Electronic prescriptions and patient records

Transcription

1 Electronic prescriptions and patient records Country: Finland Partner Institute: National Institute for Health and Welfare (THL), Helsinki Survey no: (9)2007 Author(s): Lauri Vuorenkoski, STAKES Health Policy Issues: New Technology Current Process Stages Idea Pilot Policy Paper Legislation Implementation Evaluation Change Featured in half-yearly report: Health Policy Developments 9 1. Abstract Electronic information systems have been developed for a long time in the Finnish healthcare system. A major milestone was achieved in December 2006 when parliament accepted two new acts on electronic prescription and on the electronic management of information on users of social and health services. According to the new acts all service providers are obliged to join the two new national level systems which should be fully functional in 2011 after a four year transition period. 2. Recent developments The national level electronic patient record system (EPR) has been developed since 2002 when government decided that such a system will be introduced in Finland (HPM 5/2005). In December 2006 parliament accepted a new act on the electronic management of information on users of social and health services. According to this law the Social Insurance Institution (SII) will set up a digital archiving service for health service providers. SII is a governmental agency working under the supervision of parliament. Every provider organisation will have its own patient record archive in the upcoming electronic archiving system. However, the structure of the archives will be uniform. All public service providers are obliged to enter their patient record archive into the new system. Private providers have to join to the system if they have electronic archives. Every service provider will have access to the archives of all other providers through a national index service connected to the archiving system. However, the patient's consent is needed for accessing patient records from other service providers' archives. The patient will have access to his/her own patient records and also to a log database containing information on who has accessed their personal records and when. According to law the system should be fully functional in 2011 after a four year transition period. Development of an electronic prescription system has started in A pilot programme has been implemented in In December 2006 parliament accepted a new act on electronic prescription. According to the act, a national electronic prescription database will be set up and maintained by the SII. In this system, electronic prescriptions are sent electronically straight from the physician's office to the central database, to which pharmacies have electronic access. All service providers are obliged to use electronic prescriptions in 2011 after a four year transition period. However, the patient has the possibility to deny electronic prescriptions and to receive a conventional paper prescription instead

2 During the four year transition period, expenses of these new systems are covered by government. Afterwards expenses are to be covered by the users (health service providers and pharmacies). 3. Characteristics of this policy Degree of Innovation traditional innovative Degree of Controversy consensual highly controversial Structural or Systemic Impact marginal fundamental Public Visibility very low very high Transferability strongly system-dependent system-neutral The Finnish health care system traditionally has been very decentralised. Basically these reforms are one step to a more centralised steering of health services. Until now the development of health care information systems has been pronouncedly uncoordinated which has resulted in a situation in which non-interoperable information systems are used even within individual health care organisations. 4. Purpose and process analysis Idea Pilot Policy Paper Legislation Implementation Evaluation Change Initiators of idea/main actors Government Providers Civil Society Private Sector or Industry Stakeholder positions This policy has been strongly promoted by the Ministry of Social Affairs and Health. The policy was not opposed by any relevant actor. The most controversial issue has been how misuse of these databases will be prevented and what kind of consent is needed from the patient. Actors and positions Description of actors and their positions Government Ministry for Social Affairs and Health very supportive strongly opposed - 2 -

3 Social Insurance Institution very supportive strongly opposed Providers Municipalities very supportive strongly opposed Civil Society Public very supportive strongly opposed Private Sector or Industry Software industry very supportive strongly opposed Influences in policy making and legislation The legislative process led by the Ministry of Social Affairs and Health did not bring any major changes to the systems. The most visible discussion in the legislative process was about which national level organization should be in charge of the practical implementation of the EPR system. Legislative outcome Enactment Actors and influence Description of actors and their influence Government Ministry for Social Affairs and Health very strong none Social Insurance Institution very strong none Providers Municipalities very strong none Civil Society Public very strong none Private Sector or Industry Software industry very strong none Positions and Influences at a glance Adoption and implementation The main actors in the implementation are the Social Insurance Institution, the software industry, health care providers and pharmacies. Perhaps the most significant obstacle in the construction of the EPR system is to make the necessary changes to the different software used by providers. Monitoring and evaluation The process has progressed as planned and it is monitored by the Ministry of Social Affairs and Health

4 5. Expected outcome The introduction of the national EPR and electronic prescription systems will lead to more integrated information technology solutions in health services and they will significantly improve the usability of information systems in clinical practice. In addition, these systems will enable a more efficient use of patient level information in health care steering and development. Quality of Health Care Services marginal fundamental Level of Equity system less equitable system more equitable Cost Efficiency very low very high When implemented, these electronic systems will improve the productivity and quality of the health care system and promote integration of care. 6. References Sources of Information ehealth Roadmap - Finland. Ministry of Social Affairs and Health's Reports 2007:

5 Reform formerly reported in Introduction of Electronic Patient Record System Author/s and/or contributors to this survey Lauri Vuorenkoski, STAKES Suggested citation for this online article Lauri Vuorenkoski, STAKES. "Electronic prescriptions and patient records". Health Policy Monitor, April Available at -