Country profile: Sweden

Sweden has a population of 9 million and is administratively divided into 21 county councils and 290 municipalities.The Swedish healthcare system is organized by national, regional, and local entities, with the county councils (regional level) being primarily responsible for planning and organizing health care according to their residents’ needs..

ICT use and eHealth strategy

Generally, the use of ICT in health care is quite advanced in Sweden: almost all GPs use a computer, and most practices have access to broadband Internet connections. The storage of electronic patient data (i.e.electronic health records) is common practice, with an average of 96% availability of EHR in hospitals and primary care.

Nevertheless, the transmission of electronic records via Internet or more specialized networks remains a somewhat rare occurrence, although this is more common in Sweden than in most other European countries. The high prevalence of electronic prescriptions in Sweden is especially noteworthy: the use of ePrescription services in Sweden is only excelled by the Danish health care system. 75-80 percent of all prescriptions are electronic, and at an average, 2.5-3 million e-prescriptions are handled every month.
Given that the organization of healthcare mainly takes place on the regional level, one of Sweden’s main challenges in the eHealth area is to provide interoperable solutions between different care facilities and regional borders. In 2006 the Swedish national strategy for eHealth was set up by SALAR, the National Board of Health and Welfare and the Ministry of Health and Social Affairs among others.  

To fulfil its foremost goal; safe, accessible health and social care of high quality based on public need, the strategy outlines six action areas grouping necessary improvements in order to establish a more efficient, accessible and safe eHealth ICT infrastructure:

• Bringing laws and regulations in line with extended ICT use
  e.g. establishing clear rules disegined to ensure secure and efficient handling of personal datea while improving patient safety and strengthening personal privacy.
• Creating a common information structure
  e.g. the conception and definition of ePrescription services.
• Creating a common technical infrastructure that will facilitate communication, access and the sharing of sensitive information between involved and authorized actors.
• Facilitating interoperable, supportive ICT systems  e.g. the national patient summary, NPÖ, which facilitates access to EHRs between hospitals, across private and public health care,as well as across organizational borders.
• Making information and services easily accessible to care personnel as well as citizens.
  i.e. citizens will have easy and secure access to health and social care and will be able to communicate in various ways with health and social care.

The national strategy has since been adopted by all regional entities, and municipalities and private care providers are continually working towards organising and taking part in ICT collaboration.   

Legal framework

While there’s very little regulation of electronic health services in particular, the legal framework governing the different facets of healthcare also applies to most electronic solutions.

However, one exception is the legal framework governing patient summaries and their usage, which was recently updated by the new Patient Data Act of 2008, establishing clear rules designed to ensure secure and efficient handling of personal data while improving patient safety and strengthening personal privacy.

The act enables digital access to a person’s EHR by care providers at different levels of the health system and strengthens citizens’ engagement and participation by enabling citizens to determine, upon mutual consent, who is to be given access to their overall medical record. In addition, the act stipulates the citizens’ right to direct digital access to their own information.

Patient privacy is enforced in multiple ways in Sweden:

• All healthcare providers who are also public authorities are subject to the Secrecy Act (which provides an exception to the general policy of Openness in Swedish public authorities)
• All private healthcare providers are subject to the professional activities in the Health and Medical Care Field Act.
• All healthcare providers using patient data are subject to the new Patient Data Act and its strict guidelines.