Healthcare ICT and HMIS in Norway

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Overview

• Introduction to the Norwegian Health system

• IS and public health

• IS for patients

• IS for patients’ care (hospitals) – not covering this part

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Norwegian Healthcare system

• Norway has a predominantly public health care sector.

• The Norwegian health system is characterized by universal coverage: the health system is built on the principle that all legal residents have equal access regardless of socioeconomic status, country of origin, and area of residence.

• It is financed mainly through taxation, together with income-related employee and employer contributions, and only to a small extent by out-of-pocket payments (see Frikort).

• All residents are covered by the National Insurance Scheme (Folketrygden)

• Unique personal number

• Unique identification of healthcare professionals

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Norwegian Healthcare system

• Health care services are provided at two levels: 1. primary care is at municipal level,

2. and specialized care is at regional level.• The central Government has overall managerial and financial

responsibility for the hospital sector. • Norway’s four regional health authorities control the provision of

specialised health services by 27 health enterprises.

• The Coordination Reform 1st January 2012• interaction between primary care and specialized care lacks

mediating structures.• establishment of pre-hospital low threshold wards in primary health care• municipalities are gradually obliged to establish primary emergency 24-hour

care for patients who do not need specialized hospitalization

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Primary care• Municipal health services consists of :

• general practitioners services, emergency room services, physiotherapy, nursing homes, midwife services and nursing services, (including home-based services). 

  • The municipality also runs preventative health services: Health 'Stations' and

school-based health services

• (Except for a few institutions with advanced rehabilitation services) long-term care does not exist within the hospital sector but it is integrated in primary health care.

• Primary health care and social care services also care for patients recovering after a hospital stay.

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Municipal health services (some numbers)

• On average a municipality has 10,000 inhabitants (range from 250 to 500,000 people).

• There are 430 municipalities.• The larger cities are subdivided into boroughs (city districts - bydel)

covering services for about 30,000 inhabitants each. • A municipality with 10,000 inhabitants will have about 10 GPs, 90

nursing home beds and 150 nurses, nurses aids and home helpers working in home care for elderly and disabled people.

• In 2010, there were 0.83 GPs per 1 000 population.

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GP scheme 2001

• The general practitioner scheme was introduced in 2001, states that:

• Every inhabitant is entitled to be listed with a general practitioner (GP) of his or her choice, (almost all residents (99.6%) are registered in the scheme).

• Every GP is now responsible for a list of individual patients• GPs’ role as gatekeepers: patients need to see their GPs before

they can be referred (referral letter) to the hospital (except in emergencies). 

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Specialist care • Hospitals and institutions: organised in enterprises/ trusts under four

Regional Health Authorities: • Helse Nord (covers the counties of Nordland, Troms and Finnmark) • Helse Midt-Norge (Nord-Trøndelag, Sør-Trøndelag and Møre og  Romsdal) • Helse Vest (Rogaland, Hordaland and Sogn og Fjordane) • Helse Sør-Øst  (Vest-Agder, Aust-Agder, Telemark, Vestfold, Østfold,

Buskerud, Oppland, Hedmark, Akershus, Oslo) 

• The RHAs have structured the hospitals around 25 health enterprises (65 hospitals)

• (Before 2002 the hospitals have been owned and run by the counties for over 30 years).

• In 2010, the private hospitals (both not-for-profit and for-profit privately owned hospitals) accounted for 1 601 beds, approximately 10% of the total of 16 117 beds.

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4 Regional Health Authorities - 2002

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Helse Nord

Helse Midt-Norge

Helse Vest Helse Sør-Øst

Access to specialised care

• Referral to specialist care: primary care physicians as gate keepers.

• Patients may choose the hospital. • (They are not, however, allowed to choose a hospital that is more specialised, e.g. a

university hospital, than the one they have been referred to.)

• Free choice of hospital for elective treatment was introduced from 1 January 2001 (Fritt sykehusvalg, www.frittsykehusvalg.no May 2003)

• to strengthen patients’ positions as decision-makers (informed choice) • to even out differences in waiting times for treatment.

• Some studies indicate that relatively few patients seem to have opted for the possibility of receiving treatment outside of the hospitals’ natural catchment areas. 

• Patients are willing to wait a considerable length of time to avoid travelling. The reluctance to travel increases with age and decreases with level of education.

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• www.ssb.no• www.fhi.no• www.helfo.no• www.helsedirektoratet.no• www.fryttsykehusvalg.no• www.helsenorge.no

• www.kith.no• www.nhn.no

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assignment

• Which public health data are made availabe?• …

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IS for patients

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Breadth/vision

Concretization/implementation

IT strategy in health sector

1997

2013

IT strategy in health sector• S@mspill 2.0• Specific vision/aims e.g.:

• Relevant and good quality information on health , lifestyle, services, treatments is available on internet.

• The patient has access to his own health information, own medical record, overview of prescriptions and medications, discharge letters, freecard and more.

• Via an interactive services is possible to (for instance) change appointments at the GPs or other providers.

• New services on internet support self care possibilities.

• Patients and users experience that health personnel has a good overview on their health status and health history when they come in contact with health care services.

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Historical view

• Early mover on Health ICTs:• National ICT strategies since 1997• First to implement EPR (public hospitals and GPs)• 1980’s- 90’s: Development initiatives on a national scale

• Widely digitized sector:• Hospitals, general practitioners, nursing homes, pharmacies,

private sector specialists• … but weaker on linking them together• GPs first to implement EPRs, ~100 % coverage• uptake by municipality home care and nursing homes has been

slower

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One resident – One record

• improved quality, improved patient safety, more efficiency and better use of resources

• quick, easy and secure access to all necessary information.

• regardless of where in the country the patient is receiving treatment

• Citizens should have quick access to simple and secure digital services.

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Digital dialogue GP project

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assignment

• www.helsenorge.no

• Which services are offered?• …

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Summing up…

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