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It is structured into three administrative tiers (eHealth in Sweden, n.d.):
The national government establishes health and medical care principles and guidelines, setting policy priorities through laws, ordinances, or agreements with the Swedish Association of Local Authorities and Regions (SKR)
The 21 regions organize health and medical care to ensure universal access.
The 290 municipalitieshandle care for the elderly, individuals with physical and mental disabilities, post-therapy support, and school health care.
(Swedish eHealth in Sweden, n.d.)The governmental entity known as the Swedish eHealth Agency Agency, a government entity, is dedicated to digitalizing and enhancing the exchange of information among patients, the healthcare system, and pharmacies within the country.
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Public vs private
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The national PHR
History
The Journalen is the national PHR in Sweden is called Journalen . This is defined in the country as a Patient-Accessible Electronic Health Record (PAEHR), and can be accessed via the patient national health care portal 1177.se. This service Journalen integrates EHR information from diverse systems used across Swedish healthcare organisations through a national health information exchange platform. The first region connected to the national infrastructure in 2012, and all of the others followed, with the last one connected in 2018 (Hägglund, Scandurra 2022).
The national patient portal, 1177.se, serves as a comprehensive healthcare access point, connecting to all EHR systems across the 21 regions. Utilizing a national e-ID for authentication, users gain access to administrative services and the PAEHR Journalen. Despite regional autonomy in prioritizing eHealth services, the national eHealth strategy mandates a unified online healthcare access point. The portal operates on a national health information exchange (HIE) platform, enabling access to data stored in any of the EHR systems.
The 1177.se portal offers three key components: a telephone advice service (1177 on the phone), a web-based information platform (1177.se on the web), and personalized eHealth services (1177.se personal eHealth services) accessible through authentication. The latter is the patient portal with functionality varying based on region or healthcare provider . (Hägglund, Blease & Scandurra, 2020).
The Swedish government, in collaboration with the Swedish Association of Local Authorities and Regions (SALAR), has formulated a vision for the national e-Health strategy. By 2025, the goal is to establish Sweden as a global leader in leveraging digitization and eHealth for improved health and welfare, fostering independence.
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Another challenge has been change resistance from healthcare professionals: healthcare professionals have expressed resistance to how introducing this system might change their work. Concerns include potential increases in workload, with fears that more time may be spent explaining EHR contents and addressing patient inquiries. Some professionals worry that EHRs could lead to conflicts, misunderstandings, and misinterpretations, causing unnecessary worry among patients. However, experience with e-services over time tends to alleviate these concerns, with healthcare professionals who actively use the system expressing fewer worries . (Hägglund, 2017).
In a 2022 survey on the usability of the Swedish Personal Health Record, the primary concerns raised were:
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