National ehealth Solution in Finland Teemupekka Virtanen Ministry of Social Affairs and Health Finland
Organization of health care in Finland Population 5.3 million PUBLIC SECTOR 85% Municipalities Responsible for arranging Independent in decision making Appr 230 Primary health care centres 21 Hospital districts Can send patients to University hospitals PRIVATE SECTOR 15% Primary and specialized health care Occupational health care (60%) appr 4000 private providers 600 pharmacies
Starting point Long experience in computers in health care Local level 100% coverage of EHR Regional level Good coverage of electronic referrals (public sector) Some document exchange Some regional level systems National Some disease based registers (cancer, ) FINNISH ehealth SURVEYS Assignment of the Ministry of Social Affairs and Health Conducted by FinnTelemedicum and Stakes 2003, 2005, 2007 (08) By Hämäläinen P, Reponen J, Winblad I: http://www.stakes.fi/fi/julkaisut/v erkkojulkaisut/raportteja07/index.h
Goals Quality of treatment Internal The best knowledge available Quality of treatment requires correct and valid information of a patient Effective procedures External Less specialist needed To decrease costs everything else but the treatment itself must be as effective as possible
BAD NEWS - interoperability Various EHR-systems are used in Finland 8 major and numerous small ones Various one disease / purpose systems Lab, radiology, anesthesia, intensive care, diabetes, maternity care etc appr 60 have been recognised Common standards, both technical and semantic are too few Regional information-exchange systems Coverage is not total Are based on different architecture solutions Reference directory < > same EHR system Private health care is not involved Ø NATIONAL SOLUTION NEEDED
National ehealth Road Map 2007 Availability of patient information regardless of time and place, both in public and private sector Participation of citizens and patients Acces to own patient information and log data Acces to high quality health information Development of eservices Legislation 2007 Using national archive is mandatory for public and private sector Privacy needs taken into account
The Architecture Pharmacies Doctor The archive EHR Citizen The prescription center The directory (registration) PKI The code service AAA services
General Architecture HIS Patient records HIS LAB Patient records HIS Patient records LAB HIS Patient records
All EHRs must Use the nationally defined structural information that is based on nationally approved terms, classifications and codes updated by the national code server Use the nationally defined set of standards (HL7/CDAR2, ISO/OID, Dicom etc.) Must follow the national recommendations on data security and data safety and use the national PKI service in verifying health professionals Must communicate with the national IT architecture (data transferring and archiving will be based on the national digital EHR archive) Implementation into existing EHR-systems 2007 - >
KanTa services earchive eprescription eaccess
NATIONAL earchive - functions DYNAMIC DATA REPOSITORY Information exchange and searching between health care providers On patients consent LONG TERM ELECTRONIC ARHIVE Strict legislation on archiving Summary data has to be available 12 years after death born 18th and 28th: for ever (for research purposes) Currently local paper archives STATISTICS Decision support Scientific research
earchive CONTENT Patient information Produced by local EHRs Coded core information Diagnosis, medication, procedures, medical risks Medical record texts, nursing information Lab, pathology etc test results Radiology, endoscopy etc images Log information BASIC DATA SET in first phase patient record text (including core information) medication referral and discharge letters radiology referrals and statements summary of nursing information laboratory results
eprescription NATIONAL PRESCRIPTION CENTRE eprescriptions Information of medicine dispensing in pharmacies Log Viewing on patients consent BY LEGISLATION OBLIGATORY For doctors and pharmacies Patients has an option to use traditional version
eaccess XXX - For adults only Own patient information in earchive Information in Prescription centre Log information Via Internet Authentication by electronical ID card ebanking identification
ecitizen Services Chronic diseaeses Digital cservice onnections Digital serviceconnection Citizen and home Bookings, registrations, payments Service System Iterpretation of results BASIC INFRASTRUCTURE Documentation in standard form, Archiving, Legislation
Citizen s portal In KanTa services all the information is produced by professional There is a need for citizen s own system Citizen can store his/her own information and logs Blood pressure, weight, exercise, nutrition, Citizen can decide who has access to this information A professional can transfer part of this information to the KanTa This portal is designed by another project
The current situation The main definitions are made Imaging, biosignals, many special areas are still missing eprescription is in use The central services are operational All pharmacies are connected Almost all PHR systems audited and approved About 500.000 prescriptions written in a month earchive The central services are operational The first city is in test use
Experiences this far The elephant is big It has to be eaten bite by bite Using common standards is mandatory Freedom makes systems incompatible Not only systems but doctors, too Improving an existing system is difficult The new system must be fit in a almost ready puzzle The requirements are high
The next step Taking care of people is not only medical question Social care is as important as medical We are designing the national exchange and store for social care documents The basic structure will be the same The main definitions of social care documents are made using HL7- type definitions The main working procedures has been analyzed We wait some experiences from ehealth before starting the real implementation The same information is available in both sectors Privacy conditions apply
Thank you