Mr. ulf jacobsson

Health Care IT in Stockholm
Stockholm County Council


http://www.sll.se

2005-02-24
1

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

2005-02-24
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Comprises the whole of Stockholm County

Has 1.8 million inhabitants

Geographical area includes 26 municipalities

6,500 km2

4% 80 years and older

11% 65 –79 years 22% 0 –17
years

24% 45 – 64 years 39%18 – 44
years

POPULATION ACCORDING TO AGE

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The County Council Assembly
The Council ’s political decision-making body

149 members

Elected every four years at the same
time as national MPs

Appoints committees and boards

Decisions on Policy (e.g. IT policy)

Green party 7
Left party 14

Moderates 37

Social
Democrats 54

Christian
Liberals 26 Democrats 11

DISTRIBUTION OF SEATS 2003-2006

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5,5 billion euros turnover

Council tax rate 10.32% and rising

The County Council Assembly
decides the tax rate

Health and medical care accounts
for 71% of turnover

Public transport 22%
Other sources 10%
County council tax
Fees and fares 11% 67%

State subsidies 12%
Health and
Medical Care 71% Miscellaneous 4%
Dental Care 3%

INCOME 2003 EXPENDITURE 2003

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Financing of Health Care 2002

Private
Patient fees insurance

Other funds
Government
funding

Local taxes

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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 the
SL public transport system

6,000 are treated by the Public Dental
Services (free service for under 19s)

11,000 journeys are carried out by the
Transportation of the Disabled Services

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Geriatric care

The municipalities and the County
Council cooperate to give the elderly
the best quality care

Psychiatric care
Outpatient care and mobile teams help the
mentally ill to function better in society

The child and adolescent psychiatric care
services offer treatment to children and
young people under 18 years of age

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Dental care

Free dental care for everyone
up to the age of 19

Individual child dental care allocations
mean freedom of choice

THE PUBLIC DENTAL SERVICES
Treat 400,000 children and adults every year
Work to improve the long-term dental
health of the county ’s inhabitants

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Stockholm County Council SL public
transport by
road and rail
Storstockholms Lokaltrafik (Stockholm
Transport), SL, is responsible for the
public transport services on the
county’s roads and railways

Each day, over 1 million people make
use of the public transport network
on the buses, underground, commuter
and local trains

400 km of track in total

and water

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Stockholm County Council Transportation
of the Disabled
Services

For people who for medical reasons
are unable to use public transport

Journeys are carried out by taxis
or special vehicles

About 3.5 million journeys are
carried out each year

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Healthcare in Stockholm

University hospitals General hospitals Local hospitals
Karolinska University hospital Södersjukhuset hospital Dalens hospital*
- Solna
- Huddinge Norrtälje hospital Jakobsbergs hospital*

S:t Eriks Eye hospital AB Södertälje hospital Nacka hospital*

Danderyd hospital Löwenströmska hospital*

S:t Görans hospital AB* Sabbatsbergs hospital*

Ersta hospital* * Operated by private
contractors
Sophiahemmet*

Primary care - 170 local community centres (of which 60% are private) includes
Psychiatry and Geriatrics

2500 private specialist doctors
4 laboratories – 2 private
Central administration – 2 roles: Contracting/Financing and Care Providers
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3S
Stockholm County Council New Healthcare Structure for Stockholm

3S
Stockholms SjukvårdsStruktur

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The current situation
Stockholm County Council 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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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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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 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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IT organisation

University hospitals General hospitals Primary care (120+FTE)
Southern hospital AB (65 FTE)
S:t Eriks Eye hospital AB 4 labs (10)
(5 FTE)
Norrtälje hospital AB (5 FTE)
Central admin (40+FTE)
Karolinska University hospital
Södertälje hospital (12 FTE)
(350 FTE)
Danderyds hospital AB (60 FTE)

S:t Görans hospital AB* (5 FTE)

Ersta hospital* (7 FTE) About 625 FTEs
Sophiahemmet* (3 FTE)

Also SL (Public transportation), Waxholms bolag (Boats),
Transport for the disabled, Regional planning, Dental Care,
Internal Auditors……

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Infrastructure
SLL Net

Norrtälje

Löwenströmska

Jakobsberg
Sollentuna

Rinkeby Danderyd
Karolinska Täby

S:t Göran Sabbatsberg
Gärdet
Vällingby Alvik
SöS
Liljeholmen Nacka
Skärholmen
Enskede
Tumba Haninge
Huddinge
University or general hosp.
Local hospitals
Södertälje Fibre, 1Gb/s
Fibre, 155 Mb/s
Nynäshamn + 600 ADSL lines

2005-02-24
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The challenges

Increase patient safety

Reduce waste

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To err is human….
Stockholm County Council 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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Crossing the Quality Chasm
Institute of Medicine, USA 2001

6 aims of improvement
1. Safe - Avoiding injuries to patients from the care that is intended to help
2. Effective - Providing services based on scientific knowledge
3. Patient-centred - Providing care that is respectful and responsive to
individual patient preferences
4. Timely - Reducing harmful delays
5. Efficient - Avoiding waste
6. Equitable - Providing care that does not vary in quality

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10 rules of Redesign

1. Care is based on continuous healing relationships
2. Care is customized according to patient needs and values
3. The patient is the source of control
4. Knowledge is shared and information flows freely
5. Decision making is evidence-based
6. Safety is a system property
7. Transparency is necessary
8. Needs are anticipated
9. Waste is continuously decreased
10. Co-operation among clinicians is a priority

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Applied to Stockholm

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?

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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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Step 1:Access to relevant information

…..which supports the care process
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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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Architecture for common information
Stockholm County Council storage and access
Portal
Portal

Visit History
Visit History Lab list
Lab list Medical notes
Medical notes Orders
Orders
Patient
Patient
Drug list
Drug list Images
Images X-ray list
X-ray list payments
payments

Common application services/business objects
Common application services/business objects

Data storage HISA Support services

Data services Identity Content
Data services
Authentication Care
and PKI relations.
Single Sign- Patient
CDR on/Sign off agreement
APPLICATIONS
Access
Log
Medical care Diagnostics
Responsible for supporting the user
Nursing ............. Administration
activities in the various areas of
the organisation control
Middleware of common services

GENERIC

Context
HEALTHCARE-RELATED
Responsible for
supporting generic
requirements, not
Responsible for supporting functionalities and information
relevant for the whole healthcare organisation Archiving
Subjects Concepts
specific to the Authoris- of Health Activities Resources and
ations care data terminology
.......
healthcare domain

BITWAYS Providing facilities for the integration and
interworking of the technological environments

Reports Research

2005-02-24
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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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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 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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Opportunities to increase health system
Stockholm County Council effectiveness (OECD)

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
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Health care guidance ….

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

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2005-02-24
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Mr. ulf jacobsson

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