National eHealth Solution in Finland Teemupekka Virtanen Ministry of Social Affairs and Health Finland

Organization of health care in Finland Population 5.3 million PUBLIC SECTOR 85% Municipalities §Responsible for arranging §Independent in decision making Appr 230 Primary health care centres 21 Hospital districts §Can send patients to University hospitals PRIVATE SECTOR 15% §Primary and specialized health care §Occupational health care (60%) §appr 4000 private providers § 600 pharmacies

Starting point § Long experience in computers in health care § Local level – 100% coverage of EHR

§ Regional level – Good coverage of electronic referrals (public sector) – Some document exchange – Some regional level systems

§ National – Some disease based registers (cancer, …) –

FINNISH eHEALTH SURVEYS Assignment of the Ministry of Social Affairs and Health Conducted by FinnTelemedicum and Stakes 2003, 2005, 2007 (08) By Hämäläinen P, Reponen J, Winblad I: http://www.stakes.fi/FI/Julkaisut/v erkkojulkaisut/raportteja07/index.h

Goals §

Quality of treatment – – –

§

Internal The best knowledge available Quality of treatment requires correct and valid information of a patient

Effective procedures – – –

External Less specialist needed To decrease costs everything else but the treatment itself must be as effective as possible

BAD NEWS - interoperability § Various EHR-systems are used in Finland – 8 major and numerous small ones

§ Various one disease / purpose systems – Lab, radiology, anesthesia, intensive care, diabetes, maternity care etc – appr 60 have been recognised

§ Common standards, both technical and semantic are too few § Regional information-exchange systems – Coverage is not total – Are based on different architecture solutions §

Reference directory < –> same EHR system

– Private health care is not involved § Ø NATIONAL SOLUTION NEEDED §

National eHealth Road Map 2007 § Availability of patient information regardless of time and place, both in public and private sector § Participation of citizens and patients § § §

Acces to own patient information and log data Acces to high quality health information Development of eServices

§ Legislation 2007 § §

§

Using national archive is mandatory for public and private sector Privacy needs taken into account

The Architecture Pharmacies

Doctor

EHR

The archive The prescription center The directory (registration) PKI The code service AAA services

Citizen

General Architecture

HIS LAB Patient records HIS Patient records HIS

LAB

Patient records HIS Patient records

All EHRs must § Use the nationally defined structural information that is based on nationally approved terms, classifications and codes updated by the national code server § Use the nationally defined set of standards (HL7/CDAR2, ISO/OID, Dicom etc.) § Must follow the national recommendations on data security and data safety and use the national PKI service in verifying health professionals § Must communicate with the national IT architecture (data transferring and archiving will be based on the national digital EHR archive) § Implementation into existing EHR-systems 2007 - >

KanTa services § eArchive § ePrescription § eAccess

NATIONAL eARCHIVE - functions § DYNAMIC DATA REPOSITORY – Information exchange and searching between health care providers § On patients consent § LONG TERM ELECTRONIC ARHIVE – Strict legislation on archiving – Summary data has to be available 12 years after death § born 18th and 28th: for ever (for research purposes) – Currently local paper archives § STATISTICS – Decision support – Scientific research

eARCHIVE § § CONTENT – Patient information § Produced by local EHRs § Coded core information – Diagnosis, medication, procedures, medical risks… § Medical record texts, nursing information § Lab, pathology etc test results § Radiology, endoscopy etc images – Log information § BASIC DATA SET in first phase – patient record text (including core information) – medication – referral and discharge letters – radiology referrals and statements – summary of nursing information – laboratory results

ePrescription § NATIONAL PRESCRIPTION CENTRE – ePrescriptions – Information of medicine dispensing in pharmacies – Log – Viewing on patients consent § BY LEGISLATION OBLIGATORY – For doctors and pharmacies – Patients has an option to use traditional version

§

eAccess § XXX - For adults only – Own patient information in eArchive – Information in Prescription centre – Log information

§ Via Internet § Authentication by – electronical ID card – eBanking identification

eCitizen Services

Chronic diseaeses

Digital cservice onnections

Digital serviceconnection

Bookings, registrations, payments Citizen and home

Service System Iterpretation of results BASIC INFRASTRUCTURE

Documentation in standard form, Archiving, Legislation

Citizen’s portal § In KanTa services all the information is produced by professional § There is a need for citizen’s own system – Citizen can store his/her own information and logs § Blood pressure, weight, exercise, nutrition, …

– Citizen can decide who has access to this information

§ A professional can transfer part of this information to the KanTa § This portal is designed by another project §

The current situation § The main definitions are made – Imaging, biosignals, many special areas are still missing

§ ePrescription is in use –

The central services are operational

–

All pharmacies are connected

–

Almost all PHR systems audited and approved

–

About 500.000 prescriptions written in a month

§ eArchive –

The central services are operational

–

The first city is in test use

Experiences this far § The elephant is big – It has to be eaten bite by bite

§ Using common standards is mandatory – Freedom makes systems incompatible – Not only systems but doctors, too

§ Improving an existing system is difficult – The new system must be fit in a almost ready puzzle – The requirements are high

The next step § Taking care of people is not only medical question § Social care is as important as medical § We are designing the national exchange and store for social care documents – The basic structure will be the same – The main definitions of social care documents are made using HL7type definitions – The main working procedures has been analyzed – We wait some experiences from eHealth before starting the real implementation

§ The same information is available in both sectors – Privacy conditions apply

Thank you