Mr. ulf jacobsson
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1
Stockholm County Council
2005-02-24
Health Care IT in Stockholm
Stockholm County Council
http://www.sll.se
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Stockholm County Council
2005-02-24
Agenda
• 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
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Stockholm County Council
2005-02-24
Stockholm County Council
4% 80 years and older
11% 65 –79 years 22% 0 –17 years
39%18 – 44 years
24% 45 – 64 years
POPULATION ACCORDING TO AGE
Comprises the whole of Stockholm County
Has 1.8 million inhabitants
Geographical area includes 26 municipalities
6,500 km2
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Stockholm County Council
2005-02-24
The County Council Assembly
DISTRIBUTION OF SEATS 2003-2006
Green party 7Left party 14
Moderates 37
ChristianDemocrats 11
SocialDemocrats 54
Liberals 26
The Council ’s political decision-making body
149 members
Elected every four years at the sametime as national MPs
Appoints committees and boards
Decisions on Policy (e.g. IT policy)
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Stockholm County Council
2005-02-24
5,5 billion euros turnover
INCOME 2003 EXPENDITURE 2003
Council tax rate 10.32% and rising
The County Council Assembly decides the tax rate
Health and medical care accounts for 71% of turnover
Other sources 10%County council tax
Fees and fares 11% 67%
State subsidies 12%
Public transport 22%
Health andMedical Care 71% Miscellaneous 4%
Dental Care 3%
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Stockholm County Council
2005-02-24
Financing of Health Care 2002
Local taxes
Government funding
Other funds
Patient feesPrivate
insurance
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Stockholm County Council
2005-02-24
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 theSL public transport system
6,000 are treated by the Public Dental Services (free service for under 19s)
11,000 journeys are carried out by theTransportation of the Disabled Services
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Stockholm County Council
2005-02-24
Geriatric care
The municipalities and the CountyCouncil cooperate to give the elderlythe best quality care
Psychiatric careOutpatient care and mobile teams help the mentally ill to function better in society
The child and adolescent psychiatric careservices offer treatment to children andyoung people under 18 years of age
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Stockholm County Council
2005-02-24
Dental care
Free dental care for everyoneup to the age of 19
Individual child dental care allocationsmean freedom of choice
THE PUBLIC DENTAL SERVICESTreat 400,000 children and adults every yearWork to improve the long-term dentalhealth of the county ’s inhabitants
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Stockholm County Council
2005-02-24
SL publictransport byroad and rail
Storstockholms Lokaltrafik (StockholmTransport), SL, is responsible for thepublic transport services on thecounty’s roads and railways
Each day, over 1 million people makeuse of the public transport networkon the buses, underground, commuterand local trains
400 km of track in total
and water
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Stockholm County Council
2005-02-24
Transportationof the DisabledServices
For people who for medical reasonsare unable to use public transport
Journeys are carried out by taxisor special vehicles
About 3.5 million journeys arecarried out each year
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Stockholm County Council
2005-02-24
Healthcare in Stockholm
University hospitals General hospitals Local hospitals
Primary care - 170 local community centres (of which 60% are private) includesPsychiatry and Geriatrics
2500 private specialist doctors
4 laboratories – 2 private
Central administration – 2 roles: Contracting/Financing and Care Providers
Karolinska University hospital- Solna- Huddinge
S:t Eriks Eye hospital AB
Södersjukhuset hospital
Norrtälje hospital
Södertälje hospital
Danderyd hospital
S:t Görans hospital AB*
Ersta hospital*
Sophiahemmet*
Dalens hospital*
Jakobsbergs hospital*
Nacka hospital*
Löwenströmska hospital*
Sabbatsbergs hospital*
* Operated by private contractors
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Stockholm County Council
2005-02-24
3S New Healthcare Structure for Stockholm
3S
Stockholms SjukvårdsStruktur
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Stockholm County Council
2005-02-24
The current situation Computerised islands for EMR
Melior BMS Swedestar Take Care
Obstetrix ProfDoc Medidoc InfoMedix
Pasett VAS PVS Alfa
Biosis Cambio Sigma Patient 2000
m.fl.
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Stockholm County Council
2005-02-24
Central Administrative Systems
• Financial and HR systems– Raindance (WM Data) + 6 others– Palett
• Reporting systems (c:a 30 applications)– Developed since 1970's – 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
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Stockholm County Council
2005-02-24
More central administrative systems
• 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
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Stockholm County Council
2005-02-24
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)
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Stockholm County Council
2005-02-24
IT organisation
Also SL (Public transportation), Waxholms bolag (Boats), Transport for the disabled, Regional planning, Dental Care, Internal Auditors……
S:t Eriks Eye hospital AB(5 FTE)
Karolinska University hospital(350 FTE)
University hospitalsSouthern hospital AB (65 FTE)
Norrtälje hospital AB (5 FTE)
Södertälje hospital (12 FTE)
Danderyds hospital AB (60 FTE)
S:t Görans hospital AB* (5 FTE)
Ersta hospital* (7 FTE)
Sophiahemmet* (3 FTE)
General hospitals Primary care (120+FTE)
4 labs (10)
Central admin (40+FTE)
About 625 FTEs
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Stockholm County Council
2005-02-24
InfrastructureSLL Net
Löwenströmska
Jakobsberg
TäbyRinkeby
Vällingby AlvikGärdet
Nacka
Enskede
LiljeholmenSkärholmen
Tumba Haninge
Nynäshamn
Sollentuna
Danderyd
Sabbatsberg
Huddinge
SöS
Karolinska
S:t Göran
Södertälje
Norrtälje
University or general hosp.
Local hospitalsFibre, 1Gb/sFibre, 155 Mb/s+ 600 ADSL lines
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Stockholm County Council
2005-02-24
The challenges
Increase patient safety
Reduce waste
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Stockholm County Council
2005-02-24
To err is human….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.
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Stockholm County Council
2005-02-24
Crossing the Quality ChasmInstitute of Medicine, USA 2001
6 aims of improvement1. Safe - Avoiding injuries to patients from the care that is intended to help2. Effective - Providing services based on scientific knowledge3. Patient-centred - Providing care that is respectful and responsive to
individual patient preferences4. Timely - Reducing harmful delays5. Efficient - Avoiding waste6. Equitable - Providing care that does not vary in quality
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Stockholm County Council
2005-02-24
10 rules of Redesign
1. Care is based on continuous healing relationships2. Care is customized according to patient needs and values3. The patient is the source of control4. Knowledge is shared and information flows freely5. Decision making is evidence-based6. Safety is a system property7. Transparency is necessary8. Needs are anticipated9. Waste is continuously decreased10.Co-operation among clinicians is a priority
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Stockholm County Council
2005-02-24
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?
Applied to Stockholm
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Stockholm County Council
2005-02-24
Is there a cure?
• 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
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Stockholm County Council
2005-02-24
Step 1:Access to relevant information
…..which supports the care process
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Stockholm County Council
2005-02-24
Stockholm's goal
• Patient centred common lifetime medical record• Active self care by the patient (The Internet Patient)• Effective care process support
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Stockholm County Council
2005-02-24
Architecture for common information storage and access
PortalPortal
Common application services/business objectsCommon application services/business objects
Lab listLab listVisit HistoryVisit History
ImagesImagesDrug listDrug list
Medical notesMedical notes
X-ray listX-ray list
OrdersOrders
Patient payments
Patient payments
Identity
Accesscontrol
Authentication and PKI
Content
Single Sign-on/Sign off
Support services
Log
Care relations.
Patientagreement
Context Archiving
CDR
Data storage HISA
Data servicesData services
APPLICATIONS
Responsible for supporting the useractivities in the various areas of
the organisation
Medical care
Nursing .............
Diagnostics
Administration
GENERIC
Responsible forsupporting genericrequirements, not
specific to thehealthcare domain
HEALTHCARE-RELATEDResponsible for supporting functionalities and information
relevant for the whole healthcare organisation
Authoris-ations
Subjectsof
careHealth
data Activities ResourcesConcepts
andterminology .......
Middleware of common services
BITWAYS Providing facilities for the integration andinterworking of the technological environments
Reports Research
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Stockholm County Council
2005-02-24
But how and when?….
• 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
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Stockholm County Council
2005-02-24
Challenges
• 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
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Stockholm County Council
2005-02-24
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Stockholm County Council
2005-02-24
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)
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Stockholm County Council
2005-02-24
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
Opportunities to increase health system effectiveness (OECD)
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Stockholm County Council
2005-02-24
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
Health care guidance ….
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Stockholm County Council
2005-02-24
GVDIntegrated Care Records Service
Patient to Doctor/NurseDoctor to Doctor Patient to Patient