Introduction of Electronic Patient Record System

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

In 2002 the Government decided that a nationwide electronic patient record (EPR) system is introduced in Finland in 2007. The Finnish EPR system will be based on regional information systems with a common structure and capacity for information exchange between regions. The regional systems are supported by national information services, such as servers distributing uniform classifications, identifying health care professionals, collecting statistics and offering national digital archiving.

Purpose of health policy or idea

According to the Government Decision in Principle of April 11, 2002 a nationwide electronic patient record (EPR) system will be introduced by the end of 2007. The Ministry of Social Affairs and Health (MSAH) which is coordinating and funding the developing process set up a working group to steer the introduction of the EPR system. The working group published the overall EPR strategy in 2003 and its final report on the national specifications, regional implementation and timetable in January 2005

According to the strategy a common content and structure should be in use in all EPR systems in all organisations. This will be achieved by implementing jointly specified, structured data to all EPR systems (information content, classifications, terminology, technical specifications, standards, forms). By the end of 2005 the structure of the data is scheduled to be defined in a decree issued by the MSAH.

All codes, classifications and headers for EPR systems will be delivered by an internet-server administrated by the National Research and Development Centre for Welfare and Health (STAKES). The code server will also deliver national directory services for ISO-OID (Object Identifier) codes. Every patient record, organization or professional will have the specific OID code.

The national guidelines for safeguarding information have also been defined by the working group. These are the guidelines for administrating the patient's right to issue informed consent in a digital context, guidelines for secure digital archiving, for e-signature, for identification of documents, for identification of professionals and organizations by ISO-OID-standard and guidelines for implementing Public Key Infrastructure (PKI) in health care. The National Authority for Medicolegal Affairs will administer digital identification for health care professionals. The health care providers will administer the user access control. The working group has also defined the standards for interoperability. The open standards for EPRs have been specificated in the national project by an association representing private and public interests in the integration of IT solutions in health care (the HL7 Finland, www.hl7.fi).

The working group has prepared the strategy in co-operation with national and regional authorities and interest groups. The MSAH has coordinated the process. EPRs should be in universal use by 2007 and every EPR system should be based on norms, rules and standards developed at national level. The process has been open - requirements are publicly available. All interest parties from software industry to professional associations and health care organizations have participated in the definition process. The implementation will be supported by education and by funding regional projects. In 2004-2007 the MSAH appropriates annually about 10 million Euros to support regional projects implementing national guidelines and standards. The subsidies are meant to cover 50% of the expenditures of the projects.

Main points

Main objectives

Following the decision, the Ministry of Social Affairs and Health set up a working group to steer the process. The working group published the overall EPR strategy in 2003 and its final report on the national specifications, regional implementation and timetable in Jan 2005. According the working group, the Finnish EPR system will be based on regional information systems with a common structure and capacity for information exchange between regions.

According to the Finnish Electronic Patient Record (EPR) Strategy drafted by the Ministry of Social Affairs and Health working group,  the main structure should be common to all EPR systems in Finland. The national system will be based on regional information systems in which health care organizations can transfer patient information with each other. Moreover the specifications and technical solutions of the regional EPR systems should allow data to be exchanged between regional systems. The regional systems will be supported by some national information system services like the code server, giving out OID (Object Identifier) codes, identification of health care professionals and collecting statistics. An option for centralised digital archiving at the national level is discussed.  

Type of incentives

The regional implementation of the EPR strategy is supported by providing training and partial funding for regional projects implementing national guidelines and standards.

Groups affected

Health care professionals, Software industry, Health professionals

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

The Finnish health care system has been decentralised and the development of health care information systems has been pronouncedly uncoordinated which has resulted in a situation where interoperable information systems are used even within individual health care organisations. The planned introduction of the national EPR system would totally change the current situation and obviously lead to more integrated IT solutions in health services. The planned introduction of the national EPR system is related to the Finnish political structure, legislation  and the uniform public health care system run by the municipalities. For instance, similar systems would probably not be feasible in countries with health care based mainly on private providers.

Political and economic background

The decision to introduce a national EPR system in Finland was made by the former Government as a part of its decision on securing the future of health care services in 2002 . The change of the Government did not influence these policy decisions; the introduction of the national EPR system and other health policy definitions of the former Government have been adopted by the present one. The EPR system is also adopted in the Information Society Policy Programme which is one of four policy programmes the present Government launched as a new tool for defining and directing its key intersectoral policies.

Change based on an overall national health policy statement

Decision in Principle by the Council of State on securing the future of health care, www.terveyshanke.fi/eng.pdf

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The first Finnish strategy for ICT utilization in social and health care was published by the Ministry of Social Affairs and Health (MSAH) already in 1996. The plans to introduce an uniform nationwide EPR system are based on the general principles defined in that strategy.  The regional EPR systems covering a hospital district and health centres in its area have been introduced in Finland since the mid 1990s and currently several regional EPR are operating. In 1999-2001, large demonstration projects (Satakunta Macropilot Project, Uusimaa Regional Information System, UUMA) to test the regional application of IT in social and health care have bee carried out on the funding from the MSAH. The MSAH is strongly supporting the introduction of IT in social and health services as a mean to improve the productivity and quality of the sector.  The integrated national EPR system is considered to support these goals. The Finnish health care system is decentralized. The municipalities have a strong decision making power when arranging services, with includes also utilization of ICT. The local and regional health providers are responsible for patient records and they have developed their EPR systems from their own preferences. The systems are not interoperable and the integration is very expensive. Gradually there has become a clear need for better co-operation at regional and national level.   

Initiators of idea/main actors

• Regierung: The development strategy on electronic patient records in the Finnish health care was finally decided by the former Government, but the Ministry of Social Affairs and Health has strongly supported the introduction of IT applications in social and health services.

Approach of idea

The approach of the idea is described as:
renewed: The idea to introduce an uniform EPR system in Finland has gradually developed as a part of strategic planning of IT applications in health and social care.

Innovation or pilot project

Local level - several regional EPR system are currently operating
Pilot project - Satakunta Macropilot Project

Stakeholder positions

 The introduction of the national electronic patient record system has been supported quite unanimously by all interest parties, such as municipal organisations, hospital districts and software industry. The Ministry of Social Affairs and Health has been a key actor and its working groups has drafted relevant policy formulation papers: the strategy on utilising information technology in social and health care, Memorandum of the National Project on Safeguarding the Future of Health Care Services, and the strategy on introducing a national electronic patient record system in Finland.

Actors and positions

Regierung
Ministry of Social Affairs and Health	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The introduction of a national EPR system will require several changes in legislation, such as a continuation of a temporary law on integrated regional care, and changes in law on national health care registers and ministerial decree on patient records.

Legislative outcome

n/a

Actors and influence

Regierung
Ministry of Social Affairs and Health	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The activity of the several actors are needed for the introduction of the uniform national EPR system. The MSAH's role is central in the coordination of the implementation  process and definining the specifications of the system as well as initiating the necessary changes in legislation. The responsibility for the adoption of the technical specifcations of the EPR System in development work has been agreed to be assigned to various actors; the Association of Local and Regional Authorities representing the municipalities, the Finnish Health Level 7 (HL7) Association representing public and private interests in health care IT, and government agencies (specially the National Research and Development Centre for Welfare and Health (STAKES)). However, local actors, such as hospital districts, health centres, municipalities and private health care providers, will finally implement the system. Although regional projects are supported by funding from the MSAH, the introduction of new regionally covering EPR systems requires considerable investments by local health care organisations. While regional EPRs are increasingly in use in hospital districts, the introduction of the national system seems quite conceivable but some experts suspect that the timtable for the introduction of the specified national EPR system by 2007 may be too tight.

Monitoring and evaluation

The MSAH is following the progress of the scheduled plan to introduce the national EPR system as a part of the follow-up of the National Health Project based on the Decision in Principle by the Council of State on Securing the Future of Health Care.

Results of evaluation

N/a.

Expected outcome

The national EPR system will obviously be adopted in Finland. However, the timetable is very tight. The technical and legislative prerequisite for the EPR system may probably be accomplished as scheduled but the local introduction of the system which requests substantial investments may occur later. Outcomes for patient care are difficult to predict but if opereting effectively regionally integrated health care information systems should produce a clear increase in pruductivity of the system, and improve access to and continuation of care as well as integration of care between providers.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

If effectively implemented the national EPR system should improve the productivity of health care units, access to services, and quality and integration of care.

References

Sources of Information

• Pekka Ruotsalainen, A cross-platform model for secure Electronic Health Record communication. International Journal of Medical Informatics, 73 (2004) pp. 291-295 
•  Persephone Doupi, Pekka Ruotsalainen. Healthcare informatics in Finland: Current status and future prospects. BJHC&IM, decmber 2004, vo. 21, number 10, 20-23.
• Persephone Doupi, Pekka Ruotsalainen. eHealth in Finalnd: present status and future trends. International Journal of Circumpolar Health, vol. 63(4), 2004, 322-327. 

 Decision in Principle by the Council of State on securing the future of health care. Brochures of the Ministry of Social Affairs and Health 2002:6. www.terveyshanke.fi/eng.pdf 

• HL7 Finland Association, www.hl7.fi   
• http://uuma.hus.fi
• http://www.stm.fi/Resource.phx/publishing/documents/1874/index.htx
• http://www.stm.fi/Resource.phx/publishing/documents/3052/index.htx
• http://www.stm.fi/Resource.phx/publishing/documents/2897/summary_en.htx
• http://www.stm.fi/Resource.phx/publishing/documents/1350/summary_en.htx 

Author/s and/or contributors to this survey

Annakaisa Iivari & Ilmo Keskimäki

Empfohlene Zitierweise für diesen Online-Artikel:

Annakaisa Iivari & Ilmo Keskimäki. "Introduction of Electronic Patient Record System". Health Policy Monitor, April 2005. Available at http://www.hpm.org/survey/fi/a5/1