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Electronic messaging in care coordination

By the end of 2015 electronic messaging will be the norm for exchange of patient information between all Norwegian municipalities, general practitioners and hospitals, thus increasing both information safety and accessibility.

The most important method of communication in a therapeutic setting is, and will always be the verbal, personal meeting between patient and clinician. At the same time there exists a need to exchange and share information between different parties in the treatment chain. This need will increase in accordance with a more specialised health service.

Fast and secure

Electronic messaging lays the foundation for a faster and more secure exchange of patient information, and makes it more accessible to the relevant party in the treatment chain. Consequently, unsafe channels of communication can be bypassed, e.g. transport of medical records by taxi, sending of faxes or sensitive information sent by regular mail, and also allows for continual monitoring of information access. Electronic information also provides a superior basis for the collection of data for research and administration purposes.

Sensitive information

When assuming the role of patient, you will be sharing a considerable amount of your personal information with health professionals. This information is vital in ensuring proper care and treatment. A certain amount of this information is considered particularly sensitive, and as a patient you would like to know that the information will be kept safe and remain accessible only to the proper personnel. Although they may appear conflicting, it is the main task of Norsk Helsenett to help ensure that these requirements are met.

The Code of Conduct for information security

All exchange of personal information between different parties in the Norwegian health sector are subject to existing laws and regulations. These, along with other relevant sector-specific additions, are collected in a comprehensive document called the «Code of Conduct for information security in the healthcare, care, and social services sector» (CoC). It applies to all private and public providers of health services in Norway, and regulates the nature and implementation of their information exchange, and a prerequisite for the exchange of patient information is the legal commitment to its adherence.

A further requirement set by the CoC is the user-to-user encryption of all communication containing patient information. In practice, this means that messages sent this way will not be decrypted and read by any other than the designated recipient. The health network is usually defined as the sum of its connected parties, the services they use or provide as well as the communications services and components enabling the safe and secure exchange of patient information within it. In effect, the health network is the unique and secure arena for electronic interaction within the Norwegian health and social services sector, enabling safe exchange of information.

Kinds of messages

The exchange of information in the health service is currently accomplished by using standardised messages. Examples of such messages are:

  • Referrals and discharge summaries
  • Requisitions and test results
  • Nursing/care unit messages between hospital and municipality
  • Dialog-based messaging between parties
  • Electronic prescriptions (eResept)
  • Sick notes
  • Register information: Register of adverse clinical events
    • Norwegian Patient Register
    • Medical birth registry
    • Cancer registry
    • Immunisation registry (Sysvak)

These messages have a standardised format, enabling the exchange of health-related information between all relevant parties. All parties sending or receiving such messages have to be connected to the health network and consequently have their own listing in the National Register of Electronic Addresses, which can be considered the "Yellow pages" of the health sector. The listing for each connected unit or organization includes name, contact information and a unique marker called HER-id meant for addressing of messages-in order to ensure that only the designated recipient can receive, decrypt and read its contents.

The vast possibilities of electronic interaction

The health network is the public infrastructure for the sharing and exchange of health- related information between the many different users and institutions in the Norwegian health and social services sector. The health network offers these parties a chance to carry out their respective tasks far more securely and efficiently than before. One such example is the implementation of electronic prescriptions (eResept), which now is far more efficient due to the prescription being made available to any pharmacy at the moment of issue. It is more secure, since there's no longer any risk of losing or misplacing one's prescription as you now can use any pharmacy nationwide. This is also the case for other types of communication, be it referrals, requisitions or test results.

The health network is also an important tool for planning and resource management. The transfer of patients from hospital and into municipal care has become significantly more efficient through electronic information exchange. Electronic interaction contributes greatly to a unified patient trajectory, from the first visit to the GP to hospital treatment and collecting one's prescription – Norsk Helsenett helps make this happen.