The Finnish Law on Forced Integration of Patient Records

Integration: the good, the

bad and the heroic

– case Finland

Anne KallioHead of Development

Ministry for Social Affairs and Health

Finland

Content

• Background

• Legislation

• Architecture

• eArchive

• ePrescription

• eView

• Good, bad and heroic…

PUBLIC SECTOR 85%

Municipalities

Responsible for arranging

Independent in decision making

Appr 190 Primary health care centres

21 Hospital districts

PRIVATE SECTOR 15%

Primary and specialized health care

Occupational health care (60%)

appr 4000 private providers

600 pharmacies

Organization of health care in

FinlandPopulation 5.3 million

eHealth situation now

Delights

• EHR coverage 100% (public sector)

• Regional EHR information exchange 76%

• Electronical referrals and discharge letters

• hospitals 90%

• primary health care 77%

• EHR coverage appr 80% (private sector)

Drawbacks

• private sector not involved in regional EHR information exchange

• interoperability

• many EHR-systems (>10)

• over 60 one disease/one purpose systems

• too few semantic and technical standards

National eHealth Road Map 2007

1. Availability of patient information regardless of time and place, both in public and private sector

2. Participation of citizens and patients acces to own patient information and log data

acces to high quality health information

development of eServices

-> National solution for patient data and prescription

• Population only 5.3 million

• Need of patient information does not restrict to one organisation or region

• Essential to have private sector included

Legislation

Government bill for the Client data act 2007 - eArchive• central data repository built by Kela (national insurance authority)

• data produced and owned by health care providers

• view of data on patients consent

• public and private (not if only paper in use) health care producers

• all patient data by 2011

Government bill for the Act on ePrescriptions 2007• Prescription center by Kela

• Viewing on patients consent

• obligatory for doctors, not for patients

• obligatory by 2011

eView

• for patients

Architecture

• central data repository

• data produced by local EHR-systems

• traffic via public internet (VPN)

• standardisation of information and data transfer

Functions

• dynamic data repository

• only legal long term electronic archive

• 12 yrs after death

eARCHIVE - content

First phase

• medical record – personal and life long

• coded core information (dg, procedures, medical risks)

• medication

• referral and discharge letters

• radiology referrals and statements

• summary of nursing information

• laboratory results

• necessary archiving documents

• log information

Next steps

• medical statements sent electronicaly

• dental health care

• Radiology, endoscopy etc images…

• biosignals…

ePrescription

NATIONAL PRESCRIPTION CENTRE

• ePrescriptions sent by local EHR-systems

• Information of medicine dispensing in pharmacies sen by pharmacy systems

• Log

• Viewing on patients consent

IMPLEMENTATION

• in final testing phase

BY LEGISLATION OBLIGATORY BY 2011

• For doctors and pharmacies

• Patients can refuse ePrescription

eVIEW

• Patient information in eArchive

• Information in Prescription centre

• Log information

• For citizens >18 yrs

• Acces via Internet

• Authentication by

• eBanking identification

• electronical ID card

• In the future

• consents and denials

• advanced directives (f.ex living will )

Good, bad and heroic…

Good

• long term legal electronical archiving solution for health care

• standardization of medical information

• national data base

-> clinical decision making support

-> possibility for on line statistics

-> management decision support

Bad

• lack of resources – people and money

• fragmented health care providers and IT-systems is a big challenge

• original time table was far too optimistic -> gradual approach and new time table made

Heroic

• aim is to put in nearly all patient data

• not only core information

• concerns all health care providers in Finland

Thank you

Questions?