Shareing experiences in eHealth development.
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1Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare
National Research and Development Centre for Welfare and Health 13.10.2006
Sharing experiences in eHealth development
The case Finland
Päivi Hämäläinen MD, PhD, MAHead of Unit for eHealth and eWelfare,
Stakes, Finland
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare2
The electronic health record, the idea of a patient summary and the new legislation in Finland
• EHR deployment situation in Finland•The history of the EHR (structures)• EHR policy/strategy• Core data• Finnish patient summary• The new eHealth legislation of Finland
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare3
not in use, but planned(9)piloting (4)in use (419)
General practitioners work in health care centres (270). The number of gp´s using electronic patient records is high.
2005EHR in 95,6 % of health centres .The main way of recording patient data in 99,4 % of them
2003EHR in 93,6% of health care centres
Genimap Oy
in use (18)
18/21 Hospital Districts ofFinland have EPR: The use of EHR covers evenly the departments of conservative, operative, and psychiatric treatment
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare4
The current regional networksfor exchange of electronic patientinformation
in use
(6)piloting (3)planning
(11)
0
20
40
60
80
100
Patient record Images Laboratory
Hospitals Health centres
Patient information flow between organisations in the end of 2005 (% of organisations)
Information is exchanged alsooutside to regional networks in bilateral set ups.
Genimap Oy
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare5
History of the Finnish EHR 1.
In the 1980´s The Association of Local and Regional Authorities designed a set of paper health records for primary care and specialized care and they became widely used. The idea was that there is always a continuity of the document on the next visit to the same organization (life long history). In the different clinics of each hospital the pages had the same structure but with stripes of different colours. Laboratory, x-ray etc pages were shared. GP file became to be always life long within the same health care centre. The "look" and the structure was transferred directly to several products first of EPRs.
The municipalities have a strong decision-making power in arranging services, which includes also the utilization of information andcommunication technology (ICT). As a result of this the ICT utilization and the choice of EHR products has varied between municipalities and organizations.
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare6
History of the Finnish EHR 2.
Finland became a country with lots of (one-organization) EHR´sthat have common looks and elements but no interoperability for exchange of information between organizations.
When bilateral and regional networking became technically possible, the organizations and regions started to define commonstructures of e-documents for the exchange (PACS, eReferral. eDischarge letter, eLab results) on local levels.
Also, when building information networks became technically available, a government supported project (Makropilotti) established ways to read the EHRs of an other organization (with patient consent)
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare7
In 2002 the government saw that promoting a more advanced use of EHR´s could be used as a tool in securing the future of health care (a wide health care program)
The Decision in Principle by the Council of State on securing the future of health care, given 11.4.2002
”Nationwide electronic patient records will be introduced…by the end of 2007”
The National Health Project, The EPR project is one of the main projects; Ministry of Social Affairs and Health; a preparatory working group 2003-2004, an implementing working group 2005-2007, budget for national level planning/implementation 800 000 euros/year 2003-07
>Regional implementation, state funding circa 10 milj euros yearly 2004 - 2005 and 5 milj 2006 and 15 milj expected 2007.
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare8
The EHR strategy defines the common semantic and technical structure that should be used in every EPR system in all organisations (includes core data, codes, interoperability standards)
1. Core data, code server (semantic interoperability)
2. Open standards for interoperability (xml-based HL7 CDA R2-standards)
3. National guidelines for data safeguarding (informed consent, secure archiving, e-signature, identification of patients, documents, professionals and organizations by ISO/OID-standard, PKI architecture)
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare9
Ydintiedot
Potilas
Hoidon antaja
Hoitojakso, - tapahtuma
tai palveluketju
Tunnistetiedot
Hoitotyö
Toimenpiteet
Toimintakyky
Tutkimukset
Ongelmat jadiagnoosit
Fysiologisetmittaukset
Terveyteen vaikuttavat tekijät
Suostumus Hoitotahto
Jatkohoitoakoskevat tiedot
Elinluovutus -testamentti
Apuvälineet
Lausunnotja todistukset
Hoitoprosessin tiedot
Yhteenveto
Lääkitys
Muut tiedot
Core data elements
Patient
Care giver
Care context:Process of careEtc.
Identification
Nursing data
Operations
Functional cap.
Investigations
Problems anddiagnoses
Physiologicalmeasurements
Health hazards
Agree to move data Treatment will
Treatment planOrgan donor will
Devices
Medicalcertificates
Clinical data
Summary
Medication
Other data
From Dr. J Komulainen University of Kuopio 1.2. 2006
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare10
Core data elements are located inside medical documents.
Core data can be extracted from these documents, for example to produce various listings:
DiagnosesMedicationsRisk data
Core data can be “recycled” to be included in new documents, for example referrals, doctor’s orders and medical certificates.
From Dr. J Komulainen University of Kuopio 1.2. 2006
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare11
The place in the structured documentand/or the structure of the code are designed so that the computers understand that the data is "core" data and what kind of "core" data it is
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare12
Structure of the document with HL7-CDA R2
Piia Potilas010150-xxxxSouthern hospitalDermatology clinicreferred from GP
texttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttexttext
lab cgh fbg yhgprocedure xxc-234dg ICD-10medicine dfg ghj
allergy cccblood type ab
discharge : HL7-CDA R2
xxxx
ePrescription HL7-CDA R2
Decision support warning system
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare13
Core data elements
Patient care
Administration
ClinicalDecision support
Statistics
Qualityassessment
Scientificresearch
From Dr. J Komulainen University of Kuopio 1.2. 2006
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare14
How to get the core data structuresin to all the EHR systems (products) ?
a national code server has been established
the code server stores all the common (= official versions) of different core data elements (semantics):
classifications, codes , HL7-structures, terminology
the electronic patient record products take the codes in to theirproducts from the server (updates 1-2/year)
taking the codes is free of charge and the code server (and the classification work befind it) is supported by the Ministry of Healthand Social Affairs
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare15
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare16
CodeServer
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare17
How can we make physicians and other professionals use codes?
Finnish Medical Society Duodecim has produced, together with clinicians, a large amount of synonyms that make it possible for the professionals to use their "every day" wordings and they do not have to remember the codes, just put the information on the right field in the "page" of the structured EHR
The computer will be able to handle the structured information
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare18
How is the EHR idea implemented today and how far away from the vision are we in Finland ?1. The project for common structures of the EPR was started in 2003 and is funded by the ministry and lead by the Association of Local and Regional Authorities
2. ”The minimum data set” or “core data” was defined in co-operation with different interest-groups (professionals, administration, software-enterprises), also publicly available for comments through internet, finalised and published in 2004.
3. Implementation into existing EPR-systems in pilot organizations is happening. 7 regional projects have formed clusters with software enterprises and the work is coordinated by the Association and the ministry. All major vendors are participating. Some of the elements have all ready been put in to products that are currently in testing phases and more will start running soon. MoH has promised to support projects after 2007 up to 2009.
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare19
How is the idea implemented and how far away from the vision are we in Finland ?4. More specifications for certain specialities are worked up on (occupational health care, psychiatry, dental care, child and school health care, nursing, emergency care)
5. Staff training to use to core data and the newer version of EHR products is ongoing
6. HL7 has made structures of several main documents, and they have been accepted in several products.
7. The code server was built in 2003-2004 and has been providing the main codes since 2004. In production ICD-10, Nordic codes for surgical procedures, national codes for laboratory tests and x-ray procedures, main HL7 document structures, some statistical codes. In addition a long list of other codes are given out from the code server for testing/piloting.
8. A study has been made on what codes are still missing from the list of defined core data. Preparations to have the synonyms available together with the codes has been started.
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare20
xxBBxxxxAAxxxxCCxx
BBAACC
HL7 structure of summaryThe patient summary
in the Finnish concept?It would be done by marking the chosen "core" patient data as "summary data". When you would open the file in the "summary mode" only this marked data would be shown.
Some of the regions have a set of "summary type" data in their regional spine-systems. Finland starts to build the national EHR archive next year. The national needs for creating a special patient summary will then come up, but the main idea is to share full documents.
The over all structures of Finnish EHR:s and the way the information is organized are rather common and the archive system will give access to all main documents, so it is possible that there is no national need for a summary in the form that it is planned/used in many other countries.
Discharge letters are all ready available and in wide electronic use.
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare21
Is European/international work needed?
Yes, if we want to have a summary for (international) patient data exchange situations, we still need to define together with other countries which data is the patient summary data that should be included in these situations of international collaboration on different care setups.
Medical expertise from true clinical situations,"business cases" should be the driver in the process of defining the data set for
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare22
Government decision 2006 and the current policy;
The national digital archive of (life long) patient documentsOne connectivity centre and exchange of data via the
archiveCitizens to have access (log+ health data)The National Social Insurance Institute (Kela) will provide
the archive systemNational PKI system for professionals by the National
Authority for medicolegal Affairs (TEO)National code server located at Kela, content by StakesLegislation in effect 1.7. 2007, also for the ePrescriptionSystem to be built by 2011Stronger steering role by the Ministry, close co-operation
with Kela, TEO, Stakes and a permanent national advisory board nominated by government
There is funding for 2007, planning and defining has started, call open
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National Research and Development Centre for Welfare and Health 13.10.2006
Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare23
Thank you for your attention!
correspondence; [email protected]
STAKES Unit for eHealthand eWelfareHelsinki, Finland