Electronic prescriptions and patient records

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

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Abstract

Electronic information systems have been developed for a long time in the Finnish healthcare system. A major milestone was achieved in December 2006 when parliament accepted two new acts on electronic prescription and on the electronic management of information on users of social and health services. According to the new acts all service providers are obliged to join the two new national level systems which should be fully functional in 2011 after a four year transition period.

Neue Entwicklungen

The national level electronic patient record system (EPR) has been developed since 2002 when government decided that such a system will be introduced in Finland (HPM 5/2005). In December 2006 parliament accepted a new act on the electronic management of information on users of social and health services. According to this law the Social Insurance Institution (SII) will set up a digital archiving service for health service providers. SII is a governmental agency working under the supervision of parliament.

Every provider organisation will have its own patient record archive in the upcoming electronic archiving system. However, the structure of the archives will be uniform. All public service providers are obliged to enter their patient record archive into the new system. Private providers have to join to the system if they have electronic archives. Every service provider will have access to the archives of all other providers through a national index service connected to the archiving system. However, the patient's consent is needed for accessing patient records from other service providers' archives. The patient will have access to his/her own patient records and also to a log database containing information on who has accessed their personal records and when. According to law the system should be fully functional in 2011 after a four year transition period.

Development of an electronic prescription system has started in 2001. A pilot programme has been implemented in 2003-2006. In December 2006 parliament accepted a new act on electronic prescription. According to the act, a national electronic prescription database will be set up and maintained by the SII. In this system, electronic prescriptions are sent electronically straight from the physician's office to the central database, to which pharmacies have electronic access. All service providers are obliged to use electronic prescriptions in 2011 after a four year transition period. However, the patient has the possibility to deny electronic prescriptions and to receive a conventional paper prescription instead.

During the four year transition period, expenses of these new systems are covered by government. Afterwards expenses are to be covered by the users (health service providers and pharmacies).

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

The Finnish health care system traditionally has been very decentralised. Basically these reforms are one step to a more centralised steering of health services. Until now the development of health care information systems has been pronouncedly uncoordinated which has resulted in a situation in which non-interoperable information systems are used even within individual health care organisations.

Purpose and process analysis

Current Process Stages

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

Initiators of idea/main actors

• Regierung

• Leistungserbringer

• Bürgergesellschaft

• Privatwirtschaft, privater Sektor

Stakeholder positions

This policy has been strongly promoted by the Ministry of Social Affairs and Health. The policy was not opposed by any relevant actor. The most controversial issue has been how misuse of these databases will be prevented and what kind of consent is needed from the patient.

Actors and positions

Regierung
Ministry for Social Affairs and Health	sehr unterstützend		stark dagegen
Social Insurance Institution	sehr unterstützend		stark dagegen
Leistungserbringer
Municipalities	sehr unterstützend		stark dagegen
Bürgergesellschaft
Public	sehr unterstützend		stark dagegen
Privatwirtschaft, privater Sektor
Software industry	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

The legislative process led by the Ministry of Social Affairs and Health did not bring any major changes to the systems. The most visible discussion in the legislative process was about which national level organization should be in charge of the practical implementation of the EPR system.

Legislative outcome

Enactment

Actors and influence

Regierung
Ministry for Social Affairs and Health	sehr groß		kein
Social Insurance Institution	sehr groß		kein
Leistungserbringer
Municipalities	sehr groß		kein
Bürgergesellschaft
Public	sehr groß		kein
Privatwirtschaft, privater Sektor
Software industry	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

The main actors in the implementation are the Social Insurance Institution, the software industry, health care providers and pharmacies. Perhaps the most significant obstacle in the construction of the EPR system is to make the necessary changes to the different software used by providers.

Monitoring and evaluation

The process has progressed as planned and it is monitored by the Ministry of Social Affairs and Health.

Expected outcome

The introduction of the national EPR and electronic prescription systems will lead to more integrated information technology solutions in health services and they will significantly improve the usability of information systems in clinical practice. In addition, these systems will enable a more efficient use of patient level information in health care steering and development.

Impact of this policy

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

When implemented, these electronic systems will improve the productivity and quality of the health care system and promote integration of care.

References

Sources of Information

eHealth Roadmap - Finland. Ministry of Social Affairs and Health's Reports 2007:15 http://www.stm.fi/Resource.phx/publishing/documents/10546/index.htx

Reform formerly reported in

Introduction of Electronic Patient Record System Process Stages: Strategiepapier, Gesetzgebung, Idee, Pilotprojekt

Author/s and/or contributors to this survey

Lauri Vuorenkoski, STAKES

Empfohlene Zitierweise für diesen Online-Artikel:

Lauri Vuorenkoski, STAKES. "Electronic prescriptions and patient records". Health Policy Monitor, April 2007. Available at http://www.hpm.org/survey/fi/a9/4