THEME - SOLUTION ARCHITECTURE

Transcription

1 REQUEST FOR INFORMATION FROM SUPPLIERS - «ONE PATIENT - ONE RECORD» OBJECTIVE The main purpose of this request for information is to get supplier market input for the further conceptual development in the Feasibility Study of "One patient - one record". So far in the pre-study several different concepts for realizing the overall goals are identified and assessed. Through dialogue with the supplier market we would like to get input for: Assessing whether the identified concepts are realizable from an ICT point of view Further detailing of the identified concepts Enabling the development of robust cost and benefit calculations The themes that we would like to elaborate are: Solution Architecture - functionality and infrastructure topology Information Architecture - codes, classification, terminologies and Information management Implementation Strategy - migration, organizational transformation and adoption Benefit realization - documented gains and benefits Cost estimation - documented reference models for cost estimation THEME - SOLUTION ARCHITECTURE The feasibility study has shown that it will require a high degree of consolidation of systems in order to meet the absolute requirements of One patient - one record. This means an overall solution architecture where fewer systems covers the needed functionality for all user groups, more consolidated infrastructure topology and fewer and more standardized integrations. We appreciate your input on how this can be obtained, and what plans you have for the next five years in relation to further develop your solution(s) to address these issues. Some main discussion points: Functional coverage for health professionals: What solutions have you delivered where the same solution(s) covers functional needs for respectively hospitals, GPs, home care services/ nursing home services? Functional coverage for health analysis: Which functionality do your solution(s) provide for analysis, reporting and "population health management"? Request for information - «one patient one record» 1

2 REQUEST FOR INFORMATION FROM SUPPLIERS - «ONE PATIENT - ONE RECORD» Functional coverage for citizens: How does your solution support digital services for citizens? How do you suggest that such services will be further developed and adapted to citizen different and evolving preferences? Clinical decision support (CDS): In which areas does your solution provide clinical decision support functionality? How do you work in order to identify and develop the coverage of such functionality? Support for pathway-oriented and team-oriented work practices: What usage patterns and interaction patterns do your solutions support? To which extent does your solution support pathway-oriented and team-based organization across organizational boundaries and care levels? Support for continuous quality improvement: How is functionality for quality monitoring delivered in your solution? Is there a need for a separate reporting system in addition to your solution? Consolidation and integration of systems: What specialties does your solution support and how? What experiences do you have from consolidating specialized health IT systems? Based on your experience, how many and which clinical systems in addition to your solution is it required for a large / medium-sized hospital to maintain? How do you manage integration with these systems in order to provide an integrated and uniform user experience? Infrastructure topology: To which extent is it possible to deliver your solution based on cloud computing, alternatively which plans do you have in order to enable this? In your experience, which is the best approach in order to deliver functionality to users in rural areas with limited network bandwidth? Digital user platforms: How is your support for mobile devices such as tablets and smart phones, and which security mechanism have you implemented in order to secure sensitive patient information? Can you estimate the number of tablets, laptops and desktops at a midsized digital hospital? Scalability: How does your solution handle approximate size of to users and 6 million inhabitants? Which response times can be expected? Which thresholds should be expected? Request for information - «one patient one record» 2

3 REQUEST FOR INFORMATION FROM SUPPLIERS - «ONE PATIENT - ONE RECORD» THEME INFORMATION ARCHITECTURE In order to obtain many of the main goals for the program, it will require a higher degree of standardized documentation practices based on a common information model. Moreover, many of the functional requirements cannot be realized without data existing in structured format. We would like to learn about your experiences and plans regarding how your solution addresses these aspects. Some main discussion points: Coding, classification and terminologies: For structuring of data, which standardization of terminologies and information standards (coding and classification systems) is needed in order to implement your solutions? Information Model: To what extent does the information model support the information needs of all parts of the service: hospitals, home care, nursing homes, and GP services? Adaptation to national requirements: How do you handle adaptation of your solution to national requirements in the fields of reporting and reimbursement data? How do you handle translation of the solution other languages, i.e. Norwegian? Management of process models: Which administration functionality is included in your solutions for supporting ongoing management, development and modeling of work processes and support for Clinical Pathways? Documentation Practices and usability: How do you work with improving usability of your solution for health professional (effective documentation, effective information finding, etc)? THEME IMPLEMENTATION STRATEGY A potential program will involve the majority of health professionals in the implementation activities. In addition we will need to consider the risk associated with the transfer of data connected to implementation. Some main discussion points: Implementation: What are the biggest risks associated with the implementation of your solution? What activities do you suggest implemented to reduce the risks? Migration and Conversion: What strategy and principles do you recommend regarding transferring patient information from solutions that will be replaced? How much of existing patient information is usually converted? Request for information - «one patient one record» 3

4 REQUEST FOR INFORMATION FROM SUPPLIERS - «ONE PATIENT - ONE RECORD» THEME BENEFITS We would like input on documented effects resulting from the introduction and use of your solutions. The benefits which we would like to highlight are the following: Cost reduction and process efficiency. In what areas / processes have your solution contributed to better utilization of resources and capacity? Better outcomes, improved quality and patient safety. Within which areas have your solution contributed to increased quality and patient safety (reduced adverse events), and better treatment outcomes? THEME COST ESTIMATION In the current phase of the study, we appreciate access to reference material that gives us standardized basis to calculate investment costs, implementation/restructuring costs and life cycle costs. We are fully aware that all cost figures are context dependent (i.e. constraints and external factors are different in each project), but we would like a dialogue related to your experience with estimating total cost of implementation of your solution. Your input will be used to establish an investment and costing model in accordance with guidelines issued by the Norwegian government for estimating governmental investment projects. Initially we would like to discuss the following costing elements: Basic solution cost: Which pricing model do you have for your solutions (list prices)? Price Structure: In a typical project, how are the cost split between (a) initial investment; (B) adjustments / parameter setting; (C) infrastructure and hardware; (C) implementation / training? The ongoing pre-study does not include procurement. Hence, the initiated dialogue at this stage of the process is not to be regarded as any basis or part of a possible future procurement. Request for information - «one patient one record» 4

5 Prestudy «One Patient One Record» Overall strategy and requirements Synthesis of Chapter 1-3 of Version 0.9, March 2015, preliminary translation Prestudy - One Patient One Record Overall strategy and requirements, version 0.9 1

6 Table of Contents 1 Preface Overall Strategy The Societal Policy Objective The Effect Oriented Objectives Performance Measures Overall Requirements Bibliography... 8 Prestudy - One Patient One Record Overall strategy and requirements, version 0.9 2

7 1 Preface This document summarizes the Overall Strategy and Requirements as well as the Needs Assessment in the pre-study of One patient One record initiative, and the political goals and ambitions in the Governmental white paper Stortingsmelding no. 9 ( ) (white paper 1 ). 2 Overall Strategy The overall strategy for the initiative is described through aims and objectives that, on different levels, describe what the initiative is to realize. The societal policy objective (chap. 2.1) indicates the societal benefits or value creation of the project. The effect oriented objectives (chap. 2.2) indicate the desired future state for the users. These objectives are specified through benefit areas. A set of performance measures (chap. 2.3) are stated within each benefit area. These are target figures and attributes that will be achieved throughout the execution of the project. Figure 1 is an illustration of the connection between the societal policy objective, the effect oriented objectives, the benefit areas with belonging performance measures. Figure 1. Overall structure of aims and objectives 1 White papers (Meld.St.) are drawn up when the Government wishes to present matters to the Norwegian Parliament - Stortinget - that do not require a decision. White papers tend to be in the form of a report to the Parliament on the work carried out in a particular field and future policy. These documents and the subsequent discussion of them in the Parliament often result in a draft resolution or bill.(3) Prestudy - One Patient One Record Overall strategy and requirements, version 0.9 3

8 2.1 The Societal Policy Objective The societal policy objective: A coherent and evidence-based healthcare system that utilizes the potential of ICT and involve citizens to contribute to improved health and improved health outcomes, optimal use of resources. The main concepts that the societal policy objective builds on are defined in Figure 2. Figure 2. Main concepts of the societal policy objective Coherent The healthcare system distributes and executes tasks in such a way that the citizens perceive healthcare services as safe, coordinated and continuous. Healthcare services: Practices which have a preventive, diagnostic, therapeutic, health-preserving or rehabilitating effect and are carried out by healthcare personnel for the purposes of nursing and care. (1) Evidence-based Leverages the potential of ICT Improved health for all citizens Optimal use of resources Improved health outcomes Promote the informed and active involvement of citizens in the planning and delivery of healthcare The healthcare system creates and applies new knowledge and evidence and converts research into innovation and better practice. Updated analysis of data support governance. Makes use of the technological development in order to enhance quality of care and patient safety. Technology is to be understood in interplay with organizational and managerial structures and processes, competency and culture. More citizens stay healthy longer and patients receive safer and more effective healthcare. The capacity and resources of all actors, including the citizens, are better exploited. For the healthcare institutions, this comprises both the capacity and competencies of the healthcare personnel, and available premises and equipment. Safer and more effective healthcare. Facilitates the participation of citizens in the healthcare system. Citizen: Any role a citizen may assume, e.g. individual who is responsible for his own health, patient, patient s next of kin, legal representative or legal guardian. Participation of citizens: The citizen has an overview of her/his health status and be able to influence conditions concerning her/his healthcare-related needs. To the greatest extent possible, citizens should be enabled to exercise self-care. 2.2 The Effect Oriented Objectives Based on the overall healthcare policy objectives of better quality, patient safety, efficiency and use of resources, the following effect oriented objectives are suggested: Prestudy - One Patient One Record Overall strategy and requirements, version 0.9 4

9 1. Better health, improved patient safety and quality of care 2. Better use of capacity and resources Better health means that we help more people to stay healthy longer and patients receive safer and more effective healthcare. Improved patient safety means that the probability of adverse events in healthcare is reduced to a minimum. Improved quality of care means that the healthcare system operates in evidence-based and efficient. Healthcare is universally available and distributed in a way that ensures that everyone has equal opportunities of attaining good results. The healthcare system facilitates citizen participation. Requirements for privacy/data protection and data security are met. Better use of capacity and resources means that available capacity and resources are utilized so individual citizens and the society as a whole attain as much benefit as possible. The effect oriented objectives are made more specific through eight benefit areas, as indicated in Figure 3. Figure 3. Effect oriented objectives and benefit areas 2.3 Performance Measures [will be formulated as a part of the Analysis of Alternatives] Prestudy - One Patient One Record Overall strategy and requirements, version 0.9 5

10 3 Overall Requirements The overall requirements constitute the conditions that the project must fulfill. The absolute requirements are mandatory requirements for the project and, hence, key determinants in the process of selecting alternative concepts in the Feasibility Study. The Normative Requirements and the ICT Requirements are requirements that must be fulfilled independent of the choice of concept. The remaining requirements constitute other important requirements. Absolute Requirements 1. The initiative must provide citizens and healthcare personnel with a legit need for information with an overall access to updated and requisite health information, regardless of where the citizen has received healthcare services in the past. 2. The initiative must facilitate establishing, sharing and following of individual patient plans across the healthcare services. It must be clear which actor is responsible for executing the relevant tasks at any given time. 3. The initiative must ensure that different healthcare services share common definitions across organizations, and that healthcare personnel and citizens have access to an overview of the quality and the availability of relevant services. 4. The initiative must facilitate that healthcare personnel get access to knowledge support and decision support in accordance with given priorities and defined best practice. 5. The initiative must facilitate making data accessible for quality improvement, governance and analysis, health analysis, research and health preparedness/syndromic surveillance. 6. The initiative must take future structural changes into account. As a minimum, the initiative must factor in increasing options for user choices, structural reforms and organizational change in the responsibilities of tasks. Normative Requirements 7. The initiative must comply with privacy/data protection requirements, including citizens rights related to information, access, rectification, erasure and blocking of information, as well as consent and reservation. 8. The initiative must comply with data security requirements and protect health information satisfactorily regarding confidentiality, integrity and availability. The initiative must establish a solution for coordinated access control. ICT Requirements 9. The ICT solutions of the initiative must be robust regarding availability, scalability, capacity, performance/response time and security. 10. The ICT solutions of the initiative must be user-friendly and adaptive to the needs of different usergroups. Other Requirements 11. The initiative must give citizens the possibility to register personal health information, exercising individual choice and shared decision making supported by knowledge management support, decision support and process support. 12. The initiative must provide citizens with easy and efficient means of communication with the healthcare services. Prestudy - One Patient One Record Overall strategy and requirements, version 0.9 6

11 13. The initiative must facilitate the possibility for citizens to share health information and involve others in matters of health or on their behalf. 14. The initiative must facilitate standardized documentation practice based on international and national classification methods and terminologies. 15. The ICT solutions of the initiative must be able to exchange relevant data with medical technology equipment and other technological equipment used in healthcare. 16. The initiative must facilitate inter-sectorial service integration. 17. The initiative must utilize shared national common components where appropriate. Prestudy - One Patient One Record Overall strategy and requirements, version 0.9 7

12 4 Bibliography 1. The Ministry of Health and Care Services. The Patients Rights Act Government Administration Services. Government.no. White papers. [Internett] [Sitert: ] &from= &page=4. Prestudy - One Patient One Record Overall strategy and requirements, version 0.9 8

13 Postal address: Pb. 7000, St. Olavs plass, 0130 Oslo, Norway Telephone: Prestudy - One Patient One Record Overall Fax: strategy and +47 requirements, version postmottak@helsedir.no

14 Prestudy «One Patient One Record» Introduction, preliminary translation April 2015

15 Background, organization and overall plan 2

16 Several strategic documents and action plans have defined the level of ambition for ehealth

17 Stortingsmelding no. 9 ( ) defines three objectives for the ICT development in the healthcare system (Governmental white paper) Healthcare personnel shall have user friendly and secure access to patient information The citizens shall have access to user friendly and secure digital services Data shall be accessible for quality improvement, health monitoring, management and research 4

18 The Ministry of Health and Care Services has commissioned the Directorate of Health to do a prestudy of how to realize the ambitions of one patient one record Mandate for prestudy of «one patient one record initative» Comprise the entire health and care sector Assess a wide variety of concepts Assess risk, managerial challenges and organizational consequences for each alternative concept Close collaboration with the health care sector Take into consideration that the prestudy may be reviewed according to The Ministry of Finance scheme for quality assurance of major public investments (the QA scheme) 5

19 The prestudy may be reviewed according to The Ministry of Finance scheme for quality assurance of major public investments (the QA scheme) The main phases of the QA scheme QA1 QA2 Prestudy Preproject Detailed design Execution Needs Assessment Strategy and Requirements Feasibility Study Analysis of Alternatives Guidance for Preproject 6

20 Main activities and additional assignments in the Prestudy Main activities of the prestudy Needs Assessment Assess the needs of patients, users, sector and society Additional assignments for the Ministry of Health and Care Services (HOD) Regional Health Authorities (RHF) ICT - comparative analysis Comparative analysis of the Regional Health Authorities in the area of ICT References and Experiences Assess international and national experiences Overview of ICT challenges Overview of the challenges related to ICT in the healthcare system Strategy and Feasibility Study Formulate strategy, goals and requirements. Identify alternative concepts Vendor Analysis Analysis of relevant EMR systems og vendors Analysis of Alternatives Evaluate alternative concepts, incl. socioeconomic analysis Strengthened Capability of Executing ICT Development Study of strengthened capability of executing ICT development in the healthcare system 7

21 Governing and organizing the Prestudy The Ministry of Health and Care Services (HOD) Steering Committee Prestudy «One patient One record» The Ministry of Health and Care Services is the responsible ministry (HOD) Ordinary steering dialogue with The Ministry of Health and Care Services Steering committee with strategic representatives from the healthcare sector Western Norway Regional Health Authority (RHF) Southern and Eastern Norway RHF Central Norway RHF Northern Norway RHF The Norwegian Association of Local and Regional Authorities (KS) KS Municipality of Steinkjer Municipality of Kvinesdal Norwegian Institute of Public Health Norwegian Health Network Directorate of Health The Norwegian Federation of Organizations of Disabled People (The Norwegian Cerebral Palsy Association) The Norwegian Cancer Society HOD Herlof Nilssen (L) Steinar Marthinsen Daniel Haga (Torbjørg Vanvik) Lars Harry Vorland Trude Andresen (NL) Tone Marie Nybø Solheim Torunn Austheim Camilla Dunsæd Camilla Stoltenberg Håkon Grimstad Bjørn Guldvog Eva Buschmann Anne-Lise Ryel Tor Eid (observer) 8

22 Overall timeline and scheduled meetings for the steering committee Strategy, Goals and Requirements - discuss preliminary recommendations Feasibility Study - discuss preliminary opportunity dimensions and the longlist of alternative concepts Analysis of Alternatives - discuss preliminary results Analysis of Alternatives - approval of the recommendations of the prestudy Needs Assessment Strategy and Feasibility Study Analysis of Alternatives Nov Jan 12 March June 1 Aug Nov 5-6 Needs Assessment - approval Goals and Requirements - approval Feasibility Study - approval of the shortlist of alternative concepts Analysis of Alternatives - discuss preliminary recommendations 9

23 Work in Progress The prestudy report is scheduled to be delievered by fall 2015 Main activity Month Needs Assessment Strategy and Feasibility Study Analysis of Alternatives Steering Committee Meetings

24 Aims and objectives for the initative 11

25 Structure of aims and objectives Benefit area Effect oriented objective Benefit area Societal policy objective Effect oriented objective Benefit area Benefit area The societal policy objective indicates the societal benefits or value creation of the project. The effect oriented objectives indicate the desired future state for the users. These goals are specified through benefit areas. A set of performance measures are stated within each benefit area. These are target figures and attributes that will be achieved throughout the execution of the project. Performance measure Performance measure Performance measure Performance measure 12

26 Work in Progress Societal policy objective A coherent and knowledge-based healthcare system that leverages the potential of ICT in the pursuit of improved health and well-being for all citizens, optimal use of resources and improved health outcomes, and that contributes to secure the informed and active involvement of citizens in the planning and delivery of healthcare. Coherent Knowledge-based Leverages the potential of ICT Improved health and well-being for all citizens Optimal use of resources Improved health outcomes Secure the informed and active involvement of citizens in the planning and delivery of healthcare The healthcare system distributes and executes tasks in such a way that the citizens perceive healthcare services as safe, coordinated and continuous. Healthcare services: Practices which have a preventive, diagnostic, therapeutic, health-preserving or rehabilitating effect and are carried out by healthcare personnel for the purposes of nursing and care (the Patients Rights Act 1-3 c). The healthcare system creates and applies new knowledge and converts research into innovation and better practice. Updated data and analyses support governance. Makes use of the technological development in order to enhance quality of care and patient safety. Technology is to be understood in interplay with organizational and managerial structures and processes, competency and culture. Increasingly, people stay healthy longer and patients receive safer and more effective healthcare. The capacity and resources of all actors, including the citizens, are better exploited. For the healthcare institutions, this comprises both the capacity and competencies of the healthcare personnel, and available premises and equipment. Safer and more effective healthcare. Facilitates the participation of citizens in the healthcare system. Citizen: Any role a citizen may assume, e.g. individual who is responsible for his own health, patient, patient s next of kin, legal representative or legal guardian. Participation of citizen: The citizen has an overview of her/his health status and be able to influence conditions concerning her/his healthcare-related needs. To the greatest extent possible, citizens should be enabled to exercise self-care. 13

27 Work in Progress Effect oriented goals 1.1 Enhanced citizen involvement 1. Better health, improved patient safety and quality of care 1.2 Improved healthcare and preventive health measures 1.3 Strengthened foundation for knowledge-based healthcare and preparedness 1.4 Strengthened data protection and information security 2.1 More options for self-service and digital dialog 2.2 Improved information processing in the healthcare system 2. Better use of capacity and resources 2.3 Better utilization of competencies and infrastructure 2.4 More efficient and resilient IT operation, maintenance and development 14

28 Work in Progress 1. Better health, improved patient safety and quality of care 2. Better use of capacity and resources 1.1 Enhanced citizen involvement 1.2 Improved healthcare and preventive health measures 1.3 Strengthened foundation for knowledge-based healthcare and preparedness 1.4 Strengthened data protection and information security 2.1 More options for self-service and digital dialog 2.2 Improved information processing in the healthcare system 2.3 Better utilization of competencies and infrastructure 2.4 More efficient and resilient IT operation, maintenance and development Adherence to medical treatment and advice increases Citizens make better health-related decisions Shorter periods of waiting and shorter episodes of care Reduced number of adverse incidents Better healthcare outcomes Less unjustified clinical variation Reduced unnecessary service provision Better needs assessment and service distribution Strengthened basis for built-in quality improvement measures Strengthened basis for supervision and quality inspection Strengthened foundation for preparedness Strengthened foundation for research Reduced level of unathorized access to information Reduced risk of information getting astray More options for self-service More digital dialogue between patients and healthcare personnel Less time spent on searching for information Less time spent on information processing Less money spent on paper-based sharing of information Fewer duplicate examinations Fewer patients not showing up for an appointment Reduced level of unused infrastructure and personnel Better utilization of competencies and capacity Less integration, programming and modification More efficient IT maintenance and error correction More resilient IT solutions 15

29 Feasibility study and identification of alternative concepts 16

30 What is a concept and how does the level of detailing increase throughout the prestudy? Needs, goals and requirements Feasibility Study Analysis of Alternatives Needs, goals and requirements Enterprise Enterprise Execution Needs Goals Normative needs Stakeholder-based needs Demand-oriented needs The societal policy goal Actors included in the concept Information Information standards Application Coordination between the actors Shared information classification Functional capabilities ICT security model Regulations Information Application ICT government Financing model Organization The effect oriented goals Requirements Absolute requirements Affected groups of systems Infrastructure Buy/build assessment Functional components Infrastructure Remaining requirements Infrastructure topology ICT sourcing and alliances ICT organiszation 17

31 The relationship between conceptual dimensions and alternative concepts Conceptual dimensions According to the guidelines for front-end management of major public investments it is crucial to identify and assess the feasibility of different alternative concepts. The feasibility study describes what is possible to realize in rational and political ways. One way of identifying what is a feasible concept, is by identifying different conceptual dimensions. Each dimension describes aspects of the project that, on a conceptual level, is dimensioning for the project. Overview of the ICT Challenges Needs Assessment Goals and Requirements Dimension A Dimension B Dimension C Dimension D Dimension E A key conceptual dimension is the level of ambition when it comes to functionality. A scale is defined for each conceptual dimension, and each point on the scale describes a capacity of the concept. Feasibility Study Dimension A Dimension B Dimension C Dimension D Dimension E Consept K.1 Consept K.2 The concepts are generated by combining different levels of each dimension. In the context of the overall goal, the rational and political feasibility of the combinations are assessed. The final down selection of concepts is done by «testing» the concepts against the absolute requirements. Analysis of Alternatives Zero-plus 2-3 concepts from the feasibility study 18

32 Work in Progress Selection of conceptual dimensions A B C D E Integrated care models (actors/lines of services included in the project) To what extent is a patient centric approach pursuied in which starting point is the citizens need of coordinated services across the levels and specialties of the healthcare system? Functionality for healthcare personnel To what degree is the potential of ICT exploited to develop efficient and quality-promoting work equipment and processes for healthcare personnel? Consolidation of information and ICT solutions To what extent are the chosen models for integrated care realized, and what level of ambition is realized in terms of functionality for healthcare personnel? Functionality for citizens What possibilities exists for reaching the objectives for digital citizen services? The feasibility of this dimension depends to a large extent on the level of consolidation of information and ICT solutions. Secondary use of data What are the possibilities for explointing data for secondary purposes? The feasibility of this dimension depends to a large extent on the level of consolidation of information and ICT solutions. 19

33 Work in Progress Conceptual dimension A: Integrated care models Choice of patient groups will determine what coordination challenges the project will need to address. A Municipal care services Municipal health services General practice C B Specialist healthcare services Contracted private healthcare companies A B C This integrated care model covers collaboration between all actors that are a part of the municipal healthcare services. Today most of the electronic coordination between the general practices and the remaining municipal healthcare services is done through the Norwegian Health Network (electronic messaging). This integrated care model covers collaboration between the general practices (referring unit) and the specialist healthcare services. It is particularly interesting to look at the collaboration between the general practices and the polyclinics of the specialist healthcare services. This integrated care model covers collaboration between the specialist healthcare services and the municipal healthcare services. Based on the available data sets, it is possible to estimate the number of contacts that are generated in interface A and B, respectively. The available data sets cannot be linked, so it is not possible to identify the groups of citizens that are in contact with all parts of the health and care services, i.e. their contacts are generated in interface A, B and C. 20

34 Work in Progress Conceptual dimension A: Integrated care models (The room for maneouvering with regard to establishing new integrated care models) Which actors will be sharing capabilities? This dimension describes which actors/lines of services in the healthcare services that will be coordinated to ensure that the selected patient trajectories are supported by common capibilities. This is refered to as vertical coordination. GP incl. emergency ward Municipal healthcare services GP and specialist healthcare services Municipal healthcare services; GP and specialist healthcare services All actors/lines of services in the healthcare system Including international actors The defined actors/lines of services are: GP Municipal healthcare services Specialist healthcare services Private healthcare companies with/without contracts. Actors in other sectors and international actors. Municipal healthcare services Specialist healthcare services Private healthcare with/without contract International actors 21

35 Work in Progress Conceptual dimension B: Functionality for healthcare personnel Maintaining current diversity of practice limits the conceptual possibilities In recent years, the leading health ICT solutions have shifted from merely being equipment for documentation to supporting work processes and decision making based on an increasing amount of structured data that are gathered electronically. When facing key choices, actors need to balance these two aspects: Harmonization and standardization of the documentation practice, and use of advanced process support, knowledge (management) support and decision support tools. The necessity of maintaining a sufficient level of flexibility and variation to maintain and increase the level of innovation. Implementing advanced solutions for process support, knowledge management, and decision support depends on: Establishing professional processes that strengthen the work on standardizing codes and terminology. Establishing professional processes that are properly anchored and with execution capabilities to establish solutions for process support, knowledge management, and decision support Reducing the number of specialist systems Maintaining a sufficient level of flexibility and variation depends on: Developing ICT solutions for a majority of the clinical disciplines Developing ICT solutions that support contionious knowledge development, quality improvement and innovation Maintaining specialist systems because the main solution does not offer essential functionality, implies more narrow the opportunities for implementing process and decision support. Maintaining varity, narrows the possibilities for further development/ customization of ICT solutions that can support best medical practice. 22

36 Work in Progress Conceptual dimension B: Functionality for healthcare personnel What is the level of ambition when it comes to functionality for healthcare personell? This dimension describes which ehealth capabilities the project will cover. The dimension represents the level of ambition when it comes to functionality for healthcare personnel. The minimum is that there is no common requirements to the functional level of ambition, while the other extremity implies that the highest possible functional level of ambition is required and further innovation of clinical processes is facilitated. Standardized and consolidated documentation practice Patient, service and resource administration Shared process support based on structured data Shared knowledge management support Interface adapts to the to the specificty of usergroups Shared integration of medical equipment Advanced desicion support No shared requirements for the functional level of ambition Shared requirements for documentation practice and administration As (2) + shared requirements for process support As (3) + shared requirements for knowledge mgt support and adaptive UI As (4) + shared requirements for desicion support 23

37 Work in Progress Conceptual dimension C: Consolidation of information and ICT solutions A number of factors determine the opportunities for consolidation of information and ICT solutions Factors affecting the opportunities for consolidation Scope of updated and requisite health information The opportunities of standardization of the information Models of information management The opportunity of offering variation in the system portfolio Structural changes that the initiative must take into consideration Assessment The requirement for providing an overall access to updated and requisite health information reduces the opportunities for consolidation of information and ICT solutions. Standardization of the information (classification, nomenclatures, service definitions and common definitions of the content of problem records, task records, plans) reduces the need of consolidation. The capability of establishing common processes, tools and structures of information management reduces the need of consolidation. Offering opportunities for variation in the system portfolio will make realization of national consolidation more difficult. The structural changes that the initiative is required to take into consideration reduce opportunities for consolidation. Enterprise centred consolidation Regional/local consolidation National (centralized) consolidation ICT security models Complying with privacy/data protection and data security requirements is a requirement for all concepts. The more consolidation, the more fine-meshed and centralized the management of the system must be. The factor limits the opportunities The factor limits the opportunities partly The factor does not limit the opportunities 24

38 Work in Progress Conceptual dimension C: Consolidation of information and ICT solutions Enterprise centred consolidation and responsibility Regional/local consolidation and responsibility Citizen centred concepts (centralized management and administration) Nursing and care GP Hospital Capability 1 Capability 2 Capability 3 Capability 4 Capability 1 Capability 2 Capability 3 Capability 4 Capability 1 Capability 2 Capability 3 Capability 4 Capability 1 Capability 2 Capability 3 Capability 4 Capability 1 Capability 2 Capability 3 Capability 4 Capability 1 Capability 2 Capability 3 Capability 4 Integrated care solutions Integrated care solutions Nursing and care GP Hospital Each enterprise is responsible for consolidation of its information and ICT solutions. Information, plans and responsibilities are shared through itegrated care solutions. Enterprises with great need of sharing information through various patient pathways establish a shared responsibility for administration of information and ICT solutions. Sharing information between these joint ventures is handled through integrated care solutions. One authoritative information source for all citizens is established. A national (centralized) administrative body is responsible for the information and ICT solutions. 25

39 Work in Progress Conceptual dimension D: Functionality for citizens Which functional capabilities will be available for citizens? This dimension describes which digital services for citizens the initiative will offer. The opportunities inherent to this dimension comes out of the level of ambition of the previous three conceptual dimensions. Among other things based on the Patients Rights Act.. Simple administrative services Access to personal health information Opportunity of involving others Knowledge mgmt support, register personal information, simple digital healthcare Decision support, complex administrative services Process support for selected patient groups/situations Process support for everyone Selected services and access to health information An easier everyday life Citizen involvement and user choices Self-care and preventive health measures Holistic digital healthcare services 26

40 Work in Progress Conceptual dimension E: Capabilities regarding opportunities for secondary use of data How much data will be commonly captured, and what analytical capabilities will be shared? This dimension describes the level of automated datacapture, the level of continious health data analysis,and the scope of data analysis and publishing in each concept. Data is automatically made accessible Datacapture is based on shared information structures Reporting Data, based on shared information structures, is automatically made Management information is continually made accessible Coupled datasets of mgt information is continually made accessible Advanced functionality for research Management information is continually made accessible Coupled datasets of mgt information is continually made accessible Advanced research functionality 27

41 Work in Progress Overview of the conceptual dimensions A. Integrated care models (actors/lines of services included in the project) B. Functionality for healthcare personnel C. Consolidation of information and ICT solutions D. Functionality for citizens Municipal healthcare services No shared requirements for the functional level of ambition Enterprise centred consolidation and responsibility GP and specialist healthcare services Shared requirements for documentation practice and administration Regional/local consolidation and responsibility Selected An easier everyday services and life access to health information Municipal healthcare services, GP and specialist healthcare services As (2) + shared requirements for process support Citizen centred concepts (centralized management and administration) Citizen involvement and user choices All actors/lines of services in the healthcare system As (3) + shared requirements for knowledge mgt support and adaptive UI Self-care and preventive health measures Including international actors As (4) + shared requirements for desicion support Holistic digital healthcare services Identification of possible concepts is based on the five dimensions that are described.. The five dimensions are not mutually exclusive, i.e. opportunites related to some dimensions comes out of the level of ambition of other dimensions. Dimension A-C are determinant in the process of identifying concepts. The level of dimension D-E is determined by the chosen level of dimension A-C E. Access to information as secondary use of data Reporting Data, based on shared information structures, is automatically made accessible Management information is continually made accessible Coupled datasets of mgt information is continually made accessible Advanced functionality for research 28

42 Work in Progress Consepts based on enterprise centred consolidation and responsibility for information and ICT services Enterprise centred consolidation and responsibility Nursing and care Capability 1 Capability 2 Capability 3 Capability 4 GP Capability 1 Capability 2 Capability 3 Capability 4 Hospital Capability 1 Capability 2 Capability 3 Capability 4 K1. Each enterprise implements shared requirements for documentation practices, patient-, service- and resource administration, as well as process support Nursing and care GP Hospital Zero-option/Zero-plus-option Each enterprise is responsible for its solutions, and the solutions are upgraded with considerably richer functionality. There are shared requirements for documentation practices, patient-, service- and resource administration, as well as process support. Demands a great amount of integration with other enterprises. Each actor (enterprise) must increase the level of functionality on its own. There is great need of coordination and standardization. A new integrated care solution is established. It takes full advantage of the potential of common documentation practices and administrative functionality. Integrated care solutions Each enterprise is responsible for consolidation of its information and ICT solutions. Information, plans and responsibilities are shared through itegrated care solutions. Nursing and care GP Hospital Will have today s concept/solution as starting point the needs will not be met to less satisfaction than at the decision stage. Incl. regular maintenance (corrective maintenance, repair of defects, replacement of destroyed parts, preventive maintenance), as well as replacement/reconditioning (essential reinvestment, upgrading) necessary for the solution to function through the period of time assume in the analysis. Zero-plus includes investments that will give today s concept a prolonged useful life. 29

43 Work in Progress Consepts based on regional/local consolidation and responsibility for information and ICT services (1) Regional/local consolidation and responsibility K2. Regional solutions for GP and specialist healthcare services Capability 1 Capability 2 Capability 3 Capability 4 Capability 1 Capability 2 Capability 3 Capability 4 Municipal healthcare services GP and specialist healthcare services Shared regional solutions that cover GP and specialist healthcare services. Shared responsibility for administration of information, patient-, serviceand resource administration, as well as process support. National definitions of services. Functionality for national service administration is made accessible across the actors of regional solutions. A new integrated care solution facilitates coordination between GP/specialist healthcare services and the municipal healthcare sercices. K3. Regional solutions for healthcare services (incl. process support, not advanced desicion support) Integrated care solutions Enterprises with great need of sharing information through various patient pathways establish a shared responsibility for administration of information and ICT solutions. Sharing information between these joint ventures is handled through integrated care solutions. Municipal healthcare services and specialist healthcare services Municipal healthcare services and specialist healthcare services Shared regional solutions that cover municipal healthcare services and specialist healthcare services. Shared responsibility for administration of information, patient-, service- and resource administration, as well as process support. Not advanced decision support. National definitions of healthcare services. Functionality for national service administration is made accessible across the actors of regional solutions. A new integrated care solution facilitates coordination between the regions. 30

44 Work in Progress Consepts based on regional/local consolidation and responsibility for information and ICT services (2) Regional/local consolidation and responsibility K4. Regional solutions for healthcare services (incl. process support and advanced desicion support) Capability 1 Capability 2 Capability 3 Capability 4 Capability 1 Capability 2 Capability 3 Capability 4 Municipal healthcare services and specialist healthcare services Municipal healthcare services and specialist healthcare services The K3 and K4 concepts are very similar, but K4 also covers advanced desicion support and shared integration of medical equipment. Shared regional solutions that cover municipal healthcare services and specialist healthcare services. Shared responsibility for administration of information, patient-, service- and resource administration, as well as process support and advanced decision support. National definitions of healthcare services. Functionality for national service administration is made accessible across the actors of regional solutions. A new integrated care solution facilitates coordination between the regions. There are shared requirements for implementation of shared integration of medical equipment, as well as knowledge management support and decision support across the consolidated solution. Integrated care solutions Enterprises with great need of sharing information through various patient pathways establish a shared responsibility for administration of information and ICT solutions. Sharing information between these joint ventures is handled through integrated care solutions. 31

45 Work in Progress Citizen centred concepts (national management and administration of information and services) (1) Citizen centred concepts (centralized management and administration) Capability 1 Capability 2 Capability 3 Capability 4 K5. One national solution for municipal healthcare services Municipal healthcare services Regional Health Authorities Regional Health Authorities One national solution that covers all actors of the municipal healthcare services, with process support across the actors. Shared responsibility for administration of information, patient-, service- and resource administration, process support and knowledge management support. National definitions of healthcare services. Functionality for national service administration is made accessible across the actors, incl. the specialist healthcare services. A new integrated care solution facilitates coordination between the national solution and the regional solutions for the specialist healthcare services. K6. One national solution for GP and specialist healthcare services Nursing and care GP Hospital One authoritative information source for all citizens is established. A national (centralized) administrative body is responsible for the information and ICT solutions. Nursing and care GP and specialist healthcare services One national solution that covers GP and specialist healthcare services. Shared responsibility for administration of information, patient-, serviceand resource administration and process support. National definitions of healthcare services. Functionality for national service administration is made accessible across the actors. A new integrated care solution facilitates coordination between GP/spesialist healthcare services and nursing/care. 32

46 Work in Progress Citizen centred concepts (national management and administration of information and services) (2) Citizen centred concepts (centralized management and administration) Capability 1 Capability 2 Capability 3 Capability 4 K7. One national solution for healthcare services (excl. private healthcare) Municipal and specialist healthcare services Private healthcare K8. One national solution for all healthcare services One national solution for all healthcare services excl. private healthcare, with process support, knowledge management support and decision support across the actors. The interface adapts to the specificty of usergroups. There are shared requirements for documentation practices, patient-, service- and resource administration, as well as process support and advanced decision support. A new integrated care solution facilitates coordination with private healthcare systems that can not use the national solution. Nursing and care GP Hospital One authoritative information source for all citizens is established. A national (centralized) administrative body is responsible for the information and ICT solutions. Municipal and specialist healthcare services, + private healthcare The K7 and K8 concepts are very similar, but K8 also covers private healthcare systems where appropriate. A new integrated care solution facilitates coordination with private healthcare systems that can not use the national solution, actors in other sectors and international actors. 33

47 Work in Progress Consepts that are a combination of different models of consolidation Consepts that are a combination of different models of consolidation The combinations that are possible to realize in rational and political ways, are the ones where consolidation is done separately in municipal healthcare services and specialist healthcare services. The background for this being viewed as possible to realize is that functional needs of the services may differ and that the structural starting point is different. In the specialist healthcare services, there is an ongoing consolidation process governed by the national health authorities. In the municial healthcare services, there are still many actors. K9. One national solution for municipal healthcare services and regional solutions for the specialist healthcare services Municipal healthcare services One national solution that covers the municipal healthcare services, with process support across the actors. The regions are required to increase the level of consolidation and functionality. There are shared requirements for documentation practices, patient-, service- and resource administration, as well as process support and advanced decision support. A new integrated care solution facilitates coordination with private healthcare systems that can not use the national solution. K10. One national solution for municipal healthcare services and one national solution for the specialist healthcare services Municipal healthcare services The K8 and K9 concepts are comparable, but there is one major difference. In addition to establishing a national solution for municipal healthcare services, a national solution for the specialist healthcare services is established. This implies a higher level of harmonization between the reional health authorities. 34