Trust, social commitment, and quality. Fujitsu Forum Human Centric Innovation. ICM Munich 19th 20th November

Transkriptio

1 Trust, social commitment, and quality Fujitsu Forum 2014 Human Centric Innovation ICM Munich 19th 20th November

2 Trust, social commitment, and quality Healthcare digitalisation eprescription system in Finland Head of Development Ministry of Social Affairs and Health

3 Healthcare digitalisation eprescription system in Finland Head of Development Ministry of Social Affairs and Health

4 Agenda Finnish healthcare system on-going & upcoming reforms eprescription National ehealth strategy

5 Finland Population 5,4 million GDP per capita $ (US $) Life expectancy M 77 / F 83 years Total fertility rate 1.85 Infant mortality 2.4/100 (US 6,5) 38% have tertiary education (US 41%) OECD

6 Population 1970 Population

7 Finnish healthcare system Key principles: residence-based, universal and equal right to health services Two tiers: local authorities are responsible for organising primary health care (municipalities/coalitions; approx.160) and specialised medical care (hospital districts; n=20) Public services are mainly funded by tax revenues collected by the state and municipalities. client charges are collected covering 5 10 % of costs in reality, there are 3 tax-supported service systems funding and financing of the health sector are nor included in the ongoing municipality and service structure reform

8 Large reforms for Finnish healthcare are coming This government (re)organisation of healthcare, legislation 2014 strengthen primary care, unify health and social care broader shoulders for healthcare organizers into effect Next government scrap multichannel funding for healthcare, create single funding channel remove suboptimization, unhealthy competition within system etc. ICT eservices for citizen (NOT patient/customer) implement the shift from provider (doctor/org.) centric paradigm to citizen centric paradigm

9 The decision to build a national ehealth solution Government decision in 2002: Finland should have a nation wide interoperable EHR system by end of 2007 By 2005 agreement on the National archive for health information (KanTa) comprising three nation wide services eprescription eaccess earchive Based on structured documents (HL7 V3 CDA R2) In co-operation with local systems to feed care documents and using them New legislation was needed to allow the new features Placing the centralized service to Kela Consent management, privacy & security aspects

10 IHE epsos NCP HL7 Medical Records Interfaces IHE XDS-I Patient s eaccess KanTa services Patients (> ) Aged 18 and older eprescriptions service Renewals Prescriptions Logs Dispensations Pharmacies (~800) earchive Imaging studies Logs Metadata Patient health records Hospital districts (20) Primary care org. (192) Patient Summary Service Diagnosis Vaccinations Img. reports Private healthcare providers (4000) Procedures Lab Physical findings Risks Medications Health and care plan Consent and will mgmt service Foreign epsos NCPs (22) * Also Swiss, Norwegian, Turkish Organ donor wills Living wills Opt-in / Opt-out Main standards HL7 V3: CDA R2 Level 3 and Medical Records IHE IT-I Profiles W3C XML DSig WS Addressing, WS-I TLS, X.509 Other national services National code server Code lists and terminologies Forms/document structures HCP organizations registry Pharmacies registry Healthcare professionals registry Certification services Medication database

11 Main Standards and Specifications (National Use) HL7 v3 CDA R2 Messaging Medical Records DICOM KVARKKI IHE profiles in epsos and KVARKKI Some experience on XDS.b, XDS-I.b, XCA, XCA-I, XCPD, XDR, CT, ATNA Various general purpose ICT standards W3 XML Digital Signature SOAP v1.1 TLS, x.509 certificate infrastructure, ISO 7816-* smart cards ISO OID National code server

12 Testing and Approval for KanTa Production National test cases / patient stories exist and are continuously developed for interoperability testing Kela is responsible for organizing interoperability testing with HIS and pharmacy system vendors Approval for production use also requires deployment testing as well as audit/certification of the HIS/pharmacy system, the organization joining KanTa services as well as the third parties acting as message brokers or in similar roles Development of validation rules and test tools

13 eprescription National Prescription centre eprescriptions sent by local EHR-systems Information of medicine dispensed in pharmacies Viewing allowed with patient s consent DOCTOR PATIENT eview PHARMACY Implementation nearly 100 % Pharmacies OK Public sector OK Private sector 70 % Appr 70% of all prescriptions are eprescriptions PRESCRIPTION CENTER By legislation obligatory For doctors and pharmacies Patients can refuse eprescription till Obligatory

14 Act on Electronic Prescriptions The Act on Electronic Prescriptions mandates the adoption of the eprescription system for pharmacies, for health care units and for doctors and dentists practicing on the premises of a health care unit. The purpose of the Act on Electronic Prescriptions is to improve patient and drug safety and to facilitate and streamline the prescription and dispensing of pharmaceuticals. The adoption is voluntary for health care units in the Åland Islands and for doctors and dentists not practicing on the premises of a health care unit. Adoption will be mandatory

15 All prescriptions electronic All prescriptions shall be written in an electronic format Also applies to practices of self-employed persons, prescriptions written in social welfare, the Åland Islands and prescriptions written by physicians during their free time In exceptional situations, a paper or telephone prescription can also be accepted Technical disruption at health care facility or at the pharmacy Emergency situatíons Pharmacy dispencing the medication is obligated to record the paper/telephone prescription into the prescription centre Completeness of information in the prescription centre ensured

16 Data security Prescription data and patient records are sensitive medical information. The KanTa services allow the information to be handled confidentially and securely. All communication of data between health care providers, pharmacies, the electronic archive of patient records, and the Prescription Centre is encrypted between authenticated users. All users of the Prescription Centre and the electronic archive of patient records must pass an identity check based on a strong authentication scheme

17 Data security The Prescription Centre is accessible to doctors, dentists, pharmacists, qualified students and nurses with a professional card issued by Population Register Centre (PRC), and access rights to the Prescription Centre appropriate to their professional duties. Access to the information requires an existing treatment or patient relationship and usually the patient s consent. Electronic signatures are used to verify the signer s identity and that the information has not changed during transmission or storage

18 Monitoring of information processing Privacy protection and the legality of the information processing are monitored by the health care organisations, pharmacies and Kela. To enable retrospective checks, log files are kept about the use and release of data. Health care providers and pharmacies must designate staff to serve in a monitoring and follow-up capacity and ensure that all staff members receive sufficient training in data security

19 Patients can check how their personal information is used Patients can check the use and release of their personal health information. Through the eaccess portal, patients can monitor which organisations access or process their personal information and to which organisations the information is released. Patients can also request the register authority to detail who have accessed and processed the data

20 Log files

21 Risks Specifications clear enough? Timetables software development and implementation? Usability issues? Acceptance of structured documentation? Answers Clear testing plan and implementation plan Co-operation with users and vendors Guidelines and training

22 User s perspective - doctor eprescription is readable, it can always be found and it can not be falsified All medication can be seen more time to patient and less time to document searching eprescription is faster, no phone prescriptions All patient s medication can be seen -> patient safety is increased eaccess possibilities patient empowerment

23 User s perspective / doctor Technology and software works (at least not worse than normal healthcare software) Tools for co-operation between primary and secondary care and pharmacies A huge step exactly to right direction

24 User perspective IT-management Good action plan and schedule Good national guidelines but more and more are needed Do we have enough money and enough time? New ways of co-operation New services have been useful and more use is to be expected Acceptance and use of national services and national specifications is growing Culture of project work Understanding and implementing the importance of data safety Importance of national architecture

25 earchive Patient information - national EHR First phase: medical notes, lab results, rad reports, dg, procedures, medical risks, nursing information, treatment plan Log data Central datawarehouse Data produced by local EHR and special systems Connections via public internet (high demands for data security) Standardization of information and data transfer Viewing possible with patients consent Functions Information exchange Long term electronic archive Datawarehouse for research and health care policy work

26 eview for citizens View of information Information in earchive and Prescription centre Patient centric core information Log information Active participation Consent and denials Advanced directives (f.ex living will ) Implemented for Prescription centre and earchive For adults >18 yrs Acces via Internet Authentication by ebanking identification or electronical ID card Logins /month

27 Recent ICT / ehealth developments in Finland Whole Finland is (soon) connected to national ICT services, production use increases, Kanta EHR service grows content wise (e.g. dental records, imaging) Kanta: eprescription, sharing/archive of EHR, patient access National service oriented architecture collaboration with Estonia Biobank legislation 5+1 large biobanks Renewal of EHR systems and other health/hospital/patient access systems is moving forward Enterprise architecture: national and regional work on-going New strategy for information management and ICT National genome strategy is under preparation

28 ehealth and esocial strategy Knowledge to support wellbeing and reformed services

29 Vision: Wellbeing, health and service information is in good use, social and health services are renewed to be citizen centric and cost effective 1. CITIZEN - YES I CAN! 2. PROFESSIONAL - CAPABLE USERS AND SMART SYSTEMS Reliable info Luotettava hyvinvointitieto auttaa kansalaista elämänhallinnassa Palveluiden Power to laatu- choose ja and saatavuustieto information auttaa to support kansalaista palvelujen choices valinnassa Kansalainen voi hyödyntää ja päättää Ownership itseään of koskevien data tietojen käytöstä lainsäädännön määrittelemissä Capability to rajoissa use and Kansalaisella create health on mahdollisuus data tuottaa itse tietoa sähköisesti omaan ja sote-ammattilaisten käyttöön National PHR ICT supports work Sosiaali- ja terveydenhuollon ammattilaisilla on processes käytössään työtä tukevat tietojärjestelmät sekä riittävät Usability ja toimintavarmat tiedonsiirto-yhteydet DSS 3. SERVICE SYSTEM - REASONABLE USE OF DIMINISHING RESOURCES Better accessibility and Palvelujen saatavuutta ja esteettömyyttä parannetaan availablity of data sähköisten ratkaisujen avulla Sosiaali- through ja eservices terveydenhuollon tiedot ovat käytössä riippumatta organisaatiorakenteiden, palveluiden ja tietojärjestelmien muutoksista of organization Sähköisen structures tiedonhallinnan ratkaisut lisäävät palvelujärjestelmän vaikuttavuutta ehealth increases ja kustannustehokkuutta Information independent effectiveness and reduces costs 4. SOCIETY - KNOW BEFORE LEADING! Data is in Tietoaineistot tukevat reaaliaikaisesti realtime use for yhteiskunnallista päätöksentekoa decisions, sekä tutkimus- research ja and innovaatiotoimintaa innovation Vaikuttavien, kustannustehokkaide n Big ja laadukkaiden data toimintamallien ja niitä tukevien sähköisten välineiden levittämistä ja vaikuttavuuden arviointia ohjataan kansallisesti ja alueellisesti 5.INFOSTRUCTURE: Solid base for development Multichannel services monikanavaiset ja mobiilit palvelut tavoitettavuuden ja mhealth liikkuvuuden tukena luotettava Interoperability ja koeteltu tietoturva ja HL7, tietosuoja IHE, Continua palvelu-, laatu- ja saatavuustiedot avoimesti saataville Toimiva tuotanto: luotettavat ja riittävät tietoliikenneyhteydet Kansalliset sotetietovarannot kattavasti käytössä National ICT services Regional unification and national tietojen valtakunnallinen yhtenäisyys ja tiedonkulku tietojärjestelmien alueellinen yhtenäisyys specifications ja kansallinen yhteistyö Flexible SOA innovatiiviset hankinnat kehittämisessä, konsolidointi ja laaja hankintayhteistyö levittämisessä Ecosystems for development Luodaan kansallinen infostruktuuri modulaarinen ja joustava palveluarkkitehtuuri Yhteentoimivuus kansainvälisten standardien kautta kehittämisen palveluekosysteemit

30 Questions?