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Healthcare Digitalization: The ePrescription system in Finland


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The healthcare sector, as a combination of the private and public sector, experienced various changes with the introduction of information systems. ePrescriptions are expected to save €35 million of taxpayers' money annually in Finland.It has been estimated that ePrescriptions and eRecords for healthcare together will bring €180 million in savings annually. Big savings and benefits in patient safety and quality improvements are expected. ePrescription is a part of KanTa services. KanTa is the nationwide healthcare information archive, which consists of three services: the national ePrescription system, the national EHR archive (eArchive) and the web application that provides a view of citizen´s prescription information and patient records (OmaKanTa).


Ms. Maritta Korhonen (Ministry of Social Affairs and Health, Finland)

Published in: Technology

Healthcare Digitalization: The ePrescription system in Finland

  1. 1. Trust, social commitment , and quality Fujitsu Forum 2014 ICM Munich 19th – 20th November Human Centric Innovation
  2. 2. Trust, social commitment , and quality Healthcare digitalisation ePrescription system in Finland Maritta Korhonen Head of Development Ministry of Social Affairs and Health
  3. 3. Healthcare digitalisation ePrescription system in Finland Maritta Korhonen Head of Development Ministry of Social Affairs and Health
  4. 4. Maritta Korhonen 4 14.11.2014 Agenda Finnish healthcare system – on-going & upcoming reforms ePrescription National eHealth strategy
  5. 5. Maritta Korhonen 5 14.11.2014 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
  6. 6. 6 14.11.2014 Maritta Korhonen Population 1970 Population 2007
  7. 7. Maritta Korhonen 7 14.11.2014 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
  8. 8. Maritta Korhonen 8 14.11.2014 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
  9. 9. Maritta Korhonen 9 14.11.2014 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
  10. 10. Maritta Korhonen 11 14.11.2014 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 eAccess 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 epSOS NCP 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 IHE XDS-I Pharmacies registry Prescriptions Renewals Logs Logs HL7 Medical Records Interfaces
  11. 11. Maritta Korhonen 12 14.11.2014 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
  12. 12. Maritta Korhonen 13 14.11.2014 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
  13. 13. Maritta Korhonen 14 14.11.2014 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
  14. 14. Maritta Korhonen 15 14.11.2014 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
  15. 15. Maritta Korhonen 16 14.11.2014 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
  16. 16. Maritta Korhonen 17 14.11.2014 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.
  17. 17. Maritta Korhonen 18 14.11.2014 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
  18. 18. Maritta Korhonen 19 14.11.2014 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.
  19. 19. Maritta Korhonen 20 14.11.2014 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.
  20. 20. Maritta Korhonen 21 14.11.2014 Log files
  21. 21. Maritta Korhonen 22 14.11.2014 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
  22. 22. Maritta Korhonen 23 14.11.2014 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
  23. 23. Maritta Korhonen 24 14.11.2014 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”
  24. 24. Maritta Korhonen 25 14.11.2014 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
  25. 25. Maritta Korhonen 26 14.11.2014 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
  26. 26. Maritta Korhonen 27 14.11.2014 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
  27. 27. Maritta Korhonen 28 14.11.2014 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
  28. 28. Maritta Korhonen 29 14.11.2014 eHealth and eSocial strategy 2020 - Knowledge to support wellbeing and reformed services
  29. 29. Maritta Korhonen 30 14.11.2014 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, kustannustehokkaiden 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
  30. 30. Maritta Korhonen 31 14.11.2014 Questions?