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

2. Ministry of Health and Social Affairs Sweden 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 Affairs Mr Göran Hägglund

3. Ministry of Health and Social Affairs Sweden 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. Ministry of Health and Social Affairs Sweden 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. Ministry of Health and Social Affairs Sweden The National High Level Group for eHealth 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 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

6. Ministry of Health and Social Affairs Sweden 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 healthcare in the information society; –encourage healthcare politicians and decision makers to use eHealth as the main tool for renewal and improvement of health services.

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

9. Ministry of Health and Social Affairs Sweden 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. Ministry of Health and Social Affairs Sweden 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 and co-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. Ministry of Health and Social Affairs Sweden Considerations and proposals Sweden as a nation must decide which path to follow, where the alternatives are: 1.to become involved in the international collaboration on using and developing SNOMED CT, or: 2.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. Ministry of Health and Social Affairs Sweden Proposals for the Government to 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. Ministry of Health and Social Affairs Sweden Common objectives Common vision and objectives All steps and initiatives that are taken, should try to achieve common solutions. Many actors Many initiatives

14. Ministry of Health and Social Affairs Sweden What is common? Find it! Primary Care Specialist Care Social and elderly care 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)

15. Ministry of Health and Social Affairs Sweden Expectations and different perspectives Patient/Relatives Management/ Governance IT-market Health care and social care professionals 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 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 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 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 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 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. The IT-market Clear and scalable model Compliance with standards International value Reduce costs for development The IT-market Clear and scalable model Compliance with standards International value Reduce costs for development

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

17. Ministry of Health and Social Affairs Sweden Expert groups working with developing the National Information Structure Stakeholder groups (4P) Groups working with enterprise requirements Stakeholder groups (4P) Groups working with enterprise requirements Information Structure Working group dealing with verification of the structure Information Structure Working group dealing with verification of the structure Coordination Coordination and exchange of lessons learned in other projects Coordination Coordination and exchange of lessons learned in other projects Development of the structure A small group developing the structure ”The real world” Enterprise projects used to test the structure ”The real world” Enterprise projects used to test the structure Enterprise requirements and expectations Competence and experience Verification Knowledge and experiences Information security Working group dealing with verification of the structure Information security Working group dealing with verification of the structure Analysis and verification

18. Ministry of Health and Social Affairs Sweden 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 WingeLotta Holm Sjögren Project Manager - National Information StructureNational Information Structure and SNOMED CTNational Board of Health and Welfare mobile: +46 70 484 18 99mobile: +46 70 692 45 73 monica.winge@socialstyrelsen.selotta.holm-sjogren@socialstyrelsen.se Download the National Strategy for eHealth at: www.sweden.gov.se/healthwww.sweden.gov.se/health Download the SNOMED Report at: http://www.sos.se/sosmenye.htmhttp://www.sos.se/sosmenye.htm