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Scandinavian Design (of Health IT Systems)

October 8, 2009
by David Raths
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I just returned from a three-week trip to Norway. Besides the amazing scenery I saw and wonderful people I met, I was most impressed by the widespread advanced technological infrastructure.

As soon as my plane landed at the architecturally inspiring Oslo airport, I was guided by sleek, high-resolution digital displays to ground transportation. I passed waiting areas that looked like stylish cafes. A simple swipe of my credit card at a turnstile put me on a high-speed express train to the city center. And that was just the first 10 minutes!

In bustling Oslo, everything from public transportation displays to library design is top-notch. I said to my wife: "Why can't Philadelphia be more like this?"

Even in remote towns north of the Arctic Circle, high-speed Internet access seemed ubiquitous.

So what does this have to do with health IT? From my few conversations with Norwegian, Swedish and Finnish people, I got the impression that most of the aspects of health IT transformation that we write about every day have already occurred there.

Upon my return to the United States, that sense was confirmed for me when I came across a recent report "Explaining International IT Application Leadership: Health IT." Produced by a think tank called the Information Technology and Innovation Foundation, the report details some of the successes of Nordic countries in health IT and makes some suggestions for how they might apply to U.S. circumstances.

The report notes that Nordic countries have used government mandates to achieve broad health IT adoption. Denmark and Norway, for example, have made e-prescribing mandatory for primary care providers.

Legislation in Finland will require all health care providers, both public and private, to use a new national patient record system by April 2011.

In Norway, more than 90 percent of primary care physicians and 90 percent of hospitals have implemented an electronic health record. And the ITIF report notes that "legislation in Norway requires doctors to retain patient medical records, a requirement made much simpler and more cost-effective by using digital records. As a result, Norway is one of the few countries with •paper-light' offices where primary care providers keep few paper medical records."

Remote areas of northern Norway also benefit from a variety of telehealth applications, and in 1996 the country was an early adopter of telehealth fee schedules.

What can their U.S. counterparts learn from the high adoption rates in these countries? The ITIF analysis notes that some entrenched cultural and societal factors explain their leadership role. But ITIF recommends that U.S. policymakers continue on the aggressive path they have established, with strong national-level leadership provided by ONC.

It also suggests that the stimulus funding may not be enough, and that Congress should consider providing additional financial incentives, and penalties, if necessary.

The report also recommends that like Scandinavian countries, the U.S. should focus on building common infrastructure, such as the CONNECT shared tools in the federal sector or the private-sector SureScripts network.

Nordic countries have worked through many of the difficult issues involving privacy and eliminating legislative and regulatory barriers. ITIF suggest that the United States should "continue to learn from the insights and experiences of the global leaders in health IT."

I recommend a deeper read of the details in this report as a reminder that the goals we are trying to reach are indeed achievable. (I also highly recommend a vacation in the Norwegian fjords!)

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