ehealth, digitalisation and ICT-solutions in Finland

Transcription

1 ehealth, digitalisation and ICT-solutions in Finland European Observatory Finland Workshop Maritta Korhonen Senior Adviser, Information Management Ministry of Social Affairs and Health, Finland

2 National ehealth house in Finland today Functionalities now structured patient information available for professionals and citizens eprescription functionalities (incl. epsos) eview and Patient Information service for citizens National ehealth Kanta-services Local infrastructure 100% EHR, Pacs etc Roof local implementations -> standard patient information in national repository obligatory for private and public, primary and secundary health care Floors adjustement of local EHRs auditing of EHRs and health care providers Foundation national semantic and technical standards for interoperability national repository

3 The decision to build a national ehealth solution Government decision in 2002: Finland should have a nation wide interoperable EHR system by end of 2007 By 2005 agreement on the National archive for health information (Kanta) comprising three nation wide services eprescription eaccess earchive Based on structured documents (HL7 V3 CDA R2) In co-operation with local systems to feed care documents and using them New legislation was needed to allow the new features Placing the centralized service to Kela (National Insurance Institution) Consent management, privacy & security aspects

4 The main goal of Kanta services A centralised data repository for health information and services associated with this data Offers healthcare and social care professionals up-to-date information about patients health and wellbeing and its history, and serves as a data mediator between organizations Improves patient safety Decreases the need for the local archiving of data Provides a foundation for better statistics, research and other secondary use In addition to health-related data, will include data for social services

5 National archive of health information eprescription Provides medication summary and enables a fully electronic prescription dispensing reimbursement process earchive (Patient Data Repository) Centralised active and real-time data store + legal archive Allows sharing of data between healthcare providers securely and with patient consent eaccess (MyKanta) Citizens can view their own prescriptions and electronic records National services are accessed through local systems Implement same interoperability standards also in local systems (HL7 V3 CDA R2)

6 Public healthcare providers Hospital districts (20) Kanta services Pharmaceutical database Primary care org. (192) Private healthcare providers (4000) Pharmacies (~800) Health care professionals Swedish epsos NCP Connection closed after successful pilot Citizens (> ) Social care providers epsos NCP Aged 18 and older Web- GUIs for HCPs My Kanta pages Kanta messaging layer eprescription service Patient data repository Health records, structured Patient data management service Patient summary management Diagnoses Consent and will management Consents and their restrictions Personal Health Record Prescriptions Logs Risks Data repository for social services Customer docs Encounters Renewals Dispensations Logs Radiology DICOM studies Health records, legacy Other summary data Living wills and other wills (organ donation, etc) Customer s mydata Customership and service item data Main standards HL7 V3: CDA R2 L3 and Medical Records HL7 FHIR DSTU2 (PHR) JSON, XHTML (PHR and social services) PDF/A (legacy data and social services) IHE IT-I Profiles (Imaging and epsos) W3C XML DSig WS Addressing, WS-I TLS, X.509 Other national services National code server Code systems and terminologies Form structures Pharmacy register Organization register X-Road Certification services Legacy data Summary management Logs HCP and SCP register

7 Timeline of Finnish Healthcare ICT Standardization for Interoperability Experimental legislation on seamless service chains HL7 Finland founded National health project starts Regional hospital information systems starting National core datasets defined Legislation about the national Kanta system and supporting services Kela appointed as a national actor in national healthcare ICT services eprescription service production phase incl. My Kanta pages service for citizens -> Finnish IHE SIG founded epsos work started in FIN Patient Data Repository production phase -> All public healthcare uses the Patient Data Repository IHE Finland founded All private healthcare uses the Patient Data Repository ICD-10 adopted in Finland First national HL7 v2 profiles PikaXML definition for electronic referral process Finnish profile for CDA R1 National code server founded Finnish basic profile for CDA R2 CDA R2 becomes ANSI standard Ministry decision on CDA R2 for national standard for structured dataset National Kanta architecture defined Finnish profile for HL7 V3 messaging National pharmaceutical database founded National imaging architecture defined HL7 Medical records specifications for eprescription and Patient Data Repository Oral and dental healthcare structured documentation specifications epsos national contact point in production First FHIR pilots

8 Electronic Prescription Well over 90 % of all dispensations are based on electronic prescriptions All public healthcare service providers use eprescription Many private healthcare service providers have joined the service, others are joining in Electronic prescription will become mandatory from Doctors may not write paper prescriptions or prescribe over the phone, except in extraordinary situations Any paper or phone prescriptions will be entered in the Prescription Centre by the pharmacies. Kela will provide a web-based service (HCP portal) for handling electronic prescriptions, to be used mainly by individual doctors and small organizations

9 Electronic prescription: statistics Prescriptions Dispensations (as of )

10 Patient Data Repository A national centralized repository into which patient records are entered nationwide Contains the patient s health record, data about encounters and periods of ward care. Lab results, referrals, etc. All public healthcare organizations store data in the Patient Data Repository ( ) First private healthcare service providers have joined the Patient Data Repository in the beginning of this year. Key statistics ( ): document containing data about service events of persons (89 % of the population)

11 My Kanta Pages Online service designed for citizens From summer 2016, guardians can check data of their children (under age of 10). Also minors will be able to log on, now only adults. Viewing data: Can view: prescription information and medical records, e.g. diagnoses, encounters, risks, lab results, as well as related log records. A log record for the citizens to check where and when their data was used. Also Personal Health Record data and connected apps in the future. Entering data: Citizens can receive consent-related information, give their consents and restrict them. Living wills and organ donation wills can also be given. A popular portal log-ons by unique people per month

12 My Kanta Pages statistics Log-ons in a month

13 Production Service Requests eprescription currently generates million service requests monthly with an average response time of some 1.5 seconds (median is 0.9 sec) Patient Data Repository currently generates some 50 million service requests monthly with an average response time of less than a second Availability figures for 2015: 99,93 % eprescription and 99,97 % Patient Data Repository Peak load rates: 150 interactions (mostly HL7) per sec

14 ehealth is popular! Appreciation and recommendability of network brands in Finland (ranking by Taloustutkimus Oy, an independent market research company) Yle Areena Yle Areena 2 Finnish Meteorological Institute Finnish Meteorological Institute 3 HSL Journey planner Kanta.fi 4 HelMet Yle 5 Yle HSL Journey planner 6 Kanta.fi HelMet 7 Vero.fi Vero.fi 8 Foreca Poliisi.fi 9 Osuuspankki Foreca 10 Poliisi.fi Osuuspankki

15 What s coming next? Social and health care services reform Establish 5-19 autonomous areas larger than a municipality (currently over 300), responsible for arranging the social and health care services among their area Extensive horisontal and vertical integration between social and health services Renovation of large hospital systems Apotti in the HUS area A number of new hospitals in different parts of the country UNA a collaboration project for compiling specifications for a modular EHR system Need to support the changes through new national ICT services

16 Data repository for social services A big branch of services in Finland, organized by municipalities and produced by public and private organizations Much collaboration with healthcare, but also separate services 22 service groups, 61 services implemented in 5 different ways, 270 different document types Approximately the same amount of professionals as in healthcare Much interaction with other authorities, such as the police, immigration services, courts etc. No national ICT infrastructure at the moment, being built right now as part of Kanta services. Standards base quite similar to that of the Patient Data Repository, (HL7 CDA, MR, PDF/A, XHTML, JSON, etc) Production target:

17 Imaging Archiving and Sharing Architecture The ultimate goal is to enable access to images such as DICOM studies regardless of the place they were taken. Hybrid architecture. Studies can be stored locally/regionally or centrally. Based on IHE XDS (XDS-I.b, XCA-I, XUA, etc) Enters operation in the end of

18 National Architecture for Digital Services (KaPA) Based on the Estonian X-ROAD X-ROAD is SOAP-based (and so is HL7 v3 MR). Similar situation in Estonia, note that it s possible to package HL7 messages as such in X-ROAD packets (not the neatest solution). The plan: First focus on fetching data from other services, then on serving data to other organizations. Building new application adapters ( translators ) is possible to complement the Kanta service bus Kansallinen 51

19 Personal Health Record Using the PHR people will be able to enter in Kanta their own data related to health and wellbeing. Data can be entered through various web applications and apps. Examples of use are home monitoring, risk tests, smart diagnostics online, even fitness applications and other data that patients want to follow. Kela is designing and building the data management platform. Third parties will develop services which produce, store and analyze the data. Many nationally and regionally coordinated projects are developing self care solutions, a general trend and hot topic at the moment. Healthcare professionals will be able to access the data with patient s consent, and put parts of it on the official patient health record. Currently being designed, first phase ready by end of Based on HL7 FHIR, OAuth etc

20 Present Do I need to worry? What can I do myself? Future Test Results Recomendations Looking good! Goals Guidance & support Tracking & support Life expectancy/ healthy years Digital health & wellbeing check Patient data (EMR) Mydata Data from health and wellbeing apps Weight index Cholesterol Alhocol consumption Functioning / Disability Decision support for a change -10kg / year -More everyday physical training Risks/reminders Right service contacts (for self care support) Citizen s own goals Interactive health & care plan Better balance of own economy Personal health & wellbeing guidance Personal health & wellbeing coaching supported by mhealth solutions Slide by the ODA project

21 FHIR standardization The goal is to involve software/apps manufacturers HL7 Finland Personal Health SIG already established, and there are many participants developing FHIR demos in Finland at the moment Collaboration with other national projects Also international collaboration possible Similar projects also in Norway, Denmark, Sweden, Estonia

22 Working in partnership

23 General legislation related to data protection and security issues Act on person information (523/1999) General law on how person information must handled Custodian, consent etc. defined Is used as a rule UNLESS specific legislation states otherwise Principles of person act are widely followed in different areas of society Act on electronic authentication and signatures Generic legislation for different levels of authentication and signatures 23 Name

24 History of ehealth legislation Act on Experiments with Seamless Service Chains in Social Welfare and Health Care Services and with a Social Security Card (811/2000) regional information systems National health care project ( ) Decision to create national ICT services for healthcare (2005) Legislation preparation in 2006 Several legal experiments - new model in restricted use (eg. in a specific region) final legislation to be ratified on basis of experiences

25 Specific legislation related to ehealth National ICT services Act on electronic processing of customer information in social and health care services (159/2007) under amendment during , consent - social care Act on electronic prescriptions (61/2007) Content handled in national ICT services Act on customer documents in social care (254/2015) Decree on national ICT-services (165/2012, renewed 2015) phased increase of content in national ICT services Decree on patient records (298/2009) Several individual articles in different laws eg. article 9 in the Healthcare law specifies a joint register for a hospital district and all municipalities belonging to that hospital district 25 7/5/2 Name

26 Monitoring of information processing Privacy protection and the legality of the information processing are monitored by the health care organisations, pharmacies and Kela. To enable retrospective checks, log files are kept about the use and release of data. Patients can monitor through MyKanta portal, which organisations access or process their personal information and to which organisations the information is released

27 Number of customers Proportion of eservices Information Selfassessment eservices Physical Basic service Physical Special service Demanding Special services Cost/ client General Web Services Identified Web Services Electronic connection to the provider Health Center Hospital University Hospital Web pages My Kanta (PHR) Kanta / Kansa Mental Health House System of service voucher Service Directory ODA Virtual Hospital Health Library Self-care pathway Apotti / UNA

28 Big picture Healthcare Repository Socialcare Repository eprescription Data management services Kanta-services My Kanta Service Directory Indentification Authorization Service views Other National Services (PRC,Tax) STM VM Kela THL VM Open interfaces, integration solutions and service fairway Autonomous Regions EMR/ EHR/ PHR Autonomous Regions Stakeholder s projects i.e. UNA & Apotti *National co-operation in the pipeline Autonomous Regions Common services of Self-care and eservices Welfare control Self-care plan Welfare coaching Assessments of symptoms and welfare Welfare plan Knowledgebase Scheduling and service management Mental Health House Virtual Hospital* Service voucher ODA eservices of Autonomous regions And Muncipalities Apps Innovation portal And Platform Regional solutions selected by the user (several options, more competition) i.e. Solutions for collecting own data Self-care and wellness applications for targeted user groups Supportative solutions for everyday life (i.e. elderly, disabilities.) Advanced communication applications (i.e. video, chat) 28 New innovations

29 Public sector ICT-costs Total 1,6Mrd (2014) AVI:t Ely-keskukset Pelastus Sote 0,2 % 0,9 % 0,2 % 1,2 % 44% 25% 25% 4% Itsehallintoalueet Kuntasektori Valtionhallinto Kela Regions Municipalities State

30 Genome strategy Better health through genomics Ministry of Social Affairs and Health and Sitra (Finnish innovation fund) esocial and ehealth strategy 2020 Information to support wellbeing and service renewal Ministry of Social Affairs and Health & Association of local and regional authorities Growth and innovation strategy for health sector Ministry of Employment and Economy, Ministry of Social Affairs and Health, Ministry of Education, Academy of Finland, Finnish Innovation acengy (Tekes)

31 Information to support well-being and service renewal: ehealth and esocial strategy Visual summary of the strategy STM SoTe-tieto hyötykäyttöön 2020 strategiatyön visuaalinnen tiivistelmä, sisältö:

32 Information to support well-being and service renewal ehealth and esocial strategy 2020 Focus area How to get it done Citizens Professionals Service system Information use Refinement of information and knowledge management Steering and co-operation Infostructure Taking own responsibility - doing it yourself Smart systems for capable users Effective utilisation of limited resources Knowledge-based management From soloists to harmony Ensuring a solid foundation

33 Professionals - smart systems for capable users Strategic objectives Professionals have access to information systems that support their work and its operating processes Electronic applications in the use of professionals Measures National criteria for the usability of information systems Decision-making support for professionals Training of professionals Active user involvement in the development and adoption of information systems and operating models

34 Service system effective utilisation of limited resources Strategic objectives Social and health care information is accessible to professionals and citizens Information management solutions increase the effectiveness and impact of the service system The availability and accessibility of the services is being improved through electronic solutions Measures Renewal of legislation on the use of information related to social welfare and health care services Information management solution for social welfare implemented as part of Kanta services Further implementation of Kanta-services Development and use of online services Support for processes and operations

35 Refinement of information and knowledge management knowledge-based management Strategic objectives Data sets support in real time the management of service production and decisionmaking in society in real time Data sets support research, innovation and industrial and commercial activities Measures Legislation on secondary uses (unrelated to care or client relationship) of social welfare and health care data Development and resourcing of secondary use of data Population-level statistical and indicator services Common infrastructure for secondary use

36 Steering and cooperation - from soloists to harmony Strategic objectives The structures for steering and cooperation in the area of information management are clear and support the social welfare and health care service reform Measures Renewal of steering and leadership of information management in social welfare and health care services A model for cooperation between social welfare and health care regions and national operators

37 Citizens as service users - doing it yourself Strategic objectives by 2020 Citizens use online services and produce data for their own use and for the professionals. Reliable information on well-being and services supporting its utilisation are available Information on the quality and availability of services is available in all parts of Finland use of web: 27% y 92% 16-74

38 Citizens as service users - doing it yourself Measures National platform for managing the citizens personal information in the areas of health and wellbeing The implementation will utilise national services and open interfaces. Citizens themselves will make the decisions regarding the storing of their information on the platform and its disclosure using the use of web: 27% y 92% applications to be built on the platform.

39 Local and regional ehealth situation in Finland by 2015 Delights Strong base for further development EHR coverage 100% (public prim and sec healthcare), 80% (private) EHR information exchange 90% (public, hospital districts) Electronical referrals and discharge letters 95% Very wide use of national solutions (eprescription, earchive, eaccess) Drawbacks Forerunners dilemma: old EHR systems, usability Interoperability problems Slow adaptation of citizen eservices Etunimi Sukunimi

40 Authorities and relevant parties related to ehealth and ewelfare The Ministry of Social Affairs and Health THL, National Institute of Health and Welfare KELA, The National Social Security Institution Population Register Center Valvira, National Supervisory Authority for Welfare and Health Local governments (municipalities) The National Health Information System Hospital Districts Health Care Centres Pharmacies The private health care The State owned health care institutions The patient The citizen Etunimi Sukunimi

41 EU European Hospital Survey: Benchmarking Deployment of e-health Services ( ) Finland Sweden Denmark Norway Norway Etunimi Sukunimi

42 Renewal of services must be supported by ICTsolutions! Etunimi Sukunimi

43 QUESTIONS? Ministry of Social Affairs and Health Social and Healthcare Reform National services: ehealth strategy 2010: Translations of Finnish legislation: