EHR records in Sweden and What the Future Brings
Decentralized healthcare system
Swedish healthcare system is much decentralized and in each of the 21 counties, the County Council (“Landsting”) is responsible for managing both public hospitals (95% of the hospitals) and primary care centers (40% of them are public). Each County Council is responsible for the selection and procurement of their own health IT systems, whether those may be in-house developed solutions (e.g. Melior EHR system) or outsource it to private companies (e.g. Cambio Cosmic EHR). When it comes to EHR systems, this decentralization may have a lot of benefits allowing each region to acquire the type of system based on their own needs, but it can also cause a lot of issues especially concerning interoperability with other systems and regions.
By 2012 all county councils had fully implemented EHRs in hospitals, psychiatry and primary care, but there wasn’t a single national database for patient records. Even though there are only five major vendors for the whole Swedish territory (accounting 96% of the market share), unlike in for instance the US where the 5 largest vendors make up only 50% of the market share, all of the regional systems are not interconnected. Even for the same vendor it is difficult to track their own systems. For example Cosmic EHR system which is implemented in 8 different counties also lacks interconnectivity since each system for each County has its own configuration making it 8 different systems.
In order to solve these problems, the National Patient Summary (Nationell patientöversikt – NPÖ) was initiated where the idea is that health care staff should able to directly access a patient’s medical records that are kept by other health care providers, if certain legal requirements are met. The implementation of this shared EHR system has taken place and it is planned that in the next few years all of the health care providers in Sweden, both public and private, are connected.
Major EHR players
The most widespread EHR systems and their vendors in Sweden include Melior (Siemens, USA), Cosmic (Cambio, Sweden) and TakeCare (CompGroup, Germany) which have been market leaders for several years. The chart below represents data from 2015 regarding the distribution of users for major EHR systems in Sweden where the previously mentioned 3 vendors have very similar numbers of users.
Usability and interoperability issues
Long time has passed since 1989 when the first Swedish hospital located the southern part of Sweden (Ystad) started to fully use an electronic health system called Swedestar. The overall assessment of that system in 1994 concluded that the goals of the system were partially met, but 25% of the hospital staff were dissatisfied with this EHR system and thought it worked worse than expected. Unfortunately, the EHR systems and health IT systems haven’t been advancing as well as IT in the other industries which is most likely the reason why dissatisfaction still remains, especially concerning the usability aspect. One of the main objections is the difficult layout of the record and the risk of missing important information due to the large amount of information available. The interface of the EHR also involves a lot of mouse clicks when searching for information and filling in the record, which can be frustrating for some health professionals. This implies there is a need for developing more user-centered systems focusing more on the needs of the caregivers and to work together with health professionals in making the IT systems more user- friendly, thereby allowing caregivers more time with the patient instead of wasting too much time in filling in the patient data and locating the necessary information.
With this in mind, a new Swedish health IT project involving the Stockholm County Council, Region Skåne and Västra Götaland decided to merge together to bring their IT systems into the future. According to Ann Soderstrom, director of Healthcare Services in Västra Götaland region, the current systems are simply not good enough, and do not supported the current healthcare needs. By joining together these three regions will go through what it takes to progress from an environment of systems that do not communicate with each other to a system where it will be simple to exchange information between hospitals and health centers, or between different county councils, while also making these systems more modernized and user-friendly. With a budget of 30 billion SEK the project is going to include a common platform where patients and healthcare
practitioners can interact and where the patient and resident is allowed to access their information and take active part in their own care. It also aims at increasing the ease of use and a providing a better working environment for the employees of the business and increased competence in the use of information tools. The project delivery is estimated at 2020 and then we will be able to see if all of these initiatives will have resulted in the desired success.