Sweden’s noble e-Health strategy

Clinical (archive)
1

Further to my last email, I said I would mention positive eHealth
developments that are unfolding in Sweden.
You may be interested in this article and the links to recent Swedish
eHealth presentations.
http://frectal.com/2010/11/15/swedens-noble-e-health-strategy/

The ambitions of the Swedish eHealth strategy are far seeing and
internationally leading, albeit with much work to do.

You may already know that openEHR and archetypes feature significantly
within their plans.
The openEHR technical list has recently been full of debate as to the
current state of openEHR, progress, tools etc.
Not as much debate on the clinical lists... as either not enough
clinicians here/engaged/bothered/worried about these issues?

Perhaps the Swedish vision may spark some useful discussion on clinical
gap between where we are and where we want to be..

Regards,

Tony

Dr. Tony Shannon
Consultant in Emergency Medicine, Leeds Teaching Hospitals
Clinical Lead for Informatics, Leeds Teaching Hospitals
Chair, Clinical Review Board, openEHR Foundation
+44.789.988 5068 tony.shannon@nhs.net

2

Thanks. The link in your article towards those Swedish presentations doesn't seem to work.

Cheers,

Stef

3

Thanks Stef,

The link points as far as I could..which gives the background to the
meeting.

"On 2-3 November 2010 the Center for eHealth in Sweden and the National
Board of Health and Welfare organized a meeting in Lund to present and
discuss the Swedish approach to information structures. The broad
participation by 65 participants from more than 15 countries and the
useful input they provided made the meeting a success!"
http://www.cehis.se/nyhetsarkiv/the_swedish_approach_to_information_structures/

From there the instructions explain you have to get into their document
archive and the search for "Lund" and the relevant presentations are
returned.
http://www.cehis.se/dokumentarkiv/

Sorry its bit complicated, was the only way I have found.
Perhaps a Swedish colleague can send link to a simpler way..

Thanks

Tony

4

Perhaps this could work, see titles/descriptions below, click the titles and get each specific link.

· V-Tim - presentation Lund 101102

A presentation about V-TIM – the applied information model that is a framework for the “content and context” described for a clinical perspective and a result of national and regional projects. The presentation was made by Inger Wejerfelt, Chief health informatics officer CeHis.

· The Missing Link - presentation Lund 101103

A presentation about INFOstructure, Semantic Interoperability Stack, experiences and EN13606 Association (history, goals, website/wiki, statutes, actions). The presentation was made of Gerard Freriks

· What are we trying to achieve? - presentation Lund 101102

A presentation about what we are trying to achieve made by Nils Schönström MD PhD and Senior Advisor CeHis.

· The Swedish eHealthapproach - presentation Karl-Henrik Lundell Lund 101103

A presentation about the The Swedish eHealthapproach made by Dr Karl-Henrik Lundell.

· The Swedish eHealthapproach - presentation Håkan Nordgren Lund 101103

A presentation about The Swedish eHealthapproach made by Håkan Nordgren, Head of National e-Health architecture board CeHis, MD .

· openEHR& EN13606 - presentation Madrid 100624-100625

A presentation about openEHR& EN13606 made by Thomas Beale.

· Open EHR in Sweden and beyond - presentation Lund 101103

A presentation about What open EHRoffers - in the big picture made by Thomas Beale.

· SNOMED CT - presentation Lund 101103

A presentation about SNOMED CT - concept model attributes and archetype integrationand terminology binding made by Jessica Rosenälv (Expert in health informatics).

· The reference archetypes - presentation Lund 101103

A presentation about reference archetypes made by Helene Broberg, (Expert in health informatics)

· Interdisciplinary Terminology for Health Care and Social Care in Sweden - presentation Lund 101102

A presentation about Interdisciplinary Terminology for Health Care and Social Care in Sweden made by Bengt Kron.

· Business driven archetype development - presentation Lund 101103

A presentation about Business driven archetype development made by Jessica Rosenälv (Expert in health informatics).

· Presentation Rotterdam ISO/CEN möte - Dr Karl-Henrik Lundell

A presentation of the Swedish strategy and its relation to standards made by Dr Karl-Henrik Lundell.

2010/11/24 Tony Shannon <tony.shannon@nhs.net>

5

Thanks Tony,

Those second set of instructions worked well for me! One of the
challenges in this kind of project is in deciding the best approach to
integrating existing shared clinical archetypes with the process
support requirements of the Swedish V-TIM model. I actually think they
too are very generic and being based on the CONTSYS work, are actually
a pretty good basis for a universal approach to this area.
Nevertheless, this kind of distributed process support is still in its
infancy, untested in practice, and no doubt other alternative models
will appear, so it seems premature to add the Swedish process overhead
to e.g. existing CKM archetypes.

Ian

Dr Ian McNicoll
office / fax +44(0)1536 414994
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical analyst, Ocean Informatics
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care SG Group www.phcsg.org

6

Hi Ian,

I agree with your analysis on this. Therefore I think it's necessary
to find a way to support both the reuse of existing international
clinical archetypes in CKM and local process models (might be
different from country to country).

Cheers,
Rong

7

Thomas Beale's

http://www.cehis.se/images/uploads/dokumentarkiv/Lund_101103_openEHR_Thomas_Beale_Presentation_101110.pdf

and Helene Broberg's

http://www.cehis.se/images/uploads/dokumentarkiv/Lund_101103_The_reference_Archetypes_Helene_Broberg_Presentation_101110.pdf

presentations from Lund make some of these issues clearer.

Ian

Dr Ian McNicoll
office / fax +44(0)1536 414994
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical analyst, Ocean Informatics
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care SG Group www.phcsg.org

8

Thanks for the list Rikard and the pointers Ian.

I was not able to get to Lund unfortunately - but it is clear there is some
good work going on. In Inger Wejerfelt's introduction it was good to see the
statement:

Swedish national decision – "Standards with focus on the information and not
the communication only".

This is a critical shift and one that needs more attention. I cannot help
but think we are stuck in a world where everyone thinks that health records
can be whatever anyone dreams up and then they will interoperate. It is like
the first few years of word processors and we are agreeing on what words are
and paragraph breaks. We still have our own character representation and we
are agreeing on sending paragraphs to each other to share. It is hard work.

Companies have made a lot of progress, Vista is open source and has a lot in
it and GM's collaboration with Intermountain has the benefit of Stan Huff's
insight. But health records are too important to do in a closed way or tied
to a particular technology. Peter Fleming, head of NEHTA, has said "The Best
of Breed is not an option" meaning we are not looking for good software that
everyone can use. That is why I work in the openEHR community; so we can get
on with this together and create a record that actually delivers what health
care needs while allowing maximum diversity in applications.

A risk we might fall into is trying to do everything at once - this is not
possible as 'everything' grows quickly from the previous everything. At this
stage in developments the range of new possibilities transforms every year
or less. So we need to decide on the first piece and implement it widely.
For me that has always been the personal health record - concentrating on
what has to be recorded. It will not do everything that is required but it
will keep a record of it. Then we can then get smarter and do more.

The openEHR ACTION class embodies this divide between the model of care
(workflow) and a model of recording. The care pathway steps are not actually
the steps but rather the things that a clinician might record in following
an instruction (or just doing it). People I am working with want to consider
the workflow and transitions but the fact is that these all happen in the
real world and do not get recorded consistently. When something _is_
recorded it is essential that we capture the state of the (possibly virtual)
order. This means we have an idea of what is outstanding, ongoing etc.

We need more Swedens, more countries willing to think about the health
record as possibly the most valuable resource. We need more people working
on the shared logical specifications based on shared implementations. Tony
Shannon has always said that this needs to be open source - so people can
play with the code and cut it this way or that. The risk is that people who
are not building systems will get very involved and the result will go in
the generic but unusable direction. So we need to make sure people
contributing to the stack are actually using the code in real systems. There
are enough of these to be going on with. How to get them to the point where
it all becomes self-funding? Would IHTSDO choosing to adopt openEHR as the
information model make a difference? Will a big player start to see the
value of supporting this work? Do companies like Microsoft or IBM have
anything to gain from this?

I think the answer is Yes but it might take a little while. Sweden's
approach is a great start. Lets support them to the hilt but keep
encouraging them to implement so that we can be sure that each step adds
value.

Cheers, Sam