Strategies and experiences in Sweden

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1 Strategies and experiences in Sweden Inger Wejerfelt Head of information structure group National Center for Coordination of ehealth NCCEH

2 National IT strategi organisation Ministry of health and social affairs County councils National Board of Health and Welfare Swedish Association of Local Authorities and Regions (SALAR). National Information structure National Health Language National IT-solutions for Health Care National Center for Coordination of e-health Architectural board - Security - Business rules - Information structure - Technical platform 2

3 National IT strategy to support Good Quality care E-health must represent and manage knowledge not only documenting and communicating health data in a record Health register Quality register Decision Support EHR 3

4 National IT strategy to support Good Quality care Health register Quality register Decision Support EHR E-health must represent and manage knowledge not only documenting and communicating health data in a record Semantic interoperability a base for knowledge management Terminology Archetypes 4

5 A critical aspect the daily clinical work Info...and more activities.. Info Access to care Quality registers Achievments NPÖ/epSOS Patient VpW Medication list Local follow up Other care provider Reuse of information with one registration 5

6 Represent and manage knowledge - with one registration to support Good Quality Care A decentralised structure with many different IT-solutions We can t replace these systems.. Focus on the digital information not the IT-systems National Information structure - generic models National Health Care Language SNOMED CT and classifications County councils - Architectural Board V-TIM the applied information model 6

7 V-TIM the applied information model Different types of information models: for communication like EN13606 reference models like openehr RM and HL7 v3 RIM.but you can put almost any information within a reference model we also need a reference model for the information itself - a framework for the content a maximum generic data set for the EHR V-TIM is a framework for the content the applied information model described from a clinical perspective. V-TIM is based on and adapted to the national generic models and to some extend to openehr RM is independed of standards 7

8 V-TIM Patient Request Health issue Report Request add. info Instruction Activity Goal Evaluation V-TIM is developed and described with Action Observation 8

9 RIV-method a method for development and documentation Attribut Description Format Mult Termonology Rules, comments ATC-kod ATC-code and description for the drug that is causing the alert KTOV 0..1 ATC At least the 3 first numbers in the ATC-code must be given activ substans Description of the activ substans in the drug TXT 0..1 ATC Specifies the necessary work and documentation for each national project in order to get persistent, consistent and reusable specifications of business and information requirements 9

10 Standards for the information Documentation Template bloodpressure V1/ v2 position V1>V2 Power to the clinicians No transformation Certification of the information Documentation Template bloodpressure 110/80 prone 110/80 prone Template bloodpressure 110/80 EN13606 and openehr RM with arketypes/templates standards with focus on the information, not the communication only 10

11 The Swedish decisions The Swedish county councils have February 14 th, 2008, decided: The path for the development of an applied information structure for the Swedish health care and welfare is to follow and apply the European standard effort and its recommendations. The architectural board for Healthcare has the task to: -validate the European standard effort -develop a strategy for a migration to the selected standard -inform and educate EN13606 and openehr when needed V-TIM, RIV-method and EN13606/openEHR 11

12 A first step The Swedish National Patient Summary (NPÖ) using EN13606 part 1 for communication only the information in our different county councils are very different, and there is to a large extent no common structures or concepts structure the extract according to V-TIM but most of the datatypes are text with very, very few codes each of these information structures are put in the EN structure next step archetypes/templates as a way of capturing the information no need to change the communication structure the archetypes/templates will give the new structure for NPÖ 12

13 Archetypes/templates and terminology binding through projects within the national IT-strategy Not starting with the whole EHR outside - in Starting with projects that is: - part of the national strategy - of high interest for the clinician - give effects back home - broadening the interest within the clinical community Info IT- service Info...and more activ Access to care Quality registers Achievments NPÖ/epSOS Starting with one project Quality register for Heart failure (RiksSvikt) - a pilot with 2 vendors/systems and 2 county councils - archetypes and templates with SNOMED CT binding - in test operation in February tools from Ocean Informatics Patient VpW PASCAL Local follow up Other care provider Five projects are in the pipe line Reference archetypes for V-TIM based 13

14 Handling the legacy systems IFK 3? A IFK 2 A A A EN13606 Archetype description Communicate Level 3 NPÖ EN13606 Archetype description Level 2 Level 1 EN13606 Translate System dependend RM Translate System dependend RM Handles archetypes with internal template tools openehr s Reference model Archetypes 14

15 National projects - terminology and terminology binding Different types of terminologies with different structure and purpose : the user interface attribute names the content code lists classifications like ICD10 and ICF Snomed CT Information models with another structure.. General guide lines through national projects with international experience 15

16 National governance certification of the information V-TIM Domain model National projects RIV-method V-TIM with archetypes Archetypes/ templates 20 projects are in governance After the first archetype project IFK 2, the other projects can proceed with archetypes/templates 16

17 National governance - applied informationsstructure Methods and tools Generic forms (archetypes) Shared forms Specific forms (templates) Repository with archetypes and templates Termserver Term.- server Information and education Referens models Roles and liabilities Standardisation V-TIM 17

18 Strategies and experiences 1. Information and semantic interoperability - a base for knowledge management 2. V-TIM the applied information structure 1. RIV-method a common work process and documentation 2. Standards for the information 3. Archetypes/templates and terminology binding through projects within the national IT-strategy 6. National governance 18

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