The Dutch Nationwide Electronic Health Record: Why the Centralised Services Architecture?

The Dutch nationwide electronic health record (EHR) consists of a healthcare information broker (HIB) and all connected healthcare information systems with their local EHR's. All exchange of patient data between healthcare providers passes through the HIB. Why was this centralised services architecture chosen? Why not a distributed services architecture, where all patient data is exchanged directly between the healthcare providers? This paper evaluates both architectures on technical and organisational aspects, partly based on practical experience.