EHTO Trends in Health Telematics in the European Union


	Updated: Dec 6, 1996
NORWAY

Norway has five health care regions, each with its regional (university) hospital. The regions are increasingly being given an important role in organising specialised medical services. Health care services in Norway are for the most part publicly financed.

In the Municipal Health Service more than 80% of all general practitioners (GPs) have electronic medical record systems. Two vendors supply almost all of these systems, making it easy to have an overview of the market both for users/buyers and health authorities. The work of establishing and using an electronic network for standardised information exchange between GPs and other parts of the health care sector is thus made much less complicated.

All hospitals and the Institutional Health Service have electronic information systems for admission/discharge/ transfer, laboratory administration, etc. using local networks and servers for common and shared information.

National strategy for health care informatics and telematics

Over the last 10 years, three important national programmes have been initiated:

Telemedicine - remote diagnosis and consultation
EDI - Electronic exchange of documents
The Health service emergency communication.

Remote diagnosis and consultation gives patients and health personnel access to medical specialists using sound and pictures (VIDEO). Substantial efforts have been made to develop telemedical services and to the acceptance of these services. The technology originally used for transmission, called Meganet, gave more or less standardised services with a capacity of 2 megabits per second, a speed which met the requirements for the quality of picture needed for remote diagnostic services. Now ISDN is taking over as the basis network - offering acceptable quality and availability at lower prices.

Field trials have been completed and routine services implemented in the areas of Radiology, Cardiology, Pathology, Dermatology and Otorhinolaryngology. Trial projects have been completed in northern Norway with the technological infrastructure available in some hospitals and primary health centres. Substantial funds have been allocated for telemedicine and remote diagnosis activity, and work is in process to standardise communication services for medical purposes. This will lay the groundwork for use of remote diagnosis and consultation between health institutions in and between regions throughout Norway.

In 1990, the Department of Health and Social Affairs initiated a program for the standardisation of electronic exchange of information in the health sector.
The primary aims of this project are to:

Lay the basis for the electronic exchange of information in the health sector.
Simplify access to and use of electronic communication services in the health sector.
Establish guidelines for electronic information exchange in line with international standardisation work in the field of medical informatics and other relevant areas.

The international standard X.400 is recommended. The Norwegian programme has focused on the development and establishment of standardised EDIFACT-based messages, with a clearly structured information exchange, for example with standard forms which can be used for automated routines for sending and receiving messages. This work demands technological and methodological standards as well as standards for medical practice, and a heavy investment in resources. Norway has used the results from these national projects as a basis for our contributions to international standardisation organisations and their activities. The most important here are CEN/TC 251 (*) and MD 9 (**).

The following priorities have been set for the development of EDIFACT-based messages:

Laboratory messages; Prescriptions;
Physicians bills, sent in to the National Insurance Administration; Medical Certificates (of sickness)

A national health care Emergency Communication System (ECS) has been developed. The ECS links medical emergency communications centres to the operational organisation, casualty clinics, nursing homes and health centres.

All the equipment used in the system must be approved by the Norwegian Telecommunications Regulatory Agency and the Directorate of Health approves functional requirements of equipment.

Development of ECS lies not so much in technology and telemedical innovations but rather in the complicated organisational challenges involved in getting different parts of health services to work together effectively in emergency situations. Future plans involve the development of the next generation of technological communications transmission services (for example ISDN).

Additional key initiatives

Norway has a national "waiting list" indicating the need for specialised health services. This receives input from the different ADT (Admit/Discharge/Transfer)-systems in the hospitals more of less automatically. The information is available on a World Wide Web server, as well as in a paper report.

A national system containing comparative statistical indicators on health services and resource use in municipalities as well as other social and health indicators has been established to disseminate information for use in planning and decision making at the local level. Information and communication technology is used for handling information at all phases of the processes to obtain quality, effectiveness and availability. Gerix is an information and decision support system for care and services to the elderly and disabled. Development began in 1990. It has to date been implemented in around 150 municipalities and is used by Statistics Norway as a standard for statistical reporting to central authorities.

Regional Health Care Network is a project in Western Norway, designed to establish health care facilities based on the use of electronic communication and telemedicine services. It will establish and validate large scale pilots within a health region based on recommended national and international standards. The project participated in the EU-funded CoCo project.

The Research Council of Norway runs a 5-year medical informatics R&D programme. It is jointly funded by three different Ministries, and supports basic research through doctoral and post-doctoral fellowships and large scale health care telematic projects with industrial potential.

Data protection

In Norway data protection concerns have focused on the following issues:

Requirements for access to external open networks (e.g. Internet) to prevent all direct access to internal sensitive information from external systems or users and to prevent unauthorised export of sensitive information to external systems or users;
Requirements and solutions for trustworthy health services using encryption, digital signatures and Trusted Third Party services;
Requirements for secure health information systems, including electronic patient record systems, taking into account the need for availability, integrity, access control, etc.

(*) CEN- European Standardisation Organisation, TC251 - Technical Committee for Medical Informatics.
(**) MD 9 - The group responsible for health message development in the Western European Edifact Board.

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NORWAY

National strategy for health care informatics and telematics

Additional key initiatives

Data protection