Healthcare ICT and HMIS in Norway 1

Overview Introduction to the Norwegian Health system IS and public health IS for patients IS for patients’ care (hospitals) – not covering this part 2

Norwegian Healthcare system Norway has a predominantly public health care sector. The Norwegian health system is characterized by universal coverage: the health system is built on the principle that all legal residents have equal access regardless of socioeconomic status, country of origin, and area of residence. It is financed mainly through taxation, together with income-related employee and employer contributions, and only to a small extent by out- of-pocket payments (see Frikort). All residents are covered by the National Insurance Scheme (Folketrygden) Unique personal number Unique identification of healthcare professionals 3

Norwegian Healthcare system Health care services are provided at two levels: 1.primary care is at municipal level, 2.and specialized care is at regional level. The central Government has overall managerial and financial responsibility for the hospital sector. Norway’s four regional health authorities control the provision of specialised health services by 27 health enterprises. The Coordination Reform 1 st January 2012 interaction between primary care and specialized care lacks mediating structures. establishment of pre-hospital low threshold wards in primary health care municipalities are gradually obliged to establish primary emergency 24-hour care for patients who do not need specialized hospitalization 4

Primary care Municipal health services consists of : general practitioners services, emergency room services, physiotherapy, nursing homes, midwife services and nursing services, (including home-based services). The municipality also runs preventative health services: Health 'Stations' and school-based health services (Except for a few institutions with advanced rehabilitation services) long-term care does not exist within the hospital sector but it is integrated in primary health care. Primary health care and social care services also care for patients recovering after a hospital stay. 5

Municipal health services (some numbers) On average a municipality has 10,000 inhabitants (range from 250 to 500,000 people). There are 430 municipalities. The larger cities are subdivided into boroughs (city districts - bydel) covering services for about 30,000 inhabitants each. A municipality with 10,000 inhabitants will have about 10 GPs, 90 nursing home beds and 150 nurses, nurses aids and home helpers working in home care for elderly and disabled people. In 2010, there were 0.83 GPs per population. 6

GP scheme 2001 The general practitioner scheme was introduced in 2001, states that: Every inhabitant is entitled to be listed with a general practitioner (GP) of his or her choice, (almost all residents (99.6%) are registered in the scheme). Every GP is now responsible for a list of individual patients GPs’ role as gatekeepers: patients need to see their GPs before they can be referred (referral letter) to the hospital (except in emergencies). 7

Specialist care Hospitals and institutions: organised in enterprises/ trusts under four Regional Health Authorities: Helse Nord (covers the counties of Nordland, Troms and Finnmark) Helse Midt-Norge (Nord-Trøndelag, Sør-Trøndelag and Møre og Romsdal) Helse Vest (Rogaland, Hordaland and Sogn og Fjordane) Helse Sør-Øst (Vest-Agder, Aust-Agder, Telemark, Vestfold, Østfold, Buskerud, Oppland, Hedmark, Akershus, Oslo) The RHAs have structured the hospitals around 25 health enterprises (65 hospitals) (Before 2002 the hospitals have been owned and run by the counties for over 30 years). In 2010, the private hospitals (both not-for-profit and for-profit privately owned hospitals) accounted for beds, approximately 10% of the total of beds. 8

4 Regional Health Authorities Helse Nord Helse Midt-Norge Helse Vest Helse Sør-Øst

Access to specialised care Referral to specialist care: primary care physicians as gate keepers. Patients may choose the hospital. (They are not, however, allowed to choose a hospital that is more specialised, e.g. a university hospital, than the one they have been referred to.) Free choice of hospital for elective treatment was introduced from 1 January 2001 (Fritt sykehusvalg, May 2003) to strengthen patients’ positions as decision-makers (informed choice) to even out differences in waiting times for treatment. Some studies indicate that relatively few patients seem to have opted for the possibility of receiving treatment outside of the hospitals’ natural catchment areas. Patients are willing to wait a considerable length of time to avoid travelling. The reluctance to travel increases with age and decreases with level of education. 10

assignment Which public health data are made availabe? … 12

IS for patients 13

Breadth/vision Concretization /implementation IT strategy in health sector

IT strategy in health sector 2.0 Specific vision/aims e.g.: Relevant and good quality information on health, lifestyle, services, treatments is available on internet. The patient has access to his own health information, own medical record, overview of prescriptions and medications, discharge letters, freecard and more. Via an interactive services is possible to (for instance) change appointments at the GPs or other providers. New services on internet support self care possibilities. Patients and users experience that health personnel has a good overview on their health status and health history when they come in contact with health care services. 15

Historical view Early mover on Health ICTs: National ICT strategies since 1997 First to implement EPR (public hospitals and GPs) 1980’s- 90’s: Development initiatives on a national scale Widely digitized sector: Hospitals, general practitioners, nursing homes, pharmacies, private sector specialists … but weaker on linking them together GPs first to implement EPRs, ~100 % coverage uptake by municipality home care and nursing homes has been slower 16

One resident – One record improved quality, improved patient safety, more efficiency and better use of resources quick, easy and secure access to all necessary information. regardless of where in the country the patient is receiving treatment Citizens should have quick access to simple and secure digital services. 17

Digital dialogue GP project 20

assignment Which services are offered? … 21

Summing up… 22