Improved care coordination · Improved care coordination – background, vision, solution and ... +...

Improved care coordination – background, vision, solution and experience from Sweden. Building a System of Connected Care

Håkan Nordgren, MD

Medical Advisor, InterSystems

Pediatrician and GP Dalarö

+ Håkan Nordgren, MD Background as: • CIO/CMIO/CDO Karolinska university hospital

• Implementer of large EMR/EHR systems

• Medical Director big pharma

• Partner global management consulting

• Chief Medical Officer medtech industry and Swedish eHealth programme

• Chair Swedish eHealth architectural board

• Practicing Archipelago doctor and Pediatrician

•

• Hakan.Nordgren@InterSystems.com • Cell +46 72 22 33 590

+ Stockholm Sweden Dalarö 40km SouthEast

+ Changes in healthcare domain

• Competition (service, quality & price)

• Decentralisation - more patients to GPs

• Centralisation - centers of excellence

• Financial situation

• Continuing subspecialization

• Patient choice and engagement

• Rapid knowledge turnover

+ Integrity and privacy

+

An IT-support for the Health Care of tomorrow

+ Health expenditure per capita OECD 2011

Global Healthcare Challenges

17,7 9,4

11,0 9,5

10,3 9,3

11,9 11,3 11,2

8,9

2011 Spending (% of GDP)

22 8

9 20

22 25

20 16

21 19

Medical Errors (% in 2 yrs)

4,3 5,2

4,5 2,9

3,2 2,5

5,3 6,8

3,9 3,2

Mortality After Heart Attack (%)

www.commonwealthfund.org

AU CA DK NL NO NZ SE SZ UK US

AU CA DK NL NO NZ SE SZ UK US

AU CA DK NL NO NZ SE SZ UK US

Care Coordination and Transitions of Care

Care Coordination Problems (%)

Key Information Not Shared Among Providers (%)

Gaps in Hospital Discharge Planning (%)

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+ Goal: Improve outcomes e.g. greater patient safety, effectiveness and efficiency

as cited by U.S. Office of National Coordinator Health Information Technology (ONCHIT):

1. Avoid … medical errors

2. Improve … use of resources

3. Accelerate … diffusion of knowledge

4. Reduce … variability in access to care

5. Advance … consumer role

6. Strengthen … privacy and data protection

7. Promote … public health and preparedness 10

+ Three main issues

• The patient´s participation in

the care process

• Maintainig continuity of care

in modern healthcare with

many care providers

• A knowledgebased

governance of healthcare

+

• Area: 449,964 km2

• Population: 9,6 M (2012)

• GDP $552 billion

• Three governmental levels with own taxation rights

• Healthcare funded by taxes (Beveridge system)

Sweden

+

21 County Councils

291 Municipalities

Private Care providers

100% coverage of EMR/EHR

>95% ePrescriptions

Very good outcome results

Swedish Healthcare

eHealth – EHR/EMR/HIS

Genera-

tion

Period Organizational Functions Integration

Experi-

mental

1960-80 Research projects Documentation

Scheduling

-

1st gen 1980-00 GP’s office or

Clinic based

+ Medication

+ Lab report

+

2nd gen 1990-10 Hospital based or

Primary care area

+ CPOE

+ ePrescription

++

3rd gen 2000- County council or

Regional based

+ PACS viewer

+ CDSS

+++

4th gen 2008- National based (EU

and epSoS)

+ patient services by it self an

integration

+ Solution based on Intersystems technology

• Sweden NPÖ – National Patient Overview

• Denmark NPI – National Patient Index

• Slightly different technical solutions – but same aim and same goal

• Based on International Medical Standards (ISO, HL7, WHO, IHE etc)

• Intergrates all major EMR/EHR/HIS systems in both countries (around 10 different in each country)

+

• Counties are connected as

producers and consumers

• 100 private healthcare

providers are connected

through care contracts with

the counties

• ≈90 municipalities, 10

private caregivers and the

Swedish Dental Service

are connected as

consumers

• Goal: 95% municipalities

will be connected as

consumers 2013. Some as

producers

National Patient Overview

+

• Regions are connected as

producers and consumers

• 100 private healthcare

providers are connected

through care contracts with the

counties

• ≈90 municipalities, 10 private

caregivers and the Swedish

Dental Service are connected

as consumers

• Goal: 95% municipalities will

be connected as consumers

2014. Some as producers

National Patient Overview

+ Chronic conditions – Diabetes mellitus

Caregivers

GP

Endocrinology

Internal Medicine

Nephrology

Ortopedics

Ophtamology

Podiatrist

etc

+ InterSystems Italy

http://www.intersystemsitalia.it/

InterSystems Italia s.r.l. Piazzale Biancamano, 8 20121 - Milano Italy

Tel.: +39 02 62 03 22 00 Fax: +39 02 62 03 40 00

Pedro.Bermudo@InterSystems.com

InterSystems Italia s.r.l. Via Giordano Bruno, 260 47521 Cesena (FC) Italy

Tel: +39 0547 368211 Fax: +39 0547 368231