Sweden
This issue of the Journal looks at the Swedish healthcare system and some
of the healthcare-computing developments that are taking place there.
Previous December issues have covered several countries, but this is the
first time that we concentrated on a single country.
On the evidence of this month’s articles, there is much to be learned
from our Swedish colleagues. Our first article, taken from the Swedish
Institute’s overview of the healthcare system, describes the way in which
healthcare in Sweden operates. Readers will recognise a number of features
similar to our own system but will also notice some stark differences.
In particular, the responsibility for the provision of healthcare lies
with county councils, operating within a national legislative and standards
framework — a framework that has diminished in recent years, and which is
now more concerned with results rather than methods. This devolved approach
has enabled county councils to achieve considerable changes, including a
reduction in acute beds and in the number of 24-hour casualty departments.
Even more surprising, county councils (some 89% of whose spending is on
healthcare) have been able to reduce their healthcare expenditure in real
terms by some 1.5% a year throughout the 1990s. In terms of central
direction, therefore — and in marked contrast to this country — this has
been a period of organisational stability.
It is thus not surprising that it has been possible for the county
councils to direct their energies to the sensible streamlining of their
healthcare resources, and — in furthering that end — to the development of
enabling information systems.
Our remaining three articles show what can be achieved in conditions such
as these. In his article, Per-Olof Egnell, Process Manager for Norrsken
Innovation, based at Luleå University of Technology, describes the
pioneering work carried out in Norrbotten, the northernmost, and most
sparsely populated, county in Sweden. A countywide network connects all the
healthcare facilities and provides not only the vehicle for an integrated
care record for the whole population, electronic referrals, and
eprescriptions, but is also the solid foundation upon which the practices of
telemedicine and telecare rely.
In his article, Robert Stewing, the IT Project Manager for Sunderby
Hospital explains the steps taken to ensure that, when it opened in 1999, it
could operate as a paperless hospital from the first day. This was an
extraordinary achievement, and one which splendidly complements the
architectural excellence of the hospital building. Coupled with the
countywide networking and database, the system is a superb example of the
way in which information technology can transform healthcare.
Our last article — by Karina Tellinger, Market Developer for Apoteket AB,
Sweden — describes the system now operating in Sweden for the transfer of
prescriptions, where already 42% of all prescriptions are transmitted
electronically from the physician to the chemist. It’s a percentage that has
risen dramatically over the last five years, and which continues to do so.
Plans for the future propose that the current system will evolve into a full
record of all medication for every patient, through a ‘medication account’
to be owned by the patient and shared with healthcare professionals.
All these articles record very substantial achievements in healthcare
computing. What, then, is there to be learned by this country, as we grapple
with the objectives of The NHS Plan and the enabling role of Connecting for
Health, without which The Plan cannot be achieved? The first realisation
must be that, in technical terms, the aims of England’s NPfIT are entirely
possible: they are not castles in the air, the systems are available and can
be seen in use now. The second is that the Swedish approach proves that in a
climate of organisational stability, information systems can make enormous
strides, because they are given the chance to show how they can make a
positive contribution. The third is that it is possible to install paperless
systems, both in hospitals and in the community, and that they are
acceptable to ‘the man in the street’.
All these points have relevance for NHS Connecting for Health and for the
possibilities that it has the potential to offer. A doubter might well
observe that the Swedish experience is not relevant to the English scene:
that Norrbotten with a population of only 250,000 is too small a testing
ground from which to extrapolate; that, of course, the electronic transfer
of prescriptions is possible in a land where the high-street pharmacist is a
public-sector employee; that constructing a paperless hospital is ‘easy’ in
a brand new organisation.
Those points have a modicum of relevance. But that is nothing compared to
the fact that the Swedish experience demonstrates what can be done: that
both the technical and human problems involved in so great a step forward
can be solved.
There is much for this country to ponder — and, at the same time, to
salute a remarkable achievement.
Michael Fairey |
