Transcript Case study: Electronic Medical Records (EMR) meets HMIS in Norway

Healthcare ICT and HMIS in Norway
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Overview
• Introduction to the Norwegian Health system
• IS and public health
• IS for patients
• IS for patients’ care (hospitals) – not covering this part
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Norwegian Healthcare system
• Norway has a predominantly public health care sector.
• The Norwegian health system is characterized by universal coverage:
the health system is built on the principle that all legal residents have
equal access regardless of socioeconomic status, country of origin, and
area of residence.
• It is financed mainly through taxation, together with income-related
employee and employer contributions, and only to a small extent by outof-pocket payments (see Frikort).
• All residents are covered by the National Insurance Scheme (Folketrygden)
• Unique personal number
• Unique identification of healthcare professionals
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Norwegian Healthcare system
• Health care services are provided at two levels:
1. primary care is at municipal level,
2. and specialized care is at regional level.
• The central Government has overall managerial and financial
responsibility for the hospital sector.
• Norway’s four regional health authorities control the provision of
specialised health services by 27 health enterprises.
• The Coordination Reform 1st January 2012
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interaction between primary care and specialized care lacks
mediating structures.
establishment of pre-hospital low threshold wards in primary health care
municipalities are gradually obliged to establish primary emergency 24-hour care
for patients who do not need specialized hospitalization
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Primary care
• Municipal health services consists of :
• general practitioners services, emergency room services,
physiotherapy, nursing homes, midwife services and nursing services,
(including home-based services).
• The municipality also runs preventative health services: Health 'Stations' and
school-based health services
• (Except for a few institutions with advanced rehabilitation services) long-term
care does not exist within the hospital sector but it is integrated in primary
health care.
• Primary health care and social care services also care for patients recovering
after a hospital stay.
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Municipal health services (some numbers)
• On average a municipality has 10,000 inhabitants (range from 250 to
500,000 people).
• There are 430 municipalities.
• The larger cities are subdivided into boroughs (city districts - bydel)
covering services for about 30,000 inhabitants each.
• A municipality with 10,000 inhabitants will have about 10 GPs, 90
nursing home beds and 150 nurses, nurses aids and home helpers
working in home care for elderly and disabled people.
• In 2010, there were 0.83 GPs per 1 000 population.
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GP scheme 2001
• The general practitioner scheme was introduced in 2001, states
that:
• Every inhabitant is entitled to be listed with a general practitioner
(GP) of his or her choice, (almost all residents (99.6%) are
registered in the scheme).
• Every GP is now responsible for a list of individual patients
• GPs’ role as gatekeepers: patients need to see their GPs before
they can be referred (referral letter) to the hospital (except in
emergencies).
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Specialist care
• Hospitals and institutions: organised in enterprises/ trusts under four
Regional Health Authorities:
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Helse Nord (covers the counties of Nordland, Troms and Finnmark)
Helse Midt-Norge (Nord-Trøndelag, Sør-Trøndelag and Møre og Romsdal)
Helse Vest (Rogaland, Hordaland and Sogn og Fjordane)
Helse Sør-Øst (Vest-Agder, Aust-Agder, Telemark, Vestfold, Østfold,
Buskerud, Oppland, Hedmark, Akershus, Oslo)
• The RHAs have structured the hospitals around 25 health enterprises
(65 hospitals)
• (Before 2002 the hospitals have been owned and run by the counties
for over 30 years).
• In 2010, the private hospitals (both not-for-profit and for-profit
privately owned hospitals) accounted for 1 601 beds, approximately
10% of the total of 16 117 beds.
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4 Regional Health Authorities - 2002
Helse Nord
Helse Midt-Norge
Helse Vest
Helse Sør-Øst
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Access to specialised care
• Referral to specialist care: primary care physicians as gate keepers.
• Patients may choose the hospital.
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(They are not, however, allowed to choose a hospital that is more specialised, e.g. a
university hospital, than the one they have been referred to.)
• Free choice of hospital for elective treatment was introduced from 1 January
2001 (Fritt sykehusvalg, www.frittsykehusvalg.no May 2003)
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to strengthen patients’ positions as decision-makers (informed choice)
to even out differences in waiting times for treatment.
• Some studies indicate that relatively few patients seem to have opted for
the possibility of receiving treatment outside of the hospitals’ natural
catchment areas.
• Patients are willing to wait a considerable length of time to avoid travelling.
The reluctance to travel increases with age and decreases with level of
education.
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• www.ssb.no
• www.fhi.no
• www.helfo.no
• www.helsedirektoratet.no
• www.fryttsykehusvalg.no
• www.helsenorge.no
• www.kith.no
• www.nhn.no
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assignment
• Which public health data are made availabe?
•…
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IS for patients
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IT strategy in health sector
Breadth/vision
1997
2013
Concretization
/implementation
IT strategy in health sector
• S@mspill 2.0
• Specific vision/aims e.g.:
• Relevant and good quality information on health , lifestyle, services,
treatments is available on internet.
• The patient has access to his own health information, own medical
record, overview of prescriptions and medications, discharge letters,
freecard and more.
• Via an interactive services is possible to (for instance) change
appointments at the GPs or other providers.
• New services on internet support self care possibilities.
• Patients and users experience that health personnel has a good
overview on their health status and health history when they come
in contact with health care services.
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Historical view
• Early mover on Health ICTs:
• National ICT strategies since 1997
• First to implement EPR (public hospitals and GPs)
• 1980’s- 90’s: Development initiatives on a national scale
• Widely digitized sector:
• Hospitals, general practitioners, nursing homes, pharmacies,
private sector specialists
• … but weaker on linking them together
• GPs first to implement EPRs, ~100 % coverage
• uptake by municipality home care and nursing homes has been
slower
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One resident – One record
• improved quality, improved patient
safety, more efficiency and better
use of resources
• quick, easy and secure access to all
necessary information.
• regardless of where in the country
the patient is receiving treatment
• Citizens should have quick
access to simple and secure
digital services.
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Digital dialogue GP project
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assignment
• www.helsenorge.no
• Which services are offered?
•…
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Summing up…
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