Cambio delivers integrated patient record in Sweden

While many European countries are planning or moving towards introducing integrated electronic patient records to link together hospitals, clinics and GPs, in one Swedish county it’s already a reality.

Kronoberg county, in the south of Sweden, has emerged as a leader in the development of an integrated electronic patient record available to all authorised health professionals. In the last three years it has introduced one standardised fully integrated healthcare system spanning the entire health service.

Not only is the heavily-wooded county the Moose capital of Sweden – they’ve been known to wander in to Vaxo hospital – but it is also home to one of the most advanced healthcare IT healthcare systems in Europe, where almost all the 180,000 citizens now has a shared, integrated electronic patient record. In addition, over 98% of prescriptions are issued electronically.

Sweden has been a pioneer of health IT for over 20 years, with very high levels of use of electronic records in both hospitals and family doctors. As health is a responsibility of the 20 counties in Sweden, health IT developments have historically been very locally based.

Despite this local focus, like many other healthcare systems, Kronoberg faced the problem of how to move from silos of patient data, held in different systems unable to easily communicate to enable better shared care and information exchange. Overcoming this problem has been a goal for the county for the past decade.

The system Kronoberg chose to do this is Cambio’s Cosmic, a Java-based enterprise management and clinical system. Cosmic provides a product suite, based around the ‘Cosmic Spider’ that spans all stages of the healthcare process. On top of this are a series of clinical modules ranging from e-prescribing, to theatres and order communications.

Over the past three years the system has been implemented across Kronoberg, linking up two hospitals – the biggest being Vaxo’s 400-bed general hospital, and 26 polyclinics. About 4,500 of the county’s 5,700 healthcare professionals now use the system.

Styrbjorn Ostberg, chief medical officer at Vaxo Hospital, told E-Health Europe how the new system has changed things: “Just having all the patient’s information in one place makes a lot of difference. The next step is to share that information with other clinicians, so that when we see a patient again we can see what has happened to them since.”

He said that perhaps the most important and useful part of the shared patient record was the medications list, which provides a comprehensive and up-to-date list of all the medicines prescribed to a patient. “It means I know all the prescriptions that have been made.” Being able to electronically order and receive test results has also made a huge difference.

“Our goal was to create a shared healthcare record for all healthcare professionals across the entire county. We have reached that aim, and it’s already saving time and money,” says Goran Hernell, who has lead the project for Kronoberg County Council.

Hernell acknowledges that the system has not been without its problems. There have been issues with stability and response times and there has been some bruising national press coverage.

He said that the healthcare system had embarked on the shared record project because it needed better tools to deliver and develop quality services and improve management control.

Asked why the council chose the shared record approach, Hernell told E-Health Europe. “There’s no choice you have to work this way to deliver safer and higher quality care. What’s the alternative?”

Hernell also stressed the scale and complexity the move to shared electronic records has entailed. “The project has been the biggest change ever in our county council. We now have one single data warehouse for the entire county.

“Cambio Cosmic is both our main application, and the platform for process support. Over ninety percent of the population now have a healthcare record on the system.”

He said that one of the key features of the Cosmic is that all referrals within Kronoberg county are now done within the system. For the past two-and-a-half years 100% of prescriptions issued in Kronoberg have been electronic. In addition, over 40,000 orders a month are placed through the Cosmic order communications system, with results then sent back electronically.

Just as impressive is the move to 100% digital documentation, with all paper records being scanned at ward level and historic patient records added to the integrated electronic patient records. “Old records are now being scanned and then being destroyed,” explained Hernell. The shared patient record also allows digital diagnostic images to be attached and viewed.

Planning and implementation of such a complex project has been relatively quick, taking about 30 months. But the hospital knew this was the direction it wanted move in almost a decade ago, says Hernell. It had first tried to achieve the same goals using Siemens Soarian for clinicals, but switched to Cambio Cosmic after three years.

Future plans include using Cosmic to re-engineer the delivery of care. “We’re now using Cosmic for process improvement and will introduce new processes like decision support and advanced workflows.” The council is also examining how it will link to the shared patient record to the national system of summary records now under development in Sweden, procurement for which has begun with a decision due in 2008.

In 2009 the plan is to introduce a patient portal to Cosmic that will allow patients to directly access and update their records, order prescriptions and book appointments

In addition to Kronoberg, Cosmic is now in use in seven further Swedish counties, together with installations in Denmark and a strong presence in the UK private hospital sector.

Built from the ground up to be delivered on a Service Orientated Architecture (SOA), Cambio says the system is highly scalable and that in tests with HP and Microsoft the software has been up to 100,000 concurrent users.

"Cambio Cosmic is used by approximately 40,000 doctors, nurses and administrators across Europe, with many customers are still in deployment phase," says Cambio’s CEO, Tomas Mora Morrison. "By the end of the year we should have 70,000 healthcare professionals using the system every day."