E-health Finland - national and crossborder

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1 E-health Finland - national and crossborder developments 9 June 2016 ehealth Week, Amsterdam Viveca Bergman, Development Manager National Institute for Health and Welfare

2 Check Point 2015 Health care in Finland is extensively digitalized; 100% coverage of EPRs. Information management in social welfare has advanced lately and will be one of the key areas in coming years Cross-border: Mature national infrastructure; nationwide coverage of ep and ed Robust standards-based national system with wellstructured data Roles of competent actors in cross-border deployment regulated (by law). Hyppönen H, Hämäläinen P, Reponen J (eds.) (2015). ehealth and ewelfare of Finland - Check point

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4 Electronic prescriptions dispensed by pharmacies compared with prescriptions reimbursed from sickness insurance scheme by month (3-month rolling average presented as bold line) Millions of prescriptions 5,5 Pharmacies Public healthcare Private healthcare (>5,000 prescriptions/year) 5,0 4,5 4,0 5.1 mill. Electronic prescriptions 4.5 mill. Reimbursed prescriptions 3,5 3,0 2,5 2,0 1,5 1,0 0,5 0,

5 Logins to My Kanta pages and number of visitors by month 01/ / Log-ins No of visitors

6 documents stored in the Patient Data Repository concerning medical data on persons ( )

7 epsos NCP Kanta messaging layer Patient data management service Public healthcare providers Hospital districts (20) Primary care org. (192) Private healthcare providers (4000) Pharmacies (~800) Kanta services Pharmaceutical database eprescription service Patient data repository Health records, structured Prescriptions Encounters Logs Renewals Dispensations Logs Radiology DICOM studies Health records, legacy Health care professionals Web- GUIs for HCPs Patient summary management Other summary Diagnoses Risks data Swedish epsos NCP Connection closed after successful pilot Citizens (> ) Social care providers Aged 18 and older My Kanta pages Consent and will management Consents and their restrictions Personal Health Record Data repository for social services Client docs Living wills and other wills (organ donation, etc) My data of clients Customership and service item data Main standards HL7 V3: CDA R2 L3 and Medical Records HL7 FHIR DSTU2 (PHR) JSON, XHTML (PHR and social services) PDF/A (legacy data and social services) IHE IT-I Profiles (Imaging and epsos) W3C XML DSig WS Addressing, WS-I TLS, X.509 Other national services Legacy data Summary management Logs National code server Code systems and terminologies Form structures Pharmacy register Organization register X-Road Certification services HCP and SCP register

8 Standardization for Interoperability in Finnish Health Care Experimental legislation on seamless service chains HL7 Finland founded National health project starts Regional hospital information systems starting National core datasets defined Legislation about the national Kanta system and supporting services Kela appointed as a national actor in national healthcare ICT services eprescription service production phase incl. My Kanta pages service for citizens -> Finnish IHE SIG founded epsos pilot work started in FIN Revised legislation on consent management and patient summary service Patient Data Repository production phase -> All public healthcare uses the Patient Data Repository IHE FI founded All private healthcare uses the Patient Data Repository ICD-10 adopted in Finland First national HL7 v2 profiles PikaXML definition for electronic referral process Finnish profile for CDA R1 National code server founded Finnish basic profile for CDA R2 CDA R2 becomes ANSI standard Ministry decision on CDA R2 for national standard for structured dataset National Kanta architecture defined National pharmaceutical database founded KVARKKI national imaging architecture defined HL7 Medical records specifications for Finnish profile eprescription and for HL7 V3 Patient Data Repository messaging Oral and dental healthcare structured documentation specifications epsos NCP in production First FHIR pilots

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10 Prescriptions out of scope - Case Finland No Description Reason Suggestion with regards to pivot 1 central nervous system drugs Difference in classification (what is a CNS drug and No change what is not) in different countries 2 drugs with potential for recreational use (narcotics) Out of scope of epsos in general No change 3 drugs to be prepared in the pharmacy Preparation instructions only in Finnish/Swedish No change 4 base creams No ATC code or strength, which are mandatory in pivot Include make ATC code and strength optional in pivot 5 clinical nutritional preparations No ATC code or strength, which are mandatory in pivot Include make ATC code and strength optional in pivot 6 care accessories, dietary supplements No ATC code and some other information which is No change and bandages mandatory in pivot 7 prescriptions valid for defined time periods No information on package size and number of packages No change. Some countries are able to send suitable info (amount to be dispensed at once). 8 iterated prescriptions Difficult to calculate the remaining amount. Iteration rules vary among countries. 9 combination medications ATC code system not designed for this use case. Text-based strength not allowed. 10 combination packages Package size is difficult to structure. No change 11 the prescription is in held state National rules No change 12 the prescription is in reservation state National rules No change 13 package size is not in structured form Package size is difficult to structure. No change No change. Some countries are able to send suitable info (amount to be dispensed at once). Allow providing non-structured strength information (text)

11 Lessons learned as a starting point for the CEF process aiming at the ehdsi National level deployment requires mature services. If we introduce cross-border services significantly sub-optimal to the national standards > unmet expectations jeopardizing trust among professionals and clients. The optimal solution for pharmacies is an integrated cross-border dispensation functionality not interfering with the normal work flows > need for client orientation in service design. Stepwise scaling-up needed The national solutions should be in line with jointly approved requirements even if governed by national legal frameworks Data controller s responsibility > data protection and security requirements need to be met > proper auditing mechanism

12 Thank you!