Mina VårdKontakter (My Health Contacts) (MVK) is the main Swedish e-health platform. Through the platform a patient can request, re-schedule or cancel appointments with medical personnel, request prescriptions and ask for a healthcare centre to contact him or her. Each local medical centre decides which services patients can receive from them via Mina VårdKontakter.
The Health Innovation Platform (HIP) is an attempt on behalf of the Swedish Ministry of Health and Social Affairs to attract development by third parties to expand the MVK platform. The HIP comprises an SDK (software development kit) and several APIs that provide information and tools in the shape of methods, guidelines and program code. These tools facilitate the development of healthcare services and solutions for both traditional and mobile environments.
The Mina VårdKontakter Health Innovation Platform is part of Sweden’s strategy to make the country competitive in research and innovation, and an attractive place in which to invest and conduct business. Development and promotion of the HIP is carried out by Vinnova [http://www.vinnova.se/en/About-Vinnova/], the government agency created to promote collaborations between companies, universities, research institutes and the public sector.
All apps developed using the HIP must follow Sweden’s Patient Data Act. This piece of legislation regulates the way patients’ data and privacy is managed, and the maintenance of patient records. Likewise, the development of e-services for citizens, including e-health services, must abide by the Personal Data Act, the law that regulates how personal data may be processed.
Description of target users and groups
The target users of the HIP are freelance developers, designers and software companies, both within and outside the healthcare industry, who need development tools and access to patient data from medical record systems and other sources.
Description of the way to implement the initiative
The HIP project is managed jointly by a network of partners from academia, industry and the public sector. The project is the result of collaboration between three different Swedish healthcare regions, three universities, several industrial partners, and three patient organizations. Representatives of each sector are on the project’s steering committee, which is headed by Stockholm County Council (SCC). Responsibility for the four main areas defined by the project – research, care processes, technology/infrastructure, and technology/service integration – is delegated to different track leaders. SCC also owns the project results and makes them available at a national level.
As for the technology itself, this is built as a layer on top of another technology (i.e. MVK’s underlying databases and framework), and integrated with other systems and infrastructures. It is shared with larger communities of heterogeneous entities, such as patients and patient organisations, medical staff, researchers, IT firms, and institutions. It is designed to allow independent third parties to interact with the system without any explicit coordination. This means that it is able to change its features and functionalities rapidly over time, as opposed to traditional health information systems that have a slower evolutionary curve.
The initial design of end-user services was based on a collaboration between patients, healthcare specialists, and industry and research professionals. In the initial stages of the project, design of the e-service involved three groups representing stroke, lung cancer and hip surgery patients respectively. The patients attended a series of focus group meetings to provide input on their needs. Two meetings with four to five patients in each group took place, as well as initial test sessions with early prototypes.
The HIP was made to comply with Sweden’s privacy and data protections laws early on in the development process by implementing secure methods (encryption and secure authentication) and state-sanctioned technologies into the application programming interfaces (APIs). An important aim of the project is to allow third parties to enter the healthcare market and collaborate with healthcare organisations, healthcare professionals and patients to develop e-health services. To this end, the HIP provides a software development kit (SDK) to implement the APIs that give developers access to MVK’s online services. These allow external developers to design applications that are interoperable with current health information systems through the platform, while at the same time abiding by default with Swedish data protection regulations.
The HIP SDK offers developers a toolset with which they can create new services, currently based on open data and on various categories of personal data. The SDK is freely available to developers, healthcare providers and other stakeholders, and is continuously updated.
The SDK contains a collection of APIs to make healthcare data available to third-party applications. These APIs are of two different types:
- APIs for public data: These APIs contain services linking to contact information for healthcare providers.
- APIs for patient-related data: These APIs involve services dealing with how patients interact with the system in terms of their personal records, for instance in scheduling appointments.
Together, these APIs provide four basic services that allow developers to access resources and ensures that confidential patient data is managed in accordance with the law:
- The security service is the API gateway that allows Health 2.0 companies to build apps that interact with patients’ electronic health records (EHRs) across Swedish healthcare providers. This gateway is an open source project built around RESTFul technologies [https://en.wikipedia.org/wiki/Representational_state_transfer] and an OAuth 2.0 [http://oauth.net/2/] API architecture. Patients can select Health 2.0 apps created by third parties and (through OAuth 2.0) grant apps permission to interact with healthcare data from regional EHRs that is integrated through the platform.
- The template service is a generic service that facilitates the development of structured forms and templates for an end-user e-service. It can be used to create a form for registering patient information before a planned visit, for example.
- The resource state service tracks patient-related conditions in all the databases that are connected to the information infrastructure. For example, the resource state service is used in the example e-Referral service (see below) to track the existence and status of referrals for a specific patient.
- The integration service guarantees the mapping of existing legacy databases (e.g. from older EHR systems) to the Swedish national service standards, allowing data from pre-standardised applications to be integrated into MVK.
Main results, benefits and impacts
The HIP offers a standardised way to interact with MVK, bringing together all the previously incompatible data from EHRs developed for different geographic regions and sectors. It also lowers the threshold for third parties, relieving the Swedish public sector from the need to develop all the applications patients demand for the national health service. It also standardises and secures the way third parties interact with confidential data, by implementing and enforcing security protocols governing their access to patients’ data.
As for actual apps developed using the platform, a first demo e-service, “My Referrals”, was implemented using the platform. It was tested by 20 patients at five different healthcare centres in Stockholm in 2013. This e-service is accessible through the web, and via tablet and smartphone apps. It is now in the process of being launched at national level ce that is free to all Swedish citizens.
The Health Care Guide Services website relies heavily on code developed using the HIP SDK and APIs, allowing patients to book appointments with their doctors, request prescriptions, download medical reports and certificates, and so on.
Genia is a mobile service developed with and for children with cystic fibrosis. Genia offers digital support for patients, relatives, and healthcare professionals. Genia connects user data with healthcare services, giving patients a personalised interaction with healthcare services.
Track record of sharing
The HIP project has its whole basis in sharing. By making publicly available the APIs, SDK and data from the Swedish Health Service, the Swedish government is explicitly inviting third parties, both national and from abroad, to participate in building a modern set of online services.
Furthermore, by making the APIs and SDK open source, developers can improve on the code base. Administrations in other countries can also download and use the resources for their own regional or national health services.
According to the essay "Digital Health – entering a new era" by Johanna Ulfvarson, Programme Director of the Health Division at Vinnova:
"Designing the open mobile citizen service and the Health Innovation Platform is a social act. It involves continuous negotiation with people concerning how and why they should collaborate with new actors to achieve new ways of working together. The result is services crossing traditional borders between clinicians, patients, researchers, quality registers etc. The need for a Personal Health Record as a service provided ‘by somebody’ has disappeared; today the patient wants shared services embedded in the innovative information infrastructure accessing data from various EPR systems and other database sources."
In a study published in 2014, interviews with developers and development companies revealed that many potential users found the documentation lacking, making it hard to get started in developing for the platform. Developers also noted that more runnable examples would be helpful as a way to illustrate how the SDK and APIs worked.
Another problem was that, at the moment of writing the study was written, there was still insufficient real data to properly test applications with the API, although the platform did provide fake data for testing.
Many users suggested that it would be helpful to have discussion forums, both for developers and for patients. Developers could use the forums as technical support and a way to engage in collaboration with each other. Patients could request apps and features, and could be polled by developers to find out what they need.Scope: Cross-border