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III JORNADA, "Models per cooperar"

III JORNADA, "Models per cooperar"


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  • 1. Health Care IT in StockholmStockholm County Council Stockholm County Council http://www.sll.se 2005-02-24 1
  • 2. AgendaStockholm County Council • 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 2005-02-24 2
  • 3. Stockholm County Council Stockholm County Council Comprises the whole of Stockholm County Has 1.8 million inhabitants Geographical area includes 26 municipalities 6,500 km2 4% 80 years and older 11% 65 –79 years 22% 0 –17 years 24% 45 – 64 years 39%18 – 44 years POPULATION ACCORDING TO AGE 2005-02-24 3
  • 4. Stockholm County Council The County Council Assembly The Council ’s political decision-making body 149 members Elected every four years at the same time as national MPs Appoints committees and boards Decisions on Policy (e.g. IT policy) Green party 7 Left party 14 Moderates 37 Social Democrats 54 Christian Liberals 26 Democrats 11 DISTRIBUTION OF SEATS 2003-2006 2005-02-24 4
  • 5. 5,5 billion euros turnoverStockholm County Council Council tax rate 10.32% and rising The County Council Assembly decides the tax rate Health and medical care accounts for 71% of turnover Public transport 22% Other sources 10% County council tax Fees and fares 11% 67% State subsidies 12% Health and Medical Care 71% Miscellaneous 4% Dental Care 3% INCOME 2003 EXPENDITURE 2003 2005-02-24 5
  • 6. Stockholm County Council Financing of Health Care 2002 Private Patient fees insurance Other funds Government funding Local taxes 2005-02-24 6
  • 7. Stockholm County Council 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 the SL public transport system 6,000 are treated by the Public Dental Services (free service for under 19s) 11,000 journeys are carried out by the Transportation of the Disabled Services 2005-02-24 7
  • 8. Stockholm County Council Geriatric care The municipalities and the County Council cooperate to give the elderly the best quality care Psychiatric care Outpatient care and mobile teams help the mentally ill to function better in society The child and adolescent psychiatric care services offer treatment to children and young people under 18 years of age 2005-02-24 8
  • 9. Stockholm County Council Dental care Free dental care for everyone up to the age of 19 Individual child dental care allocations mean freedom of choice THE PUBLIC DENTAL SERVICES Treat 400,000 children and adults every year Work to improve the long-term dental health of the county ’s inhabitants 2005-02-24 9
  • 10. Stockholm County Council SL public transport by road and rail Storstockholms Lokaltrafik (Stockholm Transport), SL, is responsible for the public transport services on the county’s roads and railways Each day, over 1 million people make use of the public transport network on the buses, underground, commuter and local trains 400 km of track in total and water 2005-02-24 10
  • 11. Stockholm County Council Transportation of the Disabled Services For people who for medical reasons are unable to use public transport Journeys are carried out by taxis or special vehicles About 3.5 million journeys are carried out each year 2005-02-24 11
  • 12. Stockholm County Council Healthcare in Stockholm University hospitals General hospitals Local hospitals Karolinska University hospital Södersjukhuset hospital Dalens hospital* - Solna - Huddinge Norrtälje hospital Jakobsbergs hospital* S:t Eriks Eye hospital AB Södertälje hospital Nacka hospital* Danderyd hospital Löwenströmska hospital* S:t Görans hospital AB* Sabbatsbergs hospital* Ersta hospital* * Operated by private contractors Sophiahemmet* Primary care - 170 local community centres (of which 60% are private) includes Psychiatry and Geriatrics 2500 private specialist doctors 4 laboratories – 2 private Central administration – 2 roles: Contracting/Financing and Care Providers 2005-02-24 12
  • 13. 3SStockholm County Council New Healthcare Structure for Stockholm 3S Stockholms SjukvårdsStruktur 2005-02-24 13
  • 14. The current situationStockholm County Council Computerised islands for EMR Melior BMS Swedestar Take Care Obstetrix ProfDoc Medidoc InfoMedix Pasett VAS PVS Alfa Biosis Cambio Sigma Patient 2000 m.fl. 2005-02-24 14
  • 15. Stockholm County Council Central Administrative Systems • Financial and HR systems – Raindance (WM Data) + 6 others – Palett • Reporting systems (c:a 30 applications) – Developed since 1970s – 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 2005-02-24 15
  • 16. More central administrative systemsStockholm County Council • 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 2005-02-24 16
  • 17. Stockholm County Council 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) 2005-02-24 17
  • 18. IT organisationStockholm County Council University hospitals General hospitals Primary care (120+FTE) Southern hospital AB (65 FTE) S:t Eriks Eye hospital AB 4 labs (10) (5 FTE) Norrtälje hospital AB (5 FTE) Central admin (40+FTE) Karolinska University hospital Södertälje hospital (12 FTE) (350 FTE) Danderyds hospital AB (60 FTE) S:t Görans hospital AB* (5 FTE) Ersta hospital* (7 FTE) About 625 FTEs Sophiahemmet* (3 FTE) Also SL (Public transportation), Waxholms bolag (Boats), Transport for the disabled, Regional planning, Dental Care, Internal Auditors…… 2005-02-24 18
  • 19. InfrastructureStockholm County Council SLL Net Norrtälje Löwenströmska Jakobsberg Sollentuna Rinkeby Danderyd Karolinska Täby S:t Göran Sabbatsberg Gärdet Vällingby Alvik SöS Liljeholmen Nacka Skärholmen Enskede Tumba Haninge Huddinge University or general hosp. Local hospitals Södertälje Fibre, 1Gb/s Fibre, 155 Mb/s Nynäshamn + 600 ADSL lines 2005-02-24 19
  • 20. The challengesStockholm County Council Increase patient safety Reduce waste 2005-02-24 20
  • 21. To err is human….Stockholm County Council 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. 2005-02-24 21
  • 22. Crossing the Quality ChasmStockholm County Council Institute of Medicine, USA 2001 6 aims of improvement 1. Safe - Avoiding injuries to patients from the care that is intended to help 2. Effective - Providing services based on scientific knowledge 3. Patient-centred - Providing care that is respectful and responsive to individual patient preferences 4. Timely - Reducing harmful delays 5. Efficient - Avoiding waste 6. Equitable - Providing care that does not vary in quality 2005-02-24 22
  • 23. 10 rules of RedesignStockholm County Council 1. Care is based on continuous healing relationships 2. Care is customized according to patient needs and values 3. The patient is the source of control 4. Knowledge is shared and information flows freely 5. Decision making is evidence-based 6. Safety is a system property 7. Transparency is necessary 8. Needs are anticipated 9. Waste is continuously decreased 10. Co-operation among clinicians is a priority 2005-02-24 23
  • 24. Applied to StockholmStockholm County Council 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? 2005-02-24 24
  • 25. Is there a cure?Stockholm County Council • 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 2005-02-24 25
  • 26. Stockholm County Council Step 1:Access to relevant information …..which supports the care process 2005-02-24 26
  • 27. Stockholms goalStockholm County Council • Patient centred common lifetime medical record • Active self care by the patient (The Internet Patient) • Effective care process support 2005-02-24 27
  • 28. Architecture for common informationStockholm County Council storage and access Portal Portal Visit History Visit History Lab list Lab list Medical notes Medical notes Orders Orders Patient Patient Drug list Drug list Images Images X-ray list X-ray list payments payments Common application services/business objects Common application services/business objects Data storage HISA Support services Data services Identity Content Data services Authentication Care and PKI relations. Single Sign- Patient CDR on/Sign off agreement APPLICATIONS Access Log Medical care Diagnostics Responsible for supporting the user Nursing ............. Administration activities in the various areas of the organisation control Middleware of common services GENERIC Context HEALTHCARE-RELATED Responsible for supporting generic requirements, not Responsible for supporting functionalities and information relevant for the whole healthcare organisation Archiving Subjects Concepts specific to the Authoris- of Health Activities Resources and ations care data terminology ....... healthcare domain BITWAYS Providing facilities for the integration and interworking of the technological environments Reports Research 2005-02-24 28
  • 29. But how and when?….Stockholm County Council • 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 2005-02-24 29
  • 30. ChallengesStockholm County Council • 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 2005-02-24 30
  • 31. Stockholm County Council 2005-02-24 31
  • 32. Stockholm County Council 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) 2005-02-24 32
  • 33. Opportunities to increase health systemStockholm County Council effectiveness (OECD) 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 2005-02-24 33
  • 34. Stockholm County Council Health care guidance …. 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 2005-02-24 34
  • 35. Stockholm County Council 2005-02-24 35