What s happening at regional level?

What s happening at regional level? Norwegian Health Network, visit to Kela Finland Karri Vainio, Senior Adviser Association. Of Local And Regional Authorities / Dep. of Social Welfare and Health Care

National level organizations *New unit AKUSTI under the association of reg. & local Authoroties. Starting 2014 OTHER AUTHORITIES (Fimea, Valvira, VRK,..) Medicine information, Professional authorization & identification services SOCIAL INSURANCE INSTITUTION (KELA) Running national ehealth infrastructure services (eprescription, earchive, etc.) MINISTRY OF HEALTH & WELLFARE (STM) Strategic planning and control NATIONAL INSTITUTE FOR HEALTH & WELLFARE (THL) Interoperability specifications, control of national infrastructure and national enterprise architechture Establish and coordinates the co-operation between state & regions & municipalities Interregional co-operation Nordic co-operation between regions & municipalities Association. Of Local And Regional Authorities PRIVATE CARE PROVIDERS PUBLIC CARE PROVIDERS

Regional. coordination Organization on health and social welfare services - current situation Current situation: Municipalities (300) Municipal health centers (150)» Municipality itself: 91 municipalities, 60% of the population» Inter-municipal co-operation areas: 63 areas, 229 municipalities, 40% of the population Hospital districts (20) - university hospitals (5) Mental retardation special care districts (15) University hospital regional coordination Hospital districts Hospital Dist. U- Hosp. Hospital Dist. Hospital Dist. x5 Health centers & municipalities

Municipal and social- and healthcare reform is bringing new structures By 2017: 20-22 social and healthcare regions (inc. 5 university hospitals) Regions (or municipalities) with 50 000 people can take care of wide range of services incl. main parts of secondary care (&hospitals) Municipalities with 20 000 50 000 can take care only basic level social and primary healthcare (no secondary care/hospitals) Municipalities with less than 20 000 are not allowed to arrange services (2013: 65% of all municipalities) Funding system reform on next phase, (at least)? ERVA (regional coordination) Social & HC Reg. U- Hosp. Social & HC Reg. Social & HC Reg. x5 municipalities (20 000 50 000 people) 4 [pvm] Etunimi Sukunimi titteli Tapahtuma

eservices and tools for self care and disease management available Primary Secondary Pharmacies Social Private sector Self care, prevention, Health coaching Self. management of chr. diseases Third sector seamless co-operation of primary, secondary care and social services professionel All neccessary data available 5 [pvm] Etunimi Sukunimi titteli Tapahtuma

ehealth & EHR systems current situation ehealth and social wellfare ICT spendings 380M /year (2% of total costs) Hospital districts have regional coordination task of ehealth (healthcare only) Hospital districs in same university hospital area (5) needs to coordinate ehealth solutions with each other IT Systems are regional or local» 10/20 regions are using or consolidating into same core system for primary care & hospitals» systems are still far too decentralized, incompatible and reaching the end of life cycle Two leading vendors (tieto & CGI) together have 80-90% market share

Near future??? the focus has been strongly turning from local systems to regional multi organization shared systems» supporting seamless and integrated health and social care processes The government s Health Care Act (5/2011) forces local organizations in to closer regional cooperation and enables shared patient data repositories on regional level. Due to operational needs and by using the law s possibility, many large scale regional EMR renewal / purchase projects are expected in following years.

VAKAVA-project purpose: Architechtural guidelines and recomendations to support regional development (e.g EMR renewal projects) POHJOIS-SUOMI MINISTRY OF HEALTH & WELLFARE Association of reg. Local Authorities NATIONAL INSTITUTE FOR HEALTH & WELLFARE SOCIAL INSURANCE INSTITUTION (KELA) ITÄ- JA KESKI-SUOMI / KYS-ERVA PIRKANMAA/ TAYS-ERVA Project length: 2/2013-3/2014 VARSINAIS- SUOMI UUSIMAA Permanent co-operaion in both national & regional level 1 national coordination project 5 regional projects

2020 architecture & development recomendations (DRAFT) Data sharing / infrastructure National infrastructure allows real-time data sharing from centralized and distributed sources (At the moment only centralized is supported). IHE/XDS-profiles and X-Road as a solution Connections in to the national level services and supplementary regional services must be arrenged in wider regional cooperation (5-8 regional connection points / regional platforms by the end of 2020 ) Citizen eservices One national level open PHR repository (instead of many regional) eservices must be implemented as a integrated solution (not embedded inside EHR/client information systems) More national level co-operation (scheduling, secure messaging,..) client and patient information/ehr systems LUONNOS

a.single enterprise system b. App store (best-of-breed) c. Core components and subsystems c2. controlled multivendor model + + + + + - - - - - Yksi toimittaja -selkeä toimitusvastuu Sisäinen yhteentoimivuus tietoeheys helppo saavuttaa Vähäiset integraatiokustannukset Toimittajariippuvuus - toimittajaloukko Kokonaisarkkitehtuuri toimittajan hallinnassa Kapeiden sovellusalueiden toiminnallisuudet heikompia Kattavien järjestelmien tarjonta vähäistä ei kokemusta Kytkentä alueelliseen ja paikalliseen kokonaisuuteen Heikentää toimittajalukitusta Asteittainen kehittäminen ja hankinnat Mahdollistaa eri toimintojen / käyttäjäryhmien tarvitseman parhaan mahdollisen toiminnallisuuden Korkeat yhteenlasketut kokonaiskustannukset. (hankinnat, integraatiot, ylläpito) Monimutkainen - vaikeasti hallittavissa ja ohjattavissa Kokonaisvastuu valuu käyttäjäorganisaatioille Tietoeheys vaikeaa saavuttaa Asteittainen kehittäminen ja hankinnat Riittävän selkeä ja yksinkertainen - hallittavissa oleva kokonaisuus Mahdollistaa kokonaisuutta ajatellen hyvin erillisalojen tarvitsemien toiminnallisuuksien toteuttamisen Pääjärjestelmien toimittajien asemasta voi muodostua tarpeettoman vahva Asteittainen kehittäminen ja hankinnat Riittävän selkeä ja yksinkertainen - hallittavissa oleva kokonaisuus Mahdollistaa kokonaisuutta ajatellen hyvin erillisalojen tarvitsemien toiminnallisuuksien toteuttamisen Yhteiskäyttöisen Compared client and patient pääjärjestelmien/palveluiden ansiosta kustannustehokas information Integraatiokerroksen rooli erittäin systems Integraatiokerroksen rooli merkittävä merkittävä development strategy options Yhteiskäyttöisen pääjärjestelmien/palveluiden ansiosta kustannustehokas Integraatiokerroksen rooli merkittävä, Vastuuorganisaatio tarvitaan integraatiotason toteuttamiselle sekä alueellisella että kansallisella tasolla

Interoperability based on international standards, national level specifications (semantic & APIs) client and patient information/ehr systems / main recomendation controlled multi-vendor model EMR-S PACS National and regional services Regionally shared core components(common functionalities) CRM and Care/service plans LAB OTHER HEALTH- CARE SYSTEMS ERP E- SERVICE S E- SERVICE S Integrated components (best-of-breed) Social care Documentation Integration platforms (national X-road, regional ESBs) REGIONAL APPROACH OTHER SOC.CARE SYSTEMS DRAFT Mixed architechture model which combines best elements of single vendor regionally shared core components Best-of-breed components in solutions areas where it can create more value (and where market based solutions available) Regionally shared common fuctionalities (handling diagnoses, medication, care/service plans, main ERP functionalities) Simple enough but allows also flexibility and modular approach Pros / cons. Interoperability and interface specifications are nationally specified and open (not per system / region) Allows multi vendor approach in regional and national level Role of Integration layer is crucial - Interoperability based on international standards, national level specifications (semantic & APIs) and national/regional integration platforms responsible organisations needs to point / establish in both level National (interoperability specifications and support Medcom ) Regional ( integrator ) Requires strong coordination, own recourses and common and shared (not vendor / organization specific) enterprise architecture

Recommended architecture scenarios Scenario1: common for healthcare & social care core components (Care & service plans + CRM +ERP) Scenario 2: Separate cores for healthcare and social services National and regional services Valtakunnalliset ja alueelliset palvelut (patient and client data registries & repositories, consent management, identification, IDM,..) Potilastietojen ja asiakastietojen jakaminen ja yhteiskäyttö, suostumukset ja kiellot, tunnistaminen, käyttövaltuuksien hallinta, National and regional services Valtakunnalliset ja alueelliset palvelut (patient and client data registries & repositories, consent management, identification, IDM,..) Potilastietojen ja asiakastietojen jakaminen ja yhteiskäyttö, suostumukset ja kiellot, tunnistaminen, käyttövaltuuksien hallinta, Care Suunnitelma- & service ja asiakkuustietojen plans hallinta + CRM (common for healthcare & social care) Care Suunnitelma- & service ja asiakkuustietojen plans CRM hallinta (healthcare) Toiminnanohjaus ERP (healthcare) Care Suunnitelma- & service ja asiakkuustietojen plans CRM hallinta (social services) ERP Toiminnanohjaus (social services) ERP - recource planning, management, scheduling (common for Yhteinen healthcare toiminnanohjaus & social care) Integraatioalustat/väylät Integration EMR-S (core functionalities) Potilastiedon hallinta Kotihoito, vanhuspalvelut, päihdehuolto, vammaispalvelut, terveyssosiaalityö,... Integraatioalustat/väylät Integration Social care Sos. Asiakastiedon hallinta documentation (core functionalities) EMR-S Potilastiedon hallinta (+ sisäinen toiminnanohjaus) (core functionalities) Social care Sos. asiakastiedon hallinta documentation (+sisäinen toiminnanohjaus) (core functionalities) Anestesia Intensive ja care tehohoito Special. Syöpähoito diagnosics Operation Leikkaustoiminta mgmt Room Rehabilit Kuntoutus ation non-hospital emergency care Ensihoito (ambulances) Obstetrics Synnytysosasto management Työllistymisen Special. Employment tukeminen support Suun Operation Room terveydenhuolto mgmt Intensive Elinsiirtotoiminta care Vammaispalvelut Mental retardation child welfare Lastensuojelu Omaishoidon Family care support tuki Anestesia Intensive ja care tehohoito Special. Syöpähoito diagnosics Leikkaustoiminta Operation Room mgmt Rehabilit Kuntoutus ation non-hospital emergency care Ensihoito (ambulances) Synnytysosasto Suun Operation Room terveydenhuolto mgmt Intensive Elinsiirtotoiminta care Vammaispalvelut Mental retardation Obstetrics management Työllistymisen Special. Employment tukeminen support child welfare Lastensuojelu Omaishoidon Family care support tuki Sosiaalinen.. luototus TH-ammattilaiset eservices Omahoito for citizens Asiointi TH-ammattilaiset, erilliset osajärjestelmät Kansalaiset Healtcare professionans citizens Social SOS-ammattilaiset care professionals SOS-ammattilaiset, erilliset osajärjestelmät Sosiaalinen.. luototus Healtcare professionans TH-ammattilaiset eservices Omahoito for citizens Asiointi SOS-ammattilaiset, erilliset osajärjestelmät TH-ammattilaiset, Healtcare professionans erilliset osajärjestelmät citizens Kansalaiset SOS-ammattilaiset Social care professionals Common In both scenarios: no need to separate primary and secondary care core components (=common functionalities) DRAFT

Conclusion EMR systems and first generation of eservices widely used, but far too decentralized and most of the systems are reaching EOL Renewing social- and healthcare system we need» national and regional architehture & next generation interoperable systems and citizens eservices supports seamless and integrated health and social care processes connects citizen/patient and service providers and give tools for the citizens to maintain health and self management of chronic diseases To achieve this we need» Clear goals and clear division of tasks» national and regional governance model which enables development on national and regional levels hand in hand» Healthier ehealth markets (more vendors, more competition) co-operation needs to be improved in all levels, national, regional, nordic 13 [pvm] Etunimi Sukunimi titteli Tapahtuma

What to do? Create Nordic ehealth Market And sell it! Create Nordic interoperability And tell it! Nordic ehealth cooperation! A job for Finland?

Thank you! Karri Vainio Senior Adviser, Social Welfare and Health Care ICT The Association of Finnish Local and Regional Authorities +358 50 387 1620 karri.vainio@kuntaliitto.fi