5 Hospitals, 32 Primary Care using the same EHR VAS Citizens 14 Municipalities och 1 County Council

Municipalities commitments to use the VAS peephole Each municipality have super users, 1-2 personnel. This super users has acquired more knowledge to support other users within the municipality. Each municipality have a technical contact person. We update the County Council with information about new users that need access and when access shall be removed. For each patient we always need consent from the patient. Logg control Registration/deregistration of patients and users

Each Primary Care center will be set up roles and permissions for the new municipal users belonging to the current Primary Care center. County Council Technology department will acquire, manage and maintain extended licenses for access and privileges in the VAS County Council Technology department will acquire, organize and distribute safety boxes (link to a personal mobile) to the municipality user Provide support to municipal users Designated persons at the Primary Care center will provide support to the users The Norrbotten County Council commitments

14 municipalities, about 500 nurses, occupational therapists and physiotherapists have now access to the following journal information from journal system VAS Patient journal overview ; epicrises, referrals and answers Radiographs, referrals and responses Drug List Test overview, LAB-list AVK therapy list Message function Norrbotten 2012

Municipalities can access VAS -VAS+ -Meddix -Collaboration, infrastructure, systems and management Sitsh card and HSA catalog National Patient Overview (NPÖ) The goal of a common communications platform for the people in Norrbotten Completed may 2010 The road to long-term solution

Logg in 1 Passing firewall 2 2b 3

Logg in 4 5 Access verification. VAS

Access to “my” patients at the Primary Care center Örnäsets Primary Care center Elderly housing Örnäset A1 A2A3A4 Kalle Lisa Olle … Maja Pelle Eva … ect..

Compliance with Patient data law Technical solution descriptionIT- solution Authentication = SITHS-card Two factors loggin. That is what I have and what I know. Password + mobile or password + code washer. Authentication = HSA-catalog Posted in the NLL's user database and "Active Directory" with correct permissions according to agreement in order to verify that they are competent in the NLL's network Access control Permission to enter the VASE with the role and permissions that have been in compliance with primary health care. In addition, ensure that the municipality nurses only accesses the patients who belong to their accommodation, House doctor's function in the VASE. Care relation Control the care relationship is by designed routines for log control. Concent Patient's consent by the patient to sign a piece of paper. Because patients in this case are those who live in special housing so even death signature if the patient cannot give consent. If the patient does not consent it will not be attached to the housing and thus will not access the data. Logg and logganalys The log function in the VASE is prepared, structures designed and introduced in all fourteen municipalities.

The project's importance for the medical safety All users/patients have consented and most have believed that the municipality already had access to the journal all the time The project has contributed to "good and safe care", Nurse/rehab staff can check and ensure that ordinations are performed correctly. (Earlier some ordinations were performed on oral report with several persons involved and is reprehensible from a medical point of view of safety) Gives a safer assessment for municipal nurses

The nurse follow up on his patient's test result quick via the peephole Save time, the nurse can verify the information in the medical journal instead of call the clinic and ask. Saves time in Primary Care center reception which don't have to service the municipality nurses with the information from the journal All use the same drug list, of recent version, (many medical errors have been made in the municipality due to incorrect pharmaceutical lists)

The nurse can see the background, purpose and objectives of the ordination and treatment and therefore, understand and observe the desired versus the undesirable effects of treatment. The rehab staff can make judgments on a guaranteed basis, eg. mobilization/ imobilisering after op, pacemaker for TNS, bleeding risk facing acupuncture etc.. Biggest winner is patient, decreasing error treatments because information transfer mistakes.

Meddix communication platform for municipalizes and County Council. Specialized Healthcare Hospital / Municipalastes Primary Care Center Hospital Patient ready to leave for home that needs collaboration between organisations for maintaining good healthcare Persona living at home Patient living at home that needs collaboration between organisations for maintaining good healthcare Cooperation plan regarding discharge Cooperation plan regarding discharge within the Primary Care ect. Cooperation plan regarding discharge Psychiatric conditions laws etc. LPT/LRV (ÖPT/ÖRV) Health Insurance School Work employment Relatives ect In- and out message to the emargancy unit

Access to journal information is a quality assurance of good and safe care Next step NPÖ Nationell Patient Overview Long-term solutions according to the national e- health declaration.

Anna-Lena Andersson