Last update: August 15, 1996

The national policy of responsibility for healthcare in Sweden is, in broad outline, that central government establishes the laws for healthcare which, in most cases, are framework laws. The public part of healthcare is run by the regional governments, the county councils. However, the municipalities also have a great deal of responsibility for care of the elderly and handicapped and people with psychiatric disorders. There are a small number of private providers. The healthcare system is divided into five levels: 9 regional/university hospitals, with about 1000 beds each 20 central hospitals, with about 500 beds each 60 local hospitals, with about 200 beds each 900 primary health care centres home care Various levels and ways of providing care exist for the elderly, handicapped and those with psychiatric disorders. Swedish medical research enjoys a prominent international position in many fields. It is characterised by strong links between basic and clinical research, and by the integration of R&D into the health services, particularly at the university hospitals. Medical research is mostly financed through government funds, but the county councils also provide substantial resources for clinical research which is closely connected to patient care.

Developmetns in Health Telematics At the Spri Nordic Telemedicine Conference held in Stockholm on 30-31 January 1996, attended by almost 600 participants, Jean-Claude Healy, Director of the European Commission's Health Telematics Programme, said " The Nordic countries of the European Union had a very long traditional culture of connection between isolated men and interaction within groups. The new multimedia technologies can reinforce the societal approach and the Nordic model can be offered to other European Member States." " Telemedicine is one of the key fields for the applications for the Information Society. Like me, you know the very rapid improvements in these techniques, but the new key elements are the public, and the citizens themselves appear strongly concerned by these developments. As a consequence of this evolution, the classical healthcare delivery system and town and country planning could be changed." " The G7 Conference on the Information Society, held in Brussels on 25 January 1995, produced the very clear political message that together we have to anticipate and organise the promotion of the post-industrial

society called the Information Society. The Health Sector was selected as the key issue and six feasibility studies were set in motion to select specific topics (public health, cardiovascular and cancer networks, telemedicine, enabling mechanisms, health cards, etc)." " More than 250 proposals were received for the Fourth Framework Programme. Of these 70 were selected by independent experts and funded by the Commission. All of these 70 projects deal with multimedia applications but there are more than 25 projects concerning telemedicine. The various fields covered are: teleradiology and teleconsultancy, information for the citizen, data collection for building medical epidemiological data banks etc. These developments mean a change of culture in three main health areas: what was not possible became possible (home care, personalised on-line information, etc.) what was difficult became easier (quality control, data collection for epidemiological data banks) the citizen came first and a bottom up' approach became available." During the last ten years, the healthcare system has derived benefits from the fast rate of modernisation in the Swedish and international telecomm-unication network, for example, all Swedish hospitals can use ISDN.

The diffusion of telematics in the Swedish healthcare system is the responsibility of the providers, the county councils. Generally, computerisation started with the handling of administrative matters like the monthly payroll, as well as the development of different kinds of expert systems in hospitals. Today, every county council has some co-ordination of telematics distribution within its area. One of the main points of interest in health telematics, in Sweden, is the implementation of computerised medical record systems in more than 80% of the primary health care centres, and the linking of these systems to different hospital information systems for automatic transfer of laboratory data, etc. Ongoing work in the county councils is also centred around the introduction of computerised medical record systems for hospital inpatients. This has proved to be a more complicated task and will require more time and effort. The Development of Telemedicine Telemedicine - medicine at a distance - was pioneered in the 1950s in Canada, the USA and in Australia. In Sweden, radiologists and pathologists began test trials during

the early 1970s; at present, telemedicine in Sweden is practised in the following fields of application: Radiology Pathology Psychiatry Ambulance (tele-ECG) Orthopaedics New born monitoring (when there is a risk of sudden infant death) Echo-cardiography Clinical physiology and neurophysiology Dermatology Odontology ENT Ophthalmology Referrals, laboratory and radiology reports Conferences, case discussions Education and training Off shore (at sea) Planning and discussions of new telemedicine applications in Sweden include: Speech training Gynaecology Rehabilitation Care of the elderly Handicap services More than 60 teleradiology stations, at present, are installed in the Swedish healthcare system, making this the most used telemedicine application in Sweden and represents the highest ratio of such systems per head of the population in Europe. Many county

councils are planning to introduce different kinds of clinical telemedicine systems, for example, in the Autumn of 1995, two university hospitals started a project to link their organ transplant departments by telemedicine to establish a virtually single department.Another interesting application, successfully in use, is to link two hospitals with telemedicine to facilitate co-operation during out of hours service. Other recent examples include projects in primary health care centres. At the regional level, in the south of Sweden, plans are being made to implement a more comprehensive telemedicine project, oriented towards health care organisation and structure. Initially, the project will cover oncology, cardiology, neurosurgery and angiology disciplines. At the National level, Spri is running a number of development and evaluation projects in telemedicine. Two examples of successful Swedish telemedicine projects are in telepathology and teleradiology. In telepathology it is possible to send complicated colour pictures via telecom. The Swedish Society of Pathology, Swedish Telecom, Spri and Innovativ Vision AB have carried out a one year test of a system for static image transfer for telepathology. cont ...

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