Swedish NPÖ National Patient Overview A Case Study for InterSystems HealthShare, Ensemble and...

Swedish NPÖSwedish NPÖNational Patient OverviewNational Patient Overview

A Case Study for InterSystems HealthShare, Ensemble and CachéA Case Study for InterSystems HealthShare, Ensemble and Caché

Christopher ReedInterSystems Corporation

© 2009 InterSystems Corporation

The NPÖ in Sweden

1.1. The NPÖ Project – Background & IntroductionThe NPÖ Project – Background & Introduction

2.2. The NPÖ Health Information Exchange – ObjectivesThe NPÖ Health Information Exchange – Objectives

3.3. Key Business & Societal ConsiderationsKey Business & Societal Considerations

4.4. Key Architectural & Technical ConsiderationsKey Architectural & Technical Considerations

5.5. Examples of NPÖ HealthShare ScreensExamples of NPÖ HealthShare Screens


Swedish National Patient Summary (NPÖ – Nationell Patientöversikt)• Population 9 million Population 9 million

• 21 healthcare regions21 healthcare regions

• National EHRNational EHR

• InterSystems in partnership InterSystems in partnership with Tieto.with Tieto.


• Tieto Tieto –– Prime Contractor Prime Contractor

• InterSystems HealthShare™ – Health Information InterSystems HealthShare™ – Health Information Exchange PlatformExchange Platform

Swedish National Patient Summary (NPÖ – Nationell Patientöversikt)

21 Swedish healthcare regions

National Patient Viewer ServiceHealth information exchange platform


NPÖ Timeline

• 1999-2004 Planning by Municipalities, Regions and 21 County 1999-2004 Planning by Municipalities, Regions and 21 County CouncilsCouncils

• 2005: Four-County Trial/Proof-of-Concept2005: Four-County Trial/Proof-of-Concept

• 3/2008: Contract for NPÖ awarded to Tieto & InterSystems3/2008: Contract for NPÖ awarded to Tieto & InterSystems

• 5/2009-8/2009: Live Pilot in Örebro Municipality5/2009-8/2009: Live Pilot in Örebro Municipality

• 9/2009: Full Production, Örebro Municipality9/2009: Full Production, Örebro Municipality

• 11/2009: Full Production, Östergötland County11/2009: Full Production, Östergötland County

• 2010-2011: Remaining 19 Counties in Production2010-2011: Remaining 19 Counties in Production


The NPÖ in Sweden







What does the NPÖ provide?

• National Patient Viewer National Patient Viewer SService:ervice:

• Access to patient dataAccess to patient dataHistorical and currentHistorical and currentWherever sourced in SwedenWherever sourced in Sweden

• For authorized healthcare and welfare professionalsFor authorized healthcare and welfare professionalsFrom anywhere From anywhere With appropriate computer configuration With appropriate computer configuration (Identity card (“SITHS”) reader and software)(Identity card (“SITHS”) reader and software)


Objectives of the NPÖ

• The Primary Objective of the NPÖ is to The Primary Objective of the NPÖ is to Improve the Quality & Consistency of Patient CareImprove the Quality & Consistency of Patient Care

• Doctors are working from information that is:Doctors are working from information that is:• More CompleteMore Complete• TrustedTrusted

• Expected Benefits IncludeExpected Benefits Include• Reduction in Preventable Medical ErrorsReduction in Preventable Medical Errors• Reduction in Adverse Drug EventsReduction in Adverse Drug Events• Improved OutcomesImproved Outcomes• Cost ReductionsCost Reductions• Improved Security and LoggingImproved Security and Logging


The NPÖ Provides 16 Information Types

• Patient Demographics

• Encounter

• Allergies and Alerts

• Care Plan

(Primary, Secondary)

• Community Healthcare Service

• Activities of Daily Life

• Disability

• Diagnoses

• CClinical Document

• Prescribed Medication

• Dispensed Medication

(Pharmacy)

• Clinical Chemistry

• Microbiology

• ECG

• Medical Imaging

• Other Examination


The NPÖ in Sweden







Key Business & Societal Considerations

• ParticipationParticipation

• GovernanceGovernance• SKL/SALARSKL/SALAR• SVRSVR

• Data Sharing - Data Sharing - Patient Data Act Patient Data Act

• Access Authentication and AuthorizationAccess Authentication and Authorization

• Content AuthorizationContent Authorization

• Information PresentationInformation Presentation


Data Ownership Considerations

• Healthcare Data is Owned by the CountiesHealthcare Data is Owned by the Counties• Individuals have rights to see their informationIndividuals have rights to see their information

• Primary Version of Data is Held at SourcePrimary Version of Data is Held at Source• Some Data is also Held CentrallySome Data is also Held Centrally• Patient Information is Assembled at Run-TimePatient Information is Assembled at Run-Time

• Possible Future Enhancements:Possible Future Enhancements:• Public HealthPublic Health• Patient AccessPatient Access• More Information TypesMore Information Types


The NPÖ in Sweden







Key technological considerations

• ArchitectureArchitecture

• GovernanceGovernance

• Past work with integrationPast work with integration

• Communication and interoperabilityCommunication and interoperability• EN 13606EN 13606

• Source data retrieval and handlingSource data retrieval and handling

• Response timesResponse times

• Possibilities for viewing dataPossibilities for viewing data

• Design of user interfaceDesign of user interface

• Standardized process for connectingStandardized process for connecting


Security and Privacy Technologies

• National platformNational platform• Sjunet (Seven net) – VLANSjunet (Seven net) – VLAN• SITHS – Secure IT in Health ServicesSITHS – Secure IT in Health Services• HSA catalogue – Health Services Address RegistryHSA catalogue – Health Services Address Registry

• HealthShare Security Services (HSS)HealthShare Security Services (HSS)• AuthenticationAuthentication• AuthorizationAuthorization• Consent managementConsent management• EncryptionEncryption• LoggingLogging

• BIF – National security servicesBIF – National security services


Conceptual view

ApplicationApplicationApplicationApplication IntegrationIntegrationIntegrationIntegration

AAAA BBBB

ConnectionConnectionConnectionConnection

AAAA BBBB

Care systemCare systemCare systemCare system

Responsibility of care providerResponsibility of care providerResponsibility of supplierResponsibility of supplier

Deployment serviceDeployment service

Patient summary service – NPOPatient summary service – NPO

Connection serviceConnection service(optional)(optional)

Base serviceBase service



InterSystemsInterSystemsHealthShareHealthShare

InterSystemsInterSystemsEnsembleEnsemble


HealthShareHealthShare

HubHub

ViewerViewer

......

......ConnectionConnection ConnectionConnection ConnectionConnection

Care provider 1Care provider 1 Care provider 2Care provider 2 Care provider 3Care provider 3 Care provider nCare provider n

EdgeEdgeGateway nGateway n

EdgeEdgeGateway 1Gateway 1

IntegrationIntegrationservicesservices

SI = ServiceSI = Service interfaceinterface

Access Access GatewayGateway


The NPÖ in Sweden







Summary Screen Example


Level 2 Screen Example


Level 3 Screen Example


The NPÖ in Sweden

Questions and Discussion PleaseQuestions and Discussion Please

Christopher ReedChristopher ReedDirector, Strategic Healthcare ProjectsDirector, Strategic Healthcare Projects

Enquiries please call InterSystems at Tel: +7 495 967 0088www.intersystems.com

Swedish NPÖ National Patient Overview A Case Study for InterSystems HealthShare, Ensemble and...

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