Information technology is a major driving force within every field and sector of society. Since health services are highly knowledge- and information-intensive, IT plays an increasingly greater role in the advancement of healthcare.
In Sweden there are six health care regions and telemedicine is being used in all of the six health service regions. Nearly 75 percent of the hospitals use some form of telemedicine, representing over 100 applications. More than 50 percent of these applications involve consultation of some type, for example, advice or test results from a hospital specialist or second opinions and work outside of normal working hours. Other areas where telemedicine is being increasingly applied are ambulance services and rounds. Trade sources believe that the greatest potential is to be found in the areas of consultation and emergency care and in elderly care service. Trade sources also believe that there is a major potential for international collaboration in telemedicine.
Sweden has a decentralized health care system, with 20 County Councils that are decide on the allocation of the resources to the health services and are responsible for the overall planning of the services offered. It is also the county councils that own and run the hospitals, health centers and other institutions, even if these institutions are supplemented by those of private organizations which, in most cases, have contracts with the county councils. The municipals are responsible for housing and care of elderly and disabled people.
In 2006 the Government presented a national e-health strategy for Sweden with the goal to “ensure that all patients receive adequate, safe and secure health care and good quality service”.
MARKET OVERVIEW AND BEST PROSPECTS
Sweden is the third largest country in Western Europe with a population of some 9 million people. Public health by international standards is relatively good. Life expectancy for men is 79 years and for women 83 years. Health expenditures are estimated at approximately 9 percent of Sweden’s GDP, a figure that has remained rather stable since the early 1980s. Sweden has 8 regional hospitals, 65 county/district hospitals and 1,000 health centers.
The proportion of private care providers in the publicly financed health and medical care increased in the 1990s. These care providers are generally concentrated in primary care like running health centers or homes for the elderly. There are also some hospitals that are managed by private entrepreneurs. Private care providers account for some 10 percent of total health care costs.
In 2006 the Swedish government launched a national strategy for e-health. The strategy focuses on the need to use information and communication technologies to achieve improvements for patients, healthcare professionals and decision-makers. The strategy states that “ ICT will be used as a strategic tool at all levels in the care sector and health care resources as a whole will be utilized more efficiently and effectively” and that “used as a strategic tool, ICT will promote safer, more accessible and efficient health and elderly care services”. The strategy further states “citizens must also be able to contact care services via the internet for assistance, advice or help with self-treatment”. The Government last year allocated SEK 130 million (USD 20 million) to the development of IT in health care. Sweden’s total spending on health IT is estimated by industry sources to be in the vicinity of US$1.2 billion per annum.
Many Swedish software companies have developed IT systems fore the healthcare market and large Swedish players dominate the hospital and primary care market for software.
Telemedicine/e-health is already an integrated part of daily life in Swedish health care. It is estimated that some 95 percent of all documentation in primary care are made in electronic health care records (EHRs), while corresponding figure for the specialized hospital care is estimated at 69 percent.
E-prescriptions have become very popular and it is estimated that some 55 percent of all pharmaceutical prescriptions in Sweden are issued electronically and transmitted from the hospital/doctor’s office to any of the 950 pharmacies in Sweden.
One telemedicine area within which there are a relatively large number of applications, both in Sweden and internationally, are radiology, where X-ray, computer tomography and magnetic camera images are transferred for consultation and so-called second opinion. Telemedicine is used in more permanent forms in northern Sweden. This is partly related to distance, partly to the difficulty of recruiting and keeping qualified medical staff in small towns in rural and sparsely populated areas. In addition, the use of telemedicine is rapidly increasing in connection with educational and training activities.
In a longer-term perspective, the use of telemedicine applications in combination with other IT applications has the potential to deal in different ways with problems and challenges other than those mentioned above. One of these challenges is perhaps the most serious problem in the health services during the coming decades, the opportunity to provide different forms of medical care at home, both in special institutions and in people’s own homes.
A major problem connected with the introduction of IT into Swedish health services has been the small selection of good IT products and services offered on the market. Among other things, this is due to the fact that the Swedish principals for health services and health care departments have had difficulties in cooperating and coordinating their requirements when procuring IT support for basically the same tasks. Suppliers often found their product investments unprofitable and consequently there was no incentive to invest in improvement and new products and services.
The National Strategy for e-health requires that all actors active in the care sector cooperate on a national level to create basic preconditions for ICT use. This should also include harmonization of legislation and other regulations. Another reason for cooperation at a national level is of course the need to keep costs under control. The responsibility for the overall national management and coordination rests with the National High-Level Group for e-health
By Catharina Kronstrom