Kansallinen yhteentoimivuuspäivä 29.10.2018

1. Nordic council of ministries meeting on interoperability
Copenhagen
 Purpose to figure what the different nordic countries are doing, what are common
themes, lessons learnt and possible areas for collaboration
 Participating countries:
 Denmark
 Finland
 Norway
 Sweden
 Iceland

2. Standards in Norway

3. Standards in use today in Norway
Side 3
CEN pre standards
 Referral, discharge letter and
laboratory messages
HL7 FHIR
 Patients Summary Care Record
 The Personal Connected Health
domain
 The national patient portal
HL7 v2, v3 messaging and CDA
 Within the hospitals
Norwegian standards
 ePrescription
 Messages for nursing and care homes
 Messages to the Norwegian Labour and
Welfare Administration (NAV)
A mix of different standards are in use in Norway today

4. General recommendations
Side 4
Message
exchange
Document
exchange
Document
sharing
Data sharing
Semantic/information
HL7 FHIR √ √ √ √
HL7 v3 messaging √ √
HL7 CDA √ √
openEHR √
infrastructure
IHE XDS √

5. Experiences and assessments
Side 5
Standard Experiences
HL7 FHIR • supports several collaboration models, but not yet normative
• easy to use, FHIR is chosen for new services
• strong need for governance about profiles and extensions
• FHIR documents not so mature (yet)
HL7 v3 • mature standard, but limited development expected
• not recommended for new solutions/interfaces
HL7 CDA • mature standard
• recommended for document-based collaboration and document sharing (for
example IHE XDS)
openEHR • for interoperability openEHR should only be considered for collaboration
between system that already is based on openEHR
IHE XDS • mature infrastructure/architecture for sharing documents
• requires standards for the content (for instance CDA)

6. EHR market in change? – from local vendors to multiregional (global)
vendors
Side 6
Multiregionale vendors
Contracts outside USA i 2016
56
31
13
12
12
11
5
3
0 20 40 60
Intersystems
EPIC
Cerner
Dedalus
Medasys
DXC Technology…
Allscripts
MEDITECH
Regionale vendors (European)
Contracts outside USA in 2016
National vendors (Norway)
22
21
2
0 20 40 60
Agfa Healtcare
ChipSoft
IMS MAXIMS
Kilde: KLAS Research Kilde: KLAS Research

7. SWEDEN
Side 7

8. Swedish National HIE infrastructure
managed by Inera
Health information exchange platform
Diagnoses Labresults Drugs Varnings
EHR EHR EHR EHR EHR EHREHR
Vaccinations
State agency
(e.g. EHM)
State agency
(eg. Insurance
agency)
400+ connected
EHRs
1 billion exchanges
yearly through 100
shared API:s
Service oriented
architecture for HIE
in operation since
2010
Virtual national EHR

9. Swedish National HIE Architecture & infrastructure managed by Inera

10. Other countries and conlusions
 Other themes discussed:
 Organization of national authorities
 Architectures and real life experience
 Models for promoting interoperability (legislation, financial, etc..)
 Denmark – presentations missing
 Finland – you all know it
 Conclusions
 A lot of similarities in standards used, differences also
 Work together on CEF patient summaries
 Everybody’s too busy, still need to share and collaborate in nordics
 Most mature eHealth market in the world – how can we benefit from that?
Side 10