This document summarizes a pilot study conducted by Inera, a Swedish company owned by the Swedish Association of Local Authorities and Regions, to explore how healthcare providers can share patient medication request information across electronic health records based on existing national infrastructure and legislation. The study found that a virtual, distributed national medication request list accessed through shared application programming interfaces could allow providers to view, change, and receive notifications of changes to medication requests made by other providers, improving coordination of patient care. Next steps include further legal analysis, standards development, and piloting the proposed solution.

1. Johan Eltes, Deputy Chief Technology Officer
Christina Kling Hassler, MD and Strategist

2. 21
counties
290
Municipalities
REGIONS AND
MINICIPALITIES IN
COOPORATION FOR E-
HEALTH
 Coordinates digitalisation on
behalf of the County Councils
and Municipalities
 The revenue is approximately
80 million euro
 Inera is a company owned by
the the Swedish Association of
Local Authorities and Regions
(SALAR)

3. Funding
yearly
business
plan
Projects
IT-operations
ca 80 million
euro per
year

4. Commission from County Councils and Regions
Pilot study
 What can care providers do, based on existing national
legislation, architecture and technology, to support the
need to share the patients complete information on
medication requests, in addition to the pharmacy
information managed by the National Prescription List /
den Nationella läkemedelslistan?

5. Pharmacy
Pharmacy
Pharmacy
National
Prescription
list (NLL)
Medication
requests
(EHR)
Virtual
national
medication
request list
Medication
requests
(EHR)
Medication
requests
(EHR)
Medication
requests
(EHR)
Prescriptions
Dispatches,
amendments
Pharmacy / Care Provider information exchange
Healthcare provider
information exchange
Existing
legislation New
legislation

6. The requirements in focus
 Our study is based on earlier reports and analyzes
supplemented by workshops with healthcare staff in
County Councils and Municipalities and also
representatives of patient groups.

7. Existing National HIE infrastructure
Health information exchange platform
Diagnoses Labresults Drugs Varnings
EHR EHR EHR EHR EHR EHREHR
Vaccinations
State agency
(e.g. EHM)
State agency
(eg. Insurance
agency)
400 connected EHRs
1 billion exchanges
yearly through 100
shared API:s
Virtual national EHR (incl medication request list)

8. Conclusions of the proposed solution for sharing of
medication requests
 Stick to the idea of a virtual (distributed) medication request list
 Minimum set of mandatory structured content to be supported across all care
providers
 Add APIs for cross-provider amendments of medication request lists to
achieve shared management of a virtuial medication request list
 Support local copies of the shared medication request list during an ongoing
patient relationship (temporal and synchronized)
 Technical consultations with national and international EHR vendors regarding
pros/cons of virtual/distributed versus centralized master concluded
preference for distributed (locally owned) master

9. Main features of the virtual medication request list
Care providers can:
 share madication request information between themselves
 change or inhibit treatments prescribed/ordered by
another care provider
 Exchange notifications of these changes

10. What´s next?
 Detailed legal analysis of technical solution for high availability
 Informatic activities on the national level
 Offer support in the development of working methods,
documentation, codes regarding responsibilities
 Closer collaboration with the Ministry of Social Affairs and
authorities
 Start pilot

11. Questions?
christina.kling.hassler@inera.se
johan.eltes@inera.se