SVENSK FÖRENING FÖR MEDICINSK INFORMATIK SWEDISH FEDERATION FOR MEDICAL INFORMATICS History of electronic prescriptions in Sweden from time sharing systems via smartcards to EDI History of Nordic Computing 3,IFIP Stockholm 2010-10-18 Gunnar O Klein, M.D. Ph.D. Researcher in medical informatics at KI Primary care physician Scientific secretary of SFMI Råcksta Vällingby Närvård
Personal Journey Developer of a test system for the Pharmacy printers at Philips Bank Terminal Systems AB in Vällingby 1972-73 Director, Infocard company 1987-92 EU project leader for secure communication and standardisation at Spri - Swedish Institute for Health Services Development and Karolinska Institutet 1993-2005 Medical informatics academic and a prescribing general practioner
Issues addressed by ICT for medication Decision support to the prescribing physicians to improve quality of medication selections to optimize the chance of efficacy and minimize the risk of adverse reactions. Improving cost-efficiency for the pharmacies moving from hard to read paper scripts to computerized support for retail, billing and safety checks. Improved services to the customers/patients
Apoteksbolaget Apotekens Terminalsystem ATS Minicomputer DG and terminals at the Pharmacy office Pricing, Sales statistics and printing of labels with dosage information Already 1970ies almost all pharmacies where computerised
The Bankeryd Trial Prescribing doctors in the same building as the pharmacy were conected to the local Pharmacy terminal system and could make prescriptions. Access to database of products but no decision support
The communication and security problems No networks to the doctor s office Slow telephone modems 9600 baud Authentication and confidentiality issues
The Infocard System 1986-88 Microprocessor (Smart Cards) with EEPROM The card as a bearer of medication history The card as a bearer of prescriptions The Tjörn trial
Decision support
EDI 1990ies when electronic health record systems at the desktop of the outpatient clinics went from 5 to 90% prescription functionality was added to the record systems. From Printer to EDI. Denmark was a pioneering country for this and on a European scale an EDIFACT message was developed to represent an electronic prescription. This was adapted to Sweden and used until about 2001.
Patient inclusion The card trial included the patient as a controller of the data and a legitimate user It was not until recently that the citizens have access to their prescriptions on-line
References 1. Klein GO. Infocard in Pharmacy. Proceedings of the North American Conference on Patient Cards, New Orleans March 1992. pp 1-3. (1992) 2. Klein GO. Aktiva kort - En nyckel till säkrare IT och effektivare vård. Fakta och visioner om personal- och patientkort. Spri rapport. 90 sidor (1997). 3. Klein GO, ISO/TR 22790 Health informatics Functional characteristics of prescriber support systems (2007) 4. Klein GO. Final report of the project Trustworthy Health Telematics 1 (Trusthealth). Deliverable D1.4. 16 pages. (1998) 5. Klein, G.O.: Security principles for patient card systems in the Proceedings of the Fourth Global Congress on Patient Cards and Computerization of Health Records (Köhler, C.O. and Waegeman eds), Newton, Mass, USA: Medical Records Institute, 77-87. (1992) 6. Klein GO. Smart Cards - a tool for carrying medical information by patients and creating digital signatures by professionals. Conference of the International Federation of Information processing/tc 11 Security. Cape Town. Annex "Information Security on the Electronic highways of Sweden" In Information Security The next decade, Chapman&Hall, 1-20 (1995) 7. Klein GO. The Swedish Prescription Card Trial - A technical report. Published by Apoteksbolaget in the co-operation between Sweden and the French Ministry of Health. 29 pages. (1992)