The implementation of new electronic health record (EHR) systems has become a source of major challenges and disruptions in several Swedish regions. The recent failed launch of the Millennium system at Södra Älvsborgs sjukhus in Borås, part of Västra Götalandsregionen, serves as a stark warning of the potential consequences of inadequate planning and testing. The abrupt halt of the rollout after only three days, following widespread protests from healthcare professionals, highlights the system’s unsuitability for the Swedish healthcare context. Dr. Johan Styrud, chief physician and surgeon at Danderyds sjukhus in Stockholm, expresses deep concern over these events, emphasizing the potential for even greater chaos had a similar full-scale implementation been attempted in a larger region like Stockholm. He contrasts the ease of using his current system, Take Care, with the cumbersome Millennium system, noting that simple tasks like prescribing medication require significantly more steps in Millennium. Styrud criticizes Millennium, developed by Oracle, as being fundamentally a billing system designed for the American healthcare market, with inadequate adaptations for clinical journaling.
The issues extend beyond Västra Götalandsregionen. Region Skåne, also planning to implement Millennium, has postponed its launch to allow for a more gradual transition, a decision met with relief by staff. Meanwhile, nine other regions face legal challenges and potential fines related to their procurement of the Cosmic EHR system from Cambio. In Stockholm, where the transition to a new EHR system is also underway, secrecy surrounds the procurement process, though Dr. Styrud reports receiving verbal assurances that Oracle’s Millennium is not under consideration. This backdrop of technical difficulties, cost overruns, and legal battles underscores the complex and often fraught nature of EHR system implementations. Dr. Styrud points to the failure of Västra Götalandsregionen to heed warnings from healthcare professionals about Millennium’s shortcomings, highlighting the importance of involving frontline staff in the selection and implementation processes. He also emphasizes the strain on an already overburdened healthcare system, noting that Stockholm could not afford a similar disruption to the one experienced in Borås.
The history of EHR system transitions in Sweden is marked by setbacks and changes in direction. The initial collaborative effort between Stockholm, Västra Götaland, and Skåne, known as the 3R project, ultimately dissolved in 2015. Region Stockholm has since pursued a different approach, focusing on developing a modular digital platform with open standards, allowing various IT systems to connect, in addition to replacing its main EHR system. This contrasts with Västra Götalandsregionen’s pursuit of a comprehensive, all-in-one solution with Millennium. Patrik Georgii-Hemming, medical officer at Karolinska University Hospital, explains that Stockholm’s strategy involves a more incremental approach, breaking down the complex task of transitioning to a new EHR system into smaller, more manageable steps. This ”divide and conquer” strategy aims to avoid the pitfalls of a large-scale, simultaneous implementation.
In the summer of 2024, Tieto Evry secured the contract for developing Stockholm’s digital platform, a system designed to integrate data from various sources and allow for interoperability between different healthcare providers. This platform forms the foundation for the future integration of the new main EHR system. While the cost of the new system is estimated to be between 1 and 2 billion SEK, significantly less than the 3.4 billion SEK budgeted for Millennium in Västra Götalandsregionen, the focus remains on finding a system that is truly fit for purpose within the Swedish healthcare environment. Dr. Styrud advocates for prioritizing the development of systems specifically tailored to the needs of Swedish healthcare, suggesting that even upgrading the existing Take Care system could be a viable option. This would allow time for a more considered and thorough development process, ensuring a smoother transition and minimizing disruptions to patient care.
Dr. Styrud, who also serves as the chairman of the Stockholm Medical Association, expresses skepticism about large-scale, all-encompassing EHR systems. He believes that the best approach is to develop a system specifically designed for the needs of Swedish healthcare. This perspective highlights the need for solutions that are not only technically sound but also align with the specific workflows and practices of Swedish healthcare professionals. The experience with Millennium emphasizes the importance of user-friendliness and the integration of feedback from those who will be using the system daily. Dr. Styrud’s preference for a phased approach, potentially involving upgrades to Take Care, reflects a desire to minimize disruption and ensure a smooth transition to a new system.
The ongoing challenges with EHR system implementations in Sweden highlight the complexities and potential pitfalls of these large-scale IT projects. The contrast between the approaches taken by different regions – Västra Götalandsregionen’s all-in-one strategy versus Stockholm’s more incremental, modular approach – underscores the lack of a universally accepted best practice. The emphasis on learning from past mistakes, involving healthcare professionals in the decision-making process, and prioritizing systems tailored to the specific needs of Swedish healthcare resonates strongly. The ultimate goal is to implement systems that improve patient care, streamline workflows, and avoid the disruptions and costs associated with failed implementations like the one experienced in Borås. This requires careful planning, thorough testing, and a commitment to ongoing evaluation and improvement.
