Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...

Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
Introduction to the Norwegian Directorate of e-Health
                 and the forthcoming establishment of
                           a National Service provider

                                                 Karl Vestli
                                 Director Strategy Division
Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
Health and care services for all

                        Population                                        GP acts as
                                            4 600 GPs
                        5,3 million                                       gatekeeper

                                                                      Public Funding
                    Life Expectancy 82,4   10,5% of GDP                    85 %

                                                          Source: Statistics Norway (2018) and
                                                          Norwegian Directorate of Health (2018)
Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
Current situation: Challenge to achieve connected health across
the Norwegian health and care services
Nationally                                             The
                                                                           Ministry of Local
                       Ministry of Health
                                                                           Government and
                       and Care Services

Regionally/          Regional health authorities                  422 municipalities

                    1.800 Contracted Specialists
                                                                             4.600 General Practitioners
                          and institutions

              Hospitals and Specialist health care                        Primary health care
Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
Norwegian Directorate of eHealth

                The Norwegian Directorate of eHealth
              New government agency established January 1st 2016

                                     Two roles

                Government                       National eHealth
              National governance,
                Coordination and
                 standardization                   Citizens, health
               Catalyst and driver                 providers, data
Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
National Governance

                 Ministry of Health
                                      National Advisory
                 and Care Services    Board for eHealth

                                      National Forum
                                       for Portfolio

                                      Health Professional
                                       and Architectural
                                        Advisory board
Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
Plans for a national eHealth service provider
Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
Strategy and Action plan for eHealth 2017-2022

                 Critical infrastructures and common building blocks

            National governance of eHealth and increased ability to deliver
Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
A selection of current national activities


Use                         Common             Messaging
           Health Data

                                                            Health Portal

                               Personal      Summary Care
       One Health
                              Connected         Record

                               Level of maturity
Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
The directorate suggested the establishment of a national service
provider in a report addressing the organization of IT in the
health sector in 2017
Introduction to the Norwegian Directorate of e-Health and the forthcoming establishment of a National Service provider - Karl Vestli Director ...
Three recommendations in the report
       ... The creation of a national
       service provider

       … current and future             … next step is to
       national products/solutions      detail the concept
       should be transferred to the     and implementation
       service provider                 plan.

      … the need to use private
      vendors should be
      emphasized in the strategy
      for the national service
Why new eHealth organization?

Speed                      Rolle                Finance
 Increase speed of        • Directorate        • Flexibility
  implementation           • Service provider   • Service pricing
 Need for joint efforts
A transition into two strong entities

                                        Tasks and
                                        responsibilities for
                                        the directorate

                                        National service

    The national service provider will work closely with several product owners

     Needs and                     Product owner                    Suppliers
                                          Works with the
     Specialist health                                                Software
                                          sector to define            vendors
                                         WHAT to develop

     Primary health                                                  Operations
        and care
                             National service provider
                            Professional provider
          Other                                                        Other
                          resposible for determining
                           HOW to develop/source
                            products abd services
Programme objectives
                                                         • Establishment of a national service
                                                           provider using Norsk Helsenett
                                                           (Norwegian Health Network) as an
                                                           organizational base, and defining the
                             01   Decision support         new role for the directorate
      Develop a basis
                                                         • National governance and finance
                             02     Strategy: Dir. 2.0   • Strategy and governance for the new role
        decision to                                        for the directorate of eHealth.
       establish new
          eHealth                                        • Development of the national service
      organization by        03     Road map               provider.
                                                         • Plan for implementation and
       Jan 1st 2019.                                       development according to objectives
                                                           and roadmap

Deliverables; Programme NEO (New E-health Organization)


    Organization,         Organization,       Models for governance   Risk assessments Plan for transistion of         Cost/benefit
  reponsibilities and   reponsibilities and    and finance. Legal     and security plans. existiting products and   analysis + input for
tasks. Implementation     tasks for «the         structures and                            solutions 2019-2024      state budget 2019
    plan for NSP.        directorate 2.0»         clarifications.
Key questions

 Who will decide and finance     • Responsibilities and tasks    • Company transition
  national eHealth products and     assigned to the directorate   • What is the first step Jan 1st
  solutions?                        and the NSP?                    2019?
 Governance and priorities?      • Ownership of the NSP?
 Business model?
                                  • Company structure?
Health Data Programme
National Health Analysis Platform

Marianne Braaten, Assistant Programme Manager

Hanne Cecilie Otterdal, Enterprise Architect
Side 18
Side 19
Side 20
Side 21
Side 22
Norway is comparatively efficient at collecting health data,
but less adept at using it than our neighbors

      Data governance

  Technical and operational

                                   Source: OECD, HCQI Survey of Electronic Health Record
                                                    System Development and Use, 2016       Side 23
The Health Data Program (HDP)


                                                                          Improved public health

Knowledge-based health services and efficient use of resources                                                  Empowered and involved citizens

                                                                                                                                  More innovation and business
             More and improved health research

  Efficient health registry management and
                                                                                                                                    Efficient reporting and access to health
                                  operation                                 Goals & Objectives                                      data

                  Improved data protection                                                                                          Improved data quality

Administrative services for health data and research                               Results
                                                                                                                     §     Improved legal framework

                                         Semantic interoperability                                          Technical interoperability (API)

                                                             Common technical services and national infrastructure
Health analysis platform – Concept 7:
Closed analysis, ecosystem & open architecture

                                                            Citizens     Health personnel      Health leaders          Government            Researchers          Industry

                                                                                                API: Access, exploration and dialogue

                                                         Closed / autonomous                                                                               Open analysis and
                                                                                                       Authorized analysis
                     API: Security and data protection

                                                               analysis                                                                                          tools

                                                                                                                                                                               API: Administration
                                                                                                            API: Analysis
                                                             Processed, connected health data                                               Non-sensitive data
                                                                                                                API: Data

                                                                                   Health registers, basic data, sensors, citizens and other sources
What can researchers expect from The Health Analysis Platform?
                                        The Health Analysis Platform
                                    Health research platform (


                                                                                      Apply for
                        Get an
                                                                                     data in one

                        Execute                                                      Interact with
                        analysis                                                       citizens

                                                     Gain access
                                                       to data

                Identity and access administration, anonymization, aggregation, masking, tracking, logging

                                   Gathering, receiving, validation and transformation

                        Health registers, basic data, sensors, citizens and other sources

Realization strategy


From data distribution to self-service analysis?
                                 Average processing time for access to Norwegian health data




                     15                          17 months          17 seconds



                             1      2        3           4      5           6      7           8   9
                                                     NUMBER OF DATA SOURCES
One citizen – one record
The Norwegian healthcare sector is facing several challenges (as many others…)
       1 400 000

       1 200 000

       1 000 000
                                          90+ years
        800 000
                                   80-89 years
        600 000

        400 000
                            67-79 years
        200 000

              2000   2010        2020       2030      2040           2050
                                                             Source SSB

     Increasing senior population                                                  Health problems change over time

                                                             Copyright                                      Norwegian Petroleum Directorate

     Technology and society is changing                                            Macroeconomic forecast is challenging

                                    Current IT is unfit to deal with emerging challenges

                                                                                                                                                        Side 30
Stortingsmelding no. 9 (2012-2013) defines three objectives for the IT
development in the healthcare system (Governmental white paper)

                              Healthcare personnel shall have user friendly and secure access to
                              patient information

                              The citizens shall have access to user friendly and secure digital

                              Data shall be accessible for quality improvement, health monitoring,
                              management and research

                                                                                                   Side 31
The directorate for eHealth recommends realization of the target for One citizen -
one journal through three strategic and parallel initiatives

                                                      Three strategic and parallell initiatives
  Meld. St. 9 (2012-2013) Én innbygger – én journal
                                                                Further development of existing solutions in the specialist
                                                                health services in North, West and South East

                                                               Status: Ongoing

                                                                Establish a national solution for municipal healthcare

                                                               Status: In procurement

                                                                Establish one common solution for both primary and
                                                                specialist healthcare services for the health region in
                                                                central Norway.

                                                               Status: Preparing for procurement

                                                                                                                          Side 32
One health record across all levels of care
A ground-breaking project in Central Norway
                                                    Øyvind Høyland
                                   Prosjektleder teknisk delprosjekt
The programme Helseplattformen

       o For the first time, one common EHR solution shall be acquired
         for both municipality and specialist health care services in one
         region in Norway
       o Central Norway (Midt-Norge) is a tryout arena for the national
         objective “One citizen – one health record”
       o Following a competitive dialogue with the supplier market, a
         contract with one supplier will be signed in 2019
An EHR solution across all levels of health care –
   Helseplattformen in Central Norway

o The Central Norway
  Health Authority                                   Central Norway

  and the municipality of Trondheim
  are owners and customers               Trondheim
                                                                  85 municipalities
                                        Ålesund                   8 hospitals

                                                                  720,000 citizens (14%)
o All 85 municipalities have optional
                                                                  42,000 health care
  agreements                                               Oslo   professionals
A health record that follows the patient
  Specialist health                                             Municipal
  care (hospitals)                                              institutions

     GPs                                                   Home care and
                                                           municipal health services

                      Enabling the patient to take on a more active role,
                      e.g. self-registration, booking, access and insight
A long-lasting and complex acquisition process
  2016            2017                    2018           2019         2020          2021      2022

Planning the
competition     Dialogue with suppliers    Evaluation                Adaptation
Pre-              What solutions are         Down-                 Implementation
qualification         available?            selection
of suppliers

101              Tender               Final version Contract                    Tentative:    2nd
workshops        deadline             of tender     signed                      implemen-     phase:
with 400         May 3rd              requirements                              ting in       2022
healthcare                                                                      Trondheim
workers                                                                         2021

                         Parallel national process: «One health record»
                         The work from Central Norway will be re-used in the development of
                         a national solution for municipal/local health care
Two suppliers still in the competition
          o Cerner

          o Epic               Tender documents available online
Overall objectives of the procurement
       1. Increased treatment quality and       7. Improved management information
          fewer patient injuries                    to aid quality and improvement
       2. Access to continuously updated            work in daily operations
          clinical knowledge based on best      8. Reduced time spent on
          practice                                  documentation and search for
       3. Provide the citizens with easy            health information
          access to their own health record     9. Compliance with national standards
          and more influence on their own           and requirements
          course of treatment                   10. Reduced need for municipal services
       4. Increased interaction in and              based on comprehensive
          between the primary and specialist        assessment of the patient’s
          health care services                      functional abilities through generic
       5. Improved data and information for         pathways
          use in research and innovation        11. The citizens shall be supported to
       6. Increased efficiency and better use       live longer independently in their
          of resources                              own homes
Broad, cross-disciplinary involvement
              Widely                                                    101
           competent                                                    workshops
              project                                                   with 400
            members                                                     users

                                      Tender documents
          Collaboration on all
           levels of authority                                    Supplier dialogue
                                                                 Documents available online
                                 4000+ requirements
Today: 21 patient record systems
Example: Surgery planning
                           PAS/ EPJ

          Surgical nurse



          Surgeon                                     Anesthesiologist

                                    Duplicated and sometimes contradictory information
                                    Low degree of integration and communication between
New solution:
Different demands depending on role and context

            Surgical nurse

                                                                            Homecare nurse

      Surgeon                                                Anesthesiologist

                         Configurative interfaces towards role and context rather than from
                         the invividual systems to context
21 user scenarios describing requirements
        o Situations and processes with various patient – health service encounters
        o Examples of the desired functionalities
        o Demonstrating the need for overall thinking
        o Asking suppliers to describe what kinds of support personnel can acquire
        o Asking for input on improving and streamlining services, workflows and
          clinical pathways
        o Scenario example; surgery procedure

      Booking      Consultation   Procedure    Surgery          Post-operative   Check-out and
                                  planning                      treatment        local follow-up
Areas of particular focus
                         Areas of particular focus

              4.1        Information security, privacy and access control
              4.2        Usability
              4.3        Report generator and data retrieval
              4.4        Resource planning, scheduling and work lists
              4.5        Multimedia
              4.6        Closed loop medication
              4.7        Knowledge and clinical decision support
              4.8        Master data, reference data and terminologies
              4.9        Administrative procedures
              4.10       Pediatric care and child health
              4.11       Medical device integration
              4.12       Continuous and comprehensive medical chart solution
              4.13       Specialties and specialised systems
We shall actively
include the patient
in decisions regarding
their own health
and consider the
patient’s experience
and knowledge
in the treatment.

 The empowered and contributing patient
Technical requirements – ambitions and goals
        Move from message exchange
1       to information sharing

                                               ✓   Integrations
2       High level of standardisation          ✓   Information content ( Reference data, terminologies and
                                                   master data)
                                               ✓   Operations and maintenance

        Stimulate the use of structured data   •   Realize the ambition of active, clinical decision support
3       and storage of clinical information    •   Improve data and information base for research and innovation
        throughout the solution                •   Improve administrative information as a basis for quality and
                                                   improvement work on daily operation

                                               ✓   Ability to adopt future technology to interact with
        Technical platform that enables
4       future technology
                                                   Helseplattformen and its information base
Information security – privacy – access control

                      The information is trustworthy
For further reading, please visit our homepage
Some content in English, including tender documents
and functional requirements

Central Norway Health Authority/
Helse Midt-Norge strategy 2030:

Directorate of eHealth:
Thank you!
Norwegian Code of conduct for
information security in health care

                    Jan Gunnar Broch
                       Senior Adviser
The Helse Sør-Øst outsourcing incident

                          Helse Sør-Øst: Admits that foreign IT-
                          workers could access patient information

                          The Data Protection Authority found legal
                          breaches: Millions in fines after
                          outsourcing hospital- it
Targeted cyber attack against Helse Sør-Øst
GDPR countdown…
Code of conduct for
information security in health care
                                                     The steering committee

                                                       Den offentlige tannhelsetjeneste

                                   The secretariat
                                                                            The sector
                                                                            17 000 data controllers

         Published first in 2006
         Now: Version 5.2

  •   Extensive health and care
  •   Organizationally fragmented
  •   Sensitive personal data
  •   Electronic exchange of
  •   Complicated legislation

The Code of conduct

Binding –                    The Code and some of the
affiliation agreement with   guidelines are translated to english
Norwegian Health Network

Factsheets (best
practice routines)

Not binding
Examples - guidelines and factsheets

    Guideline for remote access between
     supplier and organization *
    Guideline for privacy and information
     security in medical devices
    Fact sheet 6b: Security audits - Code
     compliance checklist *
    Guideline and template for general
     practitioners and physicians in private
    Guidelines for social media
    Factsheet 42: Use of SMS for patient
     contact *
    * available in English


Annual conference              Newsletter                      Q&A email
                                          • 4 times per year
                                          • Subscribe at

Training and talks   
                                                               Social media
                                      •    The documents
        • Training                    •    News
        • Conferences                 •    Training
        • Lectures and talks          •    Etc.

     Why has the Code been a success?

         Binding by contract
         Non-bureaucratic – “bottom up”
         The stakeholders are involved
         Practical advices
         Sector specific guidance
         An arena for information security and privacy
         In partnership with the legislative authorities
         Financed by the government
         Simplifies, and makes complicated regulation more
 CoC activities on medical devices information security

The «GE-incident»

                                                          Side 63
CoC activities on medical devices information security

    Define audience       Develop and           Communication
    •Needs and risks      publish               • Training
    •Measures and         material              • Talks
     instruments                                • Newsletter and social

                                 Reference group -> resource network
                                                                          Side 64


         Different kinds of needs – from
          small GPs to big regions

         Comprehensive document-portfolio
          – update and review

         Stricter than the law?

         «Fragile» construction
     Focus 2017 and 2018:
     Make the Code approveable as an article 40 CoC
        The GDPR endorses the use of codes of
         conduct to provide guidance on the GDPR’s

        Drivers for change
         New legislation, GDPR and health-legislation
         New technology
         New threat assessments

        Expanded scope – information security AND

        Working closely with the health sector and with
         the Data Protection Authority to prepare for the
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