The Finnish Law on Forced Integration of Patient Records. Kallio A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Integration: the good, the
bad and the heroic
– case Finland
Anne Kallio
Head of Development
Ministry for Social Affairs and Health
Finland

2. Content
• Background
• Legislation
• Architecture
• eArchive
• ePrescription
• eView
• Good, bad and heroic…

3. Organization of health care in
Finland
Population 5.3 million
PUBLIC SECTOR 85%
Municipalities
Responsible for arranging
Independent in decision making
Appr 190 Primary health care centres
21 Hospital districts
PRIVATE SECTOR 15%
Primary and specialized health care
Occupational health care (60%)
appr 4000 private providers
600 pharmacies

4. eHealth situation now
Delights
• EHR coverage 100% (public sector)
• Regional EHR information exchange 76%
• Electronical referrals and discharge letters
• hospitals 90%
• primary health care 77%
• EHR coverage appr 80% (private sector)
Drawbacks
• private sector not involved in regional EHR information exchange
• interoperability
• many EHR-systems (>10)
• over 60 one disease/one purpose systems
• too few semantic and technical standards

5. National eHealth Road Map 2007
1. Availability of patient information regardless of time and
place, both in public and private sector
2. Participation of citizens and patients
 acces to own patient information and log data
 acces to high quality health information
 development of eServices
-> National solution for patient data and prescription
• Population only 5.3 million
• Need of patient information does not restrict to one
organisation or region
• Essential to have private sector included

6. Legislation
Government bill for the Client data act 2007 - eArchive
• central data repository built by Kela (national insurance authority)
• data produced and owned by health care providers
• view of data on patients consent
• public and private (not if only paper in use) health care producers
• all patient data by 2011
Government bill for the Act on ePrescriptions 2007
• Prescription center by Kela
• Viewing on patients consent
• obligatory for doctors, not for patients
• obligatory by 2011
eView
• for patients

7. Architecture
• central data repository
• data produced by local EHR-systems
• traffic via public internet (VPN)
• standardisation of information and data transfer
Functions
• dynamic data repository
• only legal long term electronic archive
• 12 yrs after death

8. eARCHIVE - content
First phase
• medical record – personal and life long
• coded core information (dg, procedures, medical risks)
• medication
• referral and discharge letters
• radiology referrals and statements
• summary of nursing information
• laboratory results
• necessary archiving documents
• log information
Next steps
• medical statements sent electronicaly
• dental health care
• Radiology, endoscopy etc images…
• biosignals…

9. ePrescription
NATIONAL PRESCRIPTION CENTRE
• ePrescriptions sent by local EHR-systems
• Information of medicine dispensing in pharmacies sen by pharmacy
systems
• Log
• Viewing on patients consent
IMPLEMENTATION
• in final testing phase
BY LEGISLATION OBLIGATORY BY 2011
• For doctors and pharmacies
• Patients can refuse ePrescription

10. eVIEW
• Patient information in eArchive
• Information in Prescription centre
• Log information
• For citizens >18 yrs
• Acces via Internet
• Authentication by
• eBanking identification
• electronical ID card
• In the future
• consents and denials
• advanced directives (f.ex living will )

11. Good, bad and heroic…
Good
• long term legal electronical archiving solution for health care
• standardization of medical information
• national data base
-> clinical decision making support
-> possibility for on line statistics
-> management decision support
Bad
• lack of resources – people and money
• fragmented health care providers and IT-systems is a big challenge
• original time table was far too optimistic -> gradual approach and
new time table made
Heroic
• aim is to put in nearly all patient data
• not only core information
• concerns all health care providers in Finland

12. Thank you
Questions?