Healthcare Digitalization: The ePrescription system in Finland

Trust, social commitment , and quality

Fujitsu Forum 2014

ICM Munich 19th – 20th November

Human Centric Innovation

Trust, social commitment , and quality

Healthcare digitalisation ePrescription system in Finland

Maritta Korhonen Head of Development Ministry of Social Affairs and Health

Healthcare digitalisation ePrescription system in Finland

Maritta Korhonen

Head of Development

Ministry of Social Affairs and Health

Maritta Korhonen 4 14.11.2014

Agenda

Finnish healthcare system –

on-going & upcoming reforms

ePrescription

National eHealth strategy


Finland

Population 5,4 million

GDP per capita 47 000$ (US 64 000 $)

Life expectancy M 77 / F 83 years

Total fertility rate 1.85

Infant mortality 2.4/100 (US 6,5)

38% have tertiary education (US 41%)

OECD


Population

1970

Population

2007


Finnish healthcare system

Key principles: residence-based, universal and equal right to health services

Two tiers: local authorities are responsible for organising primary health care (municipalities/coalitions; approx.160) and specialised medical care (hospital districts; n=20)

Public services are mainly funded by tax revenues collected by the state and municipalities. – client charges are collected covering 5–10 % of costs

– in reality, there are 3 tax-supported service systems

– funding and financing of the health sector are nor included in the ongoing municipality and service structure reform


Large reforms for Finnish healthcare are coming

This government

– (re)organisation of healthcare, legislation 2014

– strengthen primary care, unify health and social care

– ”broader shoulders for healthcare organizers”

– into effect 1.1.2017

Next government

– scrap multichannel funding for healthcare, create single

funding channel

– remove suboptimization, unhealthy competition within system

etc.

ICT

– eServices for citizen (NOT patient/customer) implement

the shift from provider (doctor/org.) centric paradigm to

citizen centric paradigm


The decision to build a national eHealth solution

Government decision in 2002: Finland should have a nation

wide interoperable EHR system by end of 2007

By 2005 agreement on the National archive for health information (KanTa) comprising three nation wide services

– ePrescription

– eAccess

– eArchive

– Based on structured documents (HL7 V3 CDA R2)

– In co-operation with local systems to feed care documents

and using them

New legislation was needed to allow the new features

– Placing the centralized service to Kela

– Consent management, privacy & security aspects


6.9.2011

Other national services

KanTa services

ePrescriptions service

Dispensations

eArchive

Patient health records Metadata

Patient Summary Service

Consent and will mgmt service

Opt-in / Opt-out

Organ donor wills

Living wills

National code server Code lists and terminologies

Forms/document structures

Patient’s

eA

cce

ss

Pharmacies (~800)

Hospital districts (20)

Primary care org. (192)

Private healthcare providers (4000)

Patients (> 4 000 000)

Diagnosis

Lab

Img. reports

Procedures

Vaccinations

Physical findings

Healthcare professionals’ registry

Certification services

ep

SO

S N

CP

Foreign epSOS NCPs (22)

Medication database

Risks Medications Health and care plan

Main standards

• HL7 V3: CDA R2 Level 3 and Medical Records

• IHE IT-I Profiles • W3C XML DSig • WS Addressing, WS-I • TLS, X.509

Aged 18 and older

* Also Swiss, Norwegian, Turkish

HCP organizations registry

Imaging studies

IHE

IH

E

XD

S-I

Pharmacies registry

Prescriptions Renewals

Logs

Logs

HL7

Me

dic

al R

eco

rds

Inte

rfac

es


Main Standards and Specifications (National Use)

HL7 v3

– CDA R2

– Messaging

– Medical Records

DICOM

– KVARKKI

IHE profiles in epSOS and KVARKKI

– Some experience on XDS.b, XDS-I.b, XCA, XCA-I, XCPD, XDR, CT, ATNA

Various general purpose ICT standards

– W3 XML Digital Signature

– SOAP v1.1

– TLS, x.509 certificate infrastructure, ISO 7816-* smart cards

– ISO OID

National code server


Testing and Approval for KanTa Production

National test cases / patient stories exist and are continuously

developed for interoperability testing

Kela is responsible for organizing interoperability testing with HIS

and pharmacy system vendors

Approval for production use also requires deployment testing as well

as audit/certification of the HIS/pharmacy system, the organization

joining KanTa services as well as the third parties acting as message

brokers or in similar roles

Development of validation rules and test tools


PHARMACY DOCTOR

PATIENT

eVIEW

PRESCRIPTION CENTER

ePrescription

National Prescription centre • ePrescriptions sent by local

EHR-systems

• Information of medicine

dispensed in pharmacies

• Viewing allowed with

patient’s consent

Implementation nearly 100 % • Pharmacies OK

• Public sector OK

• Private sector 70 %

Appr 70% of all prescriptions are

ePrescriptions

By legislation obligatory • For doctors and pharmacies

• Patients can refuse ePrescription till

31.12.2016

• Obligatory 1.1.2017


Act on Electronic Prescriptions

The Act on Electronic Prescriptions mandates the adoption of

the ePrescription system for pharmacies, for health care units

and for doctors and dentists practicing on the premises of a

health care unit.

The purpose of the Act on Electronic Prescriptions is to improve

patient and drug safety and to facilitate and streamline the

prescription and dispensing of pharmaceuticals.

The adoption is voluntary for health care units in the Åland

Islands and for doctors and dentists not practicing on the

premises of a health care unit.

Adoption will be mandatory 1.1.2017


All prescriptions electronic

All prescriptions shall be written in an electronic format

1.1.2017

– Also applies to practices of self-employed persons, prescriptions

written in social welfare, the Åland Islands and prescriptions

written by physicians during their “free time”

In exceptional situations, a paper or telephone

prescription can also be accepted

– Technical disruption at health care facility or at the pharmacy

– Emergency situatíons

– Pharmacy dispencing the medication is obligated to record the

paper/telephone prescription into the prescription centre

– Completeness of information in the prescription centre ensured


Data security

Prescription data and patient records are sensitive medical

information. The KanTa services allow the information to be

handled confidentially and securely.

All communication of data between health care providers,

pharmacies, the electronic archive of patient records, and the

Prescription Centre is encrypted between authenticated users.

All users of the Prescription Centre and the electronic archive of

patient records must pass an identity check based on a strong

authentication scheme.


The Prescription Centre is accessible to doctors, dentists,

pharmacists, qualified students and nurses with a professional

card issued by Population Register Centre (PRC), and access

rights to the Prescription Centre appropriate to their

professional duties.

Access to the information requires an existing treatment or

patient relationship and usually the patient’s consent.

Electronic signatures are used to verify the signer’s identity

and that the information has not changed during transmission

or storage.

Data security

http://fineid.fi/?site=10


Monitoring of information processing

Privacy protection and the legality of the information processing

are monitored by the health care organisations, pharmacies

and Kela.

To enable retrospective checks, log files are kept about the use

and release of data.

Health care providers and pharmacies must designate staff to

serve in a monitoring and follow-up capacity and ensure that all

staff members receive sufficient training in data security.


Patients can check how their personal

information is used

Patients can check the use and release of their personal health

information.

Through the eAccess portal, patients can monitor which

organisations access or process their personal information and

to which organisations the information is released.

Patients can also request the register authority to detail who

have accessed and processed the data.

https://www.kanta.fi/web/en/26


Log files


Risks

Specifications – clear enough?

Timetables – software development and implementation?

Usability issues?

Acceptance of structured documentation?

Answers

Clear testing plan and implementation plan

Co-operation with users and vendors

Guidelines and training


User’s perspective - doctor

ePrescription is readable, it can always be found and

it can not be falsified

All medication can be seen – more time to patient

and less time to document searching

ePrescription is faster, no phone prescriptions

All patient’s medication can be seen -> patient

safety is increased

eAccess possibilities – patient empowerment


User’s perspective / doctor

Technology and software works (at least not worse

than normal healthcare software)

Tools for co-operation between primary and

secondary care and pharmacies

” A huge step exactly to right direction”


User perspective – IT-management

Good action plan and schedule

Good national guidelines – but more and more are needed

Do we have enough money and enough time?

New ways of co-operation

New services have been useful – and more use is to be

expected

Acceptance and use of national services and national

specifications is growing

Culture of project work

Understanding and implementing the importance of

data safety

Importance of national architecture


eArchive

Patient information - national EHR

First phase: medical notes, lab results, rad reports, dg, procedures, medical

risks, nursing information, treatment plan

Log data

Central datawarehouse

• Data produced by local EHR and special systems

• Connections via public internet (high demands for data security)

• Standardization of information and data transfer

• Viewing possible with patients consent

Functions

• Information exchange

• Long term electronic archive

• Datawarehouse for research and health care policy work


eVIEW for citizens

View of information

• Information in eArchive and Prescription centre

• Patient centric core information

• Log information

Active participation

• Consent and denials

• Advanced directives (f.ex living will )

Implemented for Prescription centre and eArchive

• For adults >18 yrs

• Acces via Internet

• Authentication by eBanking identification or electronical ID card

• Logins 215 000 /month


Recent ICT / eHealth developments in Finland

Whole Finland is (soon) connected to national ICT services,

production use increases, Kanta EHR service grows content wise

(e.g. dental records, imaging)

– Kanta: ePrescription, sharing/archive of EHR, patient access

National service oriented architecture

– collaboration with Estonia

Biobank legislation

– 5+1 large biobanks

Renewal of EHR systems and other health/hospital/patient access

systems is moving forward

Enterprise architecture: national and regional work on-going

New strategy for information management and ICT

National genome strategy is under preparation


eHealth and eSocial strategy 2020 -

Knowledge to support

wellbeing and reformed services


1. CITIZEN - ”YES I CAN!”

2. PROFESSIONAL -

”CAPABLE USERS AND

SMART SYSTEMS”

3. SERVICE SYSTEM -

”REASONABLE USE OF

DIMINISHING RESOURCES”

4. SOCIETY -

”KNOW BEFORE

LEADING!”

• Luotettava hyvinvointitieto

auttaa kansalaista

elämänhallinnassa

• Palveluiden laatu- ja

saatavuustieto auttaa

kansalaista palvelujen

valinnassa

• Kansalainen voi hyödyntää ja

päättää itseään koskevien

tietojen käytöstä

lainsäädännön

määrittelemissä rajoissa

• Kansalaisella on mahdollisuus

tuottaa itse tietoa sähköisesti

omaan ja sote-ammattilaisten

käyttöön

• Sosiaali- ja terveydenhuollon

ammattilaisilla on

käytössään työtä tukevat

tietojärjestelmät sekä

riittävät ja toimintavarmat

tiedonsiirto-yhteydet

• Palvelujen saatavuutta ja

esteettömyyttä parannetaan

sähköisten ratkaisujen avulla

• Sosiaali- ja terveydenhuollon

tiedot ovat käytössä riippumatta

organisaatiorakenteiden,

palveluiden ja tietojärjestelmien

muutoksista

• Sähköisen tiedonhallinnan

ratkaisut lisäävät

palvelujärjestelmän

vaikuttavuutta ja

kustannustehokkuutta

• Tietoaineistot tukevat

reaaliaikaisesti

yhteiskunnallista

päätöksentekoa sekä

tutkimus- ja

innovaatiotoimintaa

• Vaikuttavien,

kustannustehokkaide

n ja laadukkaiden

toimintamallien ja niitä

tukevien sähköisten

välineiden levittämistä

ja vaikuttavuuden

arviointia ohjataan

kansallisesti ja

alueellisesti

5.INFOSTRUCTURE: ”Solid base for development”

• monikanavaiset ja mobiilit

palvelut tavoitettavuuden ja

liikkuvuuden tukena

• luotettava ja koeteltu tietoturva

ja tietosuoja

• palvelu-, laatu- ja

saatavuustiedot avoimesti

saataville

Toimiva tuotanto:

• luotettavat ja riittävät

tietoliikenneyhteydet

• Kansalliset sote-

tietovarannot kattavasti

käytössä

• tietojen valtakunnallinen

yhtenäisyys ja tiedonkulku

• tietojärjestelmien alueellinen

yhtenäisyys ja kansallinen

yhteistyö

• innovatiiviset hankinnat

kehittämisessä, konsolidointi ja

laaja hankintayhteistyö

levittämisessä

• Luodaan kansallinen

infostruktuuri

• modulaarinen ja joustava

palveluarkkitehtuuri

• Yhteentoimivuus

kansainvälisten

standardien kautta

• kehittämisen

palveluekosysteemit

Vision: Wellbeing, health and service information is in good use, social and health

services are renewed to be citizen centric and cost effective

• Reliable info

• Power to choose and

information to support

choices

• Ownership of data

• Capability to use and

create health data

• National PHR

• ICT supports work

processes

• Usability

• DSS

• Better accessibility and

availablity of data

through eServices

• Information independent

of organization

structures

• eHealth increases

effectiveness and

reduces costs

• Data is in

realtime use for

decisions,

research and

innovation

• Big data

• Multichannel services

• mHealth

• Interoperability

• HL7, IHE, Continua

• National ICT services

• Regional unification and national

specifications

• Flexible SOA

• Ecosystems for development


[email protected]

Questions?