The essential role of DUO and XDS

Healthcare is rapidly moving towards a future in which medical data must be available anytime, anywhere. To make this possible, the national DUO initiative was established.

DUO (Decentralised Exchange of Information) is a Dutch initiative that brings together two infrastructures for exchanging medical images: XDS and the Twiin Portal. The goal is to create a national timeline for radiology examinations, always providing healthcare professionals with access to up-to-date medical images, regardless of the supplier or application. This enables healthcare organisations to share and view medical images and reports securely, quickly and in a scalable way.

Why the DUO initiative is relevant right now

Legislation such as the Dutch Wegiz (Electronic Data Exchange in Healthcare Act) and the upcoming European Health Data Space (EHDS) makes data availability an obligation rather than an ambition. These regulations are part of a broader development in which healthcare organisations must increasingly collaborate and exchange medical data securely and in a standardised manner to ensure continuity of care.

Within this context, XDS (Cross-Enterprise Document Sharing) has developed into a proven infrastructure for secure, standardised and scalable data exchange. Healthcare organisations use XDS to make images, reports, lab results and file information securely available within a reliable network. DUO links the functionalities of XDS and the capabilities of the Twiin Portal, giving healthcare professionals access to up-to-date medical images and reports anytime, anywhere, regardless of supplier or application. This is essential to comply with new legislation and to ensure continuity of care.

Beyond technical implementation, DUO also ensures a level playing field for suppliers, allowing healthcare organisations to choose the solution that best suits their strategy from 2026 onwards. Whereas previously, only the Twiin Portal was made available free of charge, DUO will also provide compensation for XDS. This is a pivotal moment, as the choices made today will shape data availability tomorrow.

As a supplier of XDS in the Netherlands, Enovation is closely involved in the design of national and European initiatives such as DUO, Wegiz and EHDS. Enovation XDS is part of the Enovation Platform for digital care and collaboration, enabling organisations to grow step by step towards full data availability.

With Enovation XDS we offer, among other things:

• Connection to the national XDS network, with more than 70 healthcare organisations connected as sources.
• Full data availability including images, reports, lab results, Common Clinical Datasets and other documents.
• Use of international IHE standards and options for FHIR exchange.
• Integration with Mitz for consent and localisation.
• Mature, scalable technology ready for DUO.
• Support with subsidy options for purchase and implementation.

Reliable data availability requires demonstrable interoperability. That is why Enovation has its technology tested annually during the international IHE Connectathons in Europe and North America.
Enovation XDS complies with IHE profiles such as XDS-Ib, XUA, ATNA, PIX, WIA, MHD (FHIR) and PDQ — all validated and certified through the official IHE SEALS. This ensures you have a solution that works worldwide, meets consistent standards, and is ready for the future of healthcare communication.