Mr. ulf jacobsson

1

Stockholm County Council

2005-02-24

Health Care IT in Stockholm


http://www.sll.se

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2005-02-24

Agenda

• The Stockholm County Council (SLL)• The Future Healthcare Structure for SLL• Driving forces behind the IT strategy• Current use of Information Technology• IT resources within the County Council• Where are we Going?• Q&A´s

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2005-02-24


4% 80 years and older

11% 65 –79 years 22% 0 –17 years

39%18 – 44 years

24% 45 – 64 years

POPULATION ACCORDING TO AGE

Comprises the whole of Stockholm County

Has 1.8 million inhabitants

Geographical area includes 26 municipalities

6,500 km2

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2005-02-24

The County Council Assembly

DISTRIBUTION OF SEATS 2003-2006

Green party 7Left party 14

Moderates 37

ChristianDemocrats 11

SocialDemocrats 54

Liberals 26

The Council ’s political decision-making body

149 members

Elected every four years at the sametime as national MPs

Appoints committees and boards

Decisions on Policy (e.g. IT policy)

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2005-02-24

5,5 billion euros turnover

INCOME 2003 EXPENDITURE 2003

Council tax rate 10.32% and rising

The County Council Assembly decides the tax rate

Health and medical care accounts for 71% of turnover

Other sources 10%County council tax

Fees and fares 11% 67%

State subsidies 12%

Public transport 22%

Health andMedical Care 71% Miscellaneous 4%

Dental Care 3%

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2005-02-24

Financing of Health Care 2002

Local taxes

Government funding

Other funds

Patient feesPrivate

insurance

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2005-02-24

Every day

22,000 people visit a doctor

7,000 are admitted to hospital

60 babies are born

500 undergo an operation

11 heart attacks are treated

More than 1,000,000 journeys on theSL public transport system

6,000 are treated by the Public Dental Services (free service for under 19s)

11,000 journeys are carried out by theTransportation of the Disabled Services

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2005-02-24

Geriatric care

The municipalities and the CountyCouncil cooperate to give the elderlythe best quality care

Psychiatric careOutpatient care and mobile teams help the mentally ill to function better in society

The child and adolescent psychiatric careservices offer treatment to children andyoung people under 18 years of age

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2005-02-24

Dental care

Free dental care for everyoneup to the age of 19

Individual child dental care allocationsmean freedom of choice

THE PUBLIC DENTAL SERVICESTreat 400,000 children and adults every yearWork to improve the long-term dentalhealth of the county ’s inhabitants

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2005-02-24

SL publictransport byroad and rail

Storstockholms Lokaltrafik (StockholmTransport), SL, is responsible for thepublic transport services on thecounty’s roads and railways

Each day, over 1 million people makeuse of the public transport networkon the buses, underground, commuterand local trains

400 km of track in total

and water

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2005-02-24

Transportationof the DisabledServices

For people who for medical reasonsare unable to use public transport

Journeys are carried out by taxisor special vehicles

About 3.5 million journeys arecarried out each year

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2005-02-24

Healthcare in Stockholm

University hospitals General hospitals Local hospitals

Primary care - 170 local community centres (of which 60% are private) includesPsychiatry and Geriatrics

2500 private specialist doctors

4 laboratories – 2 private

Central administration – 2 roles: Contracting/Financing and Care Providers

Karolinska University hospital- Solna- Huddinge

S:t Eriks Eye hospital AB

Södersjukhuset hospital

Norrtälje hospital

Södertälje hospital

Danderyd hospital

S:t Görans hospital AB*

Ersta hospital*

Sophiahemmet*

Dalens hospital*

Jakobsbergs hospital*

Nacka hospital*

Löwenströmska hospital*

Sabbatsbergs hospital*

* Operated by private contractors

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2005-02-24

3S New Healthcare Structure for Stockholm

3S

Stockholms SjukvårdsStruktur

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2005-02-24

The current situation Computerised islands for EMR

Melior BMS Swedestar Take Care

Obstetrix ProfDoc Medidoc InfoMedix

Pasett VAS PVS Alfa

Biosis Cambio Sigma Patient 2000

m.fl.

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2005-02-24

Central Administrative Systems

• Financial and HR systems– Raindance (WM Data) + 6 others– Palett

• Reporting systems (c:a 30 applications)– Developed since 1970's – ancient architecture and lacking in flexibility– Mix of mainframe, Unix and Microsoft– All visits registered since 1980

• ICD 9/10 coded, DRG, visit type coding, unit, financial data– Data warehouse (SAS)– Cost per patient– Drug cost analysis– Invoice handling

• Contract and Payment systems (DRG-based)

– Internal purchasing of care; contracts with ALL care organisations

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2005-02-24

More central administrative systems

• Lotus Domino– E-mail, calendar etc– New functions to be developed (process support)

• Electronic Catalogue (X500)• E-business

– Purchasing drugs, food, accessories

• Others– Waiting times for operations, visits etc– Order systems for patient transport– Population database

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2005-02-24

Central healthcare systems• Drugs

– Evidence based medicine database– E-prescribing (EDI to Apoteket –State Pharmacy)– Component to CPR for checking for interaction and adverse effects

• Vårdguiden (Patient care portal)– Information– “My care contacts” with PKI

• Booking a visit with a GP• Renewing a prescription• Self-care (Medical record registration)

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2005-02-24

IT organisation

Also SL (Public transportation), Waxholms bolag (Boats), Transport for the disabled, Regional planning, Dental Care, Internal Auditors……

S:t Eriks Eye hospital AB(5 FTE)

Karolinska University hospital(350 FTE)

University hospitalsSouthern hospital AB (65 FTE)

Norrtälje hospital AB (5 FTE)

Södertälje hospital (12 FTE)

Danderyds hospital AB (60 FTE)

S:t Görans hospital AB* (5 FTE)

Ersta hospital* (7 FTE)

Sophiahemmet* (3 FTE)

General hospitals Primary care (120+FTE)

4 labs (10)

Central admin (40+FTE)

About 625 FTEs

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2005-02-24

InfrastructureSLL Net

Löwenströmska

Jakobsberg

TäbyRinkeby

Vällingby AlvikGärdet

Nacka

Enskede

LiljeholmenSkärholmen

Tumba Haninge

Nynäshamn

Sollentuna

Danderyd

Sabbatsberg

Huddinge

SöS

Karolinska

S:t Göran

Södertälje

Norrtälje

University or general hosp.

Local hospitalsFibre, 1Gb/sFibre, 155 Mb/s+ 600 ADSL lines

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2005-02-24

The challenges

Increase patient safety

Reduce waste

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2005-02-24

To err is human….Institute of Medicine, USA 2000

• When extrapolated to the over 33.6 million admissions to U.S. hospitals in 1997, the results of the study imply that at least 44,000 Americans die each year as a result of medical errors…..……..the number may be as high as 98,000

• Up to 35% of all care costs are due to errors performed earlier in the care process.

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2005-02-24

Crossing the Quality ChasmInstitute of Medicine, USA 2001

6 aims of improvement1. Safe - Avoiding injuries to patients from the care that is intended to help2. Effective - Providing services based on scientific knowledge3. Patient-centred - Providing care that is respectful and responsive to

individual patient preferences4. Timely - Reducing harmful delays5. Efficient - Avoiding waste6. Equitable - Providing care that does not vary in quality

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2005-02-24

10 rules of Redesign

1. Care is based on continuous healing relationships2. Care is customized according to patient needs and values3. The patient is the source of control4. Knowledge is shared and information flows freely5. Decision making is evidence-based6. Safety is a system property7. Transparency is necessary8. Needs are anticipated9. Waste is continuously decreased10.Co-operation among clinicians is a priority

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2005-02-24

35% of healthcare in Stockholm……………………………..….is 1,2bn euros

1800 people died in 2001 in Sweden because of reported medical errors

source Socialstyrelsen

- 360 in Stockholm?

Applied to Stockholm

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2005-02-24

Is there a cure?

• Gartner believes that a computer-based patient record (CPR) system represents the only effective approach by care delivery organizations to automate their clinical processes and move toward a real-time enterprise (RTE) mode of operation that can support incremental medical error reduction. Gartner has estimated that

"the implementation of CPR systems can lead to a 70 percent reduction in the incidence of preventable medical errors"

Gartner Research July 2003

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2005-02-24

Step 1:Access to relevant information

…..which supports the care process

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2005-02-24

Stockholm's goal

• Patient centred common lifetime medical record• Active self care by the patient (The Internet Patient)• Effective care process support

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2005-02-24

Architecture for common information storage and access

PortalPortal

Common application services/business objectsCommon application services/business objects

Lab listLab listVisit HistoryVisit History

ImagesImagesDrug listDrug list

Medical notesMedical notes

X-ray listX-ray list

OrdersOrders

Patient payments

Patient payments

Identity

Accesscontrol

Authentication and PKI

Content

Single Sign-on/Sign off

Support services

Log

Care relations.

Patientagreement

Context Archiving

CDR

Data storage HISA

Data servicesData services

APPLICATIONS

Responsible for supporting the useractivities in the various areas of

the organisation

Medical care

Nursing .............

Diagnostics

Administration

GENERIC

Responsible forsupporting genericrequirements, not

specific to thehealthcare domain

HEALTHCARE-RELATEDResponsible for supporting functionalities and information

relevant for the whole healthcare organisation

Authoris-ations

Subjectsof

careHealth

data Activities ResourcesConcepts

andterminology .......

Middleware of common services

BITWAYS Providing facilities for the integration andinterworking of the technological environments

Reports Research

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2005-02-24

But how and when?….

• Plan– 2003-5 (Putting core infrastructure in place)

• Procurement of data storage, Portal and Access control• Development of common information model• Integration of EMR/PAS-system• Acceptance and test

– 2005-6 (Common electronic health record established)• All care support systems will be integrated or closed down• Development of new common functions and services

– 2007 (EHR aware applications and services in use) • Enhancement of common information model

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2005-02-24

Challenges

• Legal aspects– Concerns about patient integrity– Multiple laws covering secrecy, integrity, healthcare records, etc

• Performance• Reliability

– “Single point of failure”– Network

• Better Access control / security• Information model

– Terminology– Field content (semantics)

• Implementation– Training of 30.000+ users– Existing EMR’s

• Involving patients, the medical professions and politicians

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2005-02-24

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2005-02-24

Stockholm County Council Objectives

Modernization of the health care delivery structure

Reduction of production capacity

Introduction of region wide integrated electronic health care records (EHR) service (Based on European CEN standard health care information architecture – HISA)

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2005-02-24

Reduce errors in health care delivery

Improve clinical outcomes

Ensure that the “right” services are delivered at the “right” time

Minimise delivery of unnecessary care

Improve the continuity of care

Reduce unwanted variation in health care practices

Better meet the expectations of patients and consumers

Opportunities to increase health system effectiveness (OECD)

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2005-02-24

The Stockholm “eHealth Vårdguiden” – concept

• Guidance, secure communication and access to health information via the Internet (www.vardguiden.se)

• Telephone guidance services (08 - 320 100)(Personal health advice by nurses or consumer health care information from the same sources as the Internet portal )

• The Health Care Guide Magazine (a tabloid to all households and health care units, edition 940 000)

Over 70% of the population know of the “Vårdguiden Health Care Guide”The web-site has 200.000 + visitors per month and 40 000 + via phone

More than 10 000 use the secure messaging services

Health care guidance ….

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2005-02-24

GVDIntegrated Care Records Service

Patient to Doctor/NurseDoctor to Doctor Patient to Patient

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Mr. ulf jacobsson

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