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It Seems Someone In Sweden Has Done a Real HealthConnect!

Dr David More
From a Medical IT Perspective

Issue 65: October 2007
Page: 1 of 1 Author's Profile | Send to a Friend | Printer Version

Editor"s Note: David More now reports on successful health IT projects on a global basis.
By this method he hopes to stimulate Australian agencies into developing a strategy that will work for Australians.
Most of the dismal failures have been "top down" in focus with the result of being "top heavy", unstable and costly. David draws the following success story from e.Health Europe publication.

David reports: " This really seems to be a model that needs to be much further studied – as it is already operational on a scale that would be invaluable in Australia.
Fascinatingly it has been, yet again, a ground up local initiative – rather than the top down style of national or state initiative.

This is especially relevant for those who still see a shared record as having significant promise."

For the full story visit the following link:


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 3-4,000 of the county’s 5,700 healthcare professionals now use the system.

“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.”

“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.”

The level of activity is use of records is also impressive!

“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.”

Also impressive is that the implementation of the system only took of the order of 2.5 years!

Technically this newly developed system looks very modern, open and standards based. From the Cambio Web site (www.cambio.se) we read.

System architecture

“Cambio Spider - the engine at the centre of the information network. Cambio Spider gives all authorized personnel in the healthcare process access to the information stored in the Cambio Spider and Cambio COSMIC modules.

This is how Cambio Spider works:

Cambio Spider is based on modern and stable software technology (Java) with architectures such as J2EE, CORBA, Web Services, applications servers and modern relation databases.

Cambio COSMIC is designed and constructed in three tiers with a presentation layer, business logic and storage separated from each other, where Cambio Spider makes up the middle layer. This means that the final system as a whole achieves a high degree of flexibility and meets the high requirements as to performance and accessibility.

Cambio Spider is built so that it can be integrated and work together with virtually every other existing system. The technical strategy involves making use of standard products already in the market, and concentrating our own efforts on building the best healthcare system.

Cambio Spider is based on application servers such as IBM WebSphere, BEA Weblogic and Sybase Enterprise Application Server

Cambio Spider is compatible with the European prestandard HISA (Healthcare Information System Architecture) , which means that Cambio Spider is a service platform based on open standards from a technical as well as a healthcare oriented perspective.”

Given the mix of implementation success in a number of countries (Sweden, UK, France and Denmark) and the technologies and architectures being used our mates at NEHTA could do worse that have a short Swedish sojourn before they make anymore decision regarding adoption of futures that have never faced the test of implementation!


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