the Nivel

Overview

The National Quality Database (LDK) is an ongoing research project by the Nivel (the Netherlands Institute for Health Services Research), carried out in collaboration with Stichting Keurmerk Fysiotherapie (SKF).

The database collects, processes and manages data about physiotherapy care that has been provided. The results help physiotherapists understand the quality of their work and contribute to transparency and quality improvement within physiotherapy.

With the Nivel export in Flux, you can easily submit the required data to the Nivel. This is part of the data collection programme of Stichting Keurmerk Fysiotherapie.

Configuration

Go to Settings → Apps → Nivel in Flux to submit treatment data to Nivel’s National Quality Database (LDK).

Requirements

To activate the LDK integration, you need the following:

1. A Flux user with the role Owner
2. PVM (Nivel Zorgregistraties), downloadable through ZorgTTP

Setup

To upload the data, you need PVM (Nivel Zorgregistraties).

1. Open the Nivel app in Flux

2. Download the PVM through ZorgTTP
3. Install the PVM using the manual on the same page
4. Upload the export file from Flux in the PVM

National Quality Database

Physiotherapists can use the collected data to monitor and improve the quality of their services and benchmark their performance against national averages.

Mandatory participation

For practices registered in the Practice Register of Kwaliteitshuis Fysiotherapie, submitting data to the LDK is mandatory.

Other practices can participate voluntarily, including as part of research with the LDK.

Patient consent

A consent choice must be given through a clear affirmative act. The Dutch AP explains that consent must be:

1. Freely given
2. Specific
3. Informed
4. Unambiguous

The EDPB states that pre-ticked opt-in boxes are invalid under the GDPR, and that silence or inactivity does not count as valid consent. Furthermore, the AP states that health data are special-category personal data, and processing them is in principle prohibited unless a valid exception applies. For special-category data such as health data, Article 9 GDPR raises the bar further: one possible exception is explicit consent.

This consent can be recorded during intake or later in the treatment process.

• Patients can withdraw their consent at any time
• Click the pencil icon for the patient
• Go to consents

• Click the Nivel consent to change the consent status

When a patient does not give consent, no data from that patient is exported to Nivel. If a patient withdraws consent later, Flux immediately stops sending data from that treatment episode.

Results

Contact customer support if the entire upload file is rejected or not processed correctly. Other errors can often be solved by looking up the patient by ZIS number.

Data submission

Treatment data is submitted through Flux according to message specification version 11. Personal data that could lead to identification is encrypted by ZorgTTP to protect privacy. Sharing detailed data increases the value of the insights and improves visibility into practice performance.

Data exchange

Data flow

Flux → ZorgTTP: treatment data from the practice, including patient data and treatment episodes.

ZorgTTP → Nivel: encrypted, non-identifiable data.

Nivel → Practice: quarterly report with quality feedback.

Data

With Flux, you send the following data to Nivel according to message specification version 11.

Identifiable data, such as BSN, date of birth, gender and postcode, is automatically encoded through ZorgTTP and cannot be traced back to individual patients.

• File data
  • Practice AGB code
  • Chamber of Commerce number
  • EPD supplier
  • Version number (EPD software)
  • Practice postcode
  • Practice house number
  • Number of treatment episodes without consent
  • Specification number
  • Creation date of the submission file
• Patient data
  • Patient ID *
  • Postcode *
  • Date of birth *
  • Gender
• Treatment activity data
  • Practitioner AGB code
  • Practitioner BIG number
  • Date of treatment activity
  • Performance code
  • CSI (type of indication code from the VWS list)
  • NZA/DBCDOT code (for care in secondary or tertiary care)
• Treatment episode data
  • Treatment episode ID
  • Primary practitioner BIG number
  • DCSPH code
  • Care request recorded (yes/no)
  • Expected recovery recorded (yes/no)
  • Diagnosis recorded (yes/no)
  • Main goal recorded (yes/no)
  • Final evaluation date
  • Final result (treatment goal achieved)
  • Comorbidity present (yes/no)
  • Recurrence (yes/no)
  • Reason for ending care
  • Direct access/referral
  • Referrer type
  • Screening conclusion: suspicious/non-suspicious
  • Indication for physiotherapy
  • Treatment plan recorded (yes/no)
• Measurement instrument data
  • Practitioner AGB code
  • Practitioner BIG number
  • Measurement date
  • Measurement instrument code
  • Measurement instrument version number
  • Answer scores
  • Item sequence (question number)
  • Completed online (yes/no)

* Data that could lead to patient identification, such as patient ID and the combination of date of birth, gender and postcode, is encrypted through the Trusted Third Party ZorgTTP into an irreversible pseudonym.

Frequently asked questions

Frequently asked questions about Nivel.