“How convenient it is to be able to log on to HeilsuVera and take care of your own business. I must compliment you for this website”.- User of the health portal
Health care has been lagging behind in the implementation of online services compared to other sectors in recent decades. Moreover, there is increased emphasis on a global level to accelerate the use of eHealth solutions within health care in order to promote enhanced quality of health care and patient safety. It is believed that empowered patients with access to their own health information and eHealth services are more involved in their own treatment in support of better quality of care.
The annual increase in users and usage of the health portal clearly shows that there is a need for this health portal and the number of users more than doubled between 2017 and 2018, as did the number of log-ins.
Approximately 30% of the total population aged 16 years and over now use the health portal and the number of users and usage is still growing significantly. The need to access, for example, own immunization records, was clearly visible over a weekend in March 2019 following an outbreak of measles in the country. Usage of the health portal increased more than 400% over this weekend alone, compared to usage on any other weekend.
The main challenges involve human factors. Resistance from a number of doctors who were not keen on using this solution delayed the implementation for months. It appears that these doctors were worried that they would lose a degree of control, especially with regards to secure messaging between health professionals and their patients.
The health portal has now been implemented on a national level within all primary health clinics, a few hospital units and a number of private practice clinics. There is a single access point for citizens to access their health information and available eHealth services, no matter which hospital, primary health clinic or private practice services they have used. This is possible because health records are inter-connected in Iceland on a national level.
Every person has a unique ID and patient data are transferred via the Icelandic HealthNet and by using patient index services. Access to the health portal is free of charge to individuals and healthcare institutions.
New features are being continuously developed. Some additional features that will soon be available include, but are not limited to, the following:
Critical factors for implementation of the health portal include national co-ordination, shared vision, support from administration, user involvement and government funding. Furthermore, promotion of the application, networking and collaboration must be in place and site visits for follow-up are necessary.
The application has to be user friendly and easy to use for everyone (“self-taught”). Moreover, it must be free of charge to users.
Iceland has a national infrastructure that uses the Icelandic HealthNet to share health data on a national level. All government owned healthcare institutions, as well as the majority of private practise clinics and nursing homes, share health information via the HealthNet and inter-connected electronic health records. The citizen health portal is connected to electronic health records via the HealthNet.
The health portal is valuable to Icelandic citizens because of the expected outcomes for users.
These include time saved, safer patient care and increased health and well-being.
The Directorate of Health, National Centre for eHealth unit, is responsible for both the continuous development of the health portal and implementation on a national level.
Each healthcare organization is responsible for implementation in their own organization.
To support implementation on a national level, policy and law must be in place on a national level.
To monitor whether an implementation has been successful, indicators for measuring eHealth must be in place.
The Directorate of Health, unit of National Centre for eHealth, monitors the usage of eHealth services and availability by analysing log data and surveys as recommended by the Nordic eHealth Research Network (NeRN, Nordic eHealth Benchmarking, 2014).
It is presumed that the health portal will empower patients in their interaction with the healthcare system. Empowered patients are expected to be more involved in their own care and decision-making processes.
Patient interaction with their healthcare professionals will be more frequent and the need to schedule appointments at healthcare institution should decrease, as well as hospital admittance. The solution supports increased collaboration, continuity of care and quality of care. To enable patients to answer evidence-based questionnaires that measure, for example, level of pain and nausea, receiving a rapid response from their healthcare professional regarding suitable interventions and being give tailored educational material could impact patients’ wellbeing and promote improved patient outcomes.
Increased effectiveness is anticipated as valuable time will be saved in phoning patients (healthcare professionals) and the clinic/hospital (patients/citizens) and processes such as renewal of medication will be streamlined.
The ultimate goal is to achieve secure and equal access to health services and patient data for citizens, in which seamless sharing of timely information supports patient safety, increased quality of health care and improved patient outcomes for better health and well-being.
The main effects of the Citizen Health Portal include the following:
Reduced number of visits to the clinic/hospital due to secure messaging.
The health portal is user friendly and easy to use. It does not require users to have any special skills. However, citizens must have their eID to be able to log on the portal in order to protect sensitive health information.
Some information in English on the health portal can be found in the National Strategy for eHealth 2016–2020: https://www.landlaeknir.is/servlet/file/store93/item28955/National_eHealth_Strategies_January_2016_final.pdf
The health portal has received both national and international recognition. In 2014 it received the Icelandic Web Award and in 2015 it received Recognition for Innovation within the Public Sector. Moreover, in 2017 it became part of the OECD Observatory of Public Sector Innovation.
The health portal can be used for both regions and the entire country, as well as across international borders, assuming the necessary infrastructure is in place.
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Directorate of Health, National Centre for eHealth unit in co-operation with the private IT company Origo and all healthcare organizations in Iceland.