temporary override requires a clear justification from the healthcare provider.

Some possible scenarios to illustrate:

• In case of a medical emergency where the patient needs urgent care and the excluded healthcare provider needs to administer the necessary care.
• When the excluded healthcare provider is on call and the patient needs to be cared for during the on-call period.
• When the excluded healthcare provider is on the night shift, no other colleague is available and the patient needs to be cared for at night.
• When the organisation of a service does not allow the patient to be treated by another healthcare provider.

The patient shall be notified via a notification in the mynexuzhealth application, via email or via a letter according to the preferences of the patient registered via the mynexuzhealth application to receive communication.

The motivation of the healthcare provider or staff member for the temporary override of the exclusion will be shared with the patient, to help them understand why a temporary override was necessary.

When a healthcare provider or staff member implements a temporary override of the exclusion, this healthcare provider or staff member will have to substantiate it. This justification will be communicated to the patient.

If the patient questions this justification, the patient should contact the ombudsman’s office.

Nexuzhealth is a supplier of software to healthcare institutions for managing an Electronic Health Record (EHR). This EHR is a single centrally managed file covering all nexuzhealth care institutions.

Nexuzhealth does not itself manage any personal data of patients, but works purely on behalf of the healthcare institutions.