The ehealth architecture of the Swedish public healthcare payers

Deputy CTO at Inera AB à Inera AB
27 Oct 2017

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The ehealth architecture of the Swedish public healthcare payers

  1. Johan Eltes, Stf CTO
  2. 21 counties 290 Municipalities REGIONS AND MINICIPALITIES IN COOPORATION FOR E- HEALTH  Coordinates the e-health development on behalf of the public healthcare payers  The revenue is approximately 80 million euro  Inera is a company owned by the the Swedish Association of Local Authorities and Regions (SALAR)
  3. National E-health strategies: 2009-2012, 2013-2018, 2016-2025 Strategy from Ministry of social affairs 5-years action plan County Councils 2013-2018 1-years e-health development plan
  4. 10 years of execution impact of a National Strategy 21 independent county councils – planning on their own (before 2006) National Strategy for eHealth (after 2006)
  5. Funding yearly business plan Projects IT-operations ca 80 million euro per year
  6. The priorities of national e-health strategy Support to DECISION- MAKERS Support to PROFESSIO NALS INFRASTRUC TURE Support to PROFESSIONALS Support to DECISION- MAKERS Support, engage, motivate CITIZENS
  7. Support, engage and motivate citizens 1177 – a national entry point to the e-services of the patients care journey Am I ill? Do I need care? Find care Make appoint -ment Meet doctor Rehab / care plan Self- test Catch up Visit pharm a
  8. Am I ill?  1177 web advise Quality assured published content Advisors respond to anonymous questions In use since 1999  Statistics (12 months) ≈ 10 search sessions per citizen ≈ 12 000 anonymous questions answered
  9. Do I need care?  1177 Health Advice Line Distributed, load-balanced call center Supported by a dedicated national EHR system In use since 2006  Statistics (12 months) ≈1 consultation/citizen
  10. Find care  1177 Find and compare care All publically financed healthcare Direction, phone number, care types, the e-service offerings Compare by quality measures In use since 2011  Statistics (12 months) ≈ 1 search session per citizen
  11. Make appointment  1177 Appointment self-service An authenticated e-service of the patient portal Single user interface provides online access to EHR systems across Sweden ≈ 50 EHR systems connected as back-ends, supporting 3 000 facilities ≈ 20 additional e-services available In use since 2010  Statistics 500 000 appointment transactions per year 32% of citizens have logged in to the portal 8 000 facilities offer e-services through the portal
  12. Meet a doctor  1177 Video meeting Currently being piloted in Stockholm County Council There are competing private video care offerings Regional solutions are in production (without national coordination) Statistics (12 months) Not available
  13. Catch up  1177 EHR Viewer – what did the doctor say? An authenticated E-service of the patient portal Online read access to all connected EHR systems Helps remember doctors advise, prescription dose etc Patient may grant access to care giver, private doctor and other individuals In the planning: Patient may share EHR data with health apps In regional use since 2012. In national use since 2015  Statistics 9% of the citizens use the service
  14. Rehab and care plan (telemedicine)  1177 Telemedicine treatment platform Doctor may subscribe self treatment supported by remote service centers (telemedicine) Chronic diseases (diabetes…) Monitored health plans (overweight…) Remote treatment (CBT…) Personal connected health (sensors) Video sessions Currently in pilot with 1000 patients (CBT)  Statistics (12 months) Not available
  15. National patient overview E-prescription Medical certificates Decision support for medications Quality register reporting
  16. Quality indicators (“Care in numbers”)
  17. API-based Information Exchange Interoperability specifications Virtual national EHR Security services National master data sources National e-health reference architectures
  18. National e-health reference architectures  Reference architecture for information exchange (e.g. patient information)  Established in 2007 and updated in 2011  Consistently applied (some managed exceptions)  Specialised segment reference architectures for specific domains Personal Connected Health (Nordic alignment) IAM  TOGAF
  19. Referensarkitektur - logisk vy
  20. National health information exchange infrastructure Health information exchange platform Diagnoses Labresults Drugs Varnings EHR EHR EHR EHR EHR EHREHR Vaccinations State agency (e.g. EHM) State agency (eg. Insurance agency) 400 connected EHRs 1 billion exchanges yearly through 100 shared API:s Virtual national EHR (incl medication request list)
  21. ! ! ? ?! ! ? National Virtual HER (“Tjänsteplattformen”) at play: ”My EHR viewer” (“Journalen på nätet”) Samma API återanvänds för en rad olika behov
  22. Interoperability framework
  23. Interoperability specifications (~120 Api:s in total) Mätdatainsamling Följa remisstatus Remisshantering Åtkomst till journalinformation DOS-förskrivning Vårdval/Listning Spärrhantering Åtkomstloggning Samtyckeshantering Masterdata E-tjänsteutbud EHM-register AXS EHM-register Läkemedelsfört. EHM-register Ordinationsregister EHM-register PRIS Masterdata Terminologi Masterdata Anslutning NTJP Formulärhantering Elektroniska intyg Patient-journal-index Infektionsuppföljning Kvalitetsindikatorer Masterdata Medarbetare Masterdata Organisation Masterdata Behörighetsstyning Masterdata Peronuppgifter Patientportal Försäkringsmed. beslutsstöd Masterdata Utbud Högkostnadsskydd Utomlänsfakturering
  24. National master data - invaluable pre-requisites  National identification of healthcare employee (Inera)  National mobile identification of citizens (Bank federation) 🏥 🚹🚺🚼🚻 Organisation and employee master (Inera) Citizen master (Tax authority) Authorization information - PIP (Inera) 🚹🚺🚼🚻
  25. Examples of current development Support to DECISION- MAKERS Support to PROFESSIO NALS INFRASTRUC TURE Support to PROFESSIONALS Support to DECISION- MAKERS Support, engage, motivate CITIZENS - A virtual, nationally shared and accurate medication list - Digitalization of the cross-county council reimbursement process - Second take on national referrals - Personal connected health (implement the Nordic technical strategy) - Second generation patient portal Digitalized care advise (personal decision support) - Pre-visit registration of health declarations - Quality indicators for e- health - Use-based funding model

Notes de l'éditeur

  1. There are excisting integrations for drugs