Finland is on track to build a national electronic health record repository, which clinicians will be legally required to start using from 2011.
The ambitious project, which also involves the development of a national e-prescription service and a patient-viewable record called eView, represents one of the more comprehensive e-health initiatives in Europe.
Crucially, it builds on almost two decades of local health IT development, within the highly devolved Finnish healthcare system, in which municipalities are responsible for local healthcare.
But taking a local approach to developing electronic health records over the last 25 years has created serious headaches on interoperability. “We’ve done the local thing and achieved almost 100% roll-out of EHRs, but the bad new is interoperability,” said Anne Kallio, from the Finnish Ministry of Health.
Speaking at eHealth 2009 in Prague, Kallio said: “We now have a variety of systems in use that don’t easily communicate and often represent a significant local investment, so cannot be easily replaced.”
Kallio said that Finland had decided that to overcome the problems of interoperability it needed to take the step up to a national level. She stressed, however, that the new national eArchive, now under development, builds on top of existing local systems, rather than seeking to replace them.
The eArchive will serve as a long-term archive, holding patient data for 30-plus years, and providing a longitudinal record of a patient as details of their treatment over time are added.
She explained that the national eArchive will contain all coded patient information held in local EHRs, together with a log of all information exchanged and who subsequently accesses the data. Access to the eArchive will initially be limited to clinicians directly involved in a patients’ care.
A key decision taken by the Finnish government has been to mandate the use of the system. “We made a law that says use of the eArhive and ePrescription will be obligatory by 2011. Though we don’t think all information will be there by then,” explained Kallio.
She described the task ahead as huge, with the project still at an early stage. “It will be an enormous task, it will be long, and it won’t be easy.”
“We have the local infrastructure and we are now building the national infrastructure. We are taking our time because we want to get it right. We only want to do it once.”
As well as providing clinicians access to the eArchive, patients will have online access to their data through a system known as eView. This will enable them to both view their own medical record and see who else has accessed and viewed their details.
The accompanying ePrescription project will capture all electronic prescriptions, and will be supported by the introduction of electronic signatures for doctors.
Yves Mahieu of EMC , Finland, the company building the centralised repository stressed that the eArchive forms part of wider development of e-Government services in Finland.
Mahieu said that to be a success the national eArchive must deliver a Google-like experience for users and citizens, being similarly fast, reliable and complete.
He argued that the national eArchive will cost only €20m to build, the equivalent of just €4 Euros a citizen. For a project that will be one of the largest civil archives in the world he said the investment represented good value for money
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