Healthcare ICT and HMIS in Norway

1. Healthcare ICT and HMIS in Norway

2. Overview • Introduction to the Norwegian Health system • IS and public health • IS for patients • IS for patients’ care (hospitals) – not covering this part

3. Norwegian Healthcare system • Norway has a predominantly public health care sector. • The Norwegian health system is characterized by universal coverage: the health system is built on the principle that all legal residents have equal access regardless of socioeconomic status, country of origin, and area of residence. • It is financed mainly through taxation, together with income-related employee and employer contributions, and only to a small extent by out-of-pocket payments (see Frikort). • All residents are covered by the National Insurance Scheme (Folketrygden) • Unique personal number • Unique identification of healthcare professionals

4. Norwegian Healthcare system • Health care services are provided at two levels: • primary care is at municipal level, • and specialized care is at regional level. • The central Government has overall managerial and financial responsibility for the hospital sector. • Norway’s four regional health authorities control the provision of specialised health services by 27 health enterprises. • The Coordination Reform 1st January 2012 • interaction between primary care and specialized care lacks mediating structures. • establishment of pre-hospital low threshold wards in primary health care • municipalities are gradually obliged to establish primary emergency 24-hour care for patients who do not need specialized hospitalization

5. Primary care • Municipal health services consists of : • general practitioners services, emergency room services, physiotherapy, nursing homes, midwife services and nursing services, (including home-based services).  • The municipality also runs preventative health services: Health 'Stations' and school-based health services • (Except for a few institutions with advanced rehabilitation services) long-term care does not exist within the hospital sector but it is integrated in primary health care. • Primary health care and social care services also care for patients recovering after a hospital stay.

6. Municipalhealth services (somenumbers) • On average a municipality has 10,000 inhabitants (range from 250 to 500,000 people). • There are 430 municipalities. • The larger cities are subdivided into boroughs (city districts - bydel) covering services for about 30,000 inhabitants each. • A municipality with 10,000 inhabitants will have about 10 GPs, 90 nursing home beds and 150 nurses, nurses aids and home helpers working in home care for elderly and disabled people. • In 2010, there were 0.83 GPs per 1 000 population.

7. GP scheme 2001 • The general practitioner scheme was introduced in 2001, states that: • Every inhabitant is entitled to be listed with a general practitioner (GP) of his or her choice, (almost all residents (99.6%) are registered in the scheme). • Every GP is now responsible for a list of individual patients • GPs’ role as gatekeepers: patients need to see their GPs before they can be referred (referral letter) to the hospital (except in emergencies). 

8. Specialist care • Hospitals and institutions: organised in enterprises/ trusts under four Regional Health Authorities:  • Helse Nord (covers the counties of Nordland, Troms and Finnmark)  • Helse Midt-Norge (Nord-Trøndelag, Sør-Trøndelag and Møre og  Romsdal)  • Helse Vest (Rogaland, Hordaland and Sogn og Fjordane)  • Helse Sør-Øst  (Vest-Agder, Aust-Agder, Telemark, Vestfold, Østfold, Buskerud, Oppland, Hedmark, Akershus, Oslo)  • The RHAs have structured the hospitals around 25 health enterprises (65 hospitals) • (Before 2002 the hospitals have been owned and run by the counties for over 30 years). • In 2010, the private hospitals (both not-for-profit and for-profit privately owned hospitals) accounted for 1 601 beds, approximately 10% of the total of 16 117 beds.

9. 4 Regional Health Authorities - 2002 Helse Nord Helse Midt-Norge Helse Sør-Øst Helse Vest

10. Access to specialisedcare • Referral to specialist care: primary care physicians as gate keepers. • Patients may choose the hospital. • (They are not, however, allowed to choose a hospital that is more specialised, e.g. a university hospital, than the one they have been referred to.) • Free choice of hospital for elective treatment was introduced from 1 January 2001 (Fritt sykehusvalg, www.frittsykehusvalg.no May 2003) • to strengthen patients’ positions as decision-makers (informed choice) • to even out differences in waiting times for treatment. • Some studies indicate that relatively few patients seem to have opted for the possibility of receiving treatment outside of the hospitals’ natural catchment areas.  • Patients are willing to wait a considerable length of time to avoid travelling. The reluctance to travel increases with age and decreases with level of education.

11. www.ssb.no • www.fhi.no • www.helfo.no • www.helsedirektoratet.no • www.fryttsykehusvalg.no • www.helsenorge.no • www.kith.no • www.nhn.no

12. assignment • Which public health data are made availabe? • …

13. IS for patients

14. IT strategy in health sector Breadth/vision 1997 Concretization /implementation 2013

15. IT strategy in health sector • S@mspill 2.0 • Specific vision/aims e.g.: • Relevant and good quality information on health , lifestyle, services, treatments is available on internet. • The patient has access to his own health information, own medical record, overview of prescriptions and medications, discharge letters, freecard and more. • Via an interactive services is possible to (for instance) change appointments at the GPs or other providers. • New services on internet support self care possibilities. • Patients and users experience that health personnel has a good overview on their health status and health history when they come in contact with health care services.

16. Historical view • Early mover on Health ICTs: • National ICT strategies since 1997 • First to implement EPR (public hospitals and GPs) • 1980’s- 90’s: Development initiatives on a national scale • Widely digitized sector: • Hospitals, general practitioners, nursing homes, pharmacies, private sector specialists • … but weaker on linking them together • GPs first to implement EPRs, ~100 % coverage • uptake by municipality home care and nursing homes has been slower

17. One resident – One record • improved quality, improved patient safety, more efficiency and better use of resources • quick, easy and secure access to all necessary information. • regardless of where in the country the patient is receiving treatment • Citizens should have quick access to simple and secure digital services.

20. Digital dialogue GP project

21. assignment • www.helsenorge.no • Which services are offered? • …

22. Summing up…