Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                    Päivi Hämäläinen Unit for eHealth and eWelfare                        ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
How to get the core data structuresKnowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
Government decision 2006 and theUnit for eHealth and eWelfare Knowledge for welfare and health     Päivi Hämäläinen curren...
Knowledge for welfare and health                  Päivi Hämäläinen Unit for eHealth and eWelfare                          ...
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Shareing experiences in eHealth development.

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Päivi Hämäläinen, Head of STAKES Unit for eHealth and eWelfare STAKES: National Research and Development Centre for Welfare and Health. Finland

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Shareing experiences in eHealth development.

  1. 1. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 1 Sharing experiences in eHealth development The case Finland Päivi Hämäläinen MD, PhD, MA Head of Unit for eHealth and eWelfare, Stakes, Finland National Research and Development Centre for Welfare and Health 13.10.2006
  2. 2. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 2 The electronic health record, the idea of a patient summary and the new legislation in Finland • EHR deployment situation in Finland •The history of the EHR (structures) • EHR policy/strategy • Core data • Finnish patient summary • The new eHealth legislation of Finland National Research and Development Centre for Welfare and Health 13.10.2006
  3. 3. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 3 2005General practitioners work in health care centres (270). EHR in 95,6 % ofThe number of gp´s using electronic patient records health centres .is high. The main way of recording patient18/21 Hospital Districts of data in 99,4 %Finland have EPR: The use of EHR covers evenly of themthe departments of conservative,operative, and psychiatric treatment 2003 in use, but planned not (9) piloting EHRuse 93,6% of (419) in (4) in health care centres in use (18) Genimap Oy National Research and Development Centre for Welfare and Health 13.10.2006
  4. 4. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 4 The current regional networks for exchange of electronic patient Patient information flow information between organisations in the end of 2005 (% of organisations) 100 80 60 40 20 0 Patient record Images Laboratory Hospitals Health centres planning(6) Information is exchanged also piloting (3) outside to regional networks in in use (11) bilateral set ups. Genimap Oy National Research and Development Centre for Welfare and Health 13.10.2006
  5. 5. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 5History of the Finnish EHR 1. In the 1980´s The Association of Local and Regional Authorities designed a set of paper health records for primary care and specialized care and they became widely used. The idea was that there is always a continuity of the document on the next visit to the same organization (life long history). In the different clinics of each hospital the pages had the same structure but with stripes of different colours. Laboratory, x-ray etc pages were shared. GP file became to be always life long within the same health care centre. The "look" and the structure was transferred directly to several products first of EPRs. The municipalities have a strong decision-making power in arranging services, which includes also the utilization of information and communication technology (ICT). As a result of this the ICT utilization and the choice of EHR products has varied between municipalities and organizations. National Research and Development Centre for Welfare and Health 13.10.2006
  6. 6. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 6History of the Finnish EHR 2. Finland became a country with lots of (one-organization) EHR´s that have common looks and elements but no interoperability for exchange of information between organizations. When bilateral and regional networking became technically possible, the organizations and regions started to define common structures of e-documents for the exchange (PACS, eReferral. eDischarge letter, eLab results) on local levels. Also, when building information networks became technically available, a government supported project (Makropilotti) established ways to read the EHRs of an other organization (with patient consent) National Research and Development Centre for Welfare and Health 13.10.2006
  7. 7. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 7 In 2002 the government saw that promoting a more advanced use of EHR´s could be used as a tool in securing the future of health care (a wide health care program) The Decision in Principle by the Council of State on securing the future of health care, given 11.4.2002”Nationwide electronic patient records will be introduced…by the end of 2007”The National Health Project, The EPR project is one of themain projects; Ministry of Social Affairs and Health; apreparatory working group 2003-2004, an implementingworking group 2005-2007, budget for national levelplanning/implementation 800 000 euros/year 2003-07>Regional implementation, state funding circa 10 milj eurosyearly 2004 - 2005 and 5 milj 2006 and 15 milj expected 2007. National Research and Development Centre for Welfare and Health 13.10.2006
  8. 8. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 8The EHR strategy defines the common semantic andtechnical structure that should be used in every EPRsystem in all organisations (includes core data, codes,interoperability standards)1. Core data, code server (semantic interoperability)2. Open standards for interoperability (xml-based HL7 CDA R2-standards)3. National guidelines for data safeguarding (informed consent, secure archiving, e-signature, identification of patients, documents, professionals and organizations by ISO/OID-standard, PKI architecture) National Research and Development Centre for Welfare and Health 13.10.2006
  9. 9. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 9 Core data elements Ydintiedot Identification Clinical data Hoitoprosessin tiedot Tunnistetiedot Patient Potilas Problems ja Ongelmat and Functional cap. Toimintakyky diagnoses diagnoosit Investigations Tutkimukset Care giver Hoidon antaja Physiological Fysiologiset measurements mittaukset Operations Toimenpiteet Care context: Hoitojakso, - tapahtumacare Process of Nursing data Hoitotyö Medication Lääkitys taiEtc. palveluketju Summary Yhteenveto Devices Apuvälineet Terveyteen Health hazards vaikuttavat tekijät Other data Muut tiedot Elinluovutus - Lausunnot Medical Jatkohoitoa Organ donor will Treatment plan testamentti ja todistukset certificates koskevat tiedot Suostumus Agree to move data Treatment Hoitotahto willFrom Dr. J KomulainenUniversity of Kuopio 1.2. 2006 National Research and Development Centre for Welfare and Health 13.10.2006
  10. 10. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 10 Core data elements are located inside medical documents. Core data can be extracted from these documents, for example to produce various listings: Diagnoses Medications Risk data Core data can be “recycled” to be included in new documents, for example referrals, doctor’s orders and medical certificates.From Dr. J KomulainenUniversity of Kuopio 1.2. 2006 National Research and Development Centre for Welfare and Health 13.10.2006
  11. 11. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 11 The place in the structured document and/or the structure of the code are designed so that the computers understand that the data is "core" data and what kind of "core" data it is National Research and Development Centre for Welfare and Health 13.10.2006
  12. 12. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 12 Structure of the document with HL7-CDA R2 Piia Potilas allergy ccc discharge : HL7-CDA R2 010150-xxxx blood type ab xxxx Southern hospital Dermatology clinic referred from GP texttexttexttexttexttexttext ePrescription HL7-CDA R2 texttexttexttexttexttexttext texttexttexttexttexttexttext texttexttexttexttexttexttext lab cgh fbg yhg procedure xxc-234 dg ICD-10 medicine dfg ghj Decision support warning system National Research and Development Centre for Welfare and Health 13.10.2006
  13. 13. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 13 Patient care Clinical Decision support Scientific research Core data Statistics elements Quality Administration assessmentFrom Dr. J KomulainenUniversity of Kuopio 1.2. 2006 National Research and Development Centre for Welfare and Health 13.10.2006
  14. 14. How to get the core data structuresKnowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 14 in to all the EHR systems (products) ? a national code server has been established the code server stores all the common (= official versions) of different core data elements (semantics): classifications, codes , HL7-structures, terminology the electronic patient record products take the codes in to their products from the server (updates 1-2/year) taking the codes is free of charge and the code server (and the classification work befind it) is supported by the Ministry of Health and Social Affairs National Research and Development Centre for Welfare and Health 13.10.2006
  15. 15. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 15 National Research and Development Centre for Welfare and Health 13.10.2006
  16. 16. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 16 CodeServer National Research and Development Centre for Welfare and Health 13.10.2006
  17. 17. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 17 How can we make physicians and other professionals use codes? Finnish Medical Society Duodecim has produced, together with clinicians, a large amount of synonyms that make it possible for the professionals to use their "every day" wordings and they do not have to remember the codes, just put the information on the right field in the "page" of the structured EHR The computer will be able to handle the structured information National Research and Development Centre for Welfare and Health 13.10.2006
  18. 18. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 18How is the EHR idea implemented today andhow far away from the vision are we in Finland ? 1. The project for common structures of the EPR was started in 2003 and is funded by the ministry and lead by the Association of Local and Regional Authorities 2. ”The minimum data set” or “core data” was defined in co-operation with different interest-groups (professionals, administration, software- enterprises), also publicly available for comments through internet, finalised and published in 2004. 3. Implementation into existing EPR-systems in pilot organizations is happening. 7 regional projects have formed clusters with software enterprises and the work is coordinated by the Association and the ministry. All major vendors are participating. Some of the elements have all ready been put in to products that are currently in testing phases and more will start running soon. MoH has promised to support projects after 2007 up to 2009. National Research and Development Centre for Welfare and Health 13.10.2006
  19. 19. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 19How is the idea implemented and how far awayfrom the vision are we in Finland ?4. More specifications for certain specialities are worked up on (occupationalhealth care, psychiatry, dental care, child and school health care, nursing,emergency care)5. Staff training to use to core data and the newer version of EHR products isongoing6. HL7 has made structures of several main documents, and they have beenaccepted in several products.7. The code server was built in 2003-2004 and has been providing the maincodes since 2004. In production ICD-10, Nordic codes for surgical procedures,national codes for laboratory tests and x-ray procedures, main HL7 documentstructures, some statistical codes. In addition a long list of other codes are givenout from the code server for testing/piloting.8. A study has been made on what codes are still missing from the list of definedcore data. Preparations to have the synonyms available together with the codeshas been started. National Research and Development Centre for Welfare and Health 13.10.2006
  20. 20. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare HL7 structure of 20 The patient summary xxBBxx summary BB xxAAxx AA in the Finnish concept? xxCCxx CC It would be done by marking the chosen "core" patient data as "summary data". When you would open the file in the "summary mode" only this marked data would be shown. Some of the regions have a set of "summary type" data in their regional spine-systems. Finland starts to build the national EHR archive next year. The national needs for creating a special patient summary will then come up, but the main idea is to share full documents. The over all structures of Finnish EHR:s and the way the information is organized are rather common and the archive system will give access to all main documents, so it is possible that there is no national need for a summary in the form that it is planned/used in many other countries. Discharge letters are all ready available and in wide electronic use. National Research and Development Centre for Welfare and Health 13.10.2006
  21. 21. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 21 Is European/international work needed?Yes,if we want to have a summary for(international) patient data exchangesituations, we still need to define together withother countries which data is the patientsummary data that should be included inthese situations of international collaborationon different care setups.Medical expertise from true clinical situations,"business cases" should be the driver in theprocess of defining the data set for National Research and Development Centre for Welfare and Health 13.10.2006
  22. 22. Government decision 2006 and theUnit for eHealth and eWelfare Knowledge for welfare and health Päivi Hämäläinen current 22policy; The national digital archive of (life long) patient documents One connectivity centre and exchange of data via the archive Citizens to have access (log+ health data) The National Social Insurance Institute (Kela) will provide the archive system National PKI system for professionals by the National Authority for medicolegal Affairs (TEO) National code server located at Kela, content by Stakes Legislation in effect 1.7. 2007, also for the ePrescription System to be built by 2011 Stronger steering role by the Ministry, close co-operation with Kela, TEO, Stakes and a permanent national advisory board nominated by government There is funding for 2007, planning and defining has started, call openResearch and Development Centre for Welfare and Health National 13.10.2006
  23. 23. Knowledge for welfare and health Päivi Hämäläinen Unit for eHealth and eWelfare 23Thank you for yourattention! correspondence; paivi.hamalainen@stakes.fi STAKES Unit for eHealth and eWelfare Helsinki, Finland National Research and Development Centre for Welfare and Health 13.10.2006

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