2011-05-09 Lars Jerlvall Håkan Nordgren Stockholm

2011-05-09 Lars Jerlvall Håkan Nordgren Stockholm

The Swedish ehealth approach Center for ehealth in Sweden Budapest 2011-05-09 12

An IT-support for the Health Care of the future 2011-05-26 3

Three main issues for a future Health Care See the patient as an actor in its own care process Counteract the effects of an increasing fragmentation of the care process Provide a solid base for a knowledge based Health Care

Efficiency compared to EU 15, Norway and USA www.cehis.se the oldest population proportion over 80 years moderate costs and increases in costs, per capita and as a percentage of GDP good accessibility: as number of treatments related to population size but long waiting times within elective care good outcomes: lowest infant mortality rate, avoidable death and too early death, low mortality from cancer high medical quality: low percent of revisions, infections

Cost effectiveness matrix Source OECD data 2007

Swedish Healthcare www.cehis.se 21 independent County Councils 290 Municipalities Private Care providers Good healthcare for everyone irrespective of where you live Primary care, 1000 local medical centers > 70 hospitals 7 university hospitals

www.cehis.se A decentralised structure Federative approach and Country ehealth (Enterprise) Architecture

www.cehis.se ehealth EHR/EMR/HIS Generation Experimental Period Organizational Functions Integration 1960-80 Research projects Documentation Scheduling 1st gen 1980-00 GP s office or Clinic based 2nd gen 1990-10 Hospital based or Primary care area 3rd gen 2000- County council or Regional based 4th gen 2008- National based (EU and epsos) + Medication + Lab reports + CPOE + eprescription + PACS viewer + CDSS + patient services + PHR - + ++ +++ by it self an integration

ehealth in Sweden - EMR EMR -Medical records -Prescriptions -Order / entry -Scheduling -Patient administration (ADT) 100 90 80 70 60 EMR- coverage 2005-2011, per cent of total population EMR - implementation - All primary care units since 2008 -All hospitals / psychiatry units since 2010. 50 40 30 20 10 5 years Hospitals Primary Care 0 2005 2007 2009 2011

ehealth in Sweden - Medication -Medication a part of EMR -Decision support included 100 IT support medication implementation rate - Highest percentage of e- prescriptions in the world (?) -9 out of 21 county councils have a complete regional overview of all prescriptions - Common national database for prescribed and dispensed drugs to be implemented 2011. 90 80 70 60 50 40 30 20 10 5 years Primary Care Outpatient hospitalbased care In-patient hospital Care 0 2005 2007 2009 2011

EMR implementation in county councils 2005 2007 2009 2011 5 years

EMR-Vendors 11% 21% 12% 24% 32% Siemens (Germany) CompuGroup (Germany) Cambio (Sweden) Systeam (Norway) Others Four leading vendors 89% (2006 = 82%) EMR Strategy 3 18 Same system for all healthcare Integration different systems Patient Administration PACS- Vendors Trends - Function in EMR - One system for all healthcare 28% Sectra 44% 11% 17% Agfa GE Others Three leading vendors 72%

www.cehis.se 160 IT-costs, share of turnover + number of PC s, index, years 2004-2010 140 120 100 80 60 IT-costs, share of turnover, 2010, 2,9% IT-costs PC 40 20 0 2004 2005 2006 2007 2008 2009 2010

Generic Clinical level Business analysis clinical process focus Process- and Concept models in the National Information structure (NI) ICF structure Guide for clinical process application Reference Information level Archetypes/Templates National reference information model harmonisation Reference archetypes EN 13606 and openehr ref Models (EHR and Demogr IM) SCT concept model attributes non clinical attributes process attributes clincial data attributes Reference templates Clinical process level Process specific archetypes Specific templates ICD and ICF code systems Conceptual mapping to SCT nonclinical attributes process attributes clinical attributes for e.g. quality registers, knowledge management and documentation in EHR Center för ehälsa i samverkan koordinerar landstingens och regionernas samarbete för att förverkliga den nationella IT-strategin för vård och omsorg. Centret ska skapa den långsiktighet som krävs för att utveckla och införa gemensamma ehälsostöd, infrastruktur och standarder som förbättrar informationstillgänglighet, kvalitet och patientsäkerhet. Center för ehälsa i samverkan styrs av representanter från landsting och regioner, Sveriges Kommuner och Landsting (SKL), kommunerna och de privata vårdgivarna. 16

Generic Clinical level EN 12967 (HISA part 1 enterprise viewpoint) pren 13940-2 (Contsys part 2 health care process and workflow) ISO/FDIS 21667 (Health indicators conceptual framework) ISO 9001 and CEN/TS 15224 (Quality management systems) Reference Information level EN 12967-2 (HISA part 2 information viewpoint) EN 13606-2 (Electronic health record communication part 2: Archetype interchange specification) Open EHR RIM and specifications SNOMED CT concept model attributes pren 13940-2 (Contsys part 2: health care process and workflow) ICF (WHO classification for disabilities and functions) Applied Clinical level EN 13606-1 (Reference model for communication) EN 13606-4 (Electronic health record communication Part 4: Security) EN 13606-5 (Electronic health record communication Part 5: Interface specification) pren 13940-2 (Contsys part 2: health care process and workflow) SNOMED CT, ICD,ICF. Center för ehälsa i samverkan koordinerar landstingens och regionernas samarbete för att förverkliga den nationella IT-strategin för vård och omsorg. Centret ska skapa den långsiktighet som krävs för att utveckla och införa gemensamma ehälsostöd, infrastruktur och standarder som förbättrar informationstillgänglighet, kvalitet och patientsäkerhet. Center för ehälsa i samverkan styrs av representanter från landsting och regioner, Sveriges Kommuner och Landsting (SKL), kommunerna och de privata vårdgivarna.

www.cehis.se ehealth reform programme the Swedish approach An open and transparent approach was chosen to establish the National Strategy for ehealth. All relevant stakeholders involved in all parts of the process. The result: a broad understanding and commitment to the need of addressing these issues in a new way. unique co-operation between all stakeholders in healthcare established for the first time. ehealth now seen in a larger healthcare context. agreed agenda for ehealth investments and reforms.

21 County councils/regions Board Executive office Center for ehealth in Sweden Strategic advisory committee Arkitechtural board Portfifolio mgmt Architechture governance Programstyrgrupper Programstyrgrupper Program mgmt groups Projects och maintenance objects Inera AB

Socialdepartementet 21 Landsting/regioner (uppdragsgivare) SKL Social-styrelsen Nationell informationsstruktur Nationellt fackspråk Ledningsfunktion/s tyrelse Verkställande kansli Arkitekturledning Center för ehälsa i samverkan Strategiskt råd Portföljstyrning SKL avd. Vård och omsorg Arkitektur styrning Programstyrgrupper Programstyrgrupper Programstyrgrupper Områden Områden Områden Projekt och förvaltningsobjekt Inera AB Projekt Göteborg 2011-03-15

www.cehis.se Defining a common agenda for all stakeholders in healthcare National governm ent Health care regions Six Action Areas identified: 1. Bringing laws and regulations into line with an increased use of ICT. 2. Information structure and terminology. 3. Enhance the technical infrastructure. 4. Facilitating interoperable, supportive ICT systems. 5. Facilitating access to information across organisational boundaries. 6. Launching new e-services for citizens.

Retrieve Decide POE Document A comprehensive view of IT-support for health care Info IT- service Activity...and more activities.. Info Access to care Quality registers Achievments NPÖ/epSOS Patient VpW PASCAL Local follow up Other care provider

www.cehis.se Quality register and decision support in the clinical everyday work Quality register Decision Support Documentation templates EHR 23

www.cehis.se Success factors for realisation of ehealth strategies: Strong political support needed! Recognize ehealth investments as a long term undertaking to improve healthcare! Clear definition of roles and responsibilities between national and regional level! Work must be carried out co-ordinated and in parallel towards the same goal at all levels! Inclusion of stakeholders vital! Governance is an critical issue (not the least medical informatics) The real work is done in healthcare

It is not easy It is not fast but It is possible It is necessary! 2011-05-26 25