Improving Swedish healthcare by using eHealth solutions – strategic decisions towards SNOMED CT

1. Improving Swedish healthcareby using eHealth solutions– strategic decisions towards SNOMED CT Daniel Forslund Head of Section – eHealth Ministry of Health and Social Affairs Sweden

2. New Government - New visions • The Liberal-Conservative Government assumed office on October 6. • Replaced a Social-Democratic Government, in office 1994-2006. • eHealth one of the main agenda points in the new Governments extensive reform programme for healthcare. Prime Minister Mr Fredrik Reinfeldt Minister for Health and Social AffairsMr Göran Hägglund

3. eHealth – an integrated part of daily life in Swedish healthcare • Electronic healthcare records (EHR’s): • 95 percent of all documentation in primary care is made in electronic healthcare records; • over 69 percent EHR’s in specialized hospital care. • e-Prescriptions: • 55 percent of all pharmaceutical prescriptions in Sweden are today issued electronically and transmitted directly from the doctor’s office to Apoteket, thus available at all 950 pharmacies in Sweden. • Telemedicine important in sparsely populated areas.

4. A strong need for co-operation • Advanced usage of ICT in healthcare, but: • most ICT systems in healthcare built for storage of data, not exchange of data; • current structure with self-governing regions makes national decision-making challenging. • Conclusion: • co-operation between all relevant stakeholders in the healthcare sector is the only way forward!

5. TheNational High Level Group for eHealth National High Level Group for eHealth • Ministry of Health and Social Affairs • The Swedish Association of Local Authorities and Regions • National Board of Health and Welfare • Medical Products Agency • National Pharmacy Corporation (Apoteket AB) • Carelink National Stakeholder/Reference Group • National organizations for healthcare professionals • ICT Industry, Pharmaceutical Industry • Government Agencies and Legal Inquiries • Private Healthcare Providers • Research Community • Standardization Bodies

6. Sweden’s National Strategy for eHealth was presented in March 2006 • Main objectives in the National Strategy is to: • improve patient safety, accessibility as well as quality and continuity of care by creating a broad national consensus on future investments in eHealth; • enable patient mobility nationally and internationally; • meet the increasing demands from citizens and healthcare professionals to integrate healthcarein the information society; • encourage healthcare politicians and decision makersto use eHealth as the main tool for renewal and improvement of health services.

7. Services and benefits for citizens, healthcare professionals and decision makers in healthcare. • Basic structures that has to be in place for future development on the eHealth area.

8. Action Plan Regions Action Plan Municipalities Action Plan National Information Structure Action Plan SNOMED Action Plan National Library for Terminology Project Plan Project Plan Project Plan Project Plan National Activities and Steering Documents • National High Level Group for eHealth • Co-ordination and follow-up of actions related to theNational Strategy. • Regularly analyze, report and follow-up implementation. • Revision and adjustment of the National Strategy. National Strategy for eHealth Annual National Action Plan Regional Projects Proposal for a new Patient Data Act Laws and Regulations Standards Terminology

9. Swedish inquiry about SNOMED CT • In April 2006 the National Board of Health and Welfare was given the task to analyze whether Sweden should become a member of SNOMED Standards Development Organization (SSDO). • The report was published in September 2006, creating a basic knowledgebase for decision making: – “Should Sweden join now or wait?” • On October 26 the newly elected Government made the decision to declare its ambition to join the SSDO by January 1 2007 as Charter Member.

10. Possibilities with SNOMED CT: We need a terminology system like SNOMED CT to improve healthcare and use information systems in a more efficient way. Patient safety most important – we need a common terminology when information about patients is shared between many different healthcare providers International harmonization andco-operation necessary. Systemized information is required in order to make decisions regarding individual patients and facilitate administration, control, follow-up, development and research. Information must be a long-term resource, independent of any organization or technical solution. Uniform and unambiguous definitions and agreements on terms and concepts crucial to ensure patient safety, high quality treatment and follow-up. Challenges with SNOMED CT: Parts of SNOMED CT not enough validated. Not yet a full decision support system. Not exhaustive, parts missing (social care, occupational therapy, physiotherapy). SNOMED CT does not cover linguistic definitions, criteria's of diagnosis, information models etc. SNOMED CT has to be translated. Expectations on SNOMED CT are unrealistic – this has to be handled. The knowledge about SNOMED CT is generally low in Sweden. SNOMED CT not detailed enough for clinical use. Documentation about SNOMED not openly available at present. There is a lack of references on practical use of SNOMED CT. Expensive? Hard to estimate costs and resources needed for translation and implementation.

11. Considerations and proposals • Sweden as a nation must decide which path to follow, where the alternatives are: • to become involved in the international collaboration on using and developing SNOMED CT, or: • follow its own line and develop a national system for reference terminology. • The choice of direction must be linked to the desired level of ambition in the future use of information systems in the healthcare sector – and what time aspect we have in the development process.

12. Proposals for the Governmentto consider before final decision • The development of SNOMED CT has to be: • a national responsibility • developed to suit Swedish conditions and legislation • given required resources and knowledge. • We have to build an organization to pragmatically work with development, translation, education and implementation in ICT systems. • Close co-operation with other SSDO countries is needed. • SNOMED CT does not substitute ongoing local and national work with classifications and linguistic definitions of terms and concepts.

13. Common objectives All steps and initiatives that are taken, should try to achieve common solutions. Common vision and objectives Many initiatives Many actors

14. What is common? Find it! • Find what is common / independent of organisations • Process of the patient • The process of the care taker • The kernel – a small common part • Methods/models that can be used • Benefits and effects • Use and development standards • Classifications • Principles for security (business roles) Specialist Care Primary Care Social and elderly care

15. Expectations and different perspectives • The patient and relatives • Information about planned procedures and goals • Information about procedures carried out and achieved results • Facilitate the patients right to involvement • Guard the patients right to privacy Patient/Relatives • Management, governance and research • Provide possibilities in terms of measurement, control and follow up • Patient safety, patient satisfaction • Quality, costs and effects • Knowledge based clinical research • The IT-market • Clear and scalable model • Compliance with standards • International value • Reduce costs for development Management/ Governance IT-market • Health care and social care professionals • Holistic view in relation to the patients needs of health and community care • Shared information with other health care professional, actions taken and planned care. • Base for individual planning, decision-making and follow-up. Health care and social care professionals

16. Common Care process It all comes together!”enterprise architecture” Common vision and strategic objectives Effects Business description Information- structure Description of patient information National information model ”the kernel” information specifications IT-description … Systems and solutions IT-systems ”legally system” … Technical infrastructure

17. Contact Information Daniel Forslund Head of Section – eHealth Ministry of Health and Social Affairs mobile: +46 70 209 58 39 daniel.forslund@social.ministry.se Monica Winge Lotta Holm Sjögren Project Manager - National Information Structure National Information Structure and SNOMED CT National Board of Health and Welfare National Board of Health and Welfare mobile: +46 70 484 18 99 mobile: +46 70 692 45 73 monica.winge@socialstyrelsen.selotta.holm-sjogren@socialstyrelsen.se Download the National Strategy for eHealth at: www.sweden.gov.se/health Download the SNOMED Report at: http://www.sos.se/sosmenye.htm