1. Foto: Fröken Fokus Health Informatics Centre a collaboration between Stockholm County Council and KI Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI Meaningful use of EHRs in Sweden Sabine Koch

2. Foto: Fröken Fokus Swedish Healthcare 9 million inhabitants 21 self-governed regions/county councils with responsibility for hospital and primary care 290 self-governed local authorities with responsibility for healthcare of the elderly and functionally disabled Legislation of healthcare on a national level – the Parliament Sabine Koch, October 29, 2010

3. Foto: Fröken Fokus IT an integrated part of Swedish healthcare Electronic patient record (4 companies comprise 88% of the market) –100 % of all documentation in primary care is electronic – 97 % in hospitals – 97 % in psychiatry – >90 % in ambulances (with direct communication to hospitals) Sabine Koch, October 29, 2010 + Clinical champions supported by strong administrators + Collegial pressure / peer influence/ larger group practices in PC + Culture – Sweden as high-tech innovative country + Use of an unique national patient identifier + User centricity -Too many different, incompatible systems with local terminology (27 different products in 1994)

4. Foto: Fröken Fokus IT an integrated part of Swedish healthcare e-Prescriptions –80 % of all pharmaceutical prescriptions in Sweden are issued and transferred electronically Sabine Koch, October 29, 2010 + Only one national provider of pharmacy retail from 1970-2009 (Apoteksbolaget AB) - Decision support during prescription process is still lacking behind: In Sweden some 3000 deaths yearly are estimated to depend on medication errors.

5. Foto: Fröken Fokus IT an integrated part of Swedish healthcare National Quality Registries 60+ national quality registries containing individual-level data on diagnoses, treatment interventions and oucomes, organized by condition Sabine Koch, October 29, 2010 + Decentralization + Peer influence and practical use + Quality assurance – can be used for research - No interoperability between registries - Integration with EHR is lacking

6. Foto: Fröken Fokus Applications My Healthcare Contacts MVK (access to national health care information, appointment scheduling etc.) 1177 (national telephone and Internet advisory service) NPÖ (National Patient Summary) PASCAL (National Medication List) SIL (National Drug Database) Basic structures Common technical platform - Sjunet (National communication network, since 1999) - HSA registry (Health Services Address registry) - SITHS (National security solution/e-certificate) - BIF (Basic Services for Information Maintenance) NI, National information structure (ready 2009) TIS, Technical information structure (EN13606/EHRcom) IFK2, National Quality Registry Infrastructure National terminology incl. SNOMED CT (member of IHTSDO) Patient Data Act (since July 2008) Source: Swedish National eHealth Strategy, 2006 and its yearly updates 2007-2010

7. Foto: Fröken Fokus The best tool is useless if you dont know how to use it ! Its a knife to open letters with. What a stupid invention! Meaningful use?

8. Foto: Fröken Fokus Meaningful use in Sweden Towards process support at the point of need Handling patient information across organizational boundaries independant of EHR Meeting the needs of several stakeholders

9. Foto: Fröken Fokus Most important challenges Implementation is done locally but with a national consensus will it be the same for quality registries? legal and privacy issues? evaluation of the effects? education? implementation hampers interoperability – compliance with international standards?

10. Foto: Fröken Fokus Contact Sabine Koch Health Informatics Centre Department of learning, informatics, management and ethics Karolinska Institutet Stockholm sabine.koch@ki.se www.ki.se/hic