Foto Frken Fokus Health Informatics Centre a collaboration

Foto: Fröken Fokus Health Informatics Centre a collaboration between Stockholm County Council and KI Meaningful use of EHRs in Sweden Sabine Koch Health Informatics Centre, Dept. of LIME and Dept. of Medicine (Med. Solna), KI

Foto: Fröken Fokus Swedish Healthcare • 9 million inhabitants • 21 self-governed regions/county councils with responsibility for hospital and primary care • 290 self-governed local authorities with responsibility for healthcare of the elderly and functionally disabled • Legislation of healthcare on a national level – the Parliament Sabine Koch, October 29, 2010

Foto: Fröken Fokus IT an integrated part of Swedish healthcare • Electronic patient record (4 companies comprise 88% of the market) – – 100 % of all documentation in primary care is electronic 97 % in hospitals 97 % in psychiatry >90 % in ambulances (with direct communication to hospitals) + Clinical champions supported by strong administrators + Collegial pressure / peer influence/ larger group practices in PC + Use of an unique national patient identifier + Culture – ”Sweden as high-tech innovative country” + User centricity - Too many different, incompatible systems with local terminology (27 different products in 1994) Sabine Koch, October 29, 2010

Foto: Fröken Fokus IT an integrated part of Swedish healthcare • e-Prescriptions – 80 % of all pharmaceutical prescriptions in Sweden are issued and transferred electronically + Only one national provider of pharmacy retail from 1970 -2009 (Apoteksbolaget AB) - Decision support during prescription process is still lacking behind: In Sweden some 3000 deaths yearly are estimated to depend on medication errors. Sabine Koch, October 29, 2010

Foto: Fröken Fokus IT an integrated part of Swedish healthcare • National Quality Registries • 60+ national quality registries containing individual-level data on diagnoses, treatment interventions and oucomes, organized by condition + Decentralization + Peer influence and practical use + Quality assurance – can be used for research - No interoperability between registries - Integration with EHR is lacking Sabine Koch, October 29, 2010

Foto: Fröken Fokus Applications • • My Healthcare Contacts MVK (access to national health care information, appointment scheduling etc. ) 1177 (national telephone and Internet advisory service) • NPÖ (National Patient Summary) • • PASCAL (National Medication List) SIL (National Drug Database) Basic structures • Common technical platform - Sjunet (National communication network, since 1999) - HSA registry (Health Services Address registry) - SITHS (National security solution/e-certificate) - BIF (Basic Services for Information Maintenance) • • NI, National information structure (ready 2009) TIS, Technical information structure (EN 13606/EHRcom) IFK 2, National Quality Registry Infrastructure National terminology incl. SNOMED CT (member of IHTSDO) • Patient Data Act (since July 2008) Source: Swedish National e. Health Strategy, 2006 and its yearly updates 2007 -2010

Foto: Fröken Fokus Meaningful use? It’s a knife to open letters with. The best tool is useless if you don’t know how to use it ! What a stupid invention!

Foto: Fröken Fokus Meaningful use in Sweden • Towards process support at the point of need • Handling patient information across organizational boundaries independant of EHR • Meeting the needs of several stakeholders

Foto: Fröken Fokus Most important challenges Implementation is done locally but with a national consensus • implementation hampers interoperability – compliance with international standards? • will it be the same for quality registries? • legal and privacy issues? • evaluation of the effects? • education?

Foto: Fröken Fokus Contact Sabine Koch Health Informatics Centre Department of learning, informatics, management and ethics Karolinska Institutet Stockholm sabine. koch@ki. se www. ki. se/hic