ministry of health and social affairs sweden improving swedish healthcare by using ehealth solutions...

Ministry of Health and Social Affairs Sweden

Improving Swedish healthcareby using eHealth solutions – strategic decisions towards SNOMED CT

Daniel ForslundHead of Section – eHealth

Ministry of Health and Social Affairs

Sweden


New Government - New visions

• The Liberal-Conservative Government assumed office on October 6.

• Replaced a Social-Democratic Government, in office 1994-2006.

• eHealth one of the main agenda points in the new Governments extensive reform programme for healthcare.

Prime Minister Mr Fredrik Reinfeldt

Minister for Health and Social AffairsMr Göran Hägglund


eHealth – an integrated part of daily life in Swedish healthcare• Electronic healthcare records (EHR’s):

– 95 percent of all documentation in primary care is made in electronic healthcare records;

– over 69 percent EHR’s in specialized hospital care.• e-Prescriptions:

– 55 percent of all pharmaceutical prescriptions in Sweden are today issued electronically and transmitted directly from the doctor’s office to Apoteket, thus available at all 950 pharmacies in Sweden.

• Telemedicine important in sparsely populated areas.


A strong need for co-operation• Advanced usage of ICT in healthcare,

but:– most ICT systems in healthcare built for

storage of data, not exchange of data;– current structure with self-governing

regions makes national decision-making challenging.

• Conclusion:– co-operation between all relevant

stakeholders in the healthcare sector is the only way forward!


The

National High Level Group for eHealth

National Stakeholder/Reference Group• National organizations for healthcare professionals• ICT Industry, Pharmaceutical Industry• Government Agencies and Legal Inquiries• Private Healthcare Providers• Research Community• Standardization Bodies

National High Level Group for eHealth• Ministry of Health and Social Affairs• The Swedish Association of Local Authorities and Regions• National Board of Health and Welfare• Medical Products Agency• National Pharmacy Corporation (Apoteket AB)• Carelink


Sweden’s National Strategy for eHealth was presented in March 2006• Main objectives in the National Strategy is to:

– improve patient safety, accessibility as well as quality and continuity of care by creating a broad national consensus on future investments in eHealth;

– enable patient mobility nationally and internationally;

– meet the increasing demands from citizens and healthcare professionals to integrate healthcarein the information society;

– encourage healthcare politicians and decision makersto use eHealth as the main tool for renewal and improvement of health services.


• Services and benefits for citizens, healthcare professionals and decision makers in healthcare.

• Basic structures that has to be in place for future development on the eHealth area.


National Activities and Steering Documents

National Strategy for eHealth

National Strategy for eHealth

Annual National Action Plan

Annual National Action Plan

StandardsStandards TerminologyTerminology

National High Level Group for eHealth• Co-ordination and follow-up of actions related to the

National Strategy.• Regularly analyze, report and follow-up implementation.• Revision and adjustment of the National Strategy.

National High Level Group for eHealth• Co-ordination and follow-up of actions related to the

National Strategy.• Regularly analyze, report and follow-up implementation.• Revision and adjustment of the National Strategy.

Laws and RegulationsLaws and

RegulationsProposal for a new

Patient Data ActProposal for a new

Patient Data Act

Action PlanRegions

Action PlanRegions

Action Plan National

Information Structure

Action Plan National

Information Structure

Project PlanProject Plan

Action Plan MunicipalitiesAction Plan

Municipalities

Project PlanProject Plan

Action Plan SNOMED

Action Plan SNOMED

Action Plan National Library for Terminology

Action Plan National Library for Terminology

Project PlanProject Plan Project PlanProject Plan

Regional ProjectsRegional Projects


Swedish inquiry about SNOMED CT• In April 2006 the National Board of Health and

Welfare was given the task to analyze whether Sweden should become a member of SNOMED Standards Development Organization (SSDO).

• The report was published in September 2006, creating a basic knowledgebase for decision making: – “Should Sweden join now or wait?”

• On October 26 the newly elected Government made the decision to declare its ambition to join the SSDO by January 1 2007 as Charter Member.


• Possibilities with SNOMED CT:– We need a terminology system

like SNOMED CT to improve healthcare and use information systems in a more efficient way.

– Patient safety most important – we need a common terminology when information about patients is shared between many different healthcare providers

– International harmonization andco-operation necessary.

– Systemized information is required in order to make decisions regarding individual patients and facilitate administration, control, follow-up, development and research.

– Information must be a long-term resource, independent of any organization or technical solution.

– Uniform and unambiguous definitions and agreements on terms and concepts crucial to ensure patient safety, high quality treatment and follow-up.

• Challenges with SNOMED CT:– Parts of SNOMED CT not enough

validated.– Not yet a full decision support

system.– Not exhaustive, parts missing

(social care, occupational therapy, physiotherapy).

– SNOMED CT does not cover linguistic definitions, criteria's of diagnosis, information models etc.

– SNOMED CT has to be translated.– Expectations on SNOMED CT are

unrealistic – this has to be handled.

– The knowledge about SNOMED CT is generally low in Sweden.

– SNOMED CT not detailed enough for clinical use.

– Documentation about SNOMED not openly available at present.

– There is a lack of references on practical use of SNOMED CT.

– Expensive? Hard to estimate costs and resources needed for translation and implementation.


Considerations and proposals• Sweden as a nation must decide which path to

follow, where the alternatives are:1. to become involved in the international

collaboration on using and developing SNOMED CT, or:

2. follow its own line and develop a national system for reference terminology.

• The choice of direction must be linked to the desired level of ambition in the future use of information systems in the healthcare sector – and what time aspect we have in the development process.


Proposals for the Governmentto consider before final decision• The development of SNOMED CT has to be:

– a national responsibility– developed to suit Swedish conditions and legislation– given required resources and knowledge.

• We have to build an organization to pragmatically work with development, translation, education and implementation in ICT systems.

• Close co-operation with other SSDO countries is needed.

• SNOMED CT does not substitute ongoing local and national work with classifications and linguistic definitions of terms and concepts.


Common objectives

Common vision and objectives

All steps and initiatives that are taken, should try to achieve common

solutions.

Many actors

Many initiatives


What is common? Find it!

Primary Care

Specialist Care

Social and elderly care

Find what is common / independent of organisations

Process of the patient• The process of the care taker• The kernel – a small common part• Methods/models that can be used• Benefits and effects• Use and development standards• Classifications• Principles for security (business roles)


Expectations and different perspectives

Patient/Relatives

Management/Governance

IT-market

Health care and social care professionals

The patient and relatives• Information about planned procedures and goals

• Information about procedures carried out and achieved results

• Facilitate the patients right to involvement

• Guard the patients right to privacy

The patient and relatives• Information about planned procedures and goals

• Information about procedures carried out and achieved results

• Facilitate the patients right to involvement

• Guard the patients right to privacy

Management, governance and research

• Provide possibilities in terms of measurement, control and follow up

• Patient safety, patient satisfaction

• Quality, costs and effects• Knowledge based clinical research

Management, governance and research

• Provide possibilities in terms of measurement, control and follow up

• Patient safety, patient satisfaction

• Quality, costs and effects• Knowledge based clinical researchHealth care and social care

professionals• Holistic view in relation to the patients needs of health and community care

• Shared information with other health care professional, actions taken and planned care.

• Base for individual planning, decision-making and follow-up.

Health care and social care professionals

• Holistic view in relation to the patients needs of health and community care

• Shared information with other health care professional, actions taken and planned care.

• Base for individual planning, decision-making and follow-up.

The IT-market• Clear and scalable model• Compliance with standards• International value• Reduce costs for development

The IT-market• Clear and scalable model• Compliance with standards• International value• Reduce costs for development


Common vision and strategic

objectives

Description of patient information

Common Care process

Business description

…

IT-description

information specifications

…IT-systems

”legally system”

Technicalinfrastructure

It all comes together!”enterprise architecture”

Information-structure

Systems and solutions

National information model

”the kernel”

Effects


Contact Information

Daniel ForslundHead of Section – eHealthMinistry of Health and Social Affairs mobile: +46 70 209 58 39 [email protected]

Monica Winge Lotta Holm Sjögren Project Manager - National Information Structure National Information Structure

and SNOMED CTNational Board of Health and Welfare National Board of Health and

Welfaremobile: +46 70 484 18 99 mobile: +46 70 692 45 [email protected] [email protected]

Download the National Strategy for eHealth at: www.sweden.gov.se/health

Download the SNOMED Report at: http://www.sos.se/sosmenye.htm

ministry of health and social affairs sweden improving swedish healthcare by using ehealth solutions...

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