Improved care coordination · Improved care coordination – background, vision, solution and ... +...
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Improved care coordination – background, vision, solution and experience from Sweden. Building a System of Connected Care Håkan Nordgren, MD Medical Advisor, InterSystems Pediatrician and GP Dalarö
Transcript of Improved care coordination · Improved care coordination – background, vision, solution and ... +...
Improved care coordination – background, vision, solution and experience from Sweden. Building a System of Connected Care
Håkan Nordgren, MD
Medical Advisor, InterSystems
Pediatrician and GP Dalarö
+ Håkan Nordgren, MD Background as: • CIO/CMIO/CDO Karolinska university hospital
• Implementer of large EMR/EHR systems
• Medical Director big pharma
• Partner global management consulting
• Chief Medical Officer medtech industry and Swedish eHealth programme
• Chair Swedish eHealth architectural board
• Practicing Archipelago doctor and Pediatrician
•
• [email protected] • Cell +46 72 22 33 590
+ Stockholm Sweden Dalarö 40km SouthEast
+ Changes in healthcare domain
• Competition (service, quality & price)
• Decentralisation - more patients to GPs
• Centralisation - centers of excellence
• Financial situation
• Continuing subspecialization
• Patient choice and engagement
• Rapid knowledge turnover
+ Integrity and privacy
+
An IT-support for the Health Care of tomorrow
+ Health expenditure per capita OECD 2011
Global Healthcare Challenges
17,7 9,4
11,0 9,5
10,3 9,3
11,9 11,3 11,2
8,9
2011 Spending (% of GDP)
22 8
9 20
22 25
20 16
21 19
Medical Errors (% in 2 yrs)
4,3 5,2
4,5 2,9
3,2 2,5
5,3 6,8
3,9 3,2
Mortality After Heart Attack (%)
www.commonwealthfund.org
AU CA DK NL NO NZ SE SZ UK US
AU CA DK NL NO NZ SE SZ UK US
AU CA DK NL NO NZ SE SZ UK US
Care Coordination and Transitions of Care
Care Coordination Problems (%)
Key Information Not Shared Among Providers (%)
Gaps in Hospital Discharge Planning (%)
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+ Goal: Improve outcomes e.g. greater patient safety, effectiveness and efficiency
as cited by U.S. Office of National Coordinator Health Information Technology (ONCHIT):
1. Avoid … medical errors
2. Improve … use of resources
3. Accelerate … diffusion of knowledge
4. Reduce … variability in access to care
5. Advance … consumer role
6. Strengthen … privacy and data protection
7. Promote … public health and preparedness 10
+ Three main issues
• The patient´s participation in
the care process
• Maintainig continuity of care
in modern healthcare with
many care providers
• A knowledgebased
governance of healthcare
+
• Area: 449,964 km2
• Population: 9,6 M (2012)
• GDP $552 billion
• Three governmental levels with own taxation rights
• Healthcare funded by taxes (Beveridge system)
Sweden
+
21 County Councils
291 Municipalities
Private Care providers
100% coverage of EMR/EHR
>95% ePrescriptions
Very good outcome results
Swedish Healthcare
eHealth – EHR/EMR/HIS
Genera-
tion
Period Organizational Functions Integration
Experi-
mental
1960-80 Research projects Documentation
Scheduling
-
1st gen 1980-00 GP’s office or
Clinic based
+ Medication
+ Lab report
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2nd gen 1990-10 Hospital based or
Primary care area
+ CPOE
+ ePrescription
++
3rd gen 2000- County council or
Regional based
+ PACS viewer
+ CDSS
+++
4th gen 2008- National based (EU
and epSoS)
+ patient services by it self an
integration
+ Solution based on Intersystems technology
• Sweden NPÖ – National Patient Overview
• Denmark NPI – National Patient Index
• Slightly different technical solutions – but same aim and same goal
• Based on International Medical Standards (ISO, HL7, WHO, IHE etc)
• Intergrates all major EMR/EHR/HIS systems in both countries (around 10 different in each country)
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• Counties are connected as
producers and consumers
• 100 private healthcare
providers are connected
through care contracts with
the counties
• ≈90 municipalities, 10
private caregivers and the
Swedish Dental Service
are connected as
consumers
• Goal: 95% municipalities
will be connected as
consumers 2013. Some as
producers
National Patient Overview
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• Regions are connected as
producers and consumers
• 100 private healthcare
providers are connected
through care contracts with the
counties
• ≈90 municipalities, 10 private
caregivers and the Swedish
Dental Service are connected
as consumers
• Goal: 95% municipalities will
be connected as consumers
2014. Some as producers
National Patient Overview
+ Chronic conditions – Diabetes mellitus
Caregivers
GP
Endocrinology
Internal Medicine
Nephrology
Ortopedics
Ophtamology
Podiatrist
etc
+ InterSystems Italy
http://www.intersystemsitalia.it/
InterSystems Italia s.r.l. Piazzale Biancamano, 8 20121 - Milano Italy
Tel.: +39 02 62 03 22 00 Fax: +39 02 62 03 40 00
InterSystems Italia s.r.l. Via Giordano Bruno, 260 47521 Cesena (FC) Italy
Tel: +39 0547 368211 Fax: +39 0547 368231
