(mostly in english) A presentation at the yearly conference hosted by the Swedish association for archives and information management

1. Johan Eltes, Stf CTO
johan.eltes@inera.se

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. National patient overview
E-prescription
Medical certificates
Decision support for medications
Quality register reporting

17. Quality indicators
(“Care in numbers”)

18. API-based Information
Exchange
Interoperability specifications
Virtual national EHR
Security services
National master data
sources
National e-health
reference architectures

19. 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

21. Referensarkitektur - logisk vy

22. 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)

23. !
!
? ?! !
?
National Virtual HER (“Tjänsteplattformen”) at play: ”My EHR viewer”
(“Journalen på nätet”)
Samma API återanvänds för en rad
olika behov

24. Interoperability framework

25. 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

26. 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)
🚹🚺🚼🚻

27. 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