Pros and Cons of Nordic eHealth Development

1. E-Health Congress May 26th , 2011, Bucharest, Romania Pros and Cons of Nordic eHealth Development Pekka Ruotsalainen, Research professor National Institute for Health and Welfare Helsinki, Finland Adjunct professor, Tampere University

2. 24h/7d availability ePrescribing Telemedicine Distance-monitoring T e l e r a d i o l o g y PH S If you don’t know where to go – IT does not matter, but which road you select. This is true, but not quite. You have to know: - Why have you selected those goals? - What are the pros and cons of the road you selected ? Videoconferencing Cost saving Wearable devices NHNIN Patient empowerment EHR sharing

3. Scandinavia Island Scandinavia is a region of northern Europe that geographically consists of Norway, Sweden and Denmark. HC of GDP 8,2 % – 9,8% Public Health 75% - 31% Expenditure WHO Health Care 31 - 8 Rank

4. From the EU perspective, Scandinavian countries (especially Denmark, Sweden and Norway) are leading countries in the adaptation of eHealth. • Let’s have a closer look to the eHealth strategies and their implementations in Nordic Countries: • Common aspects of Nordic eHealth strategies • Pros and Cons of Nordic strategies • Lessons learned after 20 years of work

5. Nordic eHealth goals – where to go • Health benefits through sharing of EHRs and by • patient participation • Lower costs and better efficiency and effectiveness • Better accessibility to services • Better quality and patient safety • Better management of chronically ill patients • Health services for elderly • Security and privacy protection

6. The Road Nordic countries have selected • Regulatory framework for security • Nationwide digitalization and implementation of patient records • National eHealth network (NHIN) • Interoperability via standards • National data exchange and EHR sharing • eHealth applications (services) using the content of the EHR in the network

7. Pros • Easily acceptable and politically valuable goals • National communication infrastructure (NHIN) is a prerequisite • Digitalization of EHRs is necessary • Standardized messages are drivers for technical interoperability • Enables successful implementation of application • Enables successful integration of service provider organisations • Success eHealth applications in Nordic countries • National ePrescribing services (Denmark, Sweden) • Telemedicine applications • eConsultation, eRererals, eEpicrisis services • Communication via eMessages • Citizen portals

8. After more than 15 year of work and Investments what we have got ? A dress coat A wallet

9. Summary of Common Achievements • Implementation of EHRs ( 75 – 100%) • National infrastructure for EHR sharing • High level of the use EHRs by GPs (50- 100 %) • GPs use NHIN for consultations • Laboratory results are digitalized • Regional PACS networks • Millions of messages flowing through the NHIN • Integration of legacy systems and NHIN • Many successful eHealth services

10. Specific achievements in Sweden 100% coverage of the use of ePrescriptions Telemedicine:100+ applications used in 75% of hospitals (Videoconferencing and tele-consultation widely used) Portal for citizens (one common access point)

11. Achievements inDenmark • Migration to web based technology (Danish health data network) • Web portal Sundhet.dk as access port for booking and citizen access to own EHR • ePresciptions, eBooking, eConsultation, eReferrals, eReferrals • eDischarge • Tracking of medication history and drugs in use • Telemedicine applications Use of EHR communication Primary Clinics - 81%, Specialists - 48% Pharmacies - 100%,Hospitals - 100% Laboratories – 100% 60% of all communication 50 minutes saved per day in GP practice Investment cost up to EUR 725 million (2008)

12. Specific Achievements inNorway Telemedicine widely used ePrescription in roll-out National EHR and patient summary 2011

13. After 10-20 years development and implementation eHealth seems to mean: - digitalization of healthcare/medical records - national communication platforms for EHR sharing and - a set of IT enabled services for healthcare professionals rather than new models of work, or a paradigm change Videoconferencing

14. Goals partially or not at all achieved Patient in the centre eHealth services are for health professionals, support old paternalistic and organisation centric model Tools for personal Patient can access own EHRs and prescriptions health and disease No other tools (on a wide scale) management Benefits by patient Many beliefs – benefits not proven participation Better quality and Quality control is not a part of implementations Patient safety Costs savings No reliable figures exist Better accessibility No figures. EHR and NHIN is not the tool Health benefits by sharing EHRs Few/no figures

15. Cons for the Nordic Strategy • Most targets were based on beliefs (e.g. the availability of the EHR will produce huge health impact, better quality, lower cost and better availability of services). • ICT provides support for old service model – no paradigm change • Many messages but not usability and understandability of EHR’s information • Insufficient or no plan to calculate cost savings • - Missing the fact: it will not solve service availability and accessibility problems

16. Lessons learned from Nordic countries • Time and cost to build infrastructure is easy to underestimate– • ROI is still unclear • Instead of dedicated networks look for new Web 2.0 technology • It is difficult to show health impacts and savings • You get what you order (if you order messages you will messages) • Stepwise approach works (DK) - Be prepared for migrations • - Medication management, and Telehealth have been successful • EHR and sharing it is simply not enough • How to eat an elephant? • In small pieces – the Danish Way

17. Thank you for listening! Questions! pekka.ruotsalainen@thl.fi