Sjunet The National ITinfrastructure for Healthcare in Sweden

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Sjunet The National IT-infrastructure for
Healthcare in Sweden
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Disposition

• The Swedish Healthcare structure
• Carelink
• Sjunet
• Telemedicine applications on Sjunet

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Healthcare structure
21 County Councils 290 Local Authorities
State level Healthcare lawand
supervision Regional level 70 of
Healthcare Local level Long term care etc
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21 County Councils
A duty to provide equalHealthcare to its
inhabitants A right to impose taxesfor that
purpose 300 000 1.8 m inhab.
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290 Local Authorities
A duty to provide long-termcare for its
inhabitants A right to impose taxesfor that
purpose 2000 700 000 inhab.
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Private providers
Private care-companies are growing with 15 each
year now providing 10 of all healthcare - in
some counties 25
1000 companiesMax 4000 employees most 5-25
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A good question..

• With such decentralised and complex structures in
  Healthcare How can national coordination
  within IT be acheived?

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Is there a need for national co-operation?
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Association of Local Authorities
Private Health and Social Care Employers'
Association
Federation of County Councils
Co-operation ofSwedish Pharmacies
National Board of Health and Welfare
County Councils
Private Healthcare providers
Local Authorities
Carelink founded december 2000
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Carelink - vision

• A strong development of IT-use in Healthcare can
  boost quality and efficiency and support a
  better care for patients and relatives

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Carelink programme areas
Communication documentation in healthcare
process
Training/ Education research
International co-operation
Show benefits of IT stimulate implementation
Information security catalougue
Infrastructure
Integrated IT products services
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A regional initiative april 1998

• WHY?
• Sjunet a platform for
• Healthcare cooperation
• National telemedical knowledge centers
• Reducing leadtime in the care process
• Electronic Trade
• Videoconferences
• National Healthcare projects

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A national infrastructure for healthcare

• NOW!
• All county councils
• Several local Authorities
• Several private Healthcare providers
• The National Tax Board
• All pharmacies
• ca 20 private vendors of healthcare
• services

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International recognition

• The eEurope Awards are part of the eEurope
  Initiative announced by Erkki Liikanen, European
  Commissioner.
• Four award competitions will take place between
  2003 and 2005. The first competition is the
  eHealth Awards to be presented at the "eHealth
  2003 ICT for Health" Conference on 22-23 May
  2003, in Brussels, Belgium.
• Sjunet received the eHealth Award in the
  category Regional and national networks from
  Commissioner Erkki Liikanen

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Fundamentals

• A broadband (mostly 4 - 40 Mbps full duplex)
  infrastructure which connects
• all County Councils with their hospitals and
  healthcare centers
• all pharmacies,
• some larger private healthcare organizations
• some service vendors, like Philips and Siemens
• The broadband is IP-based, Gigabit Ethernet, VLAN
  
• The network is safe.
• One connection is a connection to all members
  (simple).
• There are several services connected.

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Sjunet
Sjunet

• One network operator, who is responsible for
  availability, problem handling, quality etc

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Security in Sjunet

• A Security Committee
• Security ground rules
• Security Policy Sjunet
• Incident management
• Safe installation
• Delivery tests
• A special Sjunet firewall
• Secure e-mail

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Levels of infrastructure
TELEMEDICINE
Applications Passengers
INFRASTRUCTURE
Services The trains
The basic net The rails
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Services, in production and plans
Sjunet
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Why video on IP?

• You use your own network (LAN)
• You can use your own PC
• Easy to integrate with other applications
• Simple and flexible
• ISDN is dead!

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Videoconference platform

• Interoperability between IP-ISDN
• Video-bridge in Örebro
• Video-gatekeepers in all county councils
• Common video number directory
• Low cost for partners within Sjunet

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The tools for video on IP-networks

• An infrastructure made for video
• Interoperability between video systems
• A video number plan with gatekeepers
• A video bridge
• A video manual with guidelines
• An organization for cooperation and knowledge
  the video group

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Gatekeeper video switch
Karolinska University Hospital
County Council of Stockholm
County Council of Westrogothia
Sahlgrenska University Hospital
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Certificate Authority
Catalogue
Sjunet

• SITHS, Secure IT in Healthcare, an accepted
  model,
• One technique PKI (Public Key Infrastructure)
• Smart cards
• Carelink is the national Certificate Authority
  for Healthcare
• There is a law on electronic signatures

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HSA-Directory (HSA Healthcare and Services
Adress Directory)

• A directory is a necessary part of a national
  security infrastructure
• The directory contains , names, phone numbers,
  addresses, video numbers, certificates (keys)
  etc
• Organized as
• Personnel
• Organization
• Role

Sjunet
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Connecting Local Authorities
Normal connection

• NORMAL CONNECTION
• MODEL NETSQUARE
• Connection of Local Authorities by connecting
  regional networks
• MINICONNECTION
• Lower costs, lower quality

Netsquare
Sjunet
Miniconnection
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Node for messaging to Authorities
National Health and welfare board

• SHS (Spridnings- och hämtningssystem) is a
  national standard information switch between
  national authorities
• Governemental eLink
• Examples of e-messages is registreration of
  newly born an deceased, population information
  and certificates of sickness

Sjunet
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Evaluation of Sjunet
Increased
collaboration
Increased access to higher
knowledge/competence
Increased use of
advanced equipment
Less physical
transports

Benefits of Sjunet
infrastrucure - Main groups

Increased opportunities for external
communication with healthcare
Reduced costs
for staff
Increased access to
medical information
More effective
education
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Electronic Prescriptions

• 20 nationally
• In some county councils 70-90

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Teleradiology Sweden - Barcelona

• Teleradiology
• Remote analysis of MRI
• Bridging lack of specialists in northern Sweden
• Possible expansion to pathology and ophtalmology
• 2 Mbs secure VPN connection to Sjunet

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Distributed radiotherapy

• Cancer treatment in Sundsvall
• Operational since summer of 2002
• Dosage planning and field simulation at
  University Hospital in Umeå
• Same type of service is to be started between
  Kalmar County Hospital and University Hospital of
  Linköping

• Use of videoconference, teleradiology and files
  transfers
• Patient can be treated as out-patients
• Avoidance of tiring travels for these vulnerable
  patients
• Efficient use of competence at university
  hospital
• Sjunet is essential for establishing this type
  of service

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Telepathology

• Regional project in Västerbotten, northern
  Sweden
• Lab. technician prepares frozen samples and
  slides
• Patologist can be anywhere in Sweden (or Europe)
• Videoconference and remote control of microscope
• Reduces the rate of additional surgery
• Makes it possible to do cancer surgery also in
  hospitals that do not have its own pathology
  department

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Benefits - examples

• Reducing leadtime
• Communication of large files (radiology, CT, EMG,
  ECG, EEG, Ultrasound etc)
• Resource utilization
• Sharing of Applications (Hospital transports)
• Video diagnostics neurophysiology
• National quality databases (Hernia operations)
• Network usage
• Replacement of ISDN and other lines
• IP-telephony
• Spin-offs
• Joint procurement
• Competence development
• Pooling of knowledge

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Telemedicine in Neurophysiology

• EEG
• EMG
• Planning of treatment
• Follow-up
• Access to remote specialist

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C/B analysis in Uppsala
1000Euro/year
Costs for the benefits
1000
Intangible benefits
800
Indirect benefits
Direct benefits
750
Net benefits
570
500
230
250
0
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Sjunet a summary

• Not just a network
• A collaborative platform
• An infrastructure for a wide range of services
• A driving force for implementation of
  telemedicine
• Managed by Carelink in close co-operation with
  county councils and professional end-users
• Continuous development of new services

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Thank You!
www.carelink.se
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Why not Internet?

• Security
• Patient integrity
• Reliability
• Availability
• Quality and capacity
• Very large files (ultrasound, EMG, ECG etc)
• Video
• IP-telephony