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Meaningful use of EHRs in Sweden Sabine Koch

Meaningful use of EHRs in Sweden Sabine Koch. Swedish Healthcare. 9 million inhabitants 21 self-governed regions/county councils with responsibility for hospital and primary care

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Meaningful use of EHRs in Sweden Sabine Koch

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  1. Meaningful use of EHRs in Sweden Sabine Koch

  2. 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

  3. 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 + Collegialpressure / peerinfluence/ larger group practices in PC + Useof an unique national patient identifier + Culture – ”Sweden as high-tech innovative country” + Usercentricity • Toomany different, incompatible systems with localterminology • (27 different products in 1994) Sabine Koch, October 29, 2010

  4. IT an integrated part of Swedish healthcare • e-Prescriptions • 80 % of all pharmaceutical prescriptions in Sweden are issued and transferred electronically + Onlyone national provider of pharmacyretail from 1970-2009 (Apoteksbolaget AB) -Decision support duringprescription process is still lackingbehind: In Sweden some 3000 deathsyearly are estimated to depend on medicationerrors. Sabine Koch, October 29, 2010

  5. 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 practicaluse + Qualityassurance – can be used for research - No interoperabilitybetweenregistries - Integration with EHR is lacking Sabine Koch, October 29, 2010

  6. 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 (EN13606/EHRcom) • IFK2, National Quality Registry Infrastructure • National terminology incl. SNOMED CT (member of IHTSDO) • Patient Data Act (since July 2008) Source: Swedish National eHealth Strategy, 2006 and its yearly updates 2007-2010

  7. Meaningful use? What a stupid invention! It’s a knife to open letters with. The best tool is uselessif you don’tknowhow to use it !

  8. 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

  9. Most important challenges Implementation is done locally but with a national consensus • implementationhampersinteroperability – compliance with international standards? • will it be the same for qualityregistries? • legal and privacyissues? • evaluation of the effects? • education?

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

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