Sweden dives into eHealth as Australia dallies

Australia is falling behind the rest of the world in using information technology to improve the healthcare sector, according to an Australian leading the implementation of an eHealth system in Sweden.

Kerry Stratton, managing director of Healthcare for software developer InterSystems in Australia, is two months into a trial of a national electronic health records project in Sweden, and said Australia has a lot to learn from the Scandinavian country.

Analysts suggest Australia is both in need of an eHealth overhaul and at the crossroads of accepting the privacy implications.

But Stratton said there is a lack of political will or unity in Australia.

"We have to get on with it," he told iTnews. "We can't keep talking forever."

The Swedish example

Sweden started looking into the possibility of an electronic health record system around three years ago, driven by the need to put key clinical information in front of doctors and nurses at the point of care.

The country's health officials recognised that the most vital information required for such a system is a patient's medication history - what medications they are currently on, whether they have had similar medications prescribed, and whether they have any allergies or reactions to previous medications.

This information is critical when prescribing new medications.

InterSystems signed a contract with the national government of Sweden in March 2008 for the build of a national health record system and kicked off a live pilot in April 2009.

The live pilot phase will last three months, with a limited number of healthcare professionals gaining access to the system in a limited geographical area (the municipality of Örebro, west of Stockholm.)

Stratton said the pilot "has to provide results and clarity and confidence and 100 per cent uptime before [the Swedish Government] will announce it and sign it off as being able to go into live production for the rest of the country."

Sweden chose a model whereby patient information is stored on central servers and accessed by primary and acute care providers via the internet.

When a request for patient information is made, the system checks the request against a national database for the security and privacy requests of Swedish citizens, which sends back a message as to whether the system can access specific patient information.

Stratton said Sweden adjusted its privacy laws to ensure the system could "provide information doctors and nurses could rely on."

Swedish citizens, meanwhile will be able to access their own records and also look at who has viewed their information via a running log of access to their files.

Stratton said the Swedish system is opt-out rather than opt-in. Despite the objections of privacy experts in most corners of the world, he does not believe an 'opt-in' system works.

"One of the things to make these things successful is to get doctors and nurses to use them," he said.

"They will only use them if they are confident the system is useful."

Stratton said Australia can learn five key lessons from the Swedish trail - read on to page 2.

Stratton believes Australia can learn a lot from the Swedish trial.

He cites several reasons why the Swedish trial will be successful.

1.     The project is national

As a nation of nine million people, Sweden's National Government managed to win provincial governments over to the virtues of the project, Stratton said.

In Australia, by contrast, "you've got Federal and State Governments with an interest in this, so there is no clear funding or management," he said.

"When it comes to developing an Electronic Health Record, there needs [to be] an agreement of the road forward. We are only a country of 20 million people - we need to set the way forward at national level and have the States get on board with national initiatives.

"What we need in Australia is a national commitment," he said.

2.     The project is driven by strong leadership

Sweden's eHealth system is being funded through an apolitical private/public organisation called Carelink, set up specifically to procure and manage the system.

The beauty of Carelink, Stratton said, is that the healthcare industry can be confident it would continue to exist regardless of changes in Government.

"Carelink also put on smart people to advocate the Government's commitment and carry it through," Stratton said.

"The Australian Government needs to find a champion - someone seen as credible and committed to the project, for the good of healthcare providers and citizens."

Stratton believed the Australian Medical Association (AMA) and the National Electronic Health Transition Authority (NEHTA) both need to be involved.

"But in saying that, we can't go on to more committees for the rest of time," he said.

NEHTA's initial goals around standards are "important" he said, but things have to move along.

"There'll be new standards evolving before we agree on what we're using," he said. "We need to progress, we need to move on, we need to have a group committed to getting this up and running.

"NEHTA needs to be more than a standards organisation. It needs to be an organisation committed to getting it up and running in a given period of time. There needs to be a commitment to say, it will be finished by x date."

3.     The system was de-politicised and sold on its benefits

In Australia, Stratton said, we need to "de-politicise" the eHealth issue.

"Healthcare is a motif," he said. "It can be a good thing to be on the bench about or a bad thing. It's an emotive issue, a rollercoaster."

Stratton said the Swedish Government "sold" the electronic health records project to its citizens "on the basis of it being advantageous to them."

"They have promoted it as secure and accountable, that you can look at it like a bank statement," he said.

"It was clearly understood what the aims were. They built a lot of confidence into the system and have been very consistent in their approach."

4.     The Swedish system is modular, but comprehensive

Stratton applauded the Swedish Government for extending its electronic health record system into both primary and acute care.

"Doing it that way, they have a huge percentage of those systems that collect health information locally feeding into the system," he said.

"It is no good putting up an Electronic Health Record for just the acute care sector - you need support of both private and public and of primary care. It has to be a commitment from all sides.

"If there is less value to the user and the patient, it is less likely to be used and be successful."

5.     The Swedes got on with the job

"They stopped talking about it, and actually went and did it," Stratton said.

"They had a schedule of dates and through the whole process there was never more than a delay of two or three days.

"That keeps both the vendor and their own people focused on it. Citizens and the healthcare industry get confidence it will be done properly. There was never that feeling of 'oh no, not another pilot'."

Australian authorities need to make some kind of start, he reiterated.

"You are never going to find a system that 100 per cent satisfies the visions of all stakeholders," he said.

"Stakeholders have to be flexible, they have to let a system evolve over time. We need to get started today with what's the most important thing we need to address with an Electronic Health Record - be it lab results or medication summaries - get those things up and running and lets then have a plan to evolve the systems over a period of a time."

Stratton concluded that eHealth has no technology barriers left, just social and political ones.