1. Directorate for Health and Social Affairs Action Plan 2001 – 2003 “Say @!” : Electronic interaction within the Health and Social Services

2. Directorate for Health and Social Affairs Division for Health Care and Social Services Department for IT-Strategy and Statistics Ministry of Health Ministry of Social Affairs Directorate for Health and Social Affairs

3. Directorate for Health and Social Affairs Healthcare - some relevant reforms Ownership and organisation reform (Hospitals) Free choice of hospital (1.1.01) GP reform (1.1.01) Reorganisation of central health & social welfare bureaucracy

4. Directorate for Health and Social Affairs ”Say @!” Action-plan for IT- development in the health and social sectors, for the period 2001-2003. Launched by The Ministry of Health and Social Affairs in January 2001. Managed by the Norwegian Directorate for Health and Social Welfare. Operated by local and regional parties in the health and social services sector

5. Directorate for Health and Social Affairs Objectives Stimulate electronic interaction and exchange to strengthen and increase collaboration and efficiency in and between health and social services. Improve contact with patients, clients, and those in need of care. Improve the quality of services.

6. Directorate for Health and Social Affairs “Say @!” Four areas of eHealth action: 1.Infrastructure - National healthcare network 2.Electronic interaction and exchange 3.Telemedicine 4.Services for the public

7. Directorate for Health and Social Affairs A national health network: Provide a good and secure infrastructure for electronic interaction and exchange between health personnel, with adequate capacity and a set of basic services to facilitate this interaction. The net will be realised by the end of 2003.

8. Directorate for Health and Social Affairs National healthcare network: originally based on 5 regional health networks.. Action 2001/2002: Funding regional networks connecting hospitals Linking up GPs

9. Directorate for Health and Social Affairs Action 2002/2003: Central Infrastructure - NHN: Connects 5 RHAs, Clear responsibility towards each RHA God scaling possibl./flexibility Restricted ”channels” in the transport net Run by central supplier Common approach of firewalls etc. All this: SHDir responsibility

10. Directorate for Health and Social Affairs National Healthcare Net (NHN) – Background What is NHN? Consists of RHAs regional net and SHdirs central infrastructure. These elements shall be linked up, and some basic services will be established. Goal? Equal possibilities for electronic interaction with all relevant actors and services, regardless of regional borders and point of access Division of responsibility? Each RHE: responsibility for regional net SHdir: responsibility for central infrastructure with basic services (jfr. Infrastructure project): Includes a transport net (transit net) between regional healthcare nets, offer some basic services and make possible interchange with important national actors

11. Directorate for Health and Social Affairs National Healthcare Net – Challenges/discussion points Short term: well-functioning and continuous co-operation with RHAs, suppliers, and other relevant environments Clear areas of responsibility Follow-up of relevant laws and regulations Design economic principles and stimulative measures that enables further development Long term: Organise a central organisation that runs the net (minimum the role of demander) Significant growth in daily use of the NHN

12. Directorate for Health and Social Affairs Electronic interaction and exchange During the plan period, widespread use of electronic exchange will be realised for central messages such as referrals, medical records and reimbursements. In addition the scope of electronic interaction within the sector will in time be expanded to include the care and nursing services in primary care as well as the social services.

13. Directorate for Health and Social Affairs Electronic interaction - current status Most GPs have electronic patient records Approx. 1000 GPs have communication solutions for message exchange (based on x-400) Approx. 800 GP offices (of total 1840) will be connected to the National Healthcare Net by the end of 2003

14. Directorate for Health and Social Affairs Electronic interaction - current status 34 hospitals offer electronic discharge reports to GPs 600 GP offices receive electronic discharge reports – soon to increase in number 4 pilots on electronic referral messages to hospitals electronic booking - 6 pilots merging into a common specification for online booking services and related referral messages

15. Directorate for Health and Social Affairs

16. Electronic interaction – actions 2002/2003 Standardisation program: EPR-standardisation, message standards – information content, etc. IT coordination funding to RHAs: electronic interchange with primary healthcare Referral mssg./Discharge rep. Project: project support, coordination and follow-up, Templates for ”The good discharge report” and “the good referral letter”. ELIN: sector cooperation on developing new solutions for electronic interchange with GP offices

17. Directorate for Health and Social Affairs Electronic interaction – actions 2002/2003 Demand that all hospitals shall offer electronic discharge reports til GP offices Electronic sickness reports to the National Insurance Services (NIS) – National framework contract for PKI/ digital signature (established by NIS) Electronic reports to central health registers: Cancer register and medical birth register

18. Directorate for Health and Social Affairs Electronic interaction – challenges/discussion points Stronger force behind standardisation demands– establish systems of accreditation? Web solutions - alternative to message exchange - security issues Need for investments in municipal sector

19. Directorate for Health and Social Affairs Telemedicine - goals During the plan period, telemedical solutions will be put into use throughout the country to insure greater availability of services. To a larger extent than before, telemedicine will enable people to be treated or nursed in their local environment or in their homes.

20. Directorate for Health and Social Affairs Telemedicine - actions Teleradiology, IHE – program to achieve integrating PACS/RIS Establish Telemedicine services between hospitals and primary care

21. Directorate for Health and Social Affairs Services to the public - goals Throughout the plan period quality-assured information on public health and social services will be made available to the public. Access to an increasing number of services for interaction between the general public and health and social service personnel via the net will be facilitated.

22. Directorate for Health and Social Affairs Services to the public – current status 75 % of the Norwegian population have access to the Internet (Gallup, august 2002) 31% use the Internet for health purposes (Andreassen, Tidsskrift for Den norske lægeforening 17/2002) 45% wish to use e-mail in interaction with their doctor (Andreassen) An increasing number of health sites is available, but the quality varies New roles of the patient and health personnel Use of the Internet and electronic communication can help fulfil patients rights

23. Directorate for Health and Social Affairs Services to the public – actions 2002/03 Guidelines for establishing e-health sites focus on ethics and legal issues Pilots – electronic communication between patients and doctors. Focus on security, health legislation, medical, organisational An information site for free choice of hospital – waitinglists and qualityinformation Accessibility for all also people with disabilities Web survey of e-health web sites focus on quality

24. Directorate for Health and Social Affairs Services to the public – challenges/discussion points Is electronic communication with your doctor ”safe enough”? How can you satisfy patients rights when the patient is anonymous? Can a patient “agreee” to reduced security? What kind of information do patients/relatives want from a hospital web site?

25. Directorate for Health and Social Affairs Say @! - Status Central Taskforce: 9 persons in the Directorate, working on Say @! Follow-up, in co-operation with the ministries, RHE group, SSIT/, eNorway + + Regionally: RHEs are putting IT high on the strategic agenda, and focuses on central Say @! goals RHE IT strategy integrates Say @!-goals

26. Directorate for Health and Social Affairs Funding The regional health enterprises have major responsibility for building regional infrastructure, and for facilitating interaction with the primary health care and social services sector. National funding is provided for the development of different services, standards and security guidelines.

27. Directorate for Health and Social Affairs Conclusion Evaluation of results A new action plan is on it’s way