Since 2006, a national Health Advice Line – 1177 - has been Swedish residents first point of contact with healthcare. In 2006, a national patient portal was set up to facilitate form based, secure information exchange between patients and Swedish care providers. The next step was to introduce fully digitalized self-service e-services. These services offload health care personnel from manual registration tasks and improves the service to the patients. As an example, 1177 provides a national e-service for online appointment management with primary care providers across the country. Another e-service of the national patient portal provides online access to electronic health records from the majority of the EHR systems of Sweden’s 21 county councils and 300 municipalities. The appointment e-service has had a linear increase in patient transactions, starting at 25 000 per year with a current rate of 1,2 million per year. The current development is focused on tele medicine services (a national platform for remote treatment programs), the ability for the patient to share EHR data with apps and services and a national architecture for personal connected health (home monitoring). The presentation gives an overview of e-services offered to patients, their adoption and share some lessons learned.

1. How Sweden
Improved Patients
Involvement and
Self Service with
eHealth
Johan Eltes
Swedish Association of Local Authorities and Regions, Inera AB
Deputy CTO
Johan.eltes@inera.se, +46 708 22 41 86

2. How Sweden Improved Patients Involvement
and Self Service with eHealth
Since 2006, a national Health Advice Line – 1177 - has been Swedish residents first point of contact with healthcare. In 2006, a national patient portal was set
up to facilitate form based, secure information exchange between patients and Swedish care providers. The next step was to introduce fully digitalized self-
service e-services. These services offload health care personnel from manual registration tasks and improves the service to the patients. As an example, 1177
provides a national e-service for online appointment management with primary care providers across the country. Another e-service of the national patient
portal provides online access to electronic health records from the majority of the EHR systems of Sweden’s 21 county councils and 300 municipalities. The
appointment e-service has had a linear increase in patient transactions, starting at 25 000 per year with a current rate of 1,2 million per year. The current
development is focused on tele medicine services (a national platform for remote treatment programs), the ability for the patient to share EHR data with apps
and services and a national architecture for personal connected health(home monitoring). The presentation gives an overview of e-services offered to patients,
their adoption and share some lessons learned.

3. Sweden has a regionalized care
system
21 counties 290 Municipalities
Government vision:
- At the top of the e-
health world in 2025

4. Swedish e-health has been coordinated
since 2006
21
counties
290
Municipalities
REGIONS AND
MINICIPALITIES IN
COOPORATION FOR E-
HEALTH
Challenges:
•10 000 000 residents
•Every resident may consume public care at any
location
•Large installed base (legacy) of EHR (99%)
Opportunities:
• National resident identification and
authentication
•National resident registry
•National care provider registry
•World class 4G (internet coverage)
•Large installed base of EHR (99%)

5. • A national entrypoint to support the patients care
journey
The Swedish patient portal
Am I
ill?
Do I
need
care?
Find
care
Make
appoint-
ment
Meet
doctor
Rehab /
care
plan
Self-test
Catch
up
Visit
pharma

6. Am I ill?
• 1177 web advise
– Quality assured published content
– Advisors respond to anonymous questions
– In use since 1999
• Statistics (12 months)
– ≈ 10 search sessions per resident
– ≈ 12 000 anonymousquestions answered

7. Do I need care?
• 1177 Health Advice Line
– Distributed, load-balanced call center
– Supported by a dedicated national EHR
system
– In use since 2006
• Statistics (12 months)
– ≈1 consultation/resident

8. Find care
• 1177 Find and compare care
– All publically financed healthcare
– Direction, phone number, care types, the e-
service offerings
– Compare by quality measures
– In use since 2011
• Statistics (12 months)
– ≈ 1 search session per resident

9. Make appointment (demo)
• 1177 Appointment self-service
– An authenticated e-service of the patient
portal
– Single user interface providesonline access
to EHR systems across Sweden
– ≈ 50 EHR systems connected as back-ends,
supporting 3 000 facilities
– ≈ 20 additional e-servicesavailable
– In use since 2010
• Statistics
– 500 000 appointment transactions per year
– 32% of residents have logged in to the portal
– 8 000 facilities offer e-services through the
portal

10. Meet a doctor
• 1177 Video meeting
– Currently being piloted in Stockholm County
Council
– There are competing private video care
offerings
– Regional solutionsare in production (without
national coordination)
• Statistics (12 months)
– Not available

11. Catch up
• 1177 EHR Viewer – what did the doctor say?
– An authenticated E-service of the patient portal
– Online read access to all connected EHR
systems
– Helps remember doctors advise, prescription
dose etc
– Patient may grant access to care giver, private
doctor and other individuals
– In the planning: Patient may share EHR data with
health apps
– In regional use since 2012. In national use since
2015
• Statistics
– 9% of the residents use the service

12. Rehab and care plan (telemedicine)
• 1177 Telemedicine treatment platform
– Doctor may subscribe self treatment
supported by remote service centers
(telemedicine)
– Chronic diseases (diabetes…)
– Monitored health plans (overweight…)
– Remote treatment (CBT…)
– Personal connected health (sensors)
– Video sessions
– Currently in pilot with 1000 patients (CBT)
• Statistics (12 months)
– Not available

13. • The architecture supports all national e-health
initiatives
• Manages EHR data access (two-way)
• Manages interoperability through approx 100
interoperability profiles
• National service-oriented HIE architecture in
operation since 2010
• 400 000 000 API invocations per year
• All EHR data is access at the source
(distributed) on demand
1177 depends on a national HIE architetcure

14. • Meet Inera at the BusinessSweden booth…
– HIE architecture and infrastructure
– National reference architecture
– Governance model
– Portfolio management
– Funding of national e-health
– More on 1177
• I will attend the conference. In case I’m not at the
booth, send me an e-mail and I’ll try to get in
contact:
– johan.eltes@inera.se
– +46 708 22 41 86
• Thank you!
If you have questions…