– Put away the health platform – vikebladet.no

The health platform does not seem to be introduced in Hareid municipality or else in Søre Sunnmøre now. Several municipalities are proposing postponement. Ideally, we should have a national patient record system that came together with the HelseNorge app or other services that are coordinated through the Directorate of Health. Joint solution paid for by the state and not via municipalities and hospitals. But it is not like that. Now a company has been set up in Trondheim (Helseplattformen AS) which is trying to get as many people as possible to pay for an idea that is outdated, according to the experts. One municipal director after another here in the district is now proposing to postpone the entire decision, but why not tear off the plaster at once? The best thing would be for Søre-luten to now take the lead and collaborate on a computer system that the municipalities have proposed for us in Vestland or in the other health companies. Use the billions for operations and IT development in this country and not on Epic. It is doubtful whether they deliver what they charge for. There are still many unanswered questions.

What will the final cost be for Hareid municipality? This is still not clarified. According to the presentation of the case that has now been sent to you. Grethe Aasved at St. Olav. submitted last year about finances, it says the following: “The board refers to the financial consequences of the operational situation where increased staffing is necessary as a compensatory measure to ensure patient safety and sound operations. This situation is not sustainable, and it is crucial that the adopted plans for optimisation, error correction and user-friendliness until 30.6.24 resourced and carried out.” In other words: If funds were not added this spring, the St. Olavs director, as the largest partner in the Health Platform (HP), could not ensure proper operation. Thus, they will get overruns. There are no national health politicians who want to get involved in the health company’s operations. What consequences will this have for the other shareholders in the Health Platform? Well, according to professor emeritus Ivar Sønbø Kristiansen at the Department of Health Management and Health Economics at the University of Oslo, there may be consequences. He is also a partner in Oslo Economics. He wrote a relatively clear analysis in Dagens Medisin in November that the Health Platform, or one-inhabitant-one-journal system (EIEJ) is based on a report on socio-economic profitability that predicted a national roll-out system. Not a system that should be mainly based on central Norway with 14% of the population paying. He writes: “EIEJ appeared to be socio-economically profitable, but only if introduced in all hospitals and municipalities. EIEJ, on the other hand, would cause a socio-economic loss if it were to be introduced for parts of the country or only for hospitals because the benefits are reduced more than the costs of partial introduction. Central Norway constitutes 14% of the country’s population. When HP was introduced, there was little reason to believe that HP would be economically profitable with the assumptions stated above.” So the Health Platform quote is: “However, in an economic sense, they are sunk costs.” An investment with socio-economically lost gains. Given that we do not know what this will cost and that the purchase was based on an analysis of distributed costs for the entire country where the Directorate of E-Health and the Directorate of Health take greater responsibility – it would be unreasonable that only in Central Norway and we the municipalities up here in the north-west will bear the cost of a series of misjudgments.

What obligations will there be between Hareid municipality and the IT company? It is unlikely that we will know this without signing an agreement with the Health Platform, and even then the agreements will not be able to be made public without going through the legal system, considering the “lawsuit tradition” that abounds around health giants “over there.” Hareid’s obligations will probably be in the contract we enter into with the Health Platform. But are there details about the delivered EIEJ modules? Are these only described in the specification attached to the agreement between Epic and the purchaser of the health platform? Hareid will still be responsible for its share of the Health Platform, since Hareid will be tied to the Health Platform. The content of the contract between Epic and the Health Platform is exempt from public disclosure. Many have tried to gain access without being closed. This affects both Hareid’s financial obligations, and the service itself that we get to deliver and operate. The purchase of the EIEJ system from Epic in the USA is mainly loan-financed. If the financial conditions change, this will affect Hareid’s financial obligations above the Health Platform and their – or what has then also been Hareid – their ability to answer for loan conditions for the purchase and thus maintain the agreement entered into with Epic. We should stay away from this bumblebee nest.

Does Hareid have an obligation to provide employees with relevant expertise at HP’s disposal if needed? Here HP replies that the agreement gave the parties the right to offer/be offered to make resources available in the work with the acquisition/introduction of the patient record system, but no obligation. The question then is whether it is possible to introduce the Health Platform in Hareid without getting help either from SSIKT, HP or from Epic, and where will one then get these resources from?

Will the Health Platform become a national system as they themselves say in their sales pitches? Yes, says the Health Platform itself, on the grounds that there are no other alternatives. But how good has this check been in the last ten years? It has been 12-13 years since the king’s idea that it was a gigasystem – actually based on the American Epic Systems model, which was the solution of the future here in the Nordics as well. Has IT development been at a standstill these years? How much has Epic evolved? The development means that there are many different, specialized IT applications (mobile and desktop) that are developed to meet specific needs – and that the focus is rather on the integration of these different applications, rather than trying to create a gigantic super suite system that will cover all possible needs. IT development is faster than we can predict, so flexible, easily integrated systems are better than large, expensive systems, according to the experts. Eight years is a long time in the IT world, and the Health Platform is already to blame for being built on old thinking and technology, writes ComputerWorld. What is more serious is pointed out by several people in the IT environment, namely that the creation of the Health Platform itself and the entire purchasing process with Epic is based on incorrect assumptions. It also illustrates weaknesses in the Enterprise Model and the fatal errors that can occur when policy and project management are not connected, it is claimed. The evaluations of the co-operation reform show that there is still a long way to go before the goal of complete patient care is reached – and the fragmentation and competition between the parts of the country have plagued the health sector like a mare since its creation. Then it does not help that one introduces an IT system for only 14% of the population, which does not include private hospitals and medical and treatment centres, seafarers’ doctors, occupational health services, medical centers in Ulstein, Hareid and so on. After the debate in the Storting on the Health Platform this spring, it no longer seems that there is political will for a national introduction of the Health Platform in the foreseeable future.

Will the health platform also be suitable for small and medium-sized municipalities? According to the answers given from the Health Platform, it has a wide base and has gained influence through dozens of workshops in Trøndelag and elsewhere where representatives who have either worked in smaller municipalities or who come from smaller municipalities have been involved. In addition, one has some experience from the introduction which is taking place in the towns and hospitals in Møre and Romsdal. Vanylven is a test municipality for the medical module. The management and medical personnel have been worried after the board’s decision to introduce it in hospitals, but for health centers and so on in the municipalities, the feedback has been good. At least it’s better than the old system. The question is whether services in small and medium-sized municipalities that previously had an old and outdated system need to introduce Epic at a cost of well over NOK 6 billion in order to have a good EIEJ system in a bunch of municipalities in central Norway? Those who are researching the introduction of Health IT show through studies carried out in Finland and Denmark that these very largest IT systems still have problems meeting the expectations and needs that exist. This leads to socio-economic loss, as Prof. Kristiansen points out in Dagens Medisin. But it is also bad that they do not meet the medical expectations and needs either. Does Epic suit the Nordic health service as a whole? “The experienced troubles have occurred in spite of years of implementation work to configure Epic for Nordic healthcare and prepare the healthcare organizations for Epic. Specifically, the healthcare organizations remained unprepared for some of the consequences of using Epic. These consequences did not become salient until after go-live.” (Hertum, Ellingsen, Cajander, 2022. Implementing Large-Scale Electronic Health Records: Experiences from implementations of Epic in Denmark and Finland. In International Journal of Medical Informatics, Vol. 167.) This is not positive reading for either the residents’ health or a vulnerable municipal economy. Despite the warnings, some are clearly willing to introduce HP at any price.

What will the introduction of the Health Platform mean for current operations in the municipalities? In summary, the impression is that the introduction involves risk. Staffing is unclear. The price seems higher than necessary. More of the content of the contracts should be open. But the most important thing of all is perhaps that several IT people point out that it is old-fashioned to stick to the king’s idea of ​​buying such gigasuites. Development is moving so quickly that we should rather buy flexible, modern designs that are easy to integrate and more easily cope with the revolutionary developments in the IT world. Is Epic adaptable? Despite the fact that the Health Platform says they have fixed the problem that was in Trondheim, they still appear in both Ålesund and Volda, Kristiansund and Molde. Errors in the names of departments, employees who receive the wrong patient lists or missing patient lists etc. are countable check-in errors that can be corrected continuously. But the majority on the board and CEO. Olav Lødemel and his management take risks. Firstly, they manage this introduction across advice from employees and the organizations by not getting the minimum staffing in place for the changeover. It is a little difficult to see the point of this form of “power to act.” It would be more confidence-inspiring if they showed that they listened to the professional judgment of their best professionals rather than risking their operations by going against their own professional advice. The health platform/Epic cannot come here to explain how things should be operated here. For example, this model with introduction in full operation (go-live) they need to work more with before it is applicable. After reading the report from our neighboring countries, we are still left with the question of whether Epic fits the Nordic operating model as a whole. It is clearly not just the technical introduction that represents risk, but also further operation. We must dare to ask the question whether the design of the American Epic harmonizes with the way we operate our health and welfare services. At this cost. Does it stop at six billion?

Sunnmørsposten asked questions about what was the reason for the introduction problem at the hospital in the last two weeks, but did not get a proper answer. The municipalities are governed by a local democracy and not a bureaucratic and dense civil service. The health platform must understand that as long as “the customers” are local politicians, citizens and not health bureaucrats – one must operate more openly than this. We are actually interested in the details. The municipalities are on the front line and cannot afford to gamble. The newspaper received the answer from the hospital v/adm. Mr. Olav Lødemel commented in general (via communications director May Helen Molvær Grimstad): “We fully understand that there is a great need for information about the introduction of the Health Platform in Helse Møre and Romsdal. At the same time, we are now completely in the starting pit – errors have appeared and will continue to appear, and we cannot go into detail on all matters in the media. What we can say is that all cases that are reported are processed by HMR, Helseplattformen AS and Hemit.” “The computer says no.” With all that entails, information, price, contracts and reluctant computers. Rather, the hospital asked all GPs to make an old-fashioned phone call to the hospital for safety’s sake.

Kristine Utgård Rolfsrud, member of the Living Conditions Committee, Folklista for Hareid municipality

Linn Wingsternes, member of the Living Conditions Committee, Folklista for Hareid municipality

Einar Måseide, leader of the Living Conditions Committee, Folklista for Hareid municipality