1. Cross-border healthcare in Torne Valley (Sweden/Finland)
Thanks for the introduction I am very pleased for the opportunity to be here today and introduce to you all our work with cross-border health care in Torne Valley. For a geographical orientation is this project situated in Northern Europe and along the border between the very north of Sweden and Finland.
Anna-Greta Brodin
County manager
Primary healthcare North
County Council of Norrbotten

2. TORNE VALLEY 60 000 inhabitants -40 000 on Finnish side
on Swedish side
Multilingual, multicultural
-Swedish
-Finnish
-Sami
-Meänkieli
Natural cross-border flow of people
-work
-studies
-recreation
-Health- and medical care
I will start by giving you a short background.
On this map you can see the functional region of Torne valley. It is a beautiful area, with the Torne river in the middle, the river which as well constitute the border between Finland and Sweden.
But we are facing challenges, we have long distances, a low population and demographic trends. The inhabitants on the Finnish side is and on the Swedish side but by seeing the area as a whole with inhabitants and cooperate across the border gives us a much greater ability to maintain good health care.
In year we paid attention to that it was only 200 years since the Finnish war was ended and this border was established .before was this area part of Sweden. Still it is a strong affinity among people, both in language and culture. We also have a common language which are called Meänkieli , you can say a mixture between Swedish and Finnish.
Here is a natural cross-border flow of people. For work, studies, recreation an so on. Some people describe it and says that they live ON the border.

3. Established cross-border for 30 years in: -Cross-border commuters
CROSS-BORDER CARE
Established cross-border for 30 years in:
-Cross-border commuters
-ambulance service
-“doctor on call” collaboration
-Diagnostics
-dental clinic in Karesuando
The population and administrations demand an increase in cross-border care
Regarding health care we have an established cross-border cooperation since many years.
We have cooperation within Primary health care especially for those people who live on one side of the border and work on the other. ( called cross-border commuters) those people have already today legal rights to choose in which country they want to get primary health care.
We have Ambulance cooperation and on call duty collaboration. .
We collaborate in diagnostics, x-ray and we have a common dental clinic in Karesuando.
But it was very clear, that there was a strong demand from the population and administrators to strengthen and even further increase cross-border healthcare. And it was a necessary action for the responsible municipalities on both sides of ( Swedish and Finnish) Torne Valley in order to achieve the right care quality and to be able to have sustainable health services in the region.

4. Cross-border healthcare in Torne Valley
PROJECT
Municipalities and their Care Centres in Finland
Torneå
Ylitornio
Pello
Kolari
Muonio/Enontekiö
Swedish Healthcare Centres
Haparanda
Pajala
Övertorneå
With that as background, we applied for and was granted EU funds through the Interreg IVA Nord, The project was called Cross-border health care in Torne valley and where divided into two phases.
Where Phase 1 included a operational review during 8 months and Phase 2 was a test and implementation phase during 21 months
The project was ended in July this summer
Implementation in two phases: 8 months, review (November 2008 – June 2009)
21 months, test and implementation (November 2009 – July 2011)

5. Create conditions for a free choice of cross-border healthcare.
PROJECT
Aim
Develop and deepen the healthcare cooperation between healthcare providers in Torne Valley, in order to create high quality cross-border care.
The Aim for the project was to
Further intensify and develop that existing care collaboration between healthcare providers in Torne Valley, in order to create high quality cross-border care.
And to create conditions for a free choice of care for patients in the region
The project included the geographically functional region of Torne Valley and Primary Care
Create conditions for a free choice of cross-border healthcare.
Included
Geographically limited to the interaction region Torne Valley.
Included Primary Care.

6. Free choise of cross-border care -patient survey
WORK AREAS and RESULTS
Free choise of cross-border care
-patient survey
-Cross-border commuters
Laws , insurance and compensation
-today is not a free choise of cross-border healthcare - EU Directive on -patients' rights to cross-border healthcare
-patient Data Act
-patients, staff and ambulance insurances
-nurse licence and emergency drugs
Emergency logistics
-emergency plans for ambulance cooperation
-Cross-border co-operation agreement for ambulance/helicopter
-emergency exercise
I will now give you a brief account about our work and results. and may refer you who are more interested in our results to our project report.
The project has had a goal to highlight issues and barriers to cross-border health cooperation in the field of law, insurance and compensation.During our project we have analyzed and communicated the possibilities as well as the obstacles for a free choice of cross-border care to politicians and legislators.
We have conducted a patient survey in the Torne Valley and received in total more than 1200 responses which revealed that 67% of patients wished to have access to a free-care choice over the boundary
We have also highlighted the Finnish health care centers compensation problems regarding the cross-border commuters. (don’t received the compensations and that could impede ability to take care of cross-borders commuters.)
Other examples which impede cross-border cooperation are
First of all, today it is not a free choice of cross-border health care but we are looking forward and are prepared for the introduction of the EU-directive on patients rights to cross-border healthcare. I think as well part of our work and results in this project can be used at the adaptation to the EU Directive.
Another problem is that the Finnish patient Data Act makes it difficult for on-call collaboration. Doctor in the other country are not allowed to have access to patient records as it requires. (even though patient give their approval.)
And the legislation is not adapted and developed for acute cross-border ambulance collaboration regarding nurse license, transfer of drugs and ambulance insurance.
Let us leave obstacles and go over to possibilities
When it comes to emergency logistics have we done a lot of improvement.
We have together with alarm centers and healthcare managers in northern Finland, northern Sweden and even included northern Norway, improved and quality assured our emergency plans and also developed and signed a co-operation agreement for ambulance and helicopter interaction.
We also have conducted a cross-border emergency exercise in which both the Swedish and Finnish personnel were included. The evaluation of the exercise has highlighted a number of improvement areas to be addressed.

7. Information and Communication Technology (ICT)
Cross-border
WORK AREAS and RESULTS
Information and Communication Technology (ICT)
-access to patient medical records – epSOS
-video techniques for on-call emergency consultations and meetings
-digital transmission of X-rays
Working methods and training
-common care plan
-study visits and staff exchange
Communication and dissemination
-been presented in many konferences,
-network
-projectreport
In addition to collaboration is the use of e-health, another key strategy for our project.
During the project period, we have studied and tested, access to patient medical records, use of video technology for meetings and on-call consultations between countries, and digital transmission of X-rays. Tests have shown that even small improvements in IT support has contributed to better and safer care.
When it comes to working methods.
A review of the acute care programs in each country have been conducted and the results show that treatment programs are equivalent and can be medically approved for cross-border healthcare.
At times we have difficulties with shortages of skilled personnel, and in order to be able to help each other, personnel on both sides have done studievisits and training at each others primary care centers.
The project in Torne valley has been followed with great interest, and been presented in many conferences in Sweden, Finland and within the EU, not least by the next patient mobility Directive. It has also been highlighted as a good example of how to use common resources in an area with sparse population.
A networking and communication with the EU project "Grenseløst North" between the municipalities, Enontekiö in Finland and Stor fjord in Norway has been established. A study visit to Tromso was conducted in order to learn and establish contacts with northern Norway for acute trust and use of video technology for medical consultations.
Our project report is currently in press and will be available in Finnish, Swedish and English

8. Focus on services close to the patient: -European Patient Summary
Build on existing National eHealth Projects and use experiences and knowledge from all Member States.
Focus on services close to the patient:
-European Patient Summary
-ePrescribing across the EU
”Cross-border health care in Torne Valley” is an unique opportunity for "smart" pilot test in epSOS ”
I will end my presentation by insure that “Cross-border health care in Torne valley” will continue to work with those matters and “Cross-border health care in Torne valley” has connection to EPSOS. EPSOS- European patient Smart Open Services, is an international EU-project which consists of 12 member states and at least another five member states will join in the next step, inclusive Finland
EPSOS says that eHealth are the enabler for cross-border healthcare
The strategy are to Provide concrete cross-border services that ensures a safe, secure and efficient medical treatment for citizens when travelling across Europe.
Focus is on services close to the patient:
an European Patient Summary
And ePrescribing across the EU
Cross border health care in Torne Valley is selected to be a sharp pilot test within EPSOS.
And with this I will end with thanking you so much for your attention

9. Cross-border healthcare in Torne Valley (Sweden/Finland)
Thanks for the introduction I am very pleased for the opportunity to be here today and introduce to you all our work with cross-border health care in Torne Valley. For a geographical orientation is this project situated in Northern Europe and along the border between the very north of Sweden and Finland.
Anna-Greta Brodin
County manager
Primary healthcare North
County Council of Norrbotten