Swedish flagÖrebro County Council has become the first part of Sweden to implement the national patient summary record. Sarah Bruce reports.

By the end of 2011, all of Sweden’s 21 healthcare regions should be connected to a national patient summary record (NPÖ), to improve the quality and consistency of patient care.

The ambitious national project has been a central strand of Sweden’s e-health strategy for much of the past decade. The concept was tested in trials before a national procurement was carried out, which looked for examples of best practice from around the world.

Contracts were finally awarded in 2008 and the first implementation milestone was reached in May, when Örebro County Council became the first of Sweden’s 21 devolved health regions to begin to use the summary record.

As well as overcoming technical challenges and change management issues, the project faced a major legal barrier: in Sweden, health is a responsibility for each county council, and they were legally barred from exchanging patient records with one another.

Value of a national record

Project manager Eva Leach Elfgren explained the benefits the NPÖ should deliver. “The goal is to have the care systems of all Swedish counties, municipalities and private care providers connected to the national patient summary system,” she told E-Health Europe.

“The aim is to provide authorised healthcare and welfare professionals with access to information across organisational borders.”

The summary record is accessed through a web interface, where authorised professionals can obtain relevant information, using an ID card. The information displayed is recorded and kept in the local healthcare system of the provider concerned.

The NPÖ holds a significant amount of demographic and clinical data. This includes personal identification information, next of kin, diagnosis and allergies, medicines, care documents, test results including image diagnostics, scheduled and effected contacts and plan options for care.

Learning from others

Leach said that following a change in the law, the county council directors of Sweden were able to develop a common platform to make patient information more accessible and look at what they could learn from the approach taken in other countries.

“When the directors decided to make a full scale solution it was very important that the procurement was based on existing systems in the industry,” she said.

“We looked at various countries that had achieved similar objectives, including those being used in places such as Israel. Then we looked to Brazil and saw that they were successfully using InterSystem’s HealthShare Software for regional care to share data.”

Testing the NPÖ

The rapid development of NPÖ has in part been possible thanks to an initial successful trial involving four county councils. The results of the trial were published in 2005, alongside 2005 National Swedish IT strategy for the healthcare and welfare sector.

The results of the initial summary record trial helped focus minds on the need for a common infrastructure for improved information management, better quality of care and enhanced patient security.

After the trial was completed and results published, an exhaustive three year procurement process was carried out to select suitable providers for a national solution.

At the end of this, the Swedish Healthcare Advisory Organisation then selected Tieto and InterSystems to install and deliver the system. The contract is for €12.2m over five years, with the option to extend the contract for a further two years.

Roll-out to pick up pace

Leach said the successful connection, delivered on time, to the first care providers in Örebro County Council and the Örebro Municipality, is a vital first step.

She also said the project should pick up pace now that the first sites are connected. “The next step is to link and connect County Council of Östergötland and prepare another three county councils before the end of the year.”

She added: “We are now running the project in parallel with developing the next version of the solution. We’re not sure what the newer version will include because work is still ongoing, but during autumn 2010 we will begin implementing the newer version.”

She hopes that patients will eventually have more control of their records by being able to view them online. “Citizens may be able to access their record in the future but at the moment it is only for healthcare professionals in Sweden, it will be a few more years before citizens have that opportunity,” she said.

Little controversy

Leach also told EHE the record has not created the same level of controversy as similar projects in other EU countries, particularly England, where there have been huge rows about security and confidentiality.

She said: “I’m not aware of issues surrounding security or controversy over the record and the patients still have a choice as there is an opting in and opt out process. The new Patient Data Act which came into force at the beginning of July 2008 made it clear that the data would be controlled.”

She added: “The patient has a right to say no to a record, but to do so they have to visit their GP, they are also given a list of care professionals who have had accessed or changed their record.”

Sweden to host epSOS

Sweden is also host to the European Patients’ Smart Open Service (epSOS), a pan-European project to develop a practical ehealth framework and IT structure to enable secure access to patient information summaries and prescriptions between different European healthcare systems.

Leach said that Sweden will use the solution that they have developed at a wider level as part of the high profile multi-national European project.

“The solution that we are using at this level in Sweden is the one that we will trial at European level. It is also highly likely that will be one of the candidates for the EPSOS pilots.”

She added: “The main difference in what we are doing compared to many other countries is that we are sharing information in the widest sense and not just documents in a PDF format.

“We are also not aiming for one single system to share the information. I believe that Sweden is helping to lead the way in terms of integrated healthcare records.”