“We need a precise framework of regulations in order to maintain appropriate and structured health care documentation that ensures that the information maintains a sufficient level of quality to be used in treatment, in research and by the actual patient. The users shall be aided by clearly and uniformly defined terms and concepts, and there should be an information structure that clarifies what to document and how to make the information more useful. Most of all, we need to standardize the information, not just the technical systems.” (eHälsa – nytta och näring, Riksdag report 2011/12:RFR5, p. 37).
In 2010, the Swedish Government adopted the National e-Health – the national strategy for accessible and secure information in healthcare. The strategy is a revision and extension of the previous strategy from 2006, which was used as input for the most recent efforts to develop a national information structure utilizing business-oriented generic models. A national decision on healthcare informatics standards was made by the Swedish County Councils, which decided to follow and use EN/ISO 13606 as a standard for the development of a universally applicable information structure, including archetypes and templates.
The overall aim of the Swedish strategy for development of National Healthcare Information Architecture is to achieve high level semantic interoperability for clinical content and clinical contexts. High level semantic interoperability requires consistently structured clinical data and other types of data with coherent traceability to be mapped to reference clinical models. Archetypes that are formal definitions of the clinical and demographic concepts and some administrative data were developed. Each archetype describes the information structure and content of overarching core clinical concepts. Information that is defined in archetypes should be used for different purposes. Generic clinical process model was made concrete and analyzed. For each decision-making step in the process where information is processed, the amount and type of information and its structure were defined in terms of reference templates. Reference templates manage clinical, administrative and demographic types of information in a specific clinical context.
Based on a survey of clinical processes at the reference level, the identification of specific clinical processes such as diabetes and congestive heart failure in adults were made. Process-specific templates were defined by using reference templates and populated with information that was relevant to each health problem in a specific clinical context. Throughout this process, medical data for knowledge management were collected for each health problem. Parallel with the efforts to define archetypes and templates, terminology binding work is on-going. Different strategies are used depending on the terminology binding level.