Finland eprescription experience Päivi Hämäläinen, Viveca Bergman, THL EXPAND MS and CC Workshop 21th April 2015, Luxembourg 8.5.2015 Department of Information Services / THL 1
28.1.2014 8.5.2015 Department of Information Services / THL 2
eprescriptions in Finland eprescription has been in production since May 2010. Fully rolled out in pharmacies and public health care, roll-out well ongoing in private health care. Joining the ep service is obligatory today and ep will be the only choice after 2017 Päivi Hämäläinen, THL, 2014 ehealth Forum, Athens, 14 May 2014 3
The use of eprescriptions (%) in the public health care December 2014 Pohjoinen Lappi (05/2014): 85 % Länsi-Pohja: 94 % Pohjois-Pohjanmaa: 86 % Kainuu (05/2014): 94 % Keski-Pohjanmaa: 86 % Approximately 92% Keskinen Etelä-Pohjanmaa: 98 % Pirkanmaa: 91 % Päijät-Häme: 93 % Kanta-Häme: 92 % Itäinen Keski-Suomi : 93 % Pohjois-Savo: 92 % Etelä-Savo (05/2014): 85 % Itä-Savo: 95 % Pohjois-Karjala: 96 % Läntinen Vaasa: 83 % Satakunta: 94 % Varsinais-Suomi: 97 % All pharmacies and public health care organisations have joined the ep Centre. Lähde: STM Sairaanhoidon erityisvastuualueet, sairaanhoitopiirit ja keskussairaalat 1.2.2013 Eteläinen Etelä-Karjala: 93 % Kymenlaakso: 93 % Helsinki-Uusimaa: 94 % 8.5.2015 Department of Information Services / THL 4 4
Brief history of the Finnish eprescription By 2005 agreement on the National Archive of Health Information (KanTa) : eprescription service, Patient Access and Patient Data Repository. Architecture of centralized storage (Kanta) with Pharmacy Information Systems and HIS systems as the clients.. Act on Electronic Prescriptions in 2007 Legislation was needed to allow the new features Placing the centralized service to the Social Insurance Institution of Finland (Kela) Consent management, privacy & security aspects Mandated the adoption of the eprescription for pharmacies, health care units and doctors and dentists practising in health care units (still voluntary for doctors and dentists not practicing in these units). The purpose of the Act was to improve patient and drug safety and to facilitate and streamline the prescribing and dispensing of pharmaceuticals. Amendments to Act on Electronic Prescriptions in 2010 which re-scheduled the Kansa project, and in 2014 a new Amendment makde the eps mandatory for all actors as of 2017 8.5.2015 Department of Information Services / THL 5
8.5.2015 Department of Information Services / THL 6
Enablers in place for cross-border services Mature national ehealth infrastructure; nationwide coverage of ep and ed < Kanta EU-level produced common/additional services and specifications < epsos Robust standards-based national system with data in structured form Roles of competent actors in cross border deployment regulated by law. 8.5.2015 Department of Information Services / THL 7
FI-SE Pilot Use Cases and coverage ep and ed as Country A and B Operation Dec 2013 June 2014 Country A coverage national, Country B limited to a border region in Northern Finland consisting of pharmacies in 3 municipalities Real patient data Cross-border UC regarded as a natural extension of the Nordic agreement on exchange of prescriptions the national ep Services (EU prescription was on paper) 8.5.2015 Department of Information Services / THL 8
epsos Pilot Architecture From the onset focus was on creating a sustainable integrated service - running the pilot had to be integrated with an existing national ep The roles and responsibilities in national and cross-border services defined by law; THL (National Institute for Health and Welfare) responsible for operational management and implementation Kela (Social Insurance Institution of Finland) responsible for technical deployment including the NCP. Päivi Hämäläinen, THL, 2014 ehealth Forum, Athens, 14 May 2014 9
epsos Web Portal 8.5.2015 Page 10
combined with national infrastructure and services My Kanta - National Patient Portal for consent giving: a specific epsos consent was required 8.5.2015 Department of Information Page 11 Services / THL
The path towards implementation 2011-2014 No major technical issues encountered, but the preparatory phase exposed legal, organizational and semantic issues that had to be addressed Organisational: Localisation of FWA not a mere translation task, responsibilities according to national law differed from those set out in FWA Semantic: challenges in mapping (e.g. EDQM, ATC, UCUM). Unstructured data > ep incomplete and certain types of prescriptions were ruled out Legal: not possible to establish NCP at Kela without revision of national legislation Within the given time frame full integration of epsos solutions into national infrastructure impossible > chosen ed portal probably solution not a sustainable approach 8.5.2015 Department of Information Services / THL 12
We got there! 8.5.2015 Department of Information Services / THL 13
Real-life FI-SE pilot also revealed shortcomings FI-SE pilot: 17 dispensations made successfully 34 cases: patient had not given consent or pharmacist entered patient id wrongly 15 cases: prescription out of the scope of the pilot, of which 2 time-based prescriptions (not based on prescribed amount) 4 combination medications 9 prescriptions in which package size not structured Negative feedback on cross-border service reported to PGEU by SE/FI pharmacists http://www.ehealth2014.org/wp-content/uploads/2014/07/pres_wilkinson_j.pdf 8.5.2015 Department of Information Services / THL 14
Reflections based on our experience In order to be able to sustain the services, continuous support for centralized cross-border services is required: Reliable maintenance (including support, development, and version management) of the common components produced by epsos and its successors Reliable maintenance of the semantic infrastructure established by epsos Cooperation with the standardization bodies Features to be developed and maintained at EU rather than national level: Standards, common terminologies, classifications, code sets, and other specifications. EU focus on securing the operational use of the existing, and not that much on inventing new ones. The real challenge now lies with deployment. 8.5.2015 Department of Information Services / THL 15
Prescriptions out of scope, case Finland No Description Reason Suggestion with regards to pivot 1 central nervous system drugs Difference in classification (what is a CNS drug and what is not) in different countries No change 2 drugs with potential for recreational use (narcotics) Out of scope of epsos in general No change 3 drugs to be prepared in the pharmacy Preparation instructions only in Finnish/Swedish 4 base creams No ATC code or strength, which are mandatory in pivot 5 clinical nutritional preparations No ATC code or strength, which are mandatory in pivot 6 care accessories, dietary supplements and No ATC code and some other information bandages which is mandatory in pivot No change Include make ATC code and strength optional in pivot Include make ATC code and strength optional in pivot No change 7 prescriptions valid for defined time periods No information on package size and number of packages 8 iterated prescriptions Difficult to calculate the remaining amount. Iteration rules vary among countries. 9 combination medications ATC code system not designed for this use case. Text-based strength not allowed. 10 combination packages Package size is difficult to structure. No change 11 the prescription is in held state National rules No change 12 the prescription is in reservation state National rules No change 13 package size is not in structured form Package size is difficult to structure. No change No change. Some countries are able to send suitable info (amount to be dispensed at once). No change. Some countries are able to send suitable info (amount to be dispensed at once). Allow providing non-structured strength information (text) 8.5.2015 Department of Information Services / THL 16
Cont. National deployment requires mature assets. It is not possible to introduce a cross-border service at national level if the service is significantly different from /sub-optimal to the national standards that the population is used to. Minor and major issues identified during operation as regards the epsos Pivot (semantics) > extension needs. Status quo may become a risk for sustained interoperability. In the pharmacies the sustainable solution is an integrated crossborder functionality not causing extra work load. Supportive infrastructure and close collaboration between all the relevant national authorities required (In Finland: Kela, THL, Population Register Centre, Finnish Medicines Agency, Pharmaceutical Information Centre, and the National Supervisory Authority for Welfare and Health, and Data Protection Authority). 8.5.2015 Department of Information Services / THL 17
Thank you! paivi.hamalainen@thl.f i 8.5.2015 Department of Information Services / THL 18